In This Issue
Research Spotlight: 3-D Printed Models Aid Visualization of Child Injury
CPCE In the News: Telemedicine Visits May Increase Antibiotic Scripts for Kids
CPCE In the News:
Medicaid expansion tied to positive gains for black babies
CPCE In the News: Poverty, other disadvantages tied to higher smoking risk
Open positions in cancer survivorship research
Upcoming Events
Recent Publications
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3-D Printed Models Aid Visualization of Child Injury
The team used chest computed tomography (CT) scans to three-dimensionally (3-D) print models of the rib cages of two patients with suspected non-accidental injury. Physicians frequently provide expert testimony in court cases involving suspected child abuse, and describing these injuries for non-medical personnel can sometimes be challenging, one possibility is that 3-D printed models may serve as visual aids.
For
this particular project, a pediatric radiologist, blinded to clinical data, reviewed both 3-D models, identified all rib lesions and classified them according to their healing stage. A team of experts from the Child Protection Team also interacted with the models, manipulating them in order to better visualize fractures from multiple angles. They expressed willingness to consider using such models in court.
See also a
CHOP press release about this work. Full citation: Christian A. Barrera, Elizabeth Silvestro, Juan S. Calle-Toro, Philip V. Scribano, Joanne N. Wood, M. Katherine Henry, Savvas Andronikou. Three-dimensional printed models of the rib cage in children with non-accidental injury as an effective visual-aid tool. Pediatr Radiol. 2019 Mar 15. doi:
10.1007/s00247-019-04368-7.
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Telemedicine Visits May Increase Antibiotic Scripts for Kids
A recent
article in
Pediatrics described the high likelihood of receiving a prescription for antibiotics via direct-to-consumer (DTC) telemedicine visit, relative to in-person visits to a primary care provider's office or urgent care clinic. The study looked specifically at children presenting with acute respiratory infections, using retrospective data from a large national commercial health plan. The authors found higher overall rates of antibiotic prescribing and lower rates of guideline-compliant prescribing for DTC telemedicine visits. CPCE Associate Director
Jeffrey Gerber, MD, PhD, MSCE, who was not involved in the study, wrote a
companion editorial in which he acknowledged some benefits of telemedicine and suggested it be used to triage cases that might require an antibiotic for in-person visits.
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Medicaid expansion tied to positive gains for black babies
Low birth weight and prematurity are risk factors for infant death, and black infants are more likely to be born at low birth weight and prematurely, as compared to white infants. A study published recently in JAMA, however, indicates that Medicaid expansion helped to reduce these disparities between black and white infants. CPCE Core Faculty member
Heather Burris, MD, MPH, who was not involved in the study, commented on the results. "The investigators found that while expansion was not associated with overall differences in birth outcomes, there was a reduction in black-white disparities, which has historically been very difficult to do," she said. But there is more work to be done. Remaining disparities are still "of major public health concern."
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Poverty, other disadvantages tied to higher smoking risk
A study published in JAMA found that the more adversities people face, such as unemployment, poverty, low education, disability, serious psychological distress and heavy drinking, the more likely they are to start smoking and the less likely they are to quit. CPCE researcher
Stephanie Mayne, PhD, who was not involved in the study, commented. "Smokers with lower socioeconomic status are just as likely to attempt to quit smoking as those with higher socioeconomic status, but are less likely to succeed in quitting, so disparities have widened over time," she said.
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Open positions in cancer survivorship research
CPCE Core Faculty member
Lisa Schwartz, PhD is seeking lab staff at various levels (PhD, MS/MA, BS/BA, student, postdoctoral research fellow). Her lab focuses on self-management of adolescents and young adults (AYA) impacted by cancer (those with cancer predisposition, on active treatment, or survivors). Areas of study include: 1) a multi-site study tracking self-management of AYA survivors, 2) mobile health (text, app, biosensor) interventions and assessment, 3) implementation of survivorship care plans, 4) pain and acupuncture, and 5) longitudinal tracking and outcomes of families with youth tested for cancer predisposition. Many studies include digital/mHealth components, mixed methods, validation of measures, and interventions. For more details, click
here or
contact Dr. Schwartz
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Upcoming Events
Pediatric Academic Societies Meeting
Dates: April 27-30
Location: Baltimore, MD
Full conference information is available
here. View the
schedule of CPCE Faculty, Staff and Affiliates' presentations, posters, and workshops.
Anna T. Meadows Lecture in Pediatric Cancer Survivorship
Date: Tuesday, April 30, 2019
Time: 4:00pm
Location: Colket Translational Research Building CTRB 1200 B
Charles Sklar, MD, Director of the Long-Term Follow-Up Program from Memorial Sloan Kettering Cancer Center will speak on “Endocrine, Metabolic, and Reproductive Complications in Survivors of Childhood Cancer.” Reception to follow in CTRB lobby
2019 Sixth Annual Clinical Research Coordinator Recognition Event
Date: May 2, 2019
Time: 1:00 - 3:00 pm
Location: CTRB 1200 A&B
CHOP employees are invited to the annual celebration of the profession of Clinical Research Coordination and a tribute to the tremendous efforts of coordinators at CHOP.
