Date: January 5, 2021

Time: 12:00 - 1:00 pm

The CHOP Clinical Trials Research Affinity Group (RAG) presents Dr. Holly Hedrick. Join via BlueJeans.

Aaron Masino, PhD will present “Machine learning – should you use it in your research?”

Date: January 15, 2021

Time: 12:00 - 1:00 pm

Julia Szymczak, PhD will present "The Social Life of Numbers: Advancing a Relational Framework of Measurement to Drive Sustainable Change in Healthcare."

Date: January 20, 2021

Time: 12:00 - 1:30 pm

The Penn Medicine Office of Inclusion and Diversity presents their annual symposium involving topics about health equity and disparities. Dorothy Roberts PhD, MPH, MA will present "The History and Future of Race, Health and Justice." Dr. Roberts is the 14th Penn Integrates Knowledge Professor and George A. Weiss University Professor of Law & Sociology at the University of Pennsylvania, with joint appointments in the Departments of Africana Studies and Sociology and the Law School, where she is the inaugural Raymond Pace and Sadie Tanner Mossell Alexander Professor of Civil Rights. She is also the founding director of the Penn Program on Race, Science, and Society. Learn more and register here.

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

Fran Balamuth, MD, PhD and her colleagues performed a planned secondary analysis of a retrospective cohort study to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). The sensitivity of high-risk past medical history, ill appearance, and/or abnormal white blood cell (WBC) count is suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI. Most infants with positive urinalysis results and bacterial meningitis are ≤28 days old, ill-appearing, or have an abnormal WBC count.

A research team including Sandra Amaral, MD, MHS review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from a bilateral pediatric hand-forearm transplantation. Based on recent findings, they recommend pediatric vascularized composite allotransplantation (VCA) for bilateral upper extremity amputees, preferably on immunosuppression already, and those patients who would have the most potential gain not available through standard reconstructive techniques while being able to comply with postoperative immunosuppression protocols, surveillance, rehabilitation, and follow-up.

Endocrine late effects, including reproductive disorders and secondary thyroid cancer, have been reported in up to 50 percent of childhood cancer survivors (CCS) more than 5 years after treatment. Most endocrine disorders are amenable to treatment; awareness of symptoms is therefore of great importance. Recognition of these symptoms may be delayed however because many are nonspecific. Timely treatment of endocrine disorders improves quality of life in CCS and prevents possible consequences, such as short stature, bone and cardiovascular disorders, and depression. At-risk CCS must therefore be regularly and systematically monitored. This article by Sogol Mostoufi-Moab, MD, MSCE and colleagues provides a summary of the most commonly reported endocrine late effects in CCS.

A team including Yun Li, PhD, Kelly Getz, PhD, MPH, Brian Fisher, DO, MSCE, and Richard Aplenc, MD, PhD, MSCE conducted a retrospective cohort study to examine the association between poverty and event-free survival (EFS) and overall survival (OS) for children with high-risk neuroblastoma treated in targeted immunotherapy trials. Household poverty-exposed children experienced statistically significantly inferior EFS compared with unexposed children. Neighborhood poverty was not independently associated with EFS or OS. Children with dual-poverty exposure (neighborhood poverty and household poverty) experienced statistically significantly inferior EFS compared with the unexposed group. They conclude that incorporation of social and environmental factors in future trials as health-care delivery intervention targets may increase the benefit of targeted therapies.

To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health, Susan Coffin, MD, MPH, Karen Puopolo, MD, PhD, Theoklis Zaoutis, MD, MSCE, Jeffrey Gerber, MD, PhD, MSCE used literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level "harm index" for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.

