Pediatrics Commons^™

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Use Of A Radial Artery ‘Slender’ Sheath For Facilitating Transfemoral Arterial Access For Neuroendovascular Embolization In A Very Young Infant, Timothy L. Miao, Enriqueta Lucar Figueroa, Khalid Bajunaid, Michael Mayich, Sandrine De Ribaupierre, Sachin K. Pandey

Paediatrics Publications

Pediatric neuroendovascular procedures are increasingly performed as several studies have shown the safety of these interventions. In the literature, an upper limit of 4 French catheter size is conventionally used for femoral access in neuroangiography of very young infants. However, this constraint in luminal size may not allow for more complex procedures. We present the previously unreported use of a radial 5 French slender catheter with ultrathin walls for femoral access for aneurysm embolization in a 3-month-old boy presenting with left M2 aneurysm rupture.

21st Century Clinical Trials: Rethinking Best Practices Challenges And Opportunities, William E Truog

Presentations

Panel discussion at the Pediatric Academic Societies 2019 annual meeting.

Watchful Waiting And Antibiotic Stewardship: A Quality Improvement Project, Rebecca Couper

Seton Hall University DNP Final Projects

Antibiotic misuse and overuse are major contributors to antibiotic resistance which is responsible for the death of 23,000 American’s annually. There is a growing body of evidence that antibiotic stewardship programs are successful in reducing antibiotic prescribing rates while maintaining safe patient care. Research supports a multifaceted approach with an ongoing commitment to antibiotic stewardship. This quality improvement project aimed to reduce the overuse of antibiotics in pediatric acute respiratory tract infections (ARTIs), improve the percentage of children who received laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis, and to implement and measure the efficacy of watchful waiting …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Considerations For Implementing Precision Therapeutics For Children., Matthew J. Mclaughlin, Jonathan B. Wagner, Valentina Shakhnovich, Bruce Carleton, J Steven Leeder

Manuscripts, Articles, Book Chapters and Other Papers

Improving the utilization of pharmacologic agents in the pediatric population yields significant, perhaps life-long, benefits. Genetic factors related to the disposition of a medication or an alteration at the target receptor site contributes to the observed variability of exposure and response between individuals. An additional source of this variability specific to the pediatric population is ontogeny, where age-specific changes during development may require dose adjustments to obtain the same levels of drug exposure and response. With significant improvements in characterizing both the ontogeny and genetic contributions of drug metabolizing enzymes, the time is right to begin placing more emphasis on …

Description Of An Innovative Pediatric Individualized Therapeutics Clinic: Working Toward Precision Drug Therapy., Tracy L. Sandritter, Jean C. Dinh, Jennifer A. Wagner, Jennifer Lowry

Manuscripts, Articles, Book Chapters and Other Papers

The GOLDILOKs® (Genomic and Ontogeny-Linked Dose Individualization and cLinical Optimization for KidS) Clinic aims to provide families and physicians with data to make more informed decisions with regard to pharmacological therapy by using innovative therapy and genomic technologies. The objectives are two-fold: (1) To describe the utility of the GOLDILOKs® Clinic to referring prescribers by evaluating the type of referrals made to the GOLDILOKs® Clinic and (2) to assess the most often utilized technologies (e.g., genotyping) completed to formulate therapy recommendations. Patient data from July 2010 to June 2016 was retrospectively reviewed following Institutional Review Board (IRB) approval. The GOLDILOKs® …

A Comparison Of The Diagnosis Of Gastroparesis In 4 H Pediatric Gastric Emptying Studies Versus 2 H Studies., Sarah T. Edwards, Jose Cocjin, Stephanie B. Theut, Douglas C. Rivard, Ashley K. Sherman, Craig A. Friesen

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In adults, there is a consensus for standards to diagnose gastroparesis utilizing a gastric emptying study as the key diagnostic modality but there is no consensus for a standard in pediatrics. Additionally, some cost savings might be achieved if symptoms could be utilized to predict patients with gastroparesis. The aims of the current study were to confirm the sensitivity of a 4 h study in the pediatric population and to assess whether the severity of symptoms were predictive of delayed gastric emptying.

STUDY: This was a single site, two part study. In the first part, results were reviewed for …

Prevalence Of Cardiovascular Disease Risk Factors In Childhood Glomerular Diseases, I. F. Ashoor, S. A. Mansfield, M. M. O'Shaughnessy, R. S. Parekh, J. Zee, T. L. Vasylyeva, A. J. Kogon, C. B. Sethna, L. M. Guay-Woodford, +170 Additional Authors

Journal Articles

No abstract provided.

Cancer Care Annual Report 2018-2019, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

Graduate Medical Education Annual Report 2018-2019, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Examining The Benefits Of Educating Caregivers About Tummy Time In The Acute Care Setting, Alexandra L. Turner

Occupational Therapy Doctorate Capstone Projects

Background: This project addressed providing parents with education on tummy time in the acute care setting. This is based on a gap in the literature on occupational therapy (OT) services in the acute care setting.

Purpose: The purpose of this research project was to conduct a pilot study to examine the benefit of educating parents of infants in the acute care setting on providing tummy time as a developmental education measure.

Theoretical Framework: The occupational therapy practice theory, of the Model of Human Occupation (MOHO) supports the holistic supporting of families, in their role as a parent, to meet the …

Wire Guided Cannulation Facilitates Endoscopic Management Of Buried Bumper Syndrome: A Novel Technique, Jacquelin Peck, Kaitlin Sapp, Alexander Wilsey, Michael Wilsey

Pediatrics Faculty Publications

Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of …

Down The Rabbit Hole-Considerations For Ingested Foreign Bodies, Jerry Brown, Molly Kidder, Abigail Fabbrini, Jonathan Devries, Jason Robertson, Nicole Chandler, Michael Wilsey

Pediatrics Faculty Publications

We report the case of a seven-year-old boy with an ingested foreign body, which was retained within the appendix for a known duration of ten months, ultimately requiring appendectomy. The ingested foreign body was incidentally discovered by abdominal x-ray at an emergency room visit for constipation. Despite four bowel cleanouts, subsequent x-rays showed persistence of the foreign body in the right lower quadrant. While the patient did not have signs or symptoms of acute appendicitis, laparoscopic appendectomy was performed due to the risk of this foreign body causing appendicitis in the future. A small metallic object was found within the …

Attending To The Not-So-Little "Little Things": Practicing Trauma-Informed Pediatric Health Care, Aimee K. Hildenbrand, Scottie B. Day, Meghan L. Marsac

Pediatrics Faculty Publications

No abstract provided.

Insulin Pump Adherence Behaviors Do Not Correlate With Glycemic Variability Among Youth With Type 1 Diabetes (T1d)., Emily Paprocki, Vincent S. Staggs, Susan Patton, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Pediatric Dermatology Workforce In The United States., Brea Prindaville, Kimberly A. Horii, Elaine C. Siegfried, Heather Brandling-Bennett

Manuscripts, Articles, Book Chapters and Other Papers

Studies have suggested there is a shortage of pediatric dermatologists in the United States, but the workforce has not been well defined. The Society for Pediatric Dermatology (SPD) Workforce Committee sought to characterize the US pediatric dermatology workforce with a nine-question survey, sent to all 484 US SPD members in December 2016. The response rate was 30%. Most pediatric dermatologists were practicing in major metropolitan markets, seeing an average of 80 patients a week with an average 6-week wait time. These findings indicate that geographic maldistribution and long wait times for new patient appointments remain substantial hurdles for adequate access …

The Children's Oncology Group: Organizational Structure, Membership, And Institutional Characteristics., Janice S. Withycombe, Todd A. Alonzo, Michele A. Wilkins-Sanchez, Maxine Hetherington, Peter C. Adamson, Wendy Landier

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The Children's Oncology Group (COG) is the only organization within the National Cancer Institute's National Clinical Trials Network dedicated exclusively to pediatric cancer research. The purpose of this article is to provide an overview of COG's organizational structure, to characterize its institutional and individual membership, and to summarize enrollments onto COG clinical trials.

