Akron Children Research Articles

The effects of educational interventions and the COVID-19 pandemic on the time to diagnosis in pediatric patients with primary central nervous system tumors.

Primary central nervous system tumors are a leading cause of death and disability amongst pediatric cancer patients. Akron Children's Hospital published data in 2018 on response time for brain tumor diagnosis and implemented components of an established program to decrease diagnostic delays and thereby reduce tumor- and treatment-related morbidities. This study evaluates if there was an improvement in the total diagnostic interval (TDI, time from symptom onset to diagnosis) after provider education. During the study, the COVID-19 pandemic forced alterations in care delivery. The impact this had on the TDI was also assessed. A retrospective chart review was performed, and patients were separated into 2008-2017 (historical) and 2018-2021 (posteducation) groups to assess the effect of educational interventions on TDI. The posteducation cohort was analyzed separately to assess the impact of COVID-19 pandemic. The 85 patients studied in the post-education group showed a median TDI of 31 days. Though not statistically significant (P = .939), this represents an 11-day decrease in median TDI compared to the historical group (42 days). In addition, the posteducation group showed an increase in the average number of healthcare provider visits (HCP, 2.4 historical to 3.2 posteducation, P = .009). The pre-COVID-19 group (median TDI 43.5 days) did not differ statistically from the post-COVID-19 group (30-day median TDI). The nonsignificant decrease in TDI and concurrent increase in HCP visits after implementation of education suggests a potential gap amongst providers in working-up primary CNS tumors. These results will influence expansion of education to further improve TDI.

Efficacy of intrathecal morphine administration in pediatric patients undergoing selective dorsal rhizotomy.

The purpose of this study was to evaluate the effectiveness of intrathecal morphine following selective dorsal rhizotomy in pediatric patients previously diagnosed with cerebral palsy. This was a retrospective, cohort analysis over the course of four years. The analysis consisted of a treatment group which received intrathecal morphine (5 mcg/kg) injection and a control group that did not receive the injection prior to dural closure. All patients underwent multilevel laminectomies for selective dorsal rhizotomy at Akron Children's Hospital. The effectiveness of the treatment was measured by total dose of hydromorphone administered on patient-controlled analgesia (PCA), number of days on oral narcotics, and cumulative dose of oral narcotic. Of the analyzed 15 pediatric patients, seven patients received intrathecal morphine injection while the other eight did not receive the treatment prior to dural closure. There was a difference of 1135 mcg in total PCA dose between the study group (3243 mcg) and the control group (4378 mcg). The total PCA dose based on weight was lower in the study group (163 mcg/kg) than in the control group (171 mcg/kg). Based on these findings, the administration of intrathecal morphine clinically reduces the opiate need in the first 96 hours post-operatively.

High-Volume Hemodiafiltration with Step-Down Approach versus Standard-of-Care Continuous Renal Replacement Therapy Approach in Critically Ill Burn Patients

Introduction: Acute kidney injury (AKI) is a common complication of severe burn injuries and contributes to morbidity and mortality. It is exacerbated in burn patients by elevated serum creatinine and pro-inflammatory cytokines, leading to immune dysregulation. Chronic renal replacement therapy is standard of care and removes cytokines to return the body to homeostasis. Continuous veno-venous hemodiafiltration (CVVHDF) is a high-filtration method to enhance cytokine clearance; we analyze a step-down approach for improved outcomes in burn patients. Methods: This study reviewed 15 burn patients at Akron Children’s Hospital stratified into 2 groups: high-flow CVVHDF with step-down approach versus standard CVVHDF. A normocarbia bicarbonate-based dialysate solution and citrate anticoagulation was applied, and blood flow rate was maintained greater than 200 mL/min. Results: Fifteen burn patients at Akron Children’s Hospital were separated into groups managed with high-flow CVVHDF (n = 9) and standard-flow CVVHDF (n = 6). All 15 developed AKI symptoms and diuretic-resistant fluid overload, with 4/15 displaying fluid overload greater than 40%. The most common indication for hemofiltration was acute tubular necrosis (11/15). Average time on CVVHDF was 20.2 days and length of admission was 58.6 days. Vasodepressor dependency index was significantly reduced in the high-flow group at 48 h, but no significant difference in mortality was identified. No significant difference was identified in adverse reactions, notably electrolyte imbalances. Conclusion: The literature on the efficacy of high-flow CVVHDF is limited. This study suggests improved mortality rates and length of stay with high flow compared to the literature. Further studies with multicenter involvement are necessary.

