3rd Quarter 2020
Quarterly Newsletter for members of the Nebraska Chapter, American Academy of Pediatrics.
Chapter Leadership
President's Message
Last week, I was fortunate enough to take my family on a socially-distanced RV vacation. This much-needed break gave me a chance to reflect on my journey through medicine.

Deciding to take my first RV trip was a lot like deciding on a career in medicine - it sounded exciting, novel. I knew it would be a lot of work but hey, the rewards would be worth it! The views would be spectacular! Once in a lifetime experience!

I did my research, picked a destination and a way to get there. I read up on RV options and campgrounds, just as I had investigated medical schools, specialties, and residency programs. I created packing lists for all 5 members of our family and meal plans. I reserved spots at several stops from here to Glacier National Park and back.

And then: Glacier National Park did not open this summer. Months of planning, gone with the arrival of a single strand of novel RNA.

How many times have our lives in medicine been derailed by a single strand of RNA?

We over-prepare, examine all the angles, read all the research and feel confident in our knowledge and our care of patients. And then: everything changes. New diseases emerge. New research comes out. We suffer personal setbacks - loss of loved ones, illnesses of our own.

In medicine, as in vacation planning, we have to be flexible, nimble. We have to adjust our plan based on the latest information. We have to become advocates for our patients, advisors for our schools, contributors to the research. We have a lot of work ahead of us.

Your Nebraska AAP has taken steps to remain flexible. We unfortunately had to postpone our spring conference, but hope to bring you Dr. Caspari, Dr. Zoucha, and Dr. Lester’s expertise in the near future. We made the difficult decision to convert our fall conference into a virtual format, because the safety of our members is a top priority. We have introduced monthly Chapter Chats via Zoom in which all our members can gather more informally to discuss up-to-the-minute topics like MIS-C and masking in schools. We will offer virtual advocacy training this fall with local and national advocacy experts.

My family ended up in South Dakota for our vacation. We had an amazing time, I was able to recharge, and the views were indeed spectacular.

I hope you are all able to find a way to get a break to recharge this summer. Please let us know how we can help you stay nimble in this time of drastic change. We’ll see you all virtually at the fall meeting (Oct 30!)

Melissa St Germain, MD, FAAP
Nebraska Chapter News
Changes on Chapter Executive Committee
Beginning July 1, 2020, Melissa St. Germain, MD, a pediatrician in Omaha practicing at Children's Physicians began her two-year term as president.

Additional Changes on Executive Committee:
  • Sheila Snyder, MD - President-Elect
  • Tina Scott-Mordhorst, MD - Joined Executive Committee as Secretary/Treasurer (Omaha)
  • Cindy Ellis, MD - Immediate Past-President
  • Jeremy Toffle, MD - Joined Executive Committee (Omaha)
New Members
Welcome to our newest Nebraska Chapter AAP members:
  • Morgan Carson
  • Caleb Cave, MD
  • Songita Choudhury, MD
  • Kelli-ann Corrao, MD
  • Chinenye Dike, MD, FAAP
  • Joshua Euteneuer, MD, FAAP
  • Jessica Fisher, MD
  • Snehal Gajiwala, MD
  • Natasha Gallett, MD
  • Nehemiah Gebreegzabeher, MD
  • Allison Guild, DO
  • Elizabeth Hartley, MD
  • Janice Kutilek, MD, FAAP
  • Eamon Maloney, MD, FAAP
  • Kelli Mans, MD
  • Serenity McAndrews
  • James McCluskey, MD
  • Krista Perez
  • Theodore Pham, DO
  • Sophia Schneider, MD
  • Amelia Sneve, DO
  • Shane Storm, MD
  • Claire Troia, MD
Your Chapter's Response
Collaborating Regarding School Reopening
Your Chapter has collaborated with or provided resources to a number of school districts regarding their planning for school reopening. We have sent letters and resources in support of reopening plans that include masks/face coverings for children over two as part of a plan that includes social distancing, hand washing and other efforts aimed at minimizing the unnecessary spread of the Coronavirus. We have also provided medical resources to districts expressing parental and public concerns related to masks/face coverings.

In a recent communication with Dr. John Schwartz, superintendent of Norris Public Schools, located just south of Lincoln and one of Nebraska's largest class B districts, he stated:

"I wanted to follow-up and share with you that the information you and your organization provided to Norris assisted us in moving forward with our school district plan that includes face coverings. I also wanted to share with you that we plan to use information provided by you and the physicians you cited in our upcoming parent update presentation. I'm sincerely grateful for your assistance as we all work together to create a safe return to school."

