Academic Pediatrics Research Articles

Editorial introductions

Editorial introductions

Editorial introductions.

Editorial introductions.

Improving Adherence to AAP Acute Otitis Media Guidelines in an Academic Pediatrics Practice through a Quality Improvement Project.

Introduction:Acute otitis media (AOM) is the most common reason for antibiotic use in children. The American Academy of Pediatrics (AAP) published its latest AOM guidelines in 2013. A safety-net antibiotic prescription (SNAP) is recommended for some patients based on age, severity, and duration of symptoms. At baseline, 78% of patients diagnosed with AOM in our general pediatrics practice met AAP guidelines, and 20% of eligible patients received a SNAP according to guidelines. We aimed to increase adherence to AAP AOM guidelines in an academic general pediatrics clinic from 78% to 90% by January 2020.Methods:A quality improvement team determined key drivers and developed interventions. Patients included were 6 months to 12 years old with AOM. Encounters were reviewed for adherence to AAP AOM guidelines. During the project, interventions included an ear pain note template, which generated guideline-based recommendations, note template education in clinic orientation sessions, a didactic session on AOM management, and reminders on workstations. Data were analyzed using P-charts.Results:Percent of AOM encounters (n = 1266) adhering to AAP AOM guidelines increased from 78% to 92%. We also reviewed two process measures. First, the use of the ear pain note template increased from 0% to 44%. Second, the percent of AOM encounters where an eligible patient received a SNAP increased from 21% to 78% (encounters n = 421).Conclusion:We demonstrate increased adherence to AAP AOM guidelines, including improved use of SNAPs after introducing a note template with clinical decision support and provider educational sessions.

Utilization of Family as Faculty: A Patient Directed Simulation Education to Improve Patient and Family Communication during Patient-Family Centered Rounds (PFCR).

Introduction:Patient-family-centered care (PFCC) is based on the understanding that the family is the child’s source of strength and support. Effective communication between families and providers is an essential component of PFCC. Our interprofessional team designed an initiative to improve medical providers’ communication in partnership with the Patient and Family Advisory Council (PFAC). Strategies included the creation of a competency rubric and simulation curriculum using the family as faculty. The SMART aim was to improve the percentage of respondents who answered “Always” to doctor communication domains from 72% to 75.6% in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by December 2020.Methods:Pediatric residents, medical students, faculty, nurses, and PFAC members formed a Quality Improvement (QI) team to address PFCR competency. The team created a PFCC checklist to address competency. PFAC volunteers served as standardized parents in an in situ simulation of PFCR scenarios involving interprofessional in-patient teams. Evaluators observed rounds for the pre and postintervention assessment using the checklist. The outcome measure was the percentage of respondents who answered “Always” in the HCAPHS domain for physician communication. The process measure was the PFCR pre and postintervention, using Fisher’s exact test for analysis.Results:Using a statistical process chart (SPC), HCAHPS data from 2018 to 2020 showed that we exceeded our aim of >5% increase in the physician communication performance. Pre-post intervention data showed improvement in PFCR competency.Conclusion:Family as faculty simulation led to improved physician communication, translating to improved performance in the HCAHPS score and PFCR competency communication domains.

Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits.

∗Division of Pediatric Gastroenterology, Hepatology, & Nutrition, MassGeneral Hospital for Children †Department of Pediatrics, Harvard Medical School ‡Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA.

OA43 Development of a national across specialty multi-disciplinary team for management of hyper-inflammatory conditions during the SARS-CoV-2 pandemic

Abstract Background/Aims Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions. Methods Narrative account of MDT and service development Results We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medico-legal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials; among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks. Conclusion This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT. Disclosure K. McLellan: None. L. Reilly: None. L. Pollock: None. O. Swann: None. C. Anderson: None. N. Martin: None. M. Brennan: None. R. Hague: None. J. Walsh: None.

