Date: August 18, 2020

Time: 12:00 - 1:00 pm

Sponsored by the CHOP Clinical Trials research Affinity Group and presented by Timothy Olson, MD, PhD, Medical Director of the CHOP Blood and Marrow Transplant Program, Director of Research, Comprehensive Bone Marrow Failure Center, and Assistant Professor of Pediatrics, Perelman School of Medicine at The University of Pennsylvania. Via BlueJeans.

Date: September 2, 2020

Time: 12:00 - 1:00 pm

Sponsored by the CHOP Clinical Trials Research Affinity Group and presented by Tamara Miller, MD, Pediatric Oncologist and Assistant Professor, Department of Pediatrics, Emory University School of Medicine. For information about the Clinical Trials RAG or to RSVP for the seminar, please email clinicaltrialsRAG@email.chop.edu.

Date: September 18, 2020

Time: 12:00 noon - 1:00 pm

Presented by Alex R. Kemper, MD, MPH, MS, Division Chief of Primary Care Pediatrics at Nationwide Children’s Hospital and Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Kemper is a former member of the US Preventive Services Task Force. He serves as the Chair of the Condition Review Workgroup for the U.S. Secretary of Health and Human Services Advisory Committee on Heritable Disorders in Newborns and Children. Dr. Kemper is also the Deputy Editor of Pediatrics.

*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive a BlueJeans link, please contact crosss2@email.chop.edu

Risk-based screening for type 2 diabetes (T2D) in youth with overweight/obesity is recommended, but rates remain low in practice. Mary Ellen Vajravelu, MD, MSHP, Sandra Amaral, MD, MHS and colleagues sought to evaluate predictors of T2D screening in pediatric primary care. Male adolescents were significantly less likely to have ordered screening, but were equally or more likely to complete screening if ordered. The source of this differential practice should be pursued to avoid under-recognition of cardiometabolic risk in at-risk male youth.

A team led by Brian Jenssen, MD, MSHP and including Mary Kate Kelly, MPH, Chloe Hannan, MS, and Alexander Fiks, MD, MSCE sought to understand parents’ preferences for smoking cessation messaging, in order to help clinicians tailor interventions in the pediatric setting to help parents quit smoking. Latent class analysis identified three groups of parents with similar preferences for messaging: Group 1 prioritized the impact of smoking on the child, Group 2 favored gain-framed messages (i.e. emphasizing benefits of quitting), and Group 3 preferred messages emphasizing the financial impact of smoking. This work may inform testing of tailored smoking cessation messages to different parent groups.

A multidisciplinary team of CHOP researchers including Fran Balamuth, MD, PhD, Kathleen Chiotos, MD, MSCE, Brian Fisher, DO, MSCE, Jeffrey Gerber, MD, PhD, and Alix Seif, MD, MPH reported unique hematologic and immunologic parameters that distinguish between COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

A team including Fran Balamuth, MD, PhD and Robert Grundmeier, MD conducted a retrospective study of patients > 1 month to < 20 years old with sepsis to determine how hypotension in the first 48 hours of sepsis management impacts acute kidney injury (AKI) development and persistence. The duration of severe systolic hypotension in the first 48 h of pediatric sepsis management is associated with AKI incidence and duration when defined by age, sex, and height norms, but not by pediatric advanced life support (PALS) definitions.

Barbara Chaiyachati MD, PhD and Fran Balamuth, MD, PhD and colleagues conducted a descriptive cross-sectional study of pediatric emergency healthcare utilization during the onset of SARS-CoV-2 pandemic. The study demonstrated decreased volume, increased acuity, and generally consistent chief complaints compared with the prior three years (2017 through 2019). Ingestions became a significantly more common chief complaint in 2020.

The ability of continuous glucose monitoring (CGM) to improve diabetes outcomes depends upon consistent use. To identify factors that facilitate long-term use of CGM, this study conducted by Chris Feudtner, MD, PhD and others tested the hypothesis that youth involvement in the decision to initiate this therapy would influence subsequent CGM use and that CGM self-efficacy and satisfaction mediate this relationship. When the youth shared their opinions about CGM with parents and participated in the decision to start, they perceived higher self-efficacy and lower hassle at two-month follow-up, which predicted more days of use.

Psychological reactance is an aversive response to perceived threats against personal agency. For adolescents receiving HIV treatment in Botswana, a team including Elizabeth Lowenthal, MD, MSCE, Jennifer Chapman, MPH and colleagues utilized a two-question, medication-specific reactance tool to assess whether: (1) verbal reminders to take medicines made adolescents want to avoid taking them, and, (2) whether adolescents felt anger when reminded to take medicines. Reactant adolescents had more than two-fold greater odds of treatment failure than non-reactant adolescents. Autonomy over medication-taking did not modify the association between reactance and treatment failure. Psychological reactance may be a useful interventional target for improving adolescent adherence.

Children with life-shortening serious illnesses and medically complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most. Chris Feudtner, MD, PhD, MPH and colleagues evaluated twenty domains of high-value PPHC@Home using a discrete choice experiment. Overall, highest-rated domains included Physical Aspects of Care: Symptom Management, Psychological/Emotional Support for the Child, and Care Coordination. Lowest-rated domains included Spiritual and Religious Aspects of Care and Cultural Aspects of Care. In exploratory analyses, parents who had other children rated the Psychological/Emotional Aspects of Care for the Sibling(s) domain significantly higher than parents who did not have other children. Furthermore, bereaved parents rated the Caregiver Support at the End of Life domain significantly higher than parents who were currently caring for their child. This work provides the foundation for further exploration and conversation about priority areas for resource allocation and care improvement efforts.

In adults with heart failure, elevated heart rate is associated with lower survival. A team including Joseph Rossano, MD, MS determined whether an elevated heart rate was associated with an increased risk of death or heart transplant in children with dilated cardiomyopathy, using the Pediatric Cardiomyopathy Registry. Heart rate was elevated in 192 of 557 children (34%), who were older, more likely to have heart failure symptoms, had worse ventricular function, and were more often receiving anticongestive therapies than were children with a normal heart rate. Controlling for age, ventricular function, and cardiac medications, an elevated heart rate was independently associated with death and with death or transplant. Further study is warranted into the association of elevated heart rate and disease severity in children with dilated cardiomyopathy and as a potential target of therapy.