He also agreed to share the information and resources with other class B & C districts statewide through his communication channels.
Encouraging Well Check Visits & Immunizations
Participating in the AAP #CallYourPediatrician campaign, your Chapter has used its social media channels and its member "tweetiatricians" to spread the word that it is important to keep up with these visits.

Working with the Nebraska DHHS your chapter communicated with the Omaha World Herald resulting in a front page story shedding light on the drop in immunization rates in Nebraska, the need for parents to schedule these visits and the measures many providers/clinics have taken such as separating well kid and sick kid visits, etc.
Encouraging Sports Physicals
As you no doubt have heard, the Nebraska State Athletic Association waive sports physical requirements during the 2020-2021 school year with the exception of incoming freshmen and students new to Nebraska.

After reaching out to them and encouraging them to reconsider and at minimum to reinstate the requirement for Winter 2020 and Spring 2021 sports, the Chapter received a response that in part read, "While the importance of the PPE was noted and acknowledged by school administrators from large and small schools, the option of extending the “validity” through the fall sport season only involved a process which they believed could not be accomplished and sets different standards for athletes in different seasons. As this continues to evolve, their flexibility on this point could be reevaluated."

Therefore, your Chapter leadership discussed the need to speak straight to parents on the issue. Sian Jones-Jobst, MD, a member so the NEAAP Executive Committe, put together some resources and started #PlaySafePlayWell - a social media effort aimed at educating parents on the importance of a sports physical. This effort was recently shared with other AAP Chapters nationwide.

Would love to get this trending...You can do your part
Visit the #PlaySafePlayWell resources page on the Chapter website then share any of those resources (or your own) via your social media channels using the "#PlaySafePlayWell".
New clinical guidance on MIS-C has just been released by the AAP, including signs, symptoms, diagnosis and management of this rare but serious complication associated with COVID-19.

Addressing Mask Concerns & Misinformation:
The information below was provided by NEAAP member pediatricians and shared as possible resources and/or responses.

Myth 1: Masks are harmful to your health (False)

  1. There are many concerns that wearing masks may be harmful to your health, but this is not based in fact.
  2. The masks we recommend are basic procedure or fabric masks. These masks are not tight fitting and allow airflow, while still protecting others from respiratory droplets.
  3. Just as oxygen can get in, carbon dioxide can get out. So accumulation of carbon dioxide is not a direct concern.
  4. Although these masks are new to most in our community, they are common in the health care setting. Because of this, we have years of experience with them, and are certain they are safe to wear.

Myth 2: Masks only help if someone has symptoms (False)

  1. Coughing and sneezing do create very high risk situations, but talking, yelling, exercising and singing can also spread infected respiratory droplets. Any time inhaling and exhaling occur, there is potential to spread the virus. Because of this, we continue to encourage people to wear masks.
  2. Masks help us prevent infection in several ways.
  3. You may have COVID-19 without knowing. We know it’s possible for people to carry the virus without having symptoms. By wearing a mask, you can prevent accidental spread
  4. Wearing a mask also helps protect you by preventing infection. If someone else is not masked and spreads infected droplets into the air, the mask serves as a barrier that limits the likelihood that you will breath in those droplets and become infected
  5. Touching your face with unwashed hands (or even gloves), could get the live virus in your eyes, mouth or nose. Depending on the amount of virus on your hands, this can cause infection. Masks provide a barrier to at least the mouth and nose

Myth 3: Masks cause self contamination (True and false)

  1. In truth, this is a both myth and fact. Here’s why: Masks can become contaminated on the outside surface, from the droplets mentioned above.
  2. If you do not handle your mask safely, and use great hand hygiene before and after touching it, you could contaminate yourself by getting virus off the mask, onto your hands, and into your eyes, nose or mouth. This is why washing cloth masks or replacing disposable masks is so important.
  3. However, the idea that wearing a mask after you’ve been exposed to COVID-19 will increase your level of infection, is a myth. There is no evidence to support this self contamination claim.

Mask Recommendations:
As discussed during the NEAAP Chapter Chat:

Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization now recommend cloth masks for the general public. Studies have found that viral load peaks in the days before symptoms begin and that speaking is enough to expel virus-carrying droplets. The best mask is one you can wear comfortably and consistently. N95 respirators are only necessary in medical situations such as intubation. Surgical masks are generally more protective than cloth masks, and some people find them lighter and more comfortable to wear. Valved masks protect the wearer, but not necessarily those around the wearer. The bottom line is that any mask that covers the nose and mouth will be of benefit.