VITAMIN D STATUS AND ITS CORRELATION WITH SYSTEMIC CYTOKINE LEVELS IN PEDIATRIC PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

The aim of present study was to establish correlations between vit D status and systemic cytokines profile in children with community acquired pneumonia (CAP). The prospective study was performed in 41 Children with CAP at age 5 to 15 years hospitalized in TSSU Zhvania Pediatric Academic Clinic between November 2019 to March 2021 (negative SARS-2-CoV). Vit D One moment blood concentrations of 25-hydroxyvitamin D were determined in every study participant. According to recent consensus, a 25(OH)D concentration <50 nmol/L, or <20 ng/mL was an indication of vitamin D deficiency, a 25(OH)D concentration of 50–75 nmol/L, or 20–30 ng/mL was considered to indicate insufficiency; concentrations >75 nmol/L to 250 nmol/L, or 20 ng/mL-100ng/mL was considered to be sufficient. Interleukin (IL) 6 and 10 were determined twice on first and fifth days of hospital admission in the blood of each patient. I group (11 cases) formed patients with vit D deficiency, II group (12 cases) with vit D insufficiency and control group (18 cases) formed hospitalized patients with sufficient vit D concentration. Normal values in healthy population for IL-6 2.9±0.3 pg/ml, for IL-10 1.32±1.5pg/ml.Data were analyzed using computer program SPSS 18 (SPSS INC., CHICAGO, IL, USA). Statistical significance was taken as p<0.05. Serum levels of IL-6 and IL-10 upon admission were significantly higher in every patient to compare to normal data. IL-6 in vit D deficient patients were significantly increased, as at admission, as on 5-th day of hospitalization compared with other groups. On 5-7th hospital day IL-6 in vit D insufficient and sufficient patients had already normalized to levels similar to those of healthy individuals. Whereas IL 10 level stay high in four patients who required intensive care for ARDS. Our results have shown that the systemic cytokines levels and IL6/IL/10 ratio are increased in CAP patient. Vit D plasma concentration affects systemic cytokines levels in the blood. Vit D deficiency (<20ng/ml) can be recognized as risk-factor for pneumonia severity.

Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism.

The Academic Pediatrics Association has taken multiple steps over the last 2 years to incorporate the lenses of anti-racism and social justice into our mission and work. In this commentary, we discuss the creation and work of the Anti-Racism and Diversity Task Force, which was charged by the Academic Pediatrics Association's Board of Directors with identifying strategies to promote anti-racism and advance the diversity, equity and inclusion agenda.

The Effect of the COVID-19 Pandemic on Pediatric Physician Wellness: A Cross-Sectional Study.

The COVID-19 pandemic has provided challenges to all healthcare workers. While the brunt of treating COVID-19 patients fell upon adult providers, pediatricians also experienced significant stressors and disruptions. Academic pediatricians and trainees (fellows and residents) were redeployed to manage adult patients in hospitalist and intensive care settings and/or had major changes to their clinical schedules. In this study, we aimed to describe levels of self-reported depression, anxiety, and burnout in pediatric physicians following the initial wave of the pandemic at the largest integrated health system in New York State. A cross-sectional study was conducted among pediatric physicians who cared for patients during the COVID-19 pandemic within the Northwell Health System as part of the Northwell Wellbeing Registry, a longitudinal registry assessing the psychological impact of COVID-19 on healthcare providers. A total of 99 pediatric physician respondents were included in this study; 72% of whom were attendings, 28% of whom were trainees. Compared to attendings, trainees reported significantly higher proportions of burnout–emotional exhaustion (p = 0.0007) and burnout–depersonalization (p = 0.0011) on the Abbreviated Maslach Burnout Inventory. There was not a similar trend in probable depression or probable anxiety using the Patient Health Questionnaire. In a multivariable logistic regression model, being a trainee was significantly associated with increased odds of burnout–emotional exhaustion (OR 5.94, 95% Confidence Interval: 1.85–19.02). These findings suggest that fellows and residents were a vulnerable population during the COVID-19 pandemic. Training programs should pay special attention to their trainees during times of crisis, and future studies can help to identify protective factors to reduce the risk of burnout during these times.

Gender-Based Linguistic Analysis of Pediatric Clinical Faculty Evaluations.