OTHR-11. The effects of the COVID-19 Pandemic on the time to diagnosis in pediatric patients with Primary central nervous system tumors

Primary central nervous system (CNS) tumors are a leading cause of death and disability amongst pediatric cancer patients. The early identification of symptom onset is critical in preventing diagnostic delays. In 2018, Akron Children’s Hospital published data on our response time to brain tumor diagnosis and launched educational programs in an effort to decrease diagnostic delays. The goal was to reduce the total diagnostic interval (TDI) in our patient population and reduce tumor- and treatment-related morbidities for these patients. Our post intervention group (2018-2021) was drastically affected by the numerous hospital changes secondary to the COVID-19 pandemic. We sought to examine the impact of COVID-19 related changes on TDI and attempted to identify groups at potential increased risk for diagnostic delays due to the unique pandemic constraints. A retrospective chart review was performed on patients at Akron Children’s Hospital to evaluate both for pre- (diagnosed Jan 1, 2018-February 29, 2020) and post-COVID-19 (diagnosed Mar 1, 2020-June 8, 2021) groups. Both subsets were evaluated statistically and were similar in all respects including demographics, symptomatology, tumor location, tumor type, and survival. The pre-COVID-19 group demonstrated a median TDI of 43.5 days, while the post-COVID-19 group demonstrated a 30-day median. The TDI for low-grade lesions increased from 32 to 59 days and for high-grade lesions decreased from 60 to 27.5 days in the post-pandemic cohort. Overall, this demonstrates a maintained average time to diagnosis for patients despite the pandemic restrictions in place. In addition, the differences in low vs. high-grade lesions suggest that tumors with a more subtle onset of symptoms were disproportionately affected, and highlight a population for intervention during the continued pandemic.

CORR Insights®: The Knee Injury and Osteoarthritis Outcome Score Does Not Have Adequate Structural Validity for Use With Young, Active Patients With ACL Tears.

1Division Director of Orthopedic Sports Medicine at Akron Children's Hospital, Akron, OH, USA J. Polousky ✉, Akron Children's Hospital, Considine Professional Building, 215 West Bowery Street, Level 7, Akron, OH 44308, USA, Email: [email protected] This CORR Insights® is a commentary on the article “The Knee Injury and Osteoarthritis Outcome Score Does Not Have Adequate Structural Validity for Use With Young, Active Patients With ACL Tears” by Marmura and colleagues available at: DOI: 10.1097/CORR.0000000000002158. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

The Huddle: A Daily Dose of Communication

Teamwork and communication are critical to ensure safe and quality care for students. A huddle offers the team a daily dedicated time to connect with each other. Huddles are short, regular debriefings designed to engage clinical staff in discussions about existing or emerging safety issues. The huddle was already systematically and uniformly part of the daily practice at Akron Children’s Hospital’s School Health Services daily schedule prior to COVID-19. The pandemic increased the need for the daily huddle. The fluid and frequently changing guidelines, personal protective equipment, and mitigation considerations has increased nursing anxiety and has made regular communication and daily debriefing even more important. Akron Children’s Hospital School Health Services has used huddle for over 10 years with excellent quality, team building, and nurse satisfaction outcomes.

