April 10, 2020
In This Issue

Research Spotlight:
New CHOP Frontier Programs

CPCE In the News:
Does a State Centralized Reminder/Recall System Improve Vaccination Rates? You Make the Call! 

Upcoming Events

Recent Publications
New CHOP Frontier Programs
CHOP recently announced three new Frontier Programs for the 2021 fiscal year, including the Pediatric Thyroid Center, co-led by Sogol Mostoufi-Moab, MD, MSCE.

The Frontier Programs initiative was launched in 2015 to support programs that best combine research and clinical care. All Frontier Programs have the following three components:
  • Distinctive clinical program that provides extraordinary care
  • Associated translational research that advances the clinical program and has potential to generate the next breakthrough
  • Return on investment that can support ongoing innovation in the years to come

Dr. Mostoufi-Moab, along with CHOP colleagues Andy Bauer, MD and Aime Franco, PhD lead the Pediatric Thyroid Center, currently recognized as the leading center for the treatment of pediatric thyroid disorders in the country. Its thyroidectomy surgery outcomes are unparalleled, with astonishingly low complication rates. As thyroid conditions are becoming more prevalent in pediatric populations, the Thyroid Center will build on its reputation by defining the molecular landscape of pediatric thyroid cancer, confirming targets of diagnosis, determining markers of invasive behavior, and building a global thyroid community focused on advocacy and education.

The other two Frontier Programs for 2021 are the Minds Matter Concussion Care program and the Center for Pediatric Heart Valve Disorders. Previously recognized Frontier Programs have developed unique treatments for cancer and lymphatic disorders, and peanut allergies, among other conditions. The 2021 programs will officially launch on July 1, 2020.
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Does a State Centralized Reminder/Recall System Improve Vaccination Rates? You Make the Call! 

A recent AAP Journals blog post discussed a study of statewide call systems to increase vaccination rates for human papillomavirus (HPV) and an accompanying commentary by CPCE Affiliate Faculty member Kristen Feemster, MD, MPH, MSHP. The study was conducted by non-CHOP researchers and piloted in New York and Colorado. Teens who had not completed their HPV series were identified in randomly selected practices and then families received zero to three autodialer phone calls from a state immunization information system in English or Spanish, noting the name of the practice and number to call for an appointment. The intervention appeared to have little to no impact on vaccine initiation or completion. In their commentary, Dr. Feemster and Sarah Geoghegan, MB BCh BAO, Fellow in the Division of Infectious Diseases, acknowledge the challenges with achieving adequate HPV vaccine coverage. Centralized call systems have seen more success for other childhood vaccinations. They attribute the discrepancy to declining tolerance for robocalls, at least in part. Another factor may be vaccine hesitancy, specifically for HPV vaccination. They cited earlier work conducted at CHOP, which found that clinician-focused communication was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion.

Upcoming Events

CPCE is observing guidance from CHOP and Penn for alternate work arrangements and social distancing due to COVID-19. As a result, the list below looks shorter than usual. We're investigating ways to provide remote content and will update this section appropriately. Please feel free to contact us with any questions in the meantime.

Meeting the Needs of Vulnerable Communities During the COVID Pandemic
Date: Today, April 10, 2020
Time: 12:00 - 1:00 pm
Presented by the Penn Leonard Davis Institute of Health Economics (LDI), this virtual seminar will feature LDI Senior Fellows Dennis Culhane, PhD, Shreya Kangovi, MD, MSHP, and Eugenia South, MD, MSHP; and will be moderated by LDI Executive Director Rachel Werner, MD, PhD. Learn more or join here.

Recessions and Health in the Time of COVID-19
Date: April 17, 2020
Time: 12:00 - 1:00 pm
Presented by the Penn Leonard Davis Institute of Health Economics (LDI), this virtual seminar will feature Atheendar Venkataramani, MD, PhD and will be moderated by LDI Executive Director Rachel Werner, MD, PhD. Learn more or join here.
Recent Publications

The number of patients undergoing autologous haematopoietic cell transplant (HCT) is growing, but little is known about the factors that predict adverse outcomes. Low muscle mass and obesity are associated with disability and premature mortality in individuals with non-malignant diseases and may predict outcomes after autologous HCT. Sogol Mostoufi-Moab, MD, MSCE and her team ran a retrospective cohort study of 320 patients who underwent autologous HCT for Hodgkin or non-Hodgkin lymphoma. Their results showed that sarcopenic obesity was an important predictor of outcomes in patients undergoing autologous HCT. These findings could inform targeted prevention strategies in patients at highest risk of complications after HCT.

A research team including Lisa Schwartz, PhD sought to develop and evaluate the preliminary validity of a self-report measure of parents’ treatment-related efficacy and control, Parental Efficacy and Control Questionnaire-Hematopoeitic Stem Cell Transplant (PECQ-HCT), in a pediatric HCT sample. Exploratory facor analysis results indicated that a 37-item four-factor model was the best fitting and most theoretically sound, χ2(df = 1,596) = 14,089.95, p < .01, comparative fit index = 0.92, Tucker-Lewis Index = 0.90, and root mean square error of approximation = 0.07. These findings suggest that the four-factor PECQ-HCT measure may be useful for measuring HCT-related parental efficacy and perceived control.

