“Black Girls be Knowin’”: Navigating sexual and reproductive politics in the 21st Century

AccessMatters presents a virtual conversation with Dr. LaShay Harvey. Learn more and register here.

Keynote Speaker Trevon Logan, PhD, Hazel C. Youngberg Distinguished Professor of Economics at Ohio State University . Learn more and register here.

Time: 12:00 noon - 1:00 pm

Date: January 5, 2021

Time: 12:00 - 1:00 pm

The CHOP Clinical Trials Research Affinity Group (RAG) presents Dr. Holly Hedrick. Join via BlueJeans.

*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive an Outlook invitation, please contact crosss2@email.chop.edu. 

There continues to be limited, viable ventricular assist device (VAD) technology options to support the dysfunctional states of pediatric heart failure. To address this need, Joseph W. Rossano, MD, MS and colleagues are developing a magnetically suspended, versatile pumping technology that uniquely integrates two blood pumps in a series configuration within a single device housing. They present the initial design where they conducted a virtual fit study, the Taguchi Design Optimization Method, iterative design to develop pump geometries. Two prototype designs demonstrated the capability to generate target pressures and flows. The performance data trends for physical prototypes correlated with theoretical expectations, and development will continue.

A team including Joyce Chang, MD, MSCE and Pamela Weiss, MD, MSCE ran a retrospective analysis to evaluate racial disparities in disease outcomes among children with polyarticular juvenile idiopathic arthritis (JIA) during a treat-to-target (TTT) intervention with clinical decision support (CDS). The clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) improved significantly over time for all race categories, while the rates of improvement did not differ by race in incident or prevalent cases. cJADAS-10 over time remained higher among black children compared to white children. Provider attestation to CDS use at ≥50% of encounters was associated with a 3.9 greater reduction in cJADAS-10 among black children compared to white children. Despite similar rates of improvement over time by race, disparities in JIA outcomes persisted throughout implementation of a TTT-CDS approach.

Antibiotics are administered to the vast majority of preterm newborns and to a substantial proportion of term infants in the hours after birth due to risk for early-onset sepsis. Karen Puopolo, MD, PhD discusses how the approaches taken to determine which newborns should be evaluated for early-onset sepsis, and what type and duration of antibiotics are administered, are important elements of neonatal antibiotic stewardship. Approaches incorporating serial physical examination may contribute to decreasing empiric antibiotic exposure among such infants. Data informing the epidemiology, microbiology and antibiotic susceptibility patterns of early-onset sepsis pathogens can be used to optimize antibiotic choice for empiric and targeted antibiotic therapy to ensure that effective therapies are administered, while decreasing the risks associated with broad-spectrum antibiotic exposure. Optimal use of blood culture and time to positivity data can also contribute to decreasing the risks associated with prolonged antibiotic administration in the face of sterile cultures.

Because atherosclerosis begins in childhood, universal lipid screening is recommended with special attention to conditions predisposing to early atherosclerosis. Michael O’Byrne, MD, MSCE ran a retrospective cohort study using MarketScan® commercial and Medicaid insurance claims databases. The prevalence of high-risk conditions was 2.2%. In unadjusted and adjusted analyses, these subjects were more likely to be screened than standard-risk subjects. Despite national recommendations, lipid screening was performed in a minority of children. Though subjects with high-risk conditions had a higher likelihood of screening, rates remained low.

Although norm-referenced scores are essential to the identification of disability, they possess several features which affect their sensitivity to change. Norm-referenced scores often decrease over time among people with neurodevelopmental disorders who exhibit slower-than-average increases in ability. Further, the reliability of norm-referenced scores is lower at the tails of the distribution, resulting in floor effects and increased measurement error for people with neurodevelopmental disorders. In contrast, the person ability scores generated during the process of constructing a standardized test with item response theory are designed to assess change. Whitney Guthrie, PhD and colleagues illustrate these limitations of norm-referenced scores, and relative advantages of ability scores, using data from studies of autism spectrum disorder and creatine transporter deficiency.

Pediatricians should address tobacco use and exposure with patients and parents at every opportunity, but this is not consistently done in practice. Investigators including Brian Jenssen, MD, MSHP surveyed U.S. program directors in 2018 and residents in 2019 to explore how residents learn about tobacco use and tobacco smoke exposure, components and use of the electronic record specific to tobacco use and tobacco smoke exposure, and perceived resident effectiveness in this area. All the program directors and 85% of the residents valued training, but 21% of the residents reported receiving none. A minority of the residents assessed themselves as effective at counseling parents (19%) or adolescents (23%), and their perceived effectiveness was related to small group learning and active learning workshops, modalities that were infrequently implemented in training. Respondents reported infrequent use of electronic health record prompts regarding tobacco and the absence of prompts about critical issues.