1366. Deep Neck Infections: Bacteriology and Antimicrobial Susceptibilities, Akron Children’s Experience

Abstract Background Deep neck infections (DNI’s) are uncommon (~45,000 US cases annually) but, potentially serious. Published data regarding bacteriology and antibiotic usage for DNI’s in children is limited. In addition, geographic variation in the incidence of pathogens and their antimicrobial susceptibility limits generalization of treatment guidance. Reviewing our practice at Akron childrens we noted considerable variation in the choice of empiric antibiotics (ampicillin-sulbactam vs piperacillin-tazobactam vs Ceftriaxone and Clindamycin/vancomycin/linezolid). Admission unit (floors vs intensive care) and service (hospitalist vs infectious diseases) were some important determinants that influenced choice of empiric antibiotics. This retrospective study aimed to review local data and come up with standard guidance for empiric therapy. Summary of the predominant bacterial isolates. Methods We reviewed records of 125 patients who underwent surgical drainage of DNI’s from 1/2015 – 12/2019. In addition to demographic data we gathered information on bacterial isolates and their susceptibilities. Chart review was performed for patients with staphylococcus aureus, to look for any unique presenting features. Results Up on reviewing the data- peritonsillar abscesses were common in older children (Median age 11 years). As expected, retropharyngeal and parapharyngeal infections were common in younger ones (< 5 years). Group A streptococcus remained the most common aerobic isolate followed by Hemophilus influenzae/parainfluenzae. MRSA was detected in ~7 % of all cultures (see enclosed table). Notably, none of the MRSA isolates were clindamycin resistant. However, MSSA resistance to clindamycin was about 20%. No clinical characters predicted isolation of S. aureus. Anaerobic infections (polymicrobial) were overwhelmingly common across all abscess types. Conclusion Based on our review, Ampicillin-Sulbactam is a good empiric choice antibiotic for deep neck infections in our institution. Ceftriaxone with clindamycin is another option. Clindamycin monotherapy seems to be inadequate. Staph aureus and especially MRSA, were only isolated in a small percentage of cases. Unless a patient is ill appearing, vancomycin use seems unnecessary. Clinical presentation was not helpful to suspect infection with Staph aureus. Disclosures All Authors: No reported disclosures

Beginning Medical Spanish: Oral Proficiency and Cultural Humility by Parizad T. Dejbord Sawan

Reviewed by: Beginning Medical Spanish: Oral Proficiency and Cultural Humility by Parizad T. Dejbord Sawan Karol Hardin Dejbord Sawan, Parizad T. Beginning Medical Spanish: Oral Proficiency and Cultural Humility. Routledge, 2020. Pp. 207. ISBN 978-0-36732-243-4. The well-documented need for Spanish in healthcare professions has resulted in a variety of textbooks and products; therefore, it would be easy to discount Beginning Medical Spanish: Oral Proficiency and Cultural Humility as just another elementary text. Instead, from seven years of experience teaching Spanish at Akron Children’s Hospital in Ohio, the author presents [End Page 138] conversational Spanish for the substantial niche audience of medical professionals already in the workplace. Created for healthcare personnel with little or no prior Spanish knowledge, the book has two stated foci: oral proficiency and cultural humility. The author promises goals that realistically can be met from a beginning textbook, yet it fills an important gap in existing materials. The text offers content for a specific audience and an orientation to authentic oral communication. The book also includes the commendable goal of cultural humility (cultural sensitivity and awareness of personal bias), rather than cultural competence (“mastering” knowledge about a culture). A significant degree of cultural information is integrated throughout the text, revealing informative and relevant research. Whereas many texts center around terminology, this book emphasizes conversation with patients in order to create rapport. The author has used the text activities and has experience with beginning students in a medical setting. The methodology statement in the introduction is well articulated, and every chapter includes learning outcomes in a logical sequence with a reasonable amount of information for a full-time employee (or even a pre-health undergraduate student). Designed around the format of a two-day per week meeting of 1.5 hours for a three-semester sequence, the book utilizes scaffolding to gradually increase the degree of complexity while also appropriately recycling previously introduced material. Both learners and experienced instructors will find the book’s layout to be simple and easily accessible. Icons are incorporated for a variety of activities, such as audio recordings (available on the textbook website), guided oral practice, role-plays, short conversations, brief grammar explanations, written homework, and cultural material. Activities appear geared toward active communication, and grammar is introduced within a communicative context. For example, subject-adjective order is presented when talking about a favorite season, thereby providing some small talk that can be used with patients. The author also highlights frequent issues for second-language students of Spanish in logical contexts in the book (e.g., specific false cognates, the collective noun familia, and different ways of giving commands). For the most part, vocabulary pertains to US Spanish-speaking patients, even incorporating the occasional US regionalism such as rastrillar las hojas en su yarda (118). The book is divided into twelve chapters (four chapters per semester). The text begins with an emphasis on greetings and leave-takings, something all hospital personnel regularly need to perform in order to establish rapport with patients. Chapter 1 also introduces the verb llamarse, names, titles, and the cultural value of respeto. Chapter 2 includes familial terms, grammatical gender and number, and the role of familismo, contributing to an early emphasis on making connections with patients. Chapter 3 centers on the hospital, including descriptions of people and locations, as well as ser and haber. Chapter 4 introduces estar and numbers in the context of providing directions. The chapter is visually well organized with a useful incorporation of English cognates. Although not included, instructors could augment the chapter, if desired, with additional adjectives relating to a specifically medical context, such as enfermo, mareado, cansado, débil, or decaído. Chapter 5 presents a thorough introduction to dates, time, and the present tense. The role-plays involving making appointments and describing weekly schedules are interactive, controlled, and authentic. At times, last names in activities seem more Peninsular than Latin American, but that is a minor criticism that does not diminish the activities themselves. Chapter 6 offers practice completing hospital forms and requesting patient information, again directed towards establishing rapport. Chapter 7 incorporates stem-changing verbs in the context of describing personal activities and the...

