In This Issue
Research Spotlight:
Shedding Light on Congenital Heart Disease
CPCE In the News:
The dangers of criminalizing medical care for trans youth
CPCE In the News:
Coronavirus is big news, but in the Philly area and across the U.S., flu keeps rising
Upcoming Events
Recent Publications
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Shedding Light on Congenital Heart Disease
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In the U.S., February 7 – 14 is
Congenital Heart Defect Awareness Week, and there’s better understanding of the burden of congenital heart disease worldwide, thanks to a study reported online January 21st in
The Lancet Child & Adolescent Health.
Part of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD), the 2017 Congenital Heart Disease Collaborators’
study provides important data not included in previous GBD analyses. For example, much of what was previously known about congenital heart disease was based on data from countries with high socio-demographic index (SDI). Additionally, previous work did not evaluate congenital heart disease throughout the life course. This study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017.
Joseph Rossano, MD, MS, provided
commentary on the GBD 2017 study. Summarizing the results, he wrote “Some of these important findings include a global estimate of nearly 12 million people living with congenital heart disease in 2017, which represents an 18.7% increase from 1990. The number of deaths attributed to congenital heart disease in 2017 was estimated at 261,247, a decline of 34·5% from the estimated number of deaths in 1990. Unsurprisingly, congenital heart disease was a leading cause of infant mortality, ranking 6th globally and 2nd in regions with a high SDI.”
Both Dr. Rossano and the study’s authors acknowledged some important limitations, including a lack of data from sub-Saharan Africa and other large parts of the world. Nevertheless, Rossano said the study “does provide the most comprehensive global assessment of congenital heart disease to date.”
Learn more about congenital heart disease and heart health awareness from the CHOP
Cardiac Center.
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The dangers of criminalizing medical care for trans youth
CPCE and PolicyLab Core Faculty member
Nadia Dowshen, MD, MSHP provided an opinion piece in
The Hill opposing proposed legislation in South Dakota and other states that would charge a felony to doctors who provide medical and surgical treatment to transgender youth. Dr. Dowshen provided evidence from the literature that trans youth who receive gender affirming care have better psychosocial outcomes and no negative medical consequences. “Each of my patients has their own story and challenges,” said Dowshen, who co-founded CHOP’s
Gender and Sexuality Development Clinic, “but all are thriving with the support and medical treatment our clinic provides. We need fewer barriers, not more, to trans youth getting the love, respect, dignity and medical treatment they deserve.”
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Coronavirus is big news, but in the Philly area and across the U.S., flu keeps rising
While media attention has been focused on the coronavirus that originated in Wuhan, China, influenza remains the larger threat closer to home. Flu “is our important epidemic right now that is affecting our community in a big way,” said
Kristen Feemster, MD, MPH, MSHP, CPCE Affiliate Faculty member and Medical Director of the Philadelphia Department of Public Health immunization and acute communicable diseases programs. As of February 7, the CDC had estimated that 22 million Americans have gotten the flu this season, 210,000 have been hospitalized because of it, and 12,000 have died. The number and severity of cases is not unusual for this point in the flu season.
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Upcoming Events
Design Thinking in Healthcare – How Do Innovation and Improvement Fit Together?
Date: February 18, 2020
Time: 12:00 - 1:00 pm
Location: Colket Translational Research Building, Room 6040
The Improvement Education Program within the CHOP Center for Healthcare Quality and Analytics (CHQA) is hosting an Improvement Education Program Special Topics forum on Design Thinking in Healthcare.
Philadelphia Public Health Grand Rounds: Climate Change and the Air We Breathe
Date: February 19, 2020
Time: 5:30 - 7:00 pm
Location: The College of Physicians, 19 S. 22nd Street, Philadelphia
The session aims to provide attendees with an understanding of the air pollution problem in the region and tools and strategies to implement as individuals and on a community level. Free, but
registration is required.
CPCE/PolicyLab Faculty Seminar Series featuring James Guevara, MD, MPH
Date: February 21, 2020
Time: 12:00 - 1:00 pm
Location: Roberts Center for Pediatric Research, 2nd floor, Room 2-180
James Guevara, MD, MPH is a core faculty member of CPCE and PolicyLab, professor of pediatrics and epidemiology at the University of Pennsylvania, and a primary care pediatrician at CHOP. Dr. Guevara will discuss community-based participatory research. To RSVP, e-mail
CPCE@email.chop.edu.