Sepsis continues to carry a high potential for morbidity and mortality in children. The recognition of sepsis in children in the emergency department (ED) can be challenging. Sepsis outcomes are strongly dependent on the timeliness of recognition and treatment, which has led to the successful implementation of quality improvement programs. Fran Balamuth, MD, PhD and colleagues review clinical, laboratory, and technical modalities that can be incorporated into ED practice to facilitate the recognition, treatment, and reassessment of children with suspected sepsis. The 2020 updated pediatric sepsis guidelines are reviewed and framed in the context of ED interventions, including guidelines for antibiotic administration, fluid resuscitation, and the use of vasoactive agents.

Jeremy Michel, MD, MHS and colleagues developed a systematic process for translating an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded computer-readable clinical decision support (CDS). Their process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding.

Researchers including Chén Kenyon, MD, MSHP used adherence to the Pediatric Respiratory Illness Measurement System (PRIMES) indicators to evaluate the strength of associations for individual indicators with length of stay (LOS) and cost for bronchiolitis. The team prospectively enrolled children with bronchiolitis at 5 children’s hospitals and examined associations between adherence to each PRIMES indicator for bronchiolitis and LOS and cost. Their results show that a subset of PRIMES quality indicators for bronchiolitis are strongly associated with improved outcomes and can serve as important measures for future quality improvement efforts.

Earlier pubertal development is only partially explained by childhood body mass index (BMI); the role of other factors like childhood infections is less understood. Using data from the LEGACY Girls Study (2011 - 2016), Lisa Schwartz, PhD and her colleagues prospectively examined the associations between childhood viral infections (Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Herpes Simplex Virus 1 (HSV1), HSV2 and pubertal timing. The prevalences were 31% CMV+, 37% EBV+, 14% HSV1+, 0.4% HSV2+, and 16% for both CMV+/EBV+. CMV+ infection without co-infection was associated with developing breasts an average of 7 months earlier. CMV+ infection without co-infection and HSV1+ and/or HSV2+ infection were associated with developing pubic hair 9 months later. Infection was not associated with menarche.

Children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) are at high risk for invasive fungal disease (IFD). Brian Fisher, DO, MSCE, Theoklis Zaoutis, MD, MSCE, and their team ran a multicenter, randomized, open-label trial of 560 children and adolescents undergoing allogenic HCT, who were randomly assigned to antifungal prophylaxis with caspofungin or a center-specific comparator triazole (flucanozole or voriconazole). The primary outcome was proven or probable IFD at day 42 as adjudicated by blinded central review. A planned futility analysis demonstrated a low rate of IFD in the comparator triazole arm, so the trial was closed early. In pediatric HCT patients, prophylaxis with caspofungin did not significantly reduce the cumulative incidence of early proven or probable IFD compared with triazoles.

Young adults living with HIV use digital communication media to seek out health information. This study by Nadia Dowshen, MD, MSHP and her colleagues aimed to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. Young adults with HIV self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States. Almost a third and a fifth of participants reported searching for general health and sexual and reproductive health (SRH) information, respectively; 26.7% of transgender young adults with HIV searched for gender-affirming care topics. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information.

The transition from active cancer treatment to survivorship represents a period of uncertainty for youth and their families, but factors associated with adaptation during this period are understudied. Lisa Schwartz, PhD and her team evaluated associations among cancer and treatment-related variables, family factors (family functioning, caregiver health-related quality of life [HRQL], and caregiver distress), and patient HRQL after treatment completion. Family factors were associated with self- and caregiver reports of children's HRQL. Controlling for demographic, cancer, and treatment covariates, caregiver reports of their child's neurocognitive difficulties had an indirect effect on their reports of child physical HRQL through family functioning. Caregiver reports of their child's neurocognitive difficulties indirectly related to caregiver reports of child psychosocial HRQL through family functioning and caregiver HRQL. Indirect effects for self-reported neurocognitive difficulties and HRQL were not supported.

Families of children with medical complexity (CMC) face many types of health-related decisions. Douglas Hill, PhD, Chris Feudtner, MD, PhD, MPH and their team describe an illustrative case and challenges to decision-making for CMC. These decisions vary in magnitude of consequences, degree of risk, time scale, degree of tradeoffs, degree of uncertainty, degree of linkage with other decisions, and reversibility. Primary care pediatricians are in a unique position to assist families of CMC with decision-making. Pediatric clinicians have an opportunity to establish a trusting relationship with a family over time and to understand the family's values, beliefs, and preferences during periods of relative health and stability. This allows them to support families in decision-making by helping to clarify their values and goals and apply those values to the decision at hand.

Pediatricians lack tools to support families at home for the promotion of childhood sleep. Ariel Williamson, PhD, Alexander Fiks, MD, MSCE, and their colleagues used the preparation phase of the Multiphase Optimization Strategy (MOST) framework to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep. Participants were 10-12 years old and wore a sleep tracker to measure sleep duration. In study #1, sleep duration during the intervention was higher by an average of 21 (95% CI: -8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, there was no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.