Children's Epic has a smartphrase regarding the above . pulmmaskrec

“Three W’s to ward off COVID-19:”
  1. Wearing a mask
  2. Washing your hands
  3. Watching your distance.
NEAAP E-cigarette Chapter Champion Report

So, what is an E-cigarette chapter champion, you might ask? And why are they filling up this newsletter with more stuff for me to read? Well, I’ll tell you!

The AAP is working on an initiative to increase knowledge about E-cig use, improve advocacy efforts regarding use of ENDS (electronic nicotine delivery systems), and help to spur-head local community efforts in education and in regional advocacy regarding this important health topic for children, adolescents and young adults. In order to do this, they have identified “Champions” for this effort if every state. All of these champions are completing a short course that focuses on media training, addressing tobacco use in clinical practice, supporting cessation of e-cig use in practice, and working in your community to help inform others who work with adolescents and young adults (AYA) about this important issue.

So, over the next year, I will be saying “hi” in the Nebraska Chapter Newsletter.  Each time I hope to give you some new information about ENDS use, resources, and advocacy. I would love to know if any of you are active locally in providing education or advocating regarding this important health topic for AYA patients, and what you are doing in your practices. We will also be trying to make sure that you are aware of any educational activities going on that deal with this important topic.

For starters, I want to make sure that you are all aware of 3 fabulous resources available regarding ENDS. First, the AAP’s Julius Richmond Center ( https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages/default.aspx) is an amazing repository of information about ENDS use, including both provider resources and patient education materials. Secondly, I know you’ve seen ads on TV or the web from the “Truth” initiative, but did you know they have a ton of educational information online that you can access ( https://www.thetruth.com/ )? And last, the UCSF Center for Tobacco Control, Education, and Research has terrific resources for everyone ( https://tobacco.ucsf.edu/ ).

Also, before I leave you to explore these fabulous resources, some good news to share (in case you missed it)! Last year, as you are aware, the FDA raised the age of purchase for all nicotine containing products, including ENDS, to 21 (AKA “Tobacco 21 Act”). They also called for banning sales of products that had flavorings (large following among AYA). However, there was a loophole that did not cover disposable ENDS products (which have a large market among AYA). In July, the FDA sent a letter to 10 companies that make disposable fruity flavored ENDS to get them off the market in the US ( https://apnews.com/108ce69692768e4e39b936470747f308 ). So YAY for that move!

More to come in the next newsletter. Thanks for your attention, and please feel free to reach out to me if you are looking for more specific resources or information, or have any local news to share regarding ENDS in your community, your practice, and your life!

Amy Lacroix, MD, FAAP
NEAAP Child Death Review & Intervention Chapter Champion Report
The June issue of Contemporary Pediatrics includes a short piece on Guidelines for health professionals to follow after the sudden unexplained death of a child (now abbreviated as SUDC). The article, written by Dr Erin Bowen who herself had the unfortunate experience of the sudden and unexplained death of her son, references a new text written by a collaboration of the American Academy of Pediatrics and the National Association of Medical Examiners. The Guidelines recognize the need for consistency in the evaluation of these deaths and attempt to act as an outline to help the professional as he aids the family in the navigation of what is an overwhelming event. While I feel that many of the Guidelines seem to be what we would all try to follow in the circumstance of the death of one of our patients, given how infrequently most of us deal with these unexplained pediatric deaths, these Guidelines can help us organize our dealing with these unfortunate events.

We need to recognize that there is a great deal of variability throughout the state in how these SUDC events are investigated. It is our job as pediatricians to not only provide emotional support to these families - including parents, guardians, siblings and others - but also to make certain that all involved including health care providers, public health officials and all in the community learn from each of these events to help prevent their occurrence in another family.

Howard Needelman, MD, FAAP
Child Death Review & Intervention Chapter Champion
National AAP News
AAP 2020 National Conference & Exhibition To Be Virtual

As announced on June 15, 2020, The American Academy of Pediatrics will host its first-ever virtual National Conference & Exhibition this October with an innovative program designed to reach a wider audience than ever before. Click button below for the full announcement.

This virtual conference will use creative ways to deliver outstanding education and to provide opportunities for all members to connect, collaborate, and gather in a virtual space. AAP Committees, Councils, and Sections still will have ways to host their activities and foster connections among their members online. Our new virtual exhibit hall and abstract program will be an integral part of this digital experience in inventive new ways. We promise it will be an experience to remember!
Chapter Events

This series was developed in partnership with the Nebraska Regional Council of Child & Adolescent Psychiatrists and will consist of brief 20-30 minute sessions designed to help pediatric providers advocate for their patients.

