Medical Education Commons^™

Nasal Chondromesenchymal Hamartoma: A Case Report And Review Of The Literature, Jana Ghulmiyyah

Research Days

Background: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal cavity. It commonly presents in infancy, however there are reported cases of adult tumors. As of August 2021, there have been 56 reported cases in the literature. This is the first description of a solely endoscopically resected NCMH in a neonate in addition to a review of the literature.

Case Presentation: A 5-day old male patient born at term presented to our institution for stridor and cyanosis since birth. The patient was reported to have desaturations while feeding at the outside hospital. On bedside examination, the patient …

Automating A Well Child Visit, Daniel Merrill

Research Days

No abstract provided.

Burnout In Pediatric Nephrology Fellows And Faculty: Lessons From The Sustainable Pediatric Nephrology Workforce Project (Superpower)., Susan M. Halbach, Kartik Pillutla, Patricia Seo-Mayer, Alan Schwartz, Darcy K. Weidemann, John D. Mahan

Manuscripts, Articles, Book Chapters and Other Papers

Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States …

The Transformation Of Residency Recruitment In The Era Of Covid-19: Optimizing Residency Recruitment For Lehigh Valley Health Network, David Bosch, Margaret A. Hadinger Edd, Ms, Drew Keister Md

USF-LVHN SELECT

No abstract provided.

The Knowledge, Attitudes, And Practices Of Faculty Towards Scholarly And Predatory Open Access Publishing, Julie H. Schiavo

Library Faculty Publications

No abstract provided.

Legal Aspects Of Student Social Media Behavior In Health Sciences Education, Julie H. Schiavo

Library Faculty Publications

No abstract provided.

Large Single Center Experience In Pediatric Oncology And Bone Marrow Transplant Patients On Ecmo: How Should We Decide Candidacy?, Jordan Marquess

Research Days

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Background: ECMO is rarely utilized in pediatric oncology and bone marrow transplant (BMT) populations due to concerns surrounding poor prognoses and high rates of complications. Patients with malignancies are often not offered ECMO as an option. There is paucity of data to determine whether a pediatric oncology or bone marrow transplant patient is an appropriate candidate for ECMO.

Methods: This is a single center retrospective cohort study on pediatric patients with primary oncologic diagnosis or history of bone marrow transplant who required VA- or VV-ECMO from 2015-2020.

Results: Twelve patients were identified with a 58% …

Safety, Timing And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda

Research Days

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Background: Early postoperative ( < 6weeks) cardiac catheterization (EPOCC) has been considered high risk and often delayed. Recently, the safety of EPOCC has been demonstrated. The optimal timing of catheterization and its outcomes in struggling postoperative patients remains uncertain.

Objective: To describe EPOCC in our center and its impact on length of stay (LOS), number of mechanical ventilation days, number of ECMO days, and catheter-based interventions.

Methods: This is a retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and EPOCC within 30 days after surgery. Cohorts were early EPOCC (≤72 hr) vs late EPOCC ( >72 hr). Data on timing, indication, and complications of EPOCC; days of mechanical ventilation and ECMO; and CICU/total hospital LOS were collected. Data was analyzed using chi-square and Student’s t-test, …

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

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Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Increased Prevalence Of Parenteral Nutrition-Associated Liver Disease In Neonates With Congenital Heart Disease, Yasasvhinie Santharam

Research Days

Background: A life-sustaining therapy, use of total parenteral nutrition (TPN) allows for meeting nutritional needs of low birth weight, premature, or otherwise complex infants with conditions that prevent feeding through the GI tract. However, 40-60% of infants on long-term TPN have been shown to develop parenteral nutrition-associated liver disease (PNALD)1 , a serious condition characterized by cholestatic jaundice, steatosis, and hepatic fibrosis. Given these risks, providers must account for risk of hepatic injury when prescribing TPN, including attributes of gestational age, infection, surgical and diagnosis history2-6 . Yet with a multifactorial pathogenesis, significant heterogeneity in PNALD incidence still occurs. Looking …

Pharmacometabolomics Profiling Of Preterm Infants Validates Patterns Of Metabolism Associated With Response To Dexamethasone Treatment For Bronchopulmonary Dysplasia, Bradley C. Stockard

Research Days

Background: Bronchopulmonary dysplasia (BPD) is one of the most common health complications of premature birth. Corticosteroids are commonly used for treatment of BPD, but their use is challenging due to variability in treatment response.