EPID-11. ESTABLISHING A BASELINE TIME-FRAME FOR SYMPTOM ONSET TO DEFINITIVE DIAGNOSIS FOR CHILDREN WITH NEWLY-DIAGNOSED CNS TUMORS: AN EXPANDED, MULTI-INSTITUTIONAL COLLABORATIVE STUDY

BACKGROUNDWe have previously documented the presence of diagnostic delays in children with central nervous system (CNS) tumors in the United States. This study serves to expand and validate the previously established baseline from symptom onset to definitive diagnosis in children with newly-diagnosed CNS tumors. DESIGN: The medical records of children with newly-diagnosed CNS tumors were retrospectively reviewed from January 2004 to December 2017 at Nationwide Children’s Hospital, Akron Children’s Hospital and Riley Hospital for Children at IU Health. Records were reviewed for age, gender, tumor type, presenting symptoms, number of healthcare visits prior to diagnosis, time interval (in months) from onset of symptoms to definitive diagnosis and any associated genetic syndromes.RESULTSOf the 768 patients with newly-diagnosed CNS tumors, the median time interval from symptom onset to definitive diagnosis was 40.5 days while the mean symptom interval was 144 days (range < 1 to 5,475 days). The median age of diagnosis was 7 years, with a male predominance (57%). This expanded cohort continues to reveal that pediatric brain tumor patients most often seek care at the primary care level, although many patients were seen in various multiple subspecialty clinics prior to diagnosis.CONCLUSIONSThis multi-institutional cohort study updates our previously documented single state time interval and provides a consistent Midwest “benchmark” to improve awareness for children with brain tumors through the adaptation of the UK ‘HeadSmart,’ now renamed ‘BrainFirst.’ Additionally, future work could include a prospective registry to better examine potential risk factors for delays in diagnosis.

Vaccine Hesitancy and Low Immunization Rates in Children with Down Syndrome

To determine the prevalence of vaccine hesitancy and refusal among parents of children with Down syndrome and to determine how well the Parent Attitudes about Childhood Vaccines Survey (PACV) is associated with vaccine receipt among children with Down syndrome. We mailed the PACV to parents of children with Down syndrome who attend the Down Syndrome Clinic at Akron Children's Hospital and examined associations between PACV scores and immunization status at 19months of age. Of 120 surveys sent, 63 parents completed the PACV (52% response rate) of which 60 were linked to vaccination records. Of these 60 respondents, 55 children were ≥19months old. PACV scores were significantly correlated with days of underimmunization at 19months of age. All parents who refused all vaccines had PACV scores of ≥50. Only 58% of children were up to date for the combined 7 vaccine series at 19months of age. The PACV may be a valuable tool to identify vaccine hesitancy among parents of young children with Down syndrome. Special emphasis is needed to increase adherence with on-time vaccine recommendations for children with Down syndrome to optimize their health and to potentially avoid hospitalizations.

Semaphorin‐3F, a Potential Biomarker for Lymphatic Anomalies and Bone Cell Function

