Medical Education Commons^™

Switching Lanes: Leaving Behind Discharge Antibiotics And Laboratory Testing In Perforated Appendicitis, Seth Saylors, Cory Nonnemacher, Meredith Elman, Pablo Aguayo, Richard Hendrickson, David Juang, Irene Isabel P. Lim, Rebecca Rentea, Charles Snyder, Shawn St. Peter, Tolulope Oyetunji

Research Days

Purpose: Appendicitis is the most common surgical emergency in children with approximately 30% of patients presenting with perforation, defined as a hole in the appendix or a fecalith found in the abdomen, at time of surgery. Our previous protocol at time of discharge, with an 11% intraabdominal abscess (IAA) rate, included checking a white blood cell count (WBC) on day of discharge, with a value ≥10 serving as a trigger for additional outpatient oral antibiotics course. Beginning in May, 2023 we changed our protocol to no longer obtain WBC or prescribe outpatient antibiotics at time of discharge. The purpose of …

Time From Triage To Imaging In Stroke Activations At Children’S Mercy Hospital, Annie Altschul, Marcie Files, Jennifer Flint, Brooke Fridley Phd

Research Days

Background: Stroke affects 2-3 per 100,000 children annually. Timely diagnosis is vital to provide the highest quality care to pediatric stroke patients. Features that contribute to delays in diagnosis of pediatric stroke include complex or subtle signs and symptoms, limited exams in young children, broad differential and frequent stroke mimics, low awareness in the community, and sedating or paralytic medication use in critically ill children. The establishment of stroke activation protocols for children has led to improvements in care for pediatric stroke across numerous centers, expediting time to imaging and treatment.

Objective: We aimed to quantify the time …

But, It's Just A Uti, Gillian Long

Research Days

A case report of a 12 year old female presenting to the emergency room with rash, hematuria and shortness of breath, ultimately found to have a life changing diagnosis.

What Happens After They Leave The Ed? Following Up Acute Asthma Exacerbations After Changes In Clinical Practice Guidelines For Treatment, Phillip S. Wozniak, Jade B. Tam-Williams

Research Days

In 2022, Children’s Mercy Hospital (CMH) implemented a new clinical practice guideline (CPG) recommending single-dose dexamethasone as the first line oral steroid for treatment of mild to moderate acute asthma exacerbations. We assessed the impact of this CPG change on readmission rates after discharge from emergency department/urgent care (ED/UC). We hypothesized that single-dose dexamethasone would be non-inferior to a 5-day course of prednisone/prednisolone with respect to 7-day and 30-day acute care readmission rates and need for additional outpatient steroid courses.

Bilateral Buccal Myomucosal Flap Palatoplasty For The Management Of Velopharyngeal Dysfunction In Children, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Background: The use of bilateral myomucosal buccal flap palatoplasty (BMBFP) for velopharyngeal insufficiency (VPI) has increased in popularity. Despite the increasing popularity, there is a paucity in research examining their outcomes, especially in reference to the pediatric population.

Objectives/Goal: The objective of this paper was to investigate the utility of BMBFP for the correction of VPI in children.

Methods/Design: Retrospective chart review was performed using CPT codes to locate patients with BMBFP performed at our pediatric institution between July 2020 to July 2024. Data collected included demographics, associated syndromes, complications, pre-operative and post-operative resonance outcomes, and the need for revision …

Posterior Pharyngeal Flap For The Management Of Velopharyngeal Dysfunction: Comparing Outcomes For Children With 22q11.2 Deletion Syndrome To Those Without, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Introduction (including objectives): Velopharyngeal dysfunction (VPD) is one of the most common clinical features of 22q11.2 deletion syndrome (22q11.2DS) and often requires surgical intervention; due to the multifactorial nature of VPD, these patients present unique and often complex surgical challenges. Prior studies have generally demonstrated poorer speech outcomes postoperatively in children with 22q11.2DS. The posterior pharyngeal flap (PPF) is often considered first-line surgical choice for correction of VPD in children with 22q11.2DS. The aim of this study is to compare PPF outcomes for children with 22q11.2DS to those without.