Gendered stereotypes are embedded in the culture of medicine. Women are stereotypically expected to act collaboratively and less assertively, while men are expected to act with authority and power. Whether gender-biased language is expressed in academic pediatric teaching evaluations is unknown. Determine whether stereotypic gender-based linguistic differences exist in resident evaluations of pediatric faculty. We performed a retrospective cross-sectional study of clinical faculty evaluations by pediatric residents in a single program from July 2016 to June 2019. Using Linguistic Inquiry and Word Count, responses to 2 open-ended questions were analyzed for stereotypic language. Categories were reported as a percent of total words written. Comparisons between gender groups were conducted using nonparametric Wilcoxon rank sum tests. Rates of word use within each category were analyzed using logistic regression where faculty and resident gender were included as predictor variables. A total of 6436 free-text responses from 3218 unique evaluations were included. As hypothesized, evaluations of women faculty were less likely than those of men to include certain agentic language like power (odds ratio [OR] 0.9, P < .001) and insight (OR 0.9, P < .001), and research words (OR 0.6, P=.003). As expected, evaluations of women were more likely to include grindstone words, like "hardworking" (OR 1.2, P=.012). Contrary to our hypothesis, women received fewer teaching words like "mentor" (OR 0.9, P=.048) and communal words like "friendly" (OR 0.6, P=.001). Certain stereotypic language was demonstrated in clinical teaching evaluations of pediatric faculty. These findings should be further examined to improve gender inequities in academic pediatrics.

Developmental Dysplasia of the Hip: An Examination of Care Practices of Pediatricians

To evaluate the decision making processes of pediatricians regarding diagnosis and management of developmental dysplasia of the hip (DDH) by conducting a survey of pediatricians in the United States. An electronic survey was sent to multiple American Academy of Pediatrics state chapters and academic pediatrics groups, and responses were received from pediatricians in 10 states. The survey included demographics, guideline use, clinical scenarios, and referrals/imaging practices. The number of responses to each survey question and their relative frequencies were calculated. We received 139 responses and included 126 in our analyses. Only 50% of the responding pediatricians (63 of 126) practiced in an institution that endorses a care pathway for DDH. Only 5.6% of the pediatricians (7 of 125) have referred patients at 12-18months between diagnosis and management to a specialist for suspected DDH, and 9.5% (12 of 125) have referred patients between 6 and 9months. Almost one-quarter of the pediatricians (23%; 29 of 126) cited "hip click" as an abnormality that would prompt them to refer a patient to a specialist, and 72.2% (91 of 126) indicated that family history of DDH warrants an ultrasound regardless of the physical examination findings. Moreover, 10.3% of the surveyed pediatricians (13 of 126) reported being only "somewhat" or "moderately" familiar with the Barlow and Ortolani maneuvers. The results of this study indicate that there is an opportunity to better distribute and implement DDH guidelines. The large number of pediatrician respondents who would not refer patients to a specialist or order imaging studies appropriately represents an opportunity for education. The implementation of a care map with standard referral and imaging practices could improve the care of patients with DDH.

Gender and Racial Profile of the Academic Pediatric Faculty Workforce in the United States.

BackgroundEquity, diversity, and inclusion remain a challenge in the healthcare workforce. This study explored the current gender and racial/ethnic trends in academic pediatric positions across the United States.MethodologyThe pediatric faculty self-reported data by the American Association of Medical Colleges (AAMC) Faculty Roster from 2007 to 2020 were analyzed. The races were classified as White (non-Hispanic), Asian, Hispanic, Black (non-Hispanic), Multiple races (including both non-Hispanic and Hispanic), Others, and Unknown. Gender was categorized as male and female.ResultsThe results showed that Asian, Black (non-Hispanic), and Hispanic academic pediatricians increased in full professor, associate professor, and assistant professor positions and decreased in instructor positions from 2007 to 2020. Black (non-Hispanic) academic pediatricians relatively decreased 5.5% in chairperson positions. Women increased in full professor, associate professor, instructor, and chairperson positions; however, relatively decreased 1.8% in assistant professor positions. Men and White (non-Hispanic) academic pediatricians relatively decreased 10.5% and 16%, respectively, in all academic ranks. Women, Asian, Black (non-Hispanic), Hispanic, and Other races were underrepresented in tenured, on-track (tenure-eligible), and not-on-track (tenure-eligible) positions.ConclusionsWomen and underrepresented minorities in medicine (URiM) physicians continue to remain significantly underrepresented in academic pediatric faculty positions and tenured track positions. There is a dire need to adapt multifaceted strategies to increase the engagement of women and URiM in academic pediatrics.