Lymphatic anomalies (LA) are rare conditions characterized by abnormal vascularization of lymphatic vessels (lymphangiogenesis). Gorham‐Stout Disease (GSD) is an aggressive type of LA which invades cortical bone and makes it “disappear”. There is little evidence elucidating the etiology of GSD and its osteolytic tendencies due to the rarity of the disease. In addition, there are no biomarkers capable of predicting GSD progression or treatment outcome. Normal bone does not have lymphatic vessels. It is believed that in GSD lymphatic endothelial cells (LEC) undergo genetic changes early in development that facilitate their migration and vessel formation in bone. LECs and their secretome content (lymph) are likely both crucial to lymphatic migration into bone and the cortical destruction seen in GSD. In this study, we focused on the LEC secretome with the goal of identifying proteins capable of modifying LEC and bone cell interactions. We initially assessed the effects of normal LEC conditioned media (LEC‐CM) on bone cell differentiation and function in vitro, and found that LEC‐CM stimulates osteoclast differentiation. Next, we subjected LEC‐CM to mass spectrometry and over 500 proteins were identified; we focused specifically on Semaphorin‐3F (SEMA3F) as SEMA3F effectively inhibits lymphangiogenesis in part, by competing with vascular endothelial growth factor‐C (VEGF‐C), for binding to the neuropilin‐2 receptor. We measured mRNA expression of both SEMA3F and VEGF‐C in untreated and Rapamycin treated LECs, a clinically effective therapy for patients with lymphatic anomalies. SEMA3F mRNA expression was upregulated while VEGF‐C was downregulated in Rapamycin treated versus untreated LEC cultures. We next assessed the effects of exogenous SEMA3F on LEC viability and on osteoblast differentiation and function. We found that SEMA3F reduced LEC viability in a dose‐dependent fashion. In addition, SEMA3F inhibited osteoblast differentiation as measured by alkaline‐phosphatase activity and matrix mineralization independent of its effects on osteoblast viability or proliferation. Experiments are currently underway to determine the expression/localization of SEMA3F, VEGF‐C and neuropilin‐2 in lymphatic anomalies (LA) tissues obtained from pediatric patients at our facility. We expect that SEMA3F expression will be downregulated while VEGF‐C will be upregulated in LA compared to normal lymphatics. In summary, our data suggest that SEMA3F might be a possible biomarker for patient with LA conditions or contributes to their pathogenesis.Support or Funding InformationLymphatic Malformation Institute, USA | Rebecca D. Considine Institute of Research, Akron Children’s Hospital, Akron, OH, USA| Integrated Pharmaceutical Medicine Program, NEOMED, Rootstown, OH, USA

Low incidence of maxillary hypoplasia in isolated cleft palate

BackgroundThe cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth.MethodsA retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children’s Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes.ResultsTwenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4).ConclusionsThere was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.

ASCEND: Enhancing Nurse Workforce Diversity Through a Nurse Technician Internship Program

Akron Children’s Hospital in Ohio is dedicated to advancing nursing workforce diversity through the creation of a recruitment and retention program called Assuring Success with a Commitment to Enhance Nurse Diversity (ASCEND). The hospital was recognized for this effort as a recipient of American Organization for Nursing Leadership’s (AONL) 2019 Prism Diversity Award. This article describes how the ASCEND program provides a mechanism for strategic recruitment of racial, ethnic, and gender diverse nurses.

1823. Incidence of Meningoencephalitis in the Absence of CSF Pleocytosis

BackgroundCerebrospinal fluid (CSF) pleocytosis, defined here as ≥5 white blood cells (WBC)/high power field (HPF) suggests inflammation of brain parenchyma /meninges or both. However, the absence of pleocytosis does not rule out meningoencephalitis. The frequency with which infectious targets are identified in the absence of CSF pleocytosis is not well known. Traditional diagnostic methods based on culture and single target polymerase chain reaction (PCR) assay were inadequate to answer this question. However, the availability of multiplex (PCR) panels opens up the opportunity.MethodsStarting June of 2016 Akron children’s hospital adopted the Biofire® Meningitis encephalitis panel (MEP). The panel is run routinely on all CSF specimens obtained from patients presenting with a clinical picture consistent with meningoencephalitis irrespective of their CSF biochemistry and cell count Results. We retrospectively collected laboratory data for all the MEP positive patients. The data were filtered based on CSF WBC count, pathogens identified as well as by patient age.ResultsA total of 133 positive results were identified from June 2016 to March 2019. Due to unclear significance, 22 positive Human herpes virus (HHV) 6 results were excluded, One VZV positive result was also excluded (Figure 1). Of the remaining 110 positives, 29% had CSF WBC count < 5/HPF. Parecho and Enterovirus were the most common. Three isolates were positive for Herpes simplex 1 (HSV 1) and one for Herpes simplex 2 (HSV 2). Haemophilus influenzae was detected in one patient (Figure 2).ConclusionOur observations suggest that viral meningoencephalitis may occur frequently in the absence of CSF pleocytosis. Bacterial meningitis seems less likely. Several centers have a policy to restrict multiplex PCR panel testing based on CSF WBC cut-offs, citing increased costs. However, this approach may lead to missed diagnosis. As a direct result of this additional investigations and/or treatment may be pursued leading to increased overall costs as well as exposing the patient to potential harm. Additionally making a diagnosis could lend itself to monitoring outcomes—an area where there is paucity of high-quality data. Disclosures All Authors: No reported Disclosures.