Methods: Retrospective review for pediatric patients diagnosed with VPI who underwent …

The Influence Of Perioperative Education On Postoperative Digestive Restoration, Christian Cedeno

Doctor of Nursing Practice Scholarly Project

The human body often needs encouragement to return to its natural state of functioning following intraoperative and postoperative drug therapy. Anesthesia can sedate the gastrointestinal tract and frequently requires medical and physical interventions to allow the body to return to full functionality. There are several methods thought to be beneficial in overcoming of this condition, and some have proven their significance more so than other methods. This project seeks to measure the power-of-knowledge methodology via a chart review of individuals specifically educated on what they can expect in the postoperative phase of care compared to those that receive routine education. …

Emergency Medicine Residency Website Wellness Pages: A Content Analysis, Alexandra Sappington, Brian Milman

School of Medicine Faculty Publications

Introduction: The COVID-19 pandemic impacted the way medical students seek residency positions. In 2020, the Accreditation Council for Graduate Medical Education advocated for virtual interviews. Most emergency medicine (EM) interviews in 2023 remained virtual, and this format will persist for the foreseeable future. Since students are not evaluating programs in person in most cases, residency websites are crucial for prospective residents. Resident wellness is critical for resident training and important to prospective residents; it follows that programs must be transparent about resident wellness on websites. In this study we aimed to quantify the number of EM programs with wellness pages …

Observed And Reported Outcomes Following Experiential Cultural Capability And Clinical Yarning Training For Clinicians Treating Aboriginal And Torres Strait Islander People With Persistent Pain, Stuart Ekberg, Renata F. I Meuter, Ivan Lin, Roslyn Rowen, Angela Kinnell, Eva Malacova, Tania Waring, Kushla Houkamau, Marayah Taylor, Matthew Bryant, Jermaine Isua, Andrew Claus, Paul Gray, Joseph Kluver, Christina M. Bernardes, Greg Pratt

Journal of the Australian Indigenous HealthInfoNet

Communication is recognised as crucial to culturally safe healthcare, and poor communication remains a major reason that Aboriginal and Torres Strait Islander people do not access healthcare. This pragmatic, pre-post comparison study employed mixed methods to evaluate cultural capability and clinical yarning training delivered to 57 clinicians supporting Aboriginal and Torres Strait Islander people at three persistent pain management services in Queensland, Australia. Observable outcomes of the training were evaluated by video recording clinicians’ training experiences and seven consultations with patients that occurred either pre- or post-training. Reported outcomes were evaluated by using a modified Cultural Safety Survey (CSS), which …

Novel Rpl30 Variant In Diamond Blackfan Anemia Demonstrates Early Impact On Erythroid Differentiation With Downregulated Gata1-Hsp70, Alexandra Prosser-Dombrowski, Irina Pushel, Jacqelyn Nemechek, Priyanka Kumar, Jay L. Vivian, Jennifer Gerton, John M. Perry

Research Days

Background: Diamond Blackfan anemia (DBA) is an inherited bone marrow failure syndrome caused by ribosomal protein gene mutations leading to apoptosis of erythroid progenitors. We identified a novel heterozygous variant (c.167+769C>T) in the noncoding region of RPL30 in a patient diagnosed with DBA.

Objectives/Goal: We hypothesized that this variant stunts erythroid differentiation at the proerythroblast stage and is pathogenic for DBA.

Methods/Design: We developed an induced pluripotent stem cell (iPSC) model with a wild type (WT) and three CRISPR-Cas9 edited RPL30 mutant clones. iPSCs were differentiated into hematopoietic stem cells, which were assessed by flow cytometry and single cell …

Duration Of Labor And Umbilical Artery Acidosis In Critical Congenital Heart Disease, Sarah Gwazdacz Md, Teresa Nguyen Bs, Mary Donofrio Md, Faap, Facc, Fase, Timothy Bennett Md, Amanda Mcintosh Md, Faap, Facc.

Research Days

Standard delivery protocols for most prenatally diagnosed CCHD is induction of labor at 39 weeks with aims of a vaginal delivery (VD) near a tertiary care center. There is no benefit to planned Cesarean delivery (CD) over VD for most infants with CCHD. However, longer durations of labor (DOL) in CCHD have been described as a risk factor for umbilical artery (UA) acidosis. We aim to describe the relationship between DOL and UA pH and neonatal outcomes in those with prenatally diagnosed CCHD.

Retrospective chart review of prenatally diagnosed with CCHD born at Children’s Mercy from 2012 – 2023. Inclusion …

Opportunities For Solid Organ Donation In The Neonatal Intensive Care Unit, Sarah Pippin, Jotishna Sharma, Ashley Sherman, Julie Weiner

Research Days

This study aims to characterize the theoretical eligibility of neonates undergoing withdrawal of care in the NICU for donation after circulatory determination of death (DCDD), with a focus on warm ischemic time (WIT) ≤ 90 minutes.

Abusive Head Trauma (Aht) Diagnoses: The Influence Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela N. Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Christopher Greeley, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Daniel M. Lindberg, Caitlin Mcnamara, Shalon Nienow, Ashley K. Sherman, Joanne Wood, James Anderst

Research Days

Background: In cases where Child Abuse Pediatricians (CAPs) diagnose abusive head trauma (AHT) in young children, some factors surrounding the diagnosis have been challenged including causative shaking, necessity of external signs of impact, or concomitant suspicious injuries. Evaluation of CAP diagnoses in children with subdural hemorrhage (SDH) can give insight into factors related to the frequency of abusive head trauma (AHT) diagnoses. Additionally, characterization of those with SDH+CSI without evidence of impact may inform controversies around AHT diagnoses.