Caring for Children With Medical Complexity in the Early COVID-19 Pandemic in an Ambulatory Primary Care Setting.

BackgroundChildren with medical complexity (CMC) have multiple chronic conditions and require a high level of coordinated healthcare. The risk of COVID-19 among CMC is unclear.ObjectivesWe aim to identify and describe the prevalence and experience of COVID-19 among CMC and their caregivers during the initial weeks of the COVID-19 pandemic in the NY metropolitan area.MethodsWe performed a cross-sectional study of children enrolled in a structured clinical program for CMC at a large urban, academic general pediatrics practice in NY.ResultsIn our patient population (n = 132), 16 patients had a known exposure with parents being the most common exposure in 37.5% (n = 6). Two patients were hospitalized for COVID-19 while the remainder of the confirmed or suspected COVID-19 cases were managed as an outpatient.ConclusionsCommon sources of COVID-19 exposure were family members and home care providers. Almost all of our patients experienced interruption of medical care including missed therapies and visits.

Climate advocacy among Italian pediatric pulmonologists: A national survey on the effects of climate change on respiratory allergies.

Climate change (CC) is expected to negatively impact respiratory health due to air pollution and increased aeroallergen exposure. Children are among the most vulnerable populations due to high ventilation rates, small peripheral airways, and developing respiratory and immunological systems. To assess the current knowledge among Italian pediatric pulmonologists on the potential effects of CC on pediatric respiratory allergic diseases, a national survey was launched online from February 2020 to February 2021. The members of the Italian Pediatric Respiratory Society (SIMRI) were contacted by email and 117 questionnaires were returned (response rate 16.4%). 72.6% of respondents were females, 53.8% were academic pediatricians, 42.7% had been working >10 years. Most of the participants were aware of the potential health effects of CC and stated that they had noticed an increase in the incidence (90.6%) and severity (67.5%) of allergic respiratory diseases among their patients. About 61% and 41% of participants respectively felt that there had been an increase in the number of children sensitized to pollen and molds. When applying latent class analysis to identify the features characterizing participants with greater awareness and knowledge of CC‐related health effects, two classes were identified: almost 60% of the participants were labeled as “poor knowledge” and those with greater awareness were older, had longer work experience, and were those using the Internet to gather information about CC. There is urgent need to increase pediatricians' awareness of the detrimental effects of CC on children's respiratory health and integrate them in the educational programs of healthcare professionals.

Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes

Background Gestational diabetes mellitus (GDM), a common complication of pregnancy, is associated with a 10-fold increased risk of type 2 diabetes mellitus (T2DM) compared to the general population. Evidence-based guidelines recommend that patients with GDM receive postpartum care for T2DM risk reduction including an oral glucose tolerance test (OGTT) 4-12 weeks after delivery, yet half of patients with GDM did not return for their postpartum visits by 12 weeks postpartum. Additionally, only 10% utilize primary care within 12 months of delivery and one-third of GDM patients receive timely postpartum OGTT. Objective To determine if the Mother-Infant Dyad postpartum primary care program provides a framework to link well-child visits with postpartum primary care visits to increase postpartum clinical interactions promoting longitudinal care, such as postpartum visit attendance and T2DM screening. Study design All patients with a diagnosis of GDM that received care at a postpartum mother-infant dyad program at a Midwestern academic medical center internal medicine and pediatrics primary care clinic were enrolled. Clinic level data was obtained by baseline and 6-month post-enrollment surveys and chart review. A comparison population was identified from Medicaid claims data using propensity score matching to enable a comparison of program participants’ outcomes to a population comprised of similar individuals diagnosed with GDM that received care at sites not participating in the Dyad program. Our primary outcome was completion of T2DM screening in the 4–12 week postpartum period. The secondary outcomes were postpartum visit attendance with a prenatal provider, and prediabetes diagnoses. Results A total of 75 mother-infant dyads were seen by the clinic. Of the enrolled women, 43% were Non-Hispanic White and 30% were Non-Hispanic Black; mean age was 30.75 years. The matched comparison group (n = 62) had a mean age of 30.75 years, were 43% Non-Hispanic White and 30% Non-Hispanic Black. Women who participated in the program were more likely to receive T2DM screenings than women who did not participate (87 vs. 79%, p<.001) and complete postpartum visits (95 vs. 58%, respectively; p<.001). Additionally, a higher rate of new prediabetes diagnoses was observed (12 vs. 6%, p < .001). Conclusion The Mother-Infant Dyad postpartum primary care program improved T2DM screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program participants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.