METHOD: Data from 2013 to 2015 were compiled from sources internal (Network Operations, Statistics and Data Center, Chair's Office) and external (American Hospital Association, American Nurses Credentialing Center) to COG, to present a comprehensive overview of COG's structure, individual and institutional membership, and group operations.

RESULTS: …

Precision Medicine In Pediatric Cancer: Current Applications And Future Prospects., Atif Ahmed, Divya S. Vundamati, Midhat S. Farooqi, Erin M. Guest

Manuscripts, Articles, Book Chapters and Other Papers

Precision oncologic medicine is an emerging approach for cancer treatment that has recently taken giant steps in solid clinical practice. Recent advances in molecular diagnostics that can analyze the individual tumor's variability in genes have provided greater understanding and additional strategies to treat cancers. Although tumors can be tested by several molecular methods, the use of next-generation sequencing (NGS) has greatly facilitated our understanding of pediatric cancer and identified additional therapeutic opportunities. Pediatric tumors have a different genetic make-up, with a fewer number of actionable targets than adult tumors. Nevertheless, precision oncology in the pediatric population has greatly improved the …

Proteomics Of Human Liver Membrane Transporters: A Focus On Fetuses And Newborn Infants., Bianca D. Van Groen, Evita Van De Steeg, Miriam G. Mooij, Marola M H Van Lipzig, Barbara A E De Koning, Robert M. Verdijk, Heleen M. Wortelboer, R Gaedigk, Chengpeng Bi, J Steven Leeder, Ron H N Van Schaik, Joost Van Rosmalen, Dick Tibboel, Wouter H. Vaes, Saskia N. De Wildt

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Hepatic membrane transporters are involved in the transport of many endogenous and exogenous compounds, including drugs. We aimed to study the relation of age with absolute transporter protein expression in a cohort of 62 mainly fetus and newborn samples.

METHODS: Protein expressions of BCRP, BSEP, GLUT1, MCT1, MDR1, MRP1, MRP2, MRP3, NTCP, OCT1, OATP1B1, OATP1B3, OATP2B1 and ATP1A1 were quantified with LC-MS/MS in isolated crude membrane fractions of snap-frozen post-mortem fetal and pediatric, and surgical adult liver samples. mRNA expression was quantified using RNA sequencing, and genetic variants with TaqMan assays. We explored relationships between protein expression and age …

Handwriting And Occupational Therapy In The Schools, Anne H. Zachry, L. Woods

Faculty Presentations

Handwriting is an important life skill, and handwriting tasks take up a significant amount of time during the school day. Research suggests that writing by hand influences reading skills, recall, academics, and motor and composition skills. Pediatric occupational therapists evaluate and treat children who are struggling with handwriting; therefore, it is important for practitioners to be aware of a variety of treatment strategies for addressing handwriting challenges. After participating in this session, the learner will be able to discuss the research on typical and atypical pencil grasps, identify and name 5 common handwriting errors, and explain 3 techniques for increasing …

Improving Communication Between Child Life Services And Nursing On An Inpatient Pediatric Unit, Sherryann St. Pierre, Elizabeth Shaughnessy, Bethany Kay, Barbara Bush Children's Hospital, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

IMPROVING COMMUNICATION BETWEEN CHILD LIFE SERVICES AND NURSING ON AN INPATIENT HOSPITAL UNIT

Effective communication between patient caregivers has been shown to reduce stress and trauma related to hospitalization and subsequent improved outcomes. An HCAHP score for a 30 bed acute inpatient pediatric unit illustrated the confusion faced by children as a result of nursing and care life specialists not working together as a team.