Lionel W. Young, MD

HomeRadiologyVol. 292, No. 2 Previous CommunicationsFree AccessIn MemoriamLionel W. Young, MDTina Young PoussaintTina Young PoussaintTina Young PoussaintPublished Online:Jul 18 2019https://doi.org/10.1148/radiol.2019190975MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Lionel W. Young, MD 1932–2019Download as PowerPointOpen in Image Viewer Dr Lionel W. Young, director of pediatric radiology and professor of radiology, died on April 10, 2019, in Redlands, Calif, at age 87 years.Dr Young was born March 14, 1932, in New Orleans, La. He received his MD degree from Howard University College of Medicine (Washington, DC) in 1957. After an internship at the Detroit Receiving Hospital (Detroit, Mich) and a radiology residency at Strong Memorial Hospital at the University of Rochester (Rochester, NY) from 1958 to 1961, he served in the U.S. Navy, 1961–1963, as lieutenant Commander at the Portsmouth Naval Hospital.After a pediatric radiology fellowship at Cincinnati Children’s Hospital (Cincinnati, Ohio), he established the first pediatric radiology section at the University of Rochester and worked there from 1965 to 1975. His success led to his appointment as director of the pediatric radiology department at Children’s Hospital Pittsburgh (Pittsburgh, Pa) from 1975 to 1986. In 1986, Dr Young left Pittsburgh to direct radiology at Akron Children’s Hospital (Akron, Ohio) and was professor and chairman of radiology at the College of Medicine at Northeastern Ohio Medical University (Rootstown, Ohio). In 1991, he became director of pediatric radiology and professor of radiology and pediatrics at Loma Linda University Children’s Hospital (Loma Linda, Calif), retiring in 2018 at age 86 years.Dr Young was a prolific clinician, educator, and scholar. He authored more than 250 publications and held 50 visiting professorships that included Harvard University, Yale University, Stanford University, Howard University, Johns Hopkins University, and University of California Los Angeles.Dr Young, a dedicated member of the Radiological Society of North America (RSNA) for 45 years, was chairman of the RSNA subcommittee on pediatric radiology (1982–1984) and was the American College of Radiology (ACR) councilor representing RSNA (1984–1990). Dr Young received numerous awards and honors including the first John P. Caffey Award for his study, Pneumonia of Atypical Measles: Residual Nodular Lesions. He was president of the Society for Pediatric Radiology (1984–1985). He was a Diagnostic Radiology National Institutes of Health study section member (1987–1991), Alpha Omega Honor Medical Society member, and Royal Society of Medicine member. He also received the Distinguished Service Award (25 years) Examiner for the American Board of Radiology (2000). Dr Young was a fellow of the ACR and the American Academy of Pediatrics, and he was a member of the John P. Caffey Pediatric Radiology Society. He received distinguished postgraduate achievement awards in medicine from Howard University. An active member of the section on radiology and radiation oncology of the National Medical Association, he was honored by the establishment of the annual Lionel W. Young, MD, FACR, FAAP Symposium on Pediatric Radiology.Dr Young was an internationally recognized leader in pediatric radiology, respected for his teaching and scholarship. He recruited trainees and faculty, including underrepresented minorities and women, and was committed to diversity and inclusion. He was a role model for all and a valued mentor. He was a brilliant and esteemed pediatric radiologist, a giant in his field, and a champion for the health of children. A kind, gentle man, he was a cherished friend and colleague who inspired us. He will be missed by all who knew and loved him.He is survived by his wife, Dr Florence B. Young; daughter, Dr Tina Young Poussaint; sons, Lionel T. Young and Owen C. Young; and six grandchildren.Article HistoryPublished online: July 18 2019Published in print: Aug 2019 FiguresReferencesRelatedDetailsRecommended Articles David C. Levin, MDRadiology2020Volume: 295Issue: 1pp. 251-252Atypical Pneumonia: Definition, Causes, and Imaging FeaturesRadioGraphics2021Volume: 41Issue: 3pp. 720-741Guy Morgan Hicks, MDRadiology2017Volume: 285Issue: 2pp. 695Frederick J. Bonte, MDRadiology2017Volume: 286Issue: 1pp. 366Gerald D. Dodd, Jr, MDRadiology2016Volume: 278Issue: 2pp. 638See More RSNA Education Exhibits Atypical Pneumonias: What is Atypical After All?Digital Posters2019“Do It Right”: Tips and Tricks for Successful Implementation of Deep Learning Algorithms in Medical Imaging.Digital Posters2020Perfusion and Diffusion-Weighted Imaging of Pediatric Brain TumorsDigital Posters2019 RSNA Case Collection Lipoid PneumoniaRSNA Case Collection2021Pneumocystis Jirovecii Pneumonia RSNA Case Collection2021MesotheliomaRSNA Case Collection2020 Vol. 292, No. 2 Metrics Downloaded 805 times Altmetric Score PDF download

Longitudinal assessment of exercise capacity and quality of life outcome measures in cystic fibrosis: A year‐long prospective pilot study

Multiple outcomes measures including exercise capacity and quality of life are necessary to get complete and accurate picture of cystic fibrosis (CF) progression. In this pilot study, we investigated these measures in CF longitudinally for a year to determine (a) minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) and CF Health-Related Quality of Life Questionnaire (CFQ-R) domains and (b) how 6MWD, CFQ-R, and spirometry change during times of exacerbation and baseline health and their relationship among each other. Subjects with moderate and severe CF (baseline FEV1 less than 70% predicted) at Akron Children's Hospital CF centre were followed for a full year longitudinally. All three tests (6MWT, CFQ-R, and spirometry) were done during each outpatient visit and weekly during inpatient admission. MCID was estimated for these parameters using distribution-based methods. Finally, data were examined visually using longitudinal graphs for each subject. Twelve CF subjects (eight [67%] males and age range 13-46years) were followed for a full year resulting in at least four encounters per subject. 6MWD (m) and CFQ-R respiratory had an MCID of 33m and 7.3, respectively. MCIDs for FEV1 (percentage predicted) and CFQ-R physical were 7.1 and 11.4, respectively. The longitudinal evaluation of multiple outcome measures during periods of disease exacerbation and baseline health showed that these parameters did not appear to change in accordance with each other. In this pilot study, MCIDs for 6MWD and CFQ-R domains were calculated for the first time to facilitate their use as additional outcome measures in CF. The disparity among multiple outcome measures highlights that these measures together may provide a more complete picture in CF than any single measure alone.

Comprehensive Sickle Cell Disease Management Is Associated with Superior Grade Attainment and High School Graduation Rates