Performance of Pediatric Neuroradiologists Working from Home during a Pandemic at a Quaternary Pediatric Academic Hospital.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, many radiology departments shifted to working a portion of clinical assignments from home. To determine the effect of working from home on performance, productivity, quality, and safety, we evaluated turnaround time, volume of studies, and error rates on rotations worked from home compared with in the hospital. The number of studies interpreted per day for each neuroradiologist, turnaround times, and error rates reported to peer learning was identified from April 1, 2020, through September 30, 2020. For each neuroradiologist, mean turnaround times and volumes per day at home versus in the hospital were compared. Similar comparison was performed for STAT studies. During the time period, 2597 CTs (1897 at home, 700 in the hospital) and 3685 MRIs (2601 at home, 1084 in the hospital) were read. By individual neuroradiologists, 57% (4/7) had shorter turnaround time at home and 57% (4/7) demonstrated an increase in the mean number of studies per day read at home. No statistically significant difference was noted in the neuroradiologists' performance while reading STAT studies. Reported error rates were not found to be higher at home, with statistically significantly lower rates when working at home (P = .018). Variable productivity and performance of neuroradiologists when working from home versus in the hospital were found, being 57% faster and/or more productive while working at home without an increase in error rates. The decision to work at home versus in the hospital may best be based on local factors, balancing the variability among individual neuroradiologist's and the institution's needs, recognizing that working from home is not a one-size-fits-all phenomenon but requires adaptability for successful implementation.

Mind the Gap: Women in Pediatric Hospital Medicine.

Mind the Gap: Women in Pediatric Hospital Medicine.

Evaluation of pediatric electives and core pediatric topics offered at United States schools and colleges of pharmacy

AbstractIntroductionPediatric patients are an important population in every community, and providing patient‐centered care to this population relies on fundamental knowledge of pediatric care.ObjectivesTo describe the availability of pediatric electives and depth of pediatric topics taught throughout the curricula offered at Doctor of Pharmacy (Pharm.D.) programs in the United States.MethodsThis was a quantitative/qualitative survey study assessment. A 21‐question survey was created, reviewed, and pilot‐tested prior to full distribution. The electronic survey was administered and distributed via email to relevant faculty at 145 identified Pharm.D. programs.ResultsThe survey achieved a 65% response rate with 69.2% of responding programs reported offering at least one pediatric elective. Pharmacy schools that responded represented all areas of the United States. The majority, 57.5% (n = 54), of responding programs employed at least one full‐time pediatric faculty member, and 14.9% (n = 2) had two pediatric faculty members.The most common topics taught in pharmacy curricula without a pediatric elective (&gt;80%) were cystic fibrosis, asthma, attention‐deficit/hyperactivity disorder, immunizations, otitis media, and calculations. Pediatric topics that were not offered anywhere in these curriculum (&gt;40%) were cardiology, congenital heart disease, hypersensitivity reactions, child abuse, neonatal intensive care, and health disparities in children. However, topics that were most commonly covered within a pediatric elective (&gt;50%) consisted of cardiology, congenital heart disease, cystic fibrosis, growth and development, neonatal intensive care unit foundations, medication errors/safety, and calculations.The most common type of assessments utilized in the pediatric electives were exams or quizzes (n = 53). Case‐based learning was the most common teaching method.ConclusionThis study demonstrates a growth in pediatric education, the extent of pediatric topics taught throughout curricula, and an increase in pediatric faculty members in pharmacy programs. There remains a need for all programs to teach pediatric patient‐centered care and for more pediatric pharmacists leading this education in pharmacy curricula.

"Your Silence Will Not Protect You": Using Words and Action in the Fight Against Racism.

"Your Silence Will Not Protect You": Using Words and Action in the Fight Against Racism.

Child Poverty and Health in the United States: Introduction and Executive Summary.

Child Poverty and Health in the United States: Introduction and Executive Summary.