Objectives/Goal: We aim to compare CAP diagnoses in subjects with SDH across clinical presentations and in the context of evidence of head …

In Search Of The Unknown Mimic Of Abusive Head Trauma., Ruairi Smith-Dewey, Angela N. Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Caitlin Mcnamara, Shalon Nienow, Ashley K. Sherman, Stuart Sommers, Joanne Wood, James Anderst

Research Days

Background:

Some claim that Child Abuse Pediatricians (CAPs) are misdiagnosing a yet-to-be-identified mimic as abusive head trauma (AHT), particularly in ill children with isolated subdural hemorrhage (SDH). Though not diagnostic criteria, specific social stressors have been identified as AHT risk factors. If a yet-to-be-identified mimic is meaningfully present within a group being evaluated for AHT, that group should have fewer AHT risk factors than children with actual AHT. The existence of such a mimic can be assessed by comparing the prevalence of AHT risk factors across groups: CAP-identified mimics, non-ill SDH only, ill SDH only, and SDH plus concomitant suspicious …

Engineering A Novel Treg Population To Control Autoimmune Diabetes, Sofia Colon Guzman, Elly Puckett, Mary A. Markiewicz, Ryan T. Fischer

Research Days

We created a model to test the immunosuppressive capacity of Helios+FOXP3+ eTregs compared to nTregs against islet-specific autoreactive T cells. We also showed that nTregs decrease the response of these cytotoxic T cells when co-cultured with BetaLox5 cells.

Improving Adherence To Evidence Based Sti Care For Patients Who Tested Positive At Ed Index Visit Qi Project, Noelle Tran, Melissa Miller, Kim Barbee, Julie Jost, Christopher Kaberline, M Smith

Research Days

Problem Statement/Question:

Previous work improved clinician sexually transmitted infection (STI) testing behaviors, but overlooked treatment interventions needed to facilitate risk reduction, HIV and syphilis (RPR) testing, and STI retesting at three months—critical components that reduce morbidity and disease spread. We are not adhering to evidence-based STI care for adolescents who tested positive for STIs at the ED index visit.

Background/Project Intent (Aim Statement):

According to the Centers for Disease Control and Prevention (CDC), in 2023, over 2.4 million cases of RPR, gonorrhea (GC), and chlamydia (CT) were diagnosed; about half of reported cases were among adolescents and young adults aged …

Characterizing Attendance At Faculty Education Sessions From A Diversity, Equity, & Inclusion Perspective, Mauro D. Rodriguez, Do, Kimberly A. Randell, Md, Msc, Emilie Keeton, Msod, Myles Chandler, Ms, Ashley K. . Sherman, Ma, Jacqueline Hill, Phd, Mph, Frances Turcotte Benedict, Md, Mph

Research Days

The impact of Diversity, Equity, and Inclusion (DEI) education for faculty is largely unknown. This retrospective analysis tracked CMH faculty participation over three years to determine attendance by gender, race/ethnicity, academic rank, and department at DEI and non-DEI education sessions. Ultimately, further studies are needed to understand participation barriers to DEI education.

Food Insecurity In Adolescent Athletes, Andrew Donaldson, Shannon Margherio, Jay Roberson, Kevin Latz

Research Days

Background: The prevalence of food insecurity among children in the United States is estimated at 21%. Food insecurity during childhood leads to worse school performance, more emotional and behavioral health concerns, and increased suicide attempts. Further, food insecurity has been noted to have multiple deleterious effects on the collegiate student athlete, including lower GPA, disordered eating, and substance use.

Hypothesis: Food insecurity is prevalent in the adolescent athlete population and exists across demographics.

Methods: Voluntary surveys were distributed to parents at all sports medicine clinics at our institution. Demographic data was collected including athlete age, race, school and school district, …

Curricular Impact: Training Dpt Students To Look Upstream, Rebecca Operacz, Pt, Dpt, Edd

Health Equity and Quality Improvement (HEQI) Summit

Background and Problem

• Healthcare literature highlights extensive health inequities and continued mistrust of the healthcare system among historically marginalized communities.
• Accrediting bodies advocate for inclusion of SSDH in training to prepare practitioners to address health inequities.
• Limited guidance exists regarding implementation of SSDH content or expectations for student clinicians.
• Effectiveness of education is typically measured by metrics with little connection to patients and populations (GPA, graduation rates, licensing exams).

Pcsk-9 Inhibitors Treatment: The Cardiovascular Disparity, Julia Lees, Seana-Pierre Williams, Tahir Razzaq, Michael B. Roberts

The Journal of Integrated Primary Care

Introduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, …