Abstract Background: Sickle cell disease (SCD) in adolescents and young adults has been associated with low high school graduation rates. Complications of the disease may decrease school attendance, academic performance, and grade attainment. The graduation rate for patients with SCD enrolled in the Cooperative Study of Sickle Cell Disease (CSSD) was 71%. Poor educational outcomes might be due to a number of factors including socioeconomic status or days spent in the hospital due to illness. Neurological complications of SCD may also contribute. Stroke and microvascular ischemic events are detrimental to cognitive function and influence academic achievement and grade attainment. Patient and practitioner adherence to best practices, such as those described in the NHLBI 2014 guidelines vary widely, and the association of best practices with graduation rates has not been studied. We compared high school graduation rates of patients at Akron Children's Hospital Sickle Cell Disease Program (ACHSCDP) with national and local rates. Methods: We conducted a retrospective chart review of patients born between 1994 and 2000 who received care for all forms of SCD at ACHSCDP. Patients were identified through an onsite registry. Thirty-two patients were identified for chart review. We defined successful high school attainment as graduation from 12th grade, or having completed 11th grade by July 2018 and enrolled to begin 12th grade in Fall 2018, before or at 19 years of age. We determined successful high school attainment for patients at Akron Children's Hospital and assessed factors associated with success. Results: Patients born from 1994 to 2000 with sickle cell disease (SS, SC, SBeta-0, SBeta-+) were analyzed (n=32). Two patients transferred out of ACHSCDP prior to age 14 and were not included in our analysis. Of 30 patients studied, 14 were male and 16 were female. Twenty-six patients (86.7%) had graduated or were starting senior year as of July 2018. Of the 26 successful students, 12 (46.2%) had either an IEP or 504 (federally defined accommodation plan) in place. None of the 4 unsuccessful students had an IEP, however 1 student had a 504. Of the 26 successful students, 13 had HbSS, 1 had HbS/B o thal, 5 had HbS/B + thal, and 7 had HbSC. All 4 unsuccessful students had HbSS. Of the 26 successful students, clinical data from 4 years before graduation or 3 years before completion of the 11th grade revealed that the students were hospitalized an average of 5.77 days per year and visited the emergency department an average of 1.38 times per year. Of the 4 unsuccessful patients, data collected 4 years before the age of 19 revealed that the patients were hospitalized an average of 5.85 days per year and visited the emergency department an average of 1.37 times per year. Only one patient had a documented stroke, and this child successfully graduated from high school. Of the 26 successful students, 18 (69.2%) were enrolled in college after finishing high school and 3 students were in their senior year of high school. Discussion: In this cohort, a high percentage of patients (86.7%) graduated or were on track to graduate from high school. In the United States, approximately 90% of patients with SCD are African American. All patients analyzed here were African American. With this in mind, ACHSCDP patients' graduation rate compares favorably to estimated graduation rates across the US general population (84%), the U.S. African America population (76%), the U.S. sickle cell patient population (71%), the Ohio general population (84%), and the Ohio African American population (68%). The higher graduation rate among children at the ACHSCDP is associated with a multidisciplinary care model that prioritizes optimal hematologic care adhering to evidence based best practices including stroke risk screening and prevention, and use of hydroxyurea. In addition, team members assess for educations status and disease specific limitations at each encounter. A social worker advocates for educational needs. An outreach nurse makes school visits to educate staff and assist with implementation of federal accommodation plans. A teacher is available during inpatient stays to provide education in coordination with the patients' school. With comprehensive care, SCD is not a barrier to successful grade attainment, and academic distress in SCD patients should prompt re-evaluation of the patient's holistic medical care. Disclosures No relevant conflicts of interest to declare.

Calculated versus Measured MVV-Surrogate Marker of Ventilatory Capacity in Pediatric CPET.

Maximum voluntary ventilation (MVV), a surrogate marker of maximum ventilatory capacity, allows for measuring ventilatory reserve during cardiopulmonary exercise testing (CPET), which is necessary to assess ventilatory limitation. MVV can be measured directly during a patient maneuver or indirectly by calculating from forced expiratory volume in 1 s (FEV1 × 40). We investigated for a potential difference between calculated MVV and measured MVV in pediatric subjects, and which better represents maximum ventilatory capacity during CPET. Data were collected retrospectively from CPET conducted in pediatric subjects for exercise-induced dyspnea from January 2014 to June 2015 at Akron Children's Hospital. Subjects with neuromuscular weakness, morbid obesity, and suboptimal effort during the testing were excluded from the study. Thirty-five subjects (mean ± SD, age = 13.8 ± 2.7 yr, range = 7-18 yr) fulfilled the criteria. Measured MVV was significantly lower than calculated MVV (89.9 ± 26.4 vs 122.4 ± 34.5 L·min; P < 0.01). The ventilatory reserve based on measured MVV was also significantly lower than ventilatory reserve based on calculated MVV (12.4% ± 19.6% vs 36.1% ± 13.2%; P < 0.01). Calculated MVV (as well as ventilatory reserve based on calculated MVV) was significantly correlated with ventilatory parameters. By contrast, no significant correlations were found between measured MVV (or ventilatory reserve based on measured MVV) and ventilatory parameters except for peak ventilation (peak V˙E). The measured MVV was significantly lower than the calculated MVV in our pediatric subjects. The calculated MVV was a better surrogate of maximum ventilatory capacity as shown by significant correlation to other ventilatory parameters during CPET.

Pediatric advance care planning (pACP) for teens with cancer and their families: Design of a dyadic, longitudinal RCCT

Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14–20years old with cancer and their family decision maker (≥18years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.