Adolescent and young adult survivors of childhood cancer (AYA) are at risk for long-term health problems that are exacerbated by not meeting health behavior recommendations. To identify AYA at risk, Lisa Schwartz, PhD and colleagues explored demographic and cancer-specific factors associated with not meeting specific health behavior recommendations that have implications for cancer prevention and control. Compared with AYA with public insurance, AYA with private insurance were more likely to meet multiple health behavior recommendations. AYA at greatest risk for not meeting specific health behaviors were more likely to be diagnosed in middle childhood compared with early childhood, be closer to diagnosis, and closer to treatment completion, and have a solid tumor compared with a brain tumor. Early education in the context of survivorship care is critical to provide teachable moments to AYA; such interventions might impact future long-term health and reduce risk for secondary cancers.

Therapeutic drug monitoring (TDM) has become a common tool for assuring the safety and efficacy of antimicrobial drugs at higher doses. Microsampling techniques, including dried blood spotting (DBS) and volumetric absorptive microsampling (VAMS), are attractive tools for TDM and pediatric clinical research. For microsampling techniques to be a useful tool for TDM, it is necessary to establish the blood-plasma correlation and the therapeutic window of antimicrobial drugs in the blood. This review by Kevin Downes, MD and colleagues summarizes the recent assays that have employed DBS and VAMS approaches for quantifying antimicrobial drugs. 

Nicolas Bamat, MD, MSCE and his colleagues ran a retrospective cohort study of very low birth weight and/or very preterm subjects to rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.

To characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth, Dustin Flannery, DO, MSCE and colleagues ran a retrospective matched cohort study using data from the Postnatal Growth and Retrinopathy of Prematurity study. They found that infants with sepsis had similar early weight growth trajectories as infants without sepsis but developed significant deficits in weight that were not apparent until several weeks after the onset of sepsis.

Researchers including Theoklis Zaoutis, MD, MSCE sought to systematically summarize the evidence on how to collect, analyse and report antimicrobial resistance (AMR) surveillance data to inform antimicrobial stewardship (AMS) teams providing guidance on empirical antibiotic treatment in healthcare settings. His team identified 10 key questions about the link between AMR surveillance and AMS. The questions identified focused on AMS team composition; minimum infrastructure requirements for AMR surveillance; organisms, samples and susceptibility patterns to report; data stratification strategies; reporting frequency; resistance thresholds to drive empirical therapy; surveillance in high-risk hospital units, long-term care, outpatient and veterinary settings; and surveillance data from other countries.

Children with severe neurological impairment (SNI) often take multiple medications to treat problematic symptoms. However, for children who cannot self-report symptoms, no system exists to assess multiple symptoms and their association with medication use. Chris Feudtner, MD, PhD, MPH and his colleagues ran a cross-sectional study to assess the prevalence of 28 distinct symptoms, test whether higher global symptom scores (GSS) were associated with use of more medications, and assess the associations between specific symptoms and medications. Their findings suggest that children with SNI reportedly experience substantial symptom burdens and that higher symptom scores are associated with increased medication use. Paired symptom-medication data may help clinicians identify targets for personalized symptom management, including underrecognized or undertreated symptoms.

This study by Diana Montoya-Williams, MD, Molly Passarella, and Scott Lorch, MD, MSCE aimed to retrospectively create and validate a resilience indicator using existing data from the Adolescent to Adult Health (Add Health) cohort study to better understand the resilience of its participants. Questions asked of participants during one Add Health data collection time period (N = 15,701) were matched to items on a well-known and widely validated resilience scale called the Connor Davidson Resilience Scale. Factor analysis yielded an instrument with 13 items that showed appropriate internal consistency statistics. Resilience scores were normally distributed with no ceiling or floor effects. 

A research team including Gregory Tasian, MD, MSc, MSCE and Michelle Denburg, MD, MSCE ran a prospective cohort study to assess the prevalence of therapy-related kidney outcomes in survivors of Wilms tumor (WT). Thirty-two participants (median age 13.6 years; 75% ≥Stage 3 WT) were evaluated at a median of 8.7 years post-therapy. Adverse kidney outcomes were common and should be closely monitored. This work was supported in part by a CPCE Pilot Grant awarded to David I. Chu, MD, MSCE, lead author of the study and former CHOP Urology fellow, now at Lurie Children's Hospital of Chicago.