In This Issue
Research Spotlight:
New Clinical Effectiveness and Policy-Oriented Health Services Research Projects
Upcoming Events
Recent Publications
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New Clinical Effectiveness and Policy-Oriented Health Services Research Projects
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For the first time in the history of our Pilot Grant program, CPCE partnered with
PolicyLab colleagues to offer two categories of funding: Clinical Effectiveness and Policy-Oriented Health Services Research. We are pleased to announce four winners of the new combined competition.
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In the clinical effectiveness research category,
Leila C. Posch, MD, has been awarded a grant for her project “Postoperative Antibiotic Prophylaxis for Pediatric Ambulatory Surgery.” Dr. Posch will collaborate on the project with
Jeffrey Gerber, MD, PhD, MSCE and
Yun Li, PhD. Antibiotics are often given to children after surgery to prevent surgical site infections, although these infections are rare and antibiotics can lead to adverse events. In fact, a 2017 guideline from the CDC recommended no prophylactic antibiotics for pediatric and adult routine surgeries. The project will examine the impact of postoperative prophylaxis on SSI rates and adverse events in children undergoing ambulatory surgery, as well as investigate the impact of the 2017 CDC guidance on the rate of postoperative prophylaxis in these children.
Three projects were awarded in the policy-oriented research category:
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Sarah Wood, MD, MSHP,
Vicky Tam, MA and
Jungwon Min, PhD have been awarded a grant for their project “Identifying patient, clinic, and geographic disparities in chlamydia screening for adolescent females.” The project aims to identify patient, practice and community-level disparities in chlamydia screening for adolescent females across the CHOP primary care network, and to identify policy and practice targets for policy interventions to improve routine screening. Rates of chlamydia are currently rising in adolescents in the U.S., and screening is a cornerstone of the public health prevention strategy. The project aligns with the PolicyLab adolescent health portfolio’s mission to better understand the unique health care challenges adolescents face as they transition into healthy, productive adults.
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Joanne Wood, MD, MSHP, Linda McWhorter, PhD,
Devon Kratchman, BS, and
Emily DePaul, MPH, MA, have been awarded a grant for their project, “Making Time for Time Out: Evaluating a Discipline Education Module for Caregivers of Young Children.” The project will build on the successful PriCARE parenting intervention which has shown reductions in child behavioral problems, improved parenting skills, and decreased parenting stress. A new 4-session PriCARE Positive Discipline Module was developed to provide additional support for parents who may need it. The project will assess the acceptability and feasibility of delivering the Positive Discipline Module in urban CHOP primary care settings, and obtain pilot data on efficacy of the new module to reduce child behavior problems, increase positive parenting, strengthen parent-child interactions, and reduce risk of child maltreatment.
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Nadia Dowshen, MD, MSHP, and
Sarah Wood, MD, MSHP have been awarded a grant for their project, “Simulation of Contraceptive Access for Adolescents using a Pharmacist-staffed e-Platform and Medication Dispensing Machines.” The team will develop a telemedicine platform that simulates pharmacist prescribing and dispensing of contraceptives via medication dispensing machines (MedStations) to adolescent women ages 14 to 17 years. Eight states and Washington, D.C. have passed legislation allowing pharmacists to prescribe and dispense hormonal contraceptives. Adolescents are an important population to reach with policy initiatives like these as rates of unintended pregnancies are highest in this age group. Yet, pharmacists tend to be uncomfortable providing contraceptive services to youth. To realize the potential impact of pharmacist prescribing for adolescents requires early identification of barriers to implementing this strategy.
Please join us in congratulating the awardees! Learn more about the Pilot Grant program
here. The anticipated due date for the Spring 2020 application cycle is April 1. Also, in case you missed our last issue, we announced the new
Healthcare Delivery Science Research grant program, which has a due date of January 15, 2020.
Contact us with any questions.
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Upcoming Events
Adaptive Designs for Phase I Oncology Clinical Trials: options and challenges
Date: January 8, 2019
Time: 12:00 - 1:00 pm
Location: Roberts Center, 1st floor, 1-120A
The Clinical Trials Research Affinity Group presents
Yimei Li, PhD
, Research Biostatistician with the Division of Oncology at CHOP, and Assistant Professor of Biostatistics and Pediatrics, University of Pennsylvania Perelman School of Medicine.
Pursuit of Evidence-Based Infection Supportive Care for Immunocompromised Children: A Journey OF and FOR a Lifetime
Date: January 10, 2020
Time: 12:00 - 1:00 pm
Location: Roberts, 2nd Floor, 2-170
PolicyLab Morning Speaker Series featuring Rinad Beidas, PhD
Date: January 16, 2020
Time: 9:00 - 10:00 am
Location: Roberts Center for Pediatric Research, 1st floor, room 1-120A
Dr. Beidas is associate professor of psychiatry and medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania. She is the founder and director of the Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI). Her presentation will focus on harnessing implementation science to realize the promise of evidence-based practice. She will describe the foundations of implementation science and explain the application of implementation science principles to the transportation of evidence-based practices for child psychiatric disorders in community settings.
2020 Martin Luther King, Jr. Health Equity Symposium
Date: January 22, 2020
Time: 12:00 - 1:00 pm
Location: Smilow Center for Translational Research, Arthur H. Rubenstein Auditorium
The Penn Medicine Office of Inclusion and Diversity present the annual Martin Luther King Jr. Health Equity Symposium. Keynote Address by Dr. Leandris Liburd, Diretor of the Office of Minority Health and Health Equity at the Centers for Disease Control. Register
here.