The SPARCC sacroiliac joint inflammation (SIS) and structural (SSS) scores are reliable measures to quantify abnormalities in the pediatric sacroiliac joint. Pamela Weiss, MD, MSCE, Timothy Brandon, MPH and their team aimed to evaluate the utility of online calibration modules for the SIS and SSS and the reliability of their component change scores. Change score reliability of 6 raters was assessed by overall and pairwise intraclass correlation coefficients (ICCs) before and after the use of real-time iterative calibration (RETIC) modules for the SIS and the SSS. RETIC modules improved overall reliability of SPARCC SIS and SSS change. SIS recalibration was not as helpful to experienced raters. The SPARCC SIS and all SSS components except sclerosis are reliable measures to quantify change over time in children.

Rates of sexually transmitted infections (STIs) have increased over the decade. Although guidelines recommend HIV testing with incident STIs, prevlanece and factors associated with HIV testing in acute STIs are unknown in adolescents. Danielle Petsis, MPH, Aletha Akers, MD, MPH, Sarah Wood, MD, MSHP, and their team ran a retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. They found that HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.

With the emergence of pre-exposure prophylaxis (PrEP), few studies have examined the potential for parent-child sex communication and PrEP adoption among emerging adult men who have sex with men (MSM). Sarah Wood, MD, MSHP and her colleagues aimed to describe the extent to which parents/family characteristics play supportive roles in emerging adult MSM’s current PrEP use, recruiting PrEP-indicated participants (N=222) through social media to complete an online survey. Their findings support that parents of emerging adult MSM possess a critical potential to reduce their sons’ risk of HIV and promote PrEP uptake.

Kate Henry, MD, MSCE, Joanne Wood, MD, MSHP, and their research team ran a retrospective study to determine the prevalence of (a) additional injuries, (b) abuse as determined by a standardized scale, and (c) reports to child protective services (CPS) among children younger than 5 years in whom a rib fracture was the first presenting injury concerning for abuse. Of the 67 cases included, additional injuries concerning for abuse were identified in 40 (60%), and 58% were deemed likely or definite abuse. Reports to CPS were filed in 72% of cases.
 
The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. Fran Balamuth, MD, PhD and her colleagues assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. They report the performance of the modified Boston and Philadelphia Criteria for the identification of invasive bacteria infections (IBIs) as defined as bacterial meningitis or bacteremia. They results show that the modified Boston and Philadelphia criteria misclassified a substantial number of infants with IBI, including those with bacterial meningitis.

Acute kidney injury (AKI) is nearly universally associated with worse outcomes, especially among children after hematopoetic stem cell transplant (HCT). Researchers including Michelle Denburg, MD, MSCE ran a prospective, observational cohort study to examine urinary immune biomarkers of AKI after HCT to provide insights into novel mechanisms of kidney injury in this population. Studying patients undergoing allogeneic (HCT) provides a unique opportunity to examine immune markers of AKI because the risk of AKI is high and the immune system newly develops after transplant. They found that CXCL10 and CXCL9 are associated with AKI after HCT and are therefore promising biomarkers to guide improved diagnostic and treatment strategies for AKI in this high-risk population.

Diagnosis of bacterial meningitis (BM) is challenging in newborn infants. Analysis of cerebrospinal fluid (CSF) metabolites may be a useful diagnostic tool in BM. Dustin Flannery, DO, MSCE and his team ran a nested case-control pilot study and report and first comprehensive metabolic analysis of CSF in infants with BM. In their cohort, they derived a metabolic signature that predicted the presence or absence of BM, irrespective of gestational age, postnatal age, sex, race and ethnicity, presence of neurosurgical hardware, white blood cell count in CSF, and red blood cell contamination in CSF.

Although recent studies suggest that lymphatic congestion plays a role in development of late Fontan complications, such as protein-losing enteropathy, the role of lymphatic circulation in early post-Fontan outcomes is not well defined. Andrew C. Glatz, MD, MSCE, Michael O’Byrne, MD, MSCE and their colleagues ran a retrospective, single-center study and found a substantial morbidity in the early post-Fontan period. Half of those who developed early complications had lymphatic failure or persistent effusions unrelated to structural or functional abnormalities. Preoperative T2 imaging demonstrated that patients with higher-grade lymphatic perfusion abnormalities were significantly more likely to develop early complications.

Effective October 2015, all US health care institutions and practitioners transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding system, raising concerns about the validity of examining trends over time in clinical care, costs, and quality. For child mental health disorders, alignment with psychiatric diagnosis groups in the Diagnositc and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) is also required to consistently examine trends). Stephanie Doupnik, MD, MSHP and her team thus developed the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS), which classifies child mental health disorders across coding systems and aligns with DSM-5 psychiatric diagnosis groups.

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.