CHOP Research Institute Poster Day and Scientific Symposium
Dates: May 21-22, 2019
In 2019, the CHOP Research Institute will bring together its largest community-building events, CHOP Research Poster Day and the Scientific Symposium, to create a two-day celebration of all-things-research. More details available
online, or questions questions may be directed to the
Office of Academic Training and Outreach Programs.
The 7th annual Symposium on Advances in Genomics, Epidemiology and Statistics
Date: Friday, June 7, 2019
Location: Arthur H. Rubenstein Auditorium. Smilow Center for Translational Research
All participants of SAGES 2019 are invited to submit an abstract for poster presentation at the time of registration. Poster awards will be available for trainees in pre-doc as well as post-doc categories. A limited number of submissions will be selected for oral presentation at the Symposium. All trainees who submit an abstract for poster presentations are also eligible to receive travel support including transportation and lodging. For further information, please visit:
https://www.med.upenn.edu/sages/.
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Recent Publications
Iron overload can result from certain conditions in children, such as hemochromatosis, or as a result of increased blood transfusions. Iron overload can lead to organ failure and death. Liver biopsies have been considered the best way to evaluate and monitor patients with iron overload, but there is procedure-related risk of morbidity and mortality. Non-invasive MRI-based iron quantification was developed to address these concerns. To study the effectiveness of one such procedure, R2*, a retrospective was carried out by CPCE faculty member
Hansel J. Otero and others.
Kidney stone disease is a disorder of urinary crystallization that affects 9% of the United States population accounting for $10 billion in annual healthcare costs. At lower urine volume, the risk for nephrolithiasis increases, as this results in increased urinary concentration and therefore crystallization of calcium, oxalate, uric acid, and phosphate. This relationship is the likely mechanism underlying the associating between increased risk of kidney stones and high ambient temperatures. A recent study examined potential sex differences in risk for kidney stones, hypothesizing that males would have a greater increased risk of kidney stone presentations after hot days than males. The study found that males do have a higher risk of kidney stone presentations, and that this difference is potentially related to sex differences in behaviors and/or physiologic responses to high heat.
Alarm settings for patients can be customized to better reflect their specific clinical conditions on their bedside physiologic monitor. Customized alarm settings are associated with lower workload for nurses, and allows hospital staff to better monitor their patients. CPCE faculty member
Chris Bonafide, with others, sought to understand how nurses customize devices, and found that nurses customized physiologic monitor alarms based on their level of clinical expertise and comfort. Alarm culture on their clinical unit, as well as colleagues’ and patients’ responses to alarms impacted how nurses customized alarms as well.
Acute respiratory illnesses (ARIs), such as acute exacerbations of asthma, are among the most common illnesses in childhood. Hospitalization can be common with respiratory illnesses, accounting for over 425,000 hospitalizations annually. Preventative and mitigating efforts can have a major impact on child health. A study was carried out to assess whether secondhand smoke exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness.
After cardiac arrest, it is common for acute kidney injury (AKI) to occur, and those who are subsequently treated with vancomycin have an additional risk for drug-induced kidney injury. CPCE faculty member
Kevin Downes contributed to a retrospective cohort study that sought to determine whether there are opportunities for improved drug monitoring after cardiac arrest.
The infant mortality rate in the USA is greater than that of most developed nations, with non-Hispanic black infants dying more than twice as often as non-Hispanic white infants, reflecting a disparity in preterm birth (PTB) rates.
Heather Burris contributed to a study that posited that racial disparities in PTB are a cumulative biosensor of exposures that vary by race, as a result of long-standing inequities. Next steps for addressing perinatal health disparities requires studying and addressing unequal environments rooted in racial inequities.
Resilience is a dynamic process of positive adaptation or continued development in the context of significant adversity, and it manifests as a positive outcome even in the presence of a risk, possibly strengthening an individual’s resolve against the impact of stressors. Resilience is impacted by qualities and processes in the individual, as well as in familial, environmental, and cultural contexts. Resilience in adolescents with chronic musculoskeletal pain often manifests as superior pain coping strategies and overall better physical and psychosocial function. Parental resilience may also impact outcomes for youth with chronic musculoskeletal chronic pain. In a study of this population, the level of resilience was assessed in patients and their parents, and it was found that higher patient resilience was correlated with reduced disease severity among these adolescents.
The number of common toxicity criteria adverse events has increased exponentially over time. CPCE members
Brian Fisher,
Richard Aplenc and Kelly Getz contributed to a study that showed that the increase in total potential AEs has unintended consequences, including more complex AEs and widely varied approaches to AE ascertainment approaches. There is a need for further study into methods to improve the current AE reporting system.
Several CPCE faculty members, including
Chris Bonafide,
Susan Coffin, and
Jim Guevara, participated in the development of a clinical prediction model for central line-associated bloodstream infection in children presenting to the ED. Ultimately this model can help limit unnecessary hospital admissions and antibiotic use, as most children with a central line with fever or other signs of bacteremia do not have a CLABSI. The model performed well among oncologic and nononcologic patients. Future study should validate this model so that it can be used to assess for risk of CLABSI.
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About CPCE
We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.
CPCE E-News is edited by
Holly Burnside. Please feel free to contact us with questions or feedback.
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