Update on antibiotic stewardship in the United States
Date: January 30, 2020
Time: 12:00 - 1:00 pm
Location: CHOP Main Hospital, Stokes Auditorium
Lauri Hicks, DO will present for the CPCE and PolicyLab Seminar Series. Dr. Hicks is a medical epidemiologist in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC). She is also a Captain in the US Public Health Service. For more information or to RSVP, e-mail
CPCE@email.chop.edu
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Recent Publications
Pediatric sepsis is a major cause of death and disability. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct robust surveillance using clinical data. A team of experts including
Fran Balamuth, MD, PhD,
Jeffrey Gerber, MD, PhD, MSCE, and
Karen Puopolo, MD, PhD proposed a preliminary pediatric sepsis event surveillance definition. Their paper outlines next steps to refine and validate criteria to estimate the national burden of pediatric sepsis and support site-specific surveillance that complements ongoing initiatives to improve the prevention, recognition, and treatment of sepsis.
Sogol Mostoufi-Moab, MD, MSCE and colleagues conducted a retrospective study to assess if intraoperative parathyroid hormone (ioPTH) levels correlate with parathyroid gland function recovery time in pediatric patients after total thyroidectomy. They found that the lower the ioPTH, the greater the recovery time. Their study confirms the usefulness of ioPTH levels to predict post-surgery recovery time and provides anticipatory advice to optimize the timing and frequency of postoperative laboratory surveillance.
It is difficult to identify sufficient participants with glomerular disease for clinical trials due to the disease’s rarity.
Michelle Denburg, MD, MSCE and her colleagues tested an algorithm in the electronic health recored (EHR) to identify children with glomerular disease, using PEDSnet, a national network of eight children’s hospitals with data on over 6.5 million children. Their algorithm included either two or more diagnosis codes from a qualifying list or one diagnosis code and a pretransplant biopsy. The algorithm had excellent classification accuracy across PEDSnet.
In children, intravenous line placement typically occurs after inhalation induction of general anesthesia and can be challenging, especially in young children and infants. A team including
Tori Sutherland, MD, MPH conducted a retrospective observational study to assess whether there is an association between clear liquid fasting time and the number of peripheral intravenous catheter insertion attempts in anesthetized children and to identify other factors associated with multiple attempts to insert intravenous lines. They found no association between multiple insertion attempts and fasting time, but they found greater associations with multiple insertion attempts and patient age, ethnicity, time of day of anesthesia, and American Society of Anesthesiologists Physical Status classification.
Phenotyping patients using electronic health record (EHR) data involves labor intensive chart review as it traditionally requires labeled cases and controls. A team including
Naveen Muthu, MD developed an accurate EHR phenotyping approach that does not require labeled controls. This method’s maximum likelihood approach efficiently leverages data from the specified cases and unlabeled patients to develop logistic regression phenotyping models and compare model performance with existing algorithms. Their approach enables accurate semiautomated EHR phenotyping with minimal manual labeling. It should therefore greatly facilitate EHR clinical decision support and research.
Few studies have reported on the use of automated external defibrillators (AEDs) and outcomes among pediatric out-of-hospital cardiac arrest (OHCA). A team including
Joseph W. Rossano, MD, MS ran a study of 971 pediatric OHCA describing the association between bystander AED use, neighborhood characteristics, and survival outcomes following public pediatric OHCA. Their results show that bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival.
Central-line-associated bloodstream infections (CLABSI) can cause morbidity and mortality in critically ill children.
Charlotte Woods-Hill, MD and her colleagues ran a retrospective case-control study of pediatric intensive care unit (PICU) patients to examine risk factors for CLABSI to identify new potential targets for infection prevention strategies. They discovered novel risk factors for CLABSI in PICU patients that include acute behavioral health needs and >80 central venous catheter (CVC) accesses in the 3 days before CLABSI.
Continuous enteral nutrition (EN) is used to maintain euglycemia and can exacerbate feeding problems, which are common in infants with congenital hyperinsulinism (HI).
Mary Ellen Vajravelu, MD, MSHP and her team used a retrospective cohort to describe their practice and growth, feeding, and adverse events in infants with HI who are exposed to intragastric dextrose (IGD). Over a median follow-up of nearly 1 year, IGD was well-tolerated, with no change in weight-for-length or body mass index Z-scores from baseline.
Over the past 70 years, pediatric palliative care has evolved as a subspecialty devoted to the suffering of children and adolescents confronting life-threatening illnesses and life-shortening conditions.
Chris Feudtner, MD, PhD, MPH and his colleagues review the history of how clinicians have come to understand and respond to the suffering of children with serious illnesses, from a narrow focus on anxiety to a multidimensional awareness of suffering. They further highlight the challenges remaining for the next generation of pediatric palliative care professionals.
Hansel Otero, MD and his team systematically review all published cost-effectiveness analyses (CEAs) of imaging technologies in children. They find a paucity of cost-effectiveness studies that evaluate imaging technologies in children. These studies do not incorporate the perspectives of patients and families regarding utilities or cost. They recommend that future studies should elicit and incorporate the impact of disease on families to better reflect real-world scenarios.
Establishing preventative health care between pregnancies may benefit future pregnancies and women’s long-term health, however such care is frequently incomplete. A team including
Emily Gregory, MD, MHS used Andersen’s Model of Health Services Use to identify factors associated with receipt of interconception care. Enabling factors (usual place of care, personal doctor or nurse, insurance) were associated with receipt of recommended care following birth. These factors may be modifiable components of efforts to improve care during this critical life course period.
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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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