Friday, Aug 7 @ Noon
Understanding the Legislative Process
Presented by:
Nebraska Senator John Arch &
Liz Lyons, Director of Advocacy & Government Affairs Administration for Children's Hospital & Medical Center

Thursday, Sept. 17 @ 7 PM
Introducing Yourself
to Your Lawmakers
Presented by:
Karla Lester, MD

Friday, Oct. 9th @ Noon
Writing Letters & Testifying Basics
Presented by:
Beth Ann Brooks, MD

Watch your email soon for a Zoom link for the first session.
NE AAP Fall Virtual Conference: Environmental & Climate Health
Friday, October 30, 8 AM - 3:30 PM
The morning presentations will focus on environment and climate health
and the afternoon will be sub-specialty updates and a session with the latest COVID-19 information.

The conference will now be held virtual. Watch for more details to come.
We Need You! Opportunities for Involvement
Your Chapter has a variety of opportunities for to get involved, share your voice and provide input that will impact the health Nebraska's children and adolescents.
Urgent Pediatrician input needed: DHHS immunization Survey by Aug 10
( One Response Per Clinic)

The COVID-19 pandemic has significantly disrupted the provision of pediatric immunization services, both nationally and in Nebraska.

In 2019, Nebraska ranked 5th in the nation for childhood vaccinations, evidence of the commitment and collaboration between health care providers, public health, schools, and families.

To learn more about this critical emerging issue this a survey has been created, to give providers a voice, in restoring the excellent immunization coverage of Nebraska’s children.

The following partners thank you for your participation!
  • Nebraska Department of Health and Human Services, 
  • Nebraska Medical Association, and the 
  • Nebraska Chapter of the American Academy of Pediatrics
Keep Nebraskans Well (KNEW) - Needs Pediatrician Volunteers for a
Collaborative Effort to Increase Immunization Rates:

The Nebraska Chapter AAP is currently participating in a collaborative effort aimed at immunization education and increasing vaccination rates. The effort: Keeping Nebraskans Well (KNEW) includes the Nebraska Medical Association, the Nebraska Chapter of Academy of Family Physicians, Metro Omaha Immunization Task Force and several other partners. This robust effort's goals are to build a strong alliance of immunization advocates including medical providers and parents to advocate for immunizations and dispel misinformation.

KNEW has established a steering committee and has identified several subgroups to assist with this effort. We are asking Nebraska Chapter AAP members to consider involvement in this effort - there are opportunities ranging from minimal time commitment on up in the areas of education, social media, advocacy/legislative, identifying/communicating with parents/families, and identifying/communicating with providers.

Together we are a respected and powerful voice when it comes to child health in Nebraska – let’s put that power to work.

Click the link below to see areas of need and opportunities to volunteer - including options in the areas of education, advocacy, social media, or connecting with providers and parents.
Resident & Fellow News
April Resident of the Month
JULIE RISINGER, DO - Pediatric House Officer II
"Dr Risinger is always on top of things - efficient, thorough, and a delight to work with. She always has a great attitude!"

"Dr. Risinger and the blue team were the rock stars of the month- challenging patients and a constantly full list. Well done!"
May Residents of the Month
SPENCER ROBINSON, MD - Pediatric House Officer I

"Dr. Robinson is very thorough and is always willing to answer questions. When a patient was decompensating he stayed around and pitched in where he could help! It was very much appreciated. Keep it up Spencer

Dr. Robinson did a great job this month with several challenging and demanding families. He was always up for doing admissions and helping out the team.

Dr. Robinson took complete ownership of his patients, had excellent bedside manner, and didn't back down from any challenges.
SAMMY GILG, MD - Pediatric House Officer III

"LOVE Dr. Gilg!! She is always available for us and listens when we call with concerns or questions!! She's the best!!

Dr. Gilg is always stellar. She is the ultimate team player, incredibly efficient, and always with an awareness of her patients and their needs. It instantly brings a smile to my face when I realize that I'll be working with her."
June Resident of the Month
EVAN SYMONS, DO - Pediatric House Officer II

"Dr. Symons went above and beyond this month as a supervisor. He is extremely involved while still allowing for autonomy. He is always calm, collected, and focused while making teamwork and morale a priority.

Dr. Symons puts an incredible amount of thought into everything he does. He is always trying to think of every possible clinical scenario and anticipate what's needed to keep patients safe, help his colleagues, or advance his skills. I'm incredibly impressed with his growth, maturity and tact."