Objectives/Goal: Previous pharmacometabolomics study has established patterns of metabolite levels with response to dexamethasone. We obtained additional patient samples for metabolomics analysis to find associations between the metabolome and dexamethasone response in a validation cohort.

Methods/Design: 14 infants provided 15 plasma and 12 urine samples. The measure of treatment response was the calculated change in respiratory severity score (deltaRSS) from pre-to-post treatment. Each metabolite was assessed …

Patient-Facing Antihemophilic Factor Clinical Decision Support Tool, Chandni Dargan

Research Days

Background: Hemophilia represents a medical condition suited to individualization. Adherence with prophylactic antihemophilic factor regimens ranges from 6%-167%. Clinical decision support tools (CDS) have been shown to improve guideline compliance and enhance patient adherence.

Objectives/Goal: The objective of this study is to evaluate the usability, usefulness, and satisfaction of a pharmacology-driven, patient-facing antihemophilic factor CDS.

Methods/Design: A patient-facing CDS was created to allow patients and families to explore factor levels at any time during their regimen and with the administration of different dosing regimens. Development followed a user-centered design process to ensure development of a product targeted to the needs …

Association Of Patient Demographics, Code Characteristics, And Survival To Discharge After In-Hospital Cardiac Arrests In The Pediatric Intensive Care Unit, Nathan Lavoy

Research Days

Background: Lower socioeconomic status and minority background have been linked to worse outcomes after out-ofhospital and in-hospital cardiac arrests (IHCA). Despite this, there has not been a focus on IHCA within a pediatric intensive care unit (PICU) evaluating patient demographics and code characteristics.

Objectives/Goal: The primary objective is to describe patient demographics, code characteristics, and survival to discharge of patients that suffer IHCA in a quaternary PICU. The goal of this descriptive, retrospective study is to identify possible differences in outcomes related to patient demographics, laying the foundation for further QI initiatives.

Methods/Design: Participants included patients between 24 hours and …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

The Effects Of Necrotizing Enterocolitis And Short Chain Fatty Acids On The Developing Brain In Mice, Maribel Martinez, Venkatesh Sampath, Paula Nichols, Wei Yu, Suban Burale, Tianhua Lei

Research Days

Background: Necrotizing enterocolitis (NEC) is a devastating disease in premature infants characterized by acute intestinal inflammation and necrosis with a mortality of 15%-30%. Approximately 50% of infants that survive NEC will develop neurodevelopmental defects[1]. Studies on the effects of NEC on the neonatal brain are limited, however it’s postulated that neurodevelopmental damage is induced via cytokine activation of toll-like-receptor 4 (TLR4) by high mobility group box protein 1 (HMGB1) on the microglia Accumulation of reactive oxygen and demyelination contribute to neuronal damage. Therapies that limit the development of NEC can potentially also limit the neuroinflammatory changes seen in NEC[2]. We …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Understanding Clinical Application, Edward Lyon

Research Days

Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.

Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.

Methods: A retrospective chart review occurred on 15 patients in the PICU …

Vikela Ekhaya: A Novel, Community-Based, Tuberculosis Contact Management Program In A High Burden Setting, Alexander W Kay, Micaela Sandoval, Godwin Mtetwa, Musa Mkhabela, Banele Ndlovu, Tara Devezin, Welile Sikhondze, Debrah Vambe, Joyce Sibanda, Gloria S Dube, Robert H Stevens, Bhekumusa Lukhele, Anna M Mandalakas

Faculty, Staff and Student Publications

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT.

METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes.

RESULTS: In total, 945 contacts from …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell

Research Days

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Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and development of its clinical guidelines and risk-stratification replaced ALTE. It is unknown if there is a similar association between BRUEs and CPA.

Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with/without CPA, and examine rates of diagnostic testing used to detect CPA.

Methods/Design: This study was part of the BRUE Research and Quality Improvement Network, composed of 15 academic and community hospitals. Subjects were infants …

Healthcare Utilization Of Victims Of Commercial Sexual Exploitation Compared To Non-Victims, Cree Kachelski

Research Days

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Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually. Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification. Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization. Thus, appropriate medical CSEC screening settings are unknown.

Objectives/Goal: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification. We hypothesized that compared to controls, CSEC positive …

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen

Research Days

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous …