Transformational Pediatrics features interviews with physicians and researchers at Children’s Mercy Kansas City who are transforming pediatric care through genomic medicine, personalized therapeutics, health services and outcomes research, and innovations in health care delivery.
-
New Guidelines Related to Tick-Borne Infections
Michael Smith and Mary Anne Jackson
It’s summer — so what do you need to know about Rocky Mountain Spotted Fever (RMSF), and ehrlichiosis, the two most common local tickborne infections associated with fever? During this season, when evaluating a febrile child, establishing if the child has had a tick bite or is tick exposed (lives or has visited an area where ticks have been seen) is helpful.
Listen in as Mary Anne Jackson, MD, a pediatric infectious diseases specialist with Children's Mercy, discusses the latest guidelines related to Tick-Borne infections.
-
Intestinal Rehabilitation: Multidisciplinary Approach to Care
Michael Smith and Joel D. Lim
Long-term use of total parenteral nutrition (TPN) can cause life-threatening complications. Patients that rely on TPN benefit from programs such as Intestinal Rehabilitation, with the end goal of weaning them off TPN and thus improving their quality of life. Creating a multidisciplinary team of dedicated surgeons, psychologists, nurses, dietitians and social workers can help enhance the outcomes for patients battling intestinal failure.
During this session hear from Joel Lim, MD on the importance and success gained from having a multidisciplinary approach in caring for pediatric patients with intestinal failure. -
Recognizing Tic Disorders and Tourette Syndrome
Michael Smith and Keith A. Coffman
Often misunderstood or misdiagnosed, Tourette syndrome and tic disorders have high rates of co-occurrence with diagnosis of ADHD, anxiety, sensory integration disorders, and obsessive compulsive behavior with more than 80 percent of patients being diagnosed before the age of 10.
Listen in as Dr. Coffman discusses how he guides practitioners in recognizing Tic Disorders and Tourette Syndrome, presenting services and features available at The Tourette Association of America Children’s Mercy Center of Excellence – the nation’s ONLY Tourette Association Center of Excellence devoted exclusively to pediatrics. -
22Q Deletion Syndrome: A Multidisciplinary Approach to Individualized Care
Michael Smith and Matthew M. Feldt
Children with 22q11.2 Deletion/Duplication Syndrome are faced with many doctors’ visits across the health care system. With the burdens this puts not only on the family but also their doctors, Children’s Mercy created the Super Q Express 22Q Clinic multidisciplinary clinic. The clinic provides family access to a team of expert clinicians and provides comprehensive individualized diagnostic and management services in Cardiology, Immunology, ENT/cleft palate, GI, behavior/development, and Endocrinology. A social worker and medical coordinator are also present during the visits to provide additional support.
Listen in to hear from Max Feldt, DO on the impact the Super Q Express 22Q Clinic has had on patients with 22q11.2 Deletion Syndrome. -
RAPS: Rehabilitation for Amplified Pain Syndrome
Michael Smith and Cara M. Hoffart
Amplified pain syndrome (APS) is a condition in which the child’s perception of pain is increased due to the abnormal firing of nerves which sense pain and control vascular tone. Amplified Pain Syndrome (APS) can include: Juvenile Primary Fibromyalgia Syndrome, Complex Regional Pain Syndrome (CRPS) (formerly Reflex Sympathetic Dystrophy (RSD)), and other types of nerve-related pain.
Treatment is as unique as the condition itself: intensive exercise, physical and occupational therapy; relaxation techniques; stress-management training; and music and therapeutic art.
Cara Hoffart, DO is here to explain how the RAPS program (Rehabilitation for Amplified Pain Syndrome) at Children’s Mercy is one of only a few treatment programs in the country and has attracted patients from as far away as Lima, Peru. -
Screening for Early Detection and Treatment of Scoliosis
Michael Smith and Richard M. Schwend
In a rare event, the four leading orthopedic societies have aligned on a combined statement on early detection for scoliosis.
The American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopedic Society of North America (POSNA), and American Academy of Pediatrics (AAP) believe that there are documented benefits for children of earlier detection and non-surgical management of adolescent idiopathic scoliosis (AIS), earlier identification of severe deformities that are surgically treated, and of incorporating screening of children for AIS by knowledgeable health care providers as a part of their care.
Richard Schwend, MD is here to explain all the latest developments of early detection and management of adolescent idiopathic scoliosis? -
Neurodevelopmental Disorders: Studying the Clinical Impact of Genomic Sequencing
Michael Smith and Sarah Soden
Neurodevelopmental disorders, such as intellectual disability, Tourette syndrome, autism and neuromuscular diseases affect more than 10 percent of children.
Recent advances in genomic medicine are unraveling the etiology of these disorders and providing answers to more patients and families.
These discoveries, along with advances in pharmacogenomics are the foundation of precision medicine.
This topic is important to many and is an area of focus regarding active studies being conducted within the Genome Center.
Hear from Sarah Soden, MD, on GSEND (Genomic Sequencing for the Etiology of Neurodevelopmental Disorders) a prospective study designed to determine whether genomic sequencing early in a child’s diagnostic evaluation improves diagnoses and transforms outcomes. -
Children’s Research Institute: Expanding Research Efforts
Michael Smith and Tom Curran
In 2015, Children’s Mercy created the Children’s Research Institute to coordinate the work of its scientists and physicians and to expand its research portfolio.
This institute was designed to bridge science and medicine to benefit the pediatric community.
In February of 2016, Children’s Mercy welcomed Tom Curran, PhD to lead the new institute.
Hear from Dr. Curran as he shares the role the Children’s Research Institute will have within Children’s Mercy and vision to be the leader in pediatric research. -
Headaches in Children and Adolescents: Evidence-Based Guidelines for Optimal Treatment
Michael Smith and Jennifer Bickel
The Headache Action Plan was developed as a simple tool to guide primary care providers in migraine management, including prevention and abortive therapy as well as recommendations for school and lifestyle.
Jennifer L. Bickel, MD is here to discuss how the Headache Action Plan web application takes medical providers through four sections to help guide the management of migraines and to provide handouts for the family and school. -
Adolescent Idiopathic Scoliosis (AIS) Protocol Improves Length of Stay
Michael Smith and Bobbie Carter
In 2012, Adolescent Idiopathic Scoliosis (AIS) patients were automatically slotted for PICU beds on the first night post-op.
Due to PICU access, 22 AIS surgeries had to be rescheduled.
In alignment with hospital-wide lean six-sigma management strategies, an AIS project team was tasked with development of AIS to floor guidelines, resulting in a 15% improvement in length of stay, a 100% increase in patients served and a renewed joy for staff nurses empowered to transform the lives of AIS patients.
Join Bobbie Carter, RN, to learn more about the background, implementation, and outcomes for AIS patients at Children’s Mercy Kansas City. -
Liver Transplant: Improving Outcomes for Medication Adherence
Michael Smith and Jamie L. Ryan
Medication adherence is critical to the long-term health of liver transplant patients.
Yet, adjusting to the demands of a complex regimen and coping with the psychosocial issues commonly associated with transplantation can negatively impact disease management, with average rates of nonadherence among pediatric liver transplant recipients exceeding 50% and accounting for nearly half of acute rejection episodes.
Children’s Mercy Kansas City has created the Liver Transplant Psychosocial and Adherence Promotion Service to aid in facilitating long-term disease management, enhanced patient well-being, and optimal health outcomes.
Jamie L. Ryan, PhD, is joining us to discuss this integrated service and share how Children’s Mercy is treating the whole patient by providing comprehensive psychosocial services as a part of standard liver care. -
Mercy Tape: Taking the Guesswork Out of Pediatric Weight Estimation
Michael Smtih and Susan M. Abdel-Rahman
Accurate weight estimates are important because they are used to determine appropriate medication dosage, fluid volumes for resuscitation, breathing tube sizes, and more.
But what do you do in situations when you are unable to weigh the child?
The Mercy TAPE was developed by Children’s Mercy researchers led by Susan Abdel-Rahman, Pharm.D, Clinical Pharmacology and Medical Toxicology, (TAPE stands for TAking the guesswork out of Pediatric weight Estimation) to address that question.
The unique and pragramatic Mercy Tape has been demonstrated to be more accurate than any other method currently available for children ages two months to 16 years, accurately predicting weight within 10 percent of actual weight in about 80 percent of children, and within 20 percent of actual weight in 98 percent of children; in essence, getting within 20 percent of actual weight in nearly 100 percent of children (including children that are malnourished or obese)…all at a cost of about 1/3 of a penny per device.
Dr. Susan Abel-Rahman is here to explain how The Mercy TAPE allows clinicians to get an accurate idea of a child’s weight by making two measurements of the upper arm. -
Cleft Palate/Adoption Program
Michael Smith and Shao Jiang
At Children’s Mercy Kansas City, Shao Jiang, MD coordinates an international adoption program with China for cleft lip/palate surgeries.
The experienced cleft palate/lip and craniofacial team provides comprehensive medical services, with pre-adoption counseling and social workers available for ongoing parental support.
Dr. Jiang is uniquely positioned to not only provide palate/lip and craniofacial care, but also to read Chinese medical records and translate.
Join Dr. Jiang to talk about the Cleft Palate/Craniofacial Clinic and its work with Chinese international adoptions. -
Kernicterus and Bilirubin-induced Neurological Disorders (BIND) Center
Michael Smith and Steven Shapiro
About 60% to 80% of newborn Infants in the United States are jaundiced, that is they look yellow.
Kernicterus is a form of brain damage caused by excessive jaundice.
The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue.
Join Dr. Shapiro as he speaks with Transformational Pediatrics about the diagnosis, treatment and research supporting the pediatric population with kernicterus and other bilirubin-induced neurological disorders. -
EOS and 3D Modeling
Michael Smith and Nigel Price
Early onset scoliosis (EOS) is a complex and heterogeneous group of disorders in children under 5 years of age.
It involves a spectrum of conditions from infantile resolving scoliosis to more severe deformity that is less likely to resolve without aggressive treatment.
EOS imaging technology captures whole-body images of a standing patient in a single scan.
Frontal and lateral digital images can be obtained simultaneously and converted to a personalized 3D bone modeling of the patient in a weight-bearing position with automatic calculation of clinical parameters.
The result is a customized model of each patient to ensure tailored treatment throughout the care continuum.
Nigel J. Price, MD is here to explain what EOS is, what are the benefits, and how has it changed your pediatric orthopedic management. -
Preventive Cardiology
Michael Smith and Geetha Raghuveer
For more than a decade, the Preventive Cardiology Clinic at Children’s Mercy has been providing comprehensive evaluation, risk factor counseling and management for children with familial dyslipidemia, lifestyle-induced dyslipidemia and chronic diseases that associated with development of atherosclerosis.
Each year, the clinic sees approximately 300 patients.
The Preventive Cardiology Clinic began tracking patient outcomes in 2008 and has built a database that includes demographic, anthropometric, blood pressure, clinical and laboratory information on more than 610 children with dyslipidemia and other atherosclerosis-promoting factors.
Geetha Raghuveer, MD is here to explain how the database has been used as a resource for patient screening and research studies. -
Double Balloon Enteroscopy
Michael Smith and Thomas M. Attard
Children’s Mercy is preparing to become one of the few institutions in the country to perform a procedure known as “Double Balloon Enteroscopy” (DBE) for children with small bowel disorders.
Listen in as Thomas Attard, MD, FAAP, FACG, Medical Director of Endoscopy Services-Division of Gastroenterology, has shared that DBE provides a more complete evaluation of the small intestine because the instrument used allows access to areas beyond the reach of conventional endoscopes.
The DBE scope provides sharp, clear, high-definition images; it can be used to biopsy tumors, remove small lesions and mark an area with dye for future surgical localization, helping a surgeon know exactly where to go.
Gastrointestinal bleeding, abdominal pain, chronic diarrhea, polyps and tumors are among the conditions that can be evaluated and treated with DBE technology. -
Thermal Laser Ablation Reduces Risk
Michael Smith and Christian Kaufman
Drug-resistant temporal epilepsy can now be treated with minimally invasive Stereotactic Laser Amygdalohippocampectomy (SLAH).
This same technology also is being used to treat certain brain tumors, further expanding treatment options for children.
The state-of-the art technology allows patients to remain neurologically intact and be discharged home within one day of the surgery.
The technology dramatically can reduce risks, morbidities and length of hospital stay.
Learn more from Dr. Christian Kaufman on this edition of Transformational Pediatrics. -
Neonatal/Pediatric Transport: Experience Matters
Michael Smith and Angie Cunningham
Typically, less than 10 percent of the patients transported by traditional “adult” transport teams are under the age of 14.
Research has shown that outcomes are better when children are transported by dedicated neonatal and pediatric transport teams.
Highly specialized neonatal and pediatric programs, such as the Critical Care Transport Program at Children’s Mercy Kansas City, can be the difference between life and death.
What do these programs offer that others don’t?
Angie Cunningham, RN, CCRN, C-NPT is here to explain how the Transport Program at Children’s Mercy is one of the largest in the nation and was the first neonatal/pediatric specialty program in the nation accredited by the Commission on Accreditation of Medical Transport Services (CAMTS) in all three forms of transport: ground, rotor wing and fixed wing. -
The Five Most Common Pitfalls in Diagnosis and Treatment of Group A Streptococcal Infection
Michael Smith and Angela Myers
While 80 percent of pharyngitis is viral in etiology, Group A streptococcus (GAS) remains an important cause of pharyngotonsillitis in the pediatric population.
Inappropriate testing for GAS pharyngitis inevitably leads to overuse of antibiotics, which can result in a pitfall of treatment with an inappropriate antimicrobial agent.
Join Dr. Myers, MD, MPH to learn more about an algorithm your office can use to optimize testing and treatment of GAS pharyngitis, avoiding the five most common pitfalls in diagnosis and treatment of GAS Infection. -
Study Examines Genetics Impact on Statin Disposition and Response
Michael Smith and Jonathan B. Wagner
Based on guidelines from the American Academy of Pediatrics (AAP), approximately 0.8 percent of adolescents 12 to 17 years old with dyslipidemia may qualify for pharmacological treatment.
That translates into approximately 200,000 adolescents who could be eligible for statin therapy.
With the increasing prevalence of overweight children, the incidence of clinically diagnosed coronary artery disease in young to middle-aged adults is expected to increase by 5 to 16 percent over the next two decades.
Jon Wagner, DO, is here to discuss how he is leading a research study looking at the liver specific protein transporter, OATP1B1, which is the major transporter of statins from the blood to the liver to better understand how children’s bodies distribute statins in the body. -
MAGEC® Rod System: Minimally Invasive Approach to Pediatric Spinal Care
Michael Smith and Nigel Price
Children’s Mercy Kansas City is one of only 20 children’s hospitals in the nation selected to participate in the early user group for the MAGEC® (MAGnetic Expansion Control) System.
In early 2015, a seven-year-old became the first patient in Kansas and Missouri to receive a new, ground-breaking treatment for scoliosis, aptly named MAGEC.
To brace the spine and minimize the progression of spinal curvature, the MAGEC system’s magnetic rods are implanted along each side of the spine during a one-time, surgical procedure.
Nigel Price, MD shares more about how MAGEC is transforming pediatric medicine during this segment of Transformational Pediatrics. -
New Emerging Food Allergies
Michael Smith and Chitra Dinakar
Food allergies have increased dramatically over the past 15 years with more and more children affected.
In addition to traditional food allergies such as peanuts, dairy products and shellfish, there has been a increase in children with reactions to foods not previously considered part of the top eight allergens.
Specialists are now seeing allergies to sesame, fruits, and other foods as we are importing more foods and consuming more foods from other cultures.
The increase has been seen in both percentage of people with reactions and in the severity of reactions, and is particularly a problem in developed countries and among the children of immigrants.
How big is the problem? What is the reason for the increase? How do you prevent or treat these allergies?
Chitra Dinakar, MD is here to discuss the future with food allergy treatment and prevention? -
Treatment of Elevated Blood Pressure in Children
Michael Smith and Douglas Blowey
In the NICU, the decision to initiate inotropic therapy, provide volume support, or initiate antihyperintensive therapy is often guided by blood pressure measurements.
However, research led by Doug Blowey at Children’s Mercy and reported in the Journal of the American Society of Hypertension, found that standard oscillometric measurement overestimates the blood pressure in very ill neonates.
Dr. Blowey is here to explain elevated blood pressure in children and is now part of an international committee that is writing guidelines to address the measurement, evaluation and treatment of hypertension in hospitalized children. -
Home Ventilator Program: Treating Infants and Children in the Comfort of Home
Michael Smith and Winston M. Manimtim
Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program provides infants and children who require long-term ventilation, individualized care in the home setting.
Children’s Mercy’s program is one of the largest in the U.S., with more than 25 new patients treated each year.
While at home, patients and their families are given the opportunity to have a sense of normalcy and thrive in an environment outside the hospital critical care units while still receiving complex medical care with access to on-call physician 24/7 and multidisciplinary care team and the support of local private duty nurse in the home.
The program has seen excellent results both in survival rate and short-term neurodevelopmental outcome since its creation in 2005.
Most infants are successfully weaned off the ventilator by the time they are 2 ½ to 3 years of age and the tracheostomy tube removed after several months.
Winston Manimtim, MD is here to discuss Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program.