A root cause analysis identified a number of issues as to why patients were not benefitting fully from child life services. Several counter measures were instituted with the goals of improving the HCAHP score and …

Pediatric Obesity: Influence On Drug Dosing And Therapeutics, Barbara Ameer Pharmd, Mba, Bcps, Fcp, Michael Weintraub Md

Department of Medicine Faculty Papers

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of US children and adolescents. Severe obesity (³120% of the 95^th percentile of BMI-for-age, or a BMI of ³35 kg/m²) is the fastest growing subgroup and now approaches 6% of all US youth. Health consequences (e.g., type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Since therapeutic interventions are less effective in severe obesity, prevention is a high priority.

Treatment plans involving combinations of …

Does A Step Back Approach To The Implementation Of Project Spraoi Affect The Health And Fundamental Movement Skill Proficiency Of Irish Children?, Conor Hemmersley

Masters

Title: Does a step back approach to the implementation of Project Spraoi affect the health and fundamental movement skill proficiency of Irish children? Background: Project Spraoi is an intervention which attempts to positively influence the overall health of Irish primary school children. Previous iterations of Project Spraoi have been labour intensive with an Energiser working with a maximum of two schools to deliver the intervention. The purpose of this research was to evaluate the effectiveness of the intervention on fundamental movement skills (FMS), and markers of health of Irish primary school children using a step back approach. The step back …

Development And Implementation Of A Mobile Device-Based Pediatric Electronic Decision Support Tool As Part Of A National Practice Standardization Project, Russell J. Mcculloh, Sarah Fouquet, Joshua Herigon, Eric A. Biondi, Brandan Kennedy, Ellen Kerns, Adrienne G. Deporre, Jessica L. Markham, Y Raymond Chan, Krista Nelson, Jason G. Newland

Manuscripts, Articles, Book Chapters and Other Papers

© The Author(s) 2018.

Objective: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.

Materials and Methods: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled "Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE)." The mobile application (app), PedsGuide, was developed using evidence-based …

Screening Tools In Adolescent Health Care, David L. Wood

ETSU Faculty Works

Learning Objectives: (1) Identify three primary care friendly screening tools useful for identifying behavioral health concerns in adolescents. (2) Describe how a "champion" (quality improvement) team can help facilitate implementation of a screener in a primary care.

Training Pediatric Primary Care Providers In Behavior Management Strategies, Kate Burger

Dissertations

Childhood mental health disorders are a significant public health concern in the United States. It is estimated that every year 13 to 20% of children living in the United States experience a mental health disorder (National Research Council and Institute of Medicine, 2009). Despite the clear need for mental health care, less than half (45.6%) of children with one or more emotional, behavioral, or developmental conditions receive treatment from a mental health professional (The National Survey of Children's Health, 2007). There is growing evidence that integrating mental health services into pediatric primary care can result in increased treatment access as …

Partnering With Pediatric Patients And Families In High Reliability To Identify And Reduce Preventable Safety Events, Julie Kirby, Courtney Cannon, Lynn Darrah, Yolanda Milliman-Richard

Patient Experience Journal

Frameworks for designing highly reliable behaviors and tools to reduce preventable harm are the result of the continued effort to improve patient safety in healthcare. Evidence shows that there has been limited research on engaging patients and families in the development of safety and reliability efforts to achieve zero harm. Our aim was to develop a tool that engages patients and families in an effort to reduce preventable harm in a pediatric academic medical center.

Perspectives From The Society For Pediatric Research: Interventions Targeting Social Needs In Pediatric Clinical Care., Andrew F. Beck, Alicia J. Cohen, Jeffrey D. Colvin, Caroline M. Fichtenberg, Eric W. Fleegler, Arvin Garg, Laura M. Gottlieb, Matthew S S. Pantell, Megan T. Sandel, Adam Schickedanz, Robert S. Kahn

Manuscripts, Articles, Book Chapters and Other Papers

The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, …

Effect Of A Voice Recognition System On Pediatric Outpatient Medication Errors At A Tertiary Healthcare Facility In Kenya, Angela Migowa, William Macharia, Pauline Samia, John Tole, Alfred K. Keter

Paediatrics and Child Health, East Africa

Background: Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors. Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers.

Methods: This was a before–after intervention study …