Global Health Research Affinity Group Seminar Series featuring Julianne Burns, MD, MSCE
Date: February 25, 2020
Time: 12:00 - 1:30 pm
Location: Roberts Center for Pediatric Research, 2nd floor, Room 2-160
Emerging Therapies in a New Era of Care
Date: March 3, 2020
Time: 6:00 - 7:30 pm
Location: The Franklin Institute, 222 North 20th Street, Philadelphia
Penn Medicine bioethicist and pediatric oncologist
Dr. Steven Joffe joins Franklin Institute’s Dr. Jayatri Das for a dynamic discussion exploring the promise and the realities of newer breakthrough therapies. Free,
advance registration required.
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Recent Publications
Some children six months through 8 years old need two doses of the influenza vaccine in a season to be adequately protected against influenza. However, only half of those who receive the first dose receive a second. As part of a national-randomized control trial,
Ekaterina Nekrasova, MPH and
Alexander Fiks, MD, MSCE and their team sought to assess vaccine hesitancy and influence of disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. Their results demonstrated that caregivers whose children received the first dose of the influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs.
Robert Grundmeier, MD and his colleagues ran a retrospective cohort study of pediatric emergency department (ED) visits in 2015 to measure the variability in discharge opioid prescription practices for children discharged from the ED with a long-bone fracture. They found that discharge opioid prescription varied widely by ED site of care. Black patients, Hispanic patients, and patients with government insurance were also less likely to be prescribed opioids. This variability was not accounted for by patient- or injury-related factors associated with increased pain.
Brittney Henderson, MPH and
Gregory Tasian, MD, MSc, MSCE and their team sought to determine the association between daily water intake and 24-hour urine volume among adolescents with nephrolithiasis in order to estimate a “fluid prescription,” which would reflect the additional water needed to increase urine volume to a target goal. They conducted a secondary analysis of an ecological momentary assessment study that prospectively measured daily water intake of 25 adolescents with nephrolithiasis over 7 days and identified 24-hour urine volumes obtained for clinical care within 12 months of water intake assessment. They developed a fluid prescription equation, describing the relationship between water intake and urine volume, which could help adolescents with nephrolithiasis achieve urine output goals to decrease stone recurrence.
Sepsis recognition is a clinical challenge in children.
Fran Balamuth, MD, PhD and her team sought to determine whether peripheral blood gene expression profiles are associated with pathogen type and sepsis severity in children with suspected sepsis. This prospective pilot observational study sampled from a tertiary pediatric emergency room. The primary outcome was source pathogen and secondary outcome was sepsis severity. The results suggest that gene expression profiling may facilitate identification of source pathogen in children with suspected sepsis, which could lead to improved tailoring of sepsis treatment and antimicrobial stewardship.
Another recent study by
Fran Balamuth, MD, PhD and colleagues sought to compare the timeliness of sepsis recognition and the initial treatment in patients with and without high-risk comorbid conditions. They ran a retrospective cohort study of patients presenting to the pediatric emergency department (ED) who triggered a vital sign-based electronic sepsis alert resulting in bedside “huddle” assessment. Placement on the protocol and time to initiation of protocol and individual therapies were compared for patients with and without high-risk conditions. They found that timeliness of care initiation was no different in high-risk patients with sepsis when using an electronic sepsis alert and protocolized sepsis care.
Pediatric lead exposure in the United States remains a preventable public health crisis. Although shareable electronic clinical decision support (CDS) could improve lead screening and management, discrepancies between federal, state, and local recommendations could present significant challenges for implementation.
Jeremy Michel, MD, MHS and colleagues identified guidance on lead screening and management and extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. They compared obligations for management actions and assessed the feasibility of development of shareable CDS. They found that current variability poses challenges for clinicians but developing shareable CDS is feasible and could improve pediatric lead screening and management.
The relationship between muscle strength and chronic kidney disease (CKD) in children is unknown.
Michelle Denburg, MD, MSCE and her team sought to quantify the association between grip strength (GS) and kidney function and to explore factors associated with GS in children and adolescents in CKD. They found that CKD is associated with impaired muscle strength in children independent of growth retardation and BMI. Exposure to CKD for a prolonged time is associated with impaired muscle strength. Potential mediators of the impact of CKD on muscle strength include growth retardation, acidosis, poor nutritional status, and low physical activity.
Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes.
Joyce Chang, MD, MSCE and
Andrea Knight, MD, MSCE and their colleagues describe patterns of rheumatology/nephrology care and changes in health care utilization and medication adherence during transfer. They found that youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months of transfer and have worse medication adherence, which places them at higher risk for adverse outcomes.
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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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