Research Fair October 2022 - PowerPoint Presentation

1. Research FairOctober 2022

2. Sleep MedicineNo ongoing projects, but residents can initiate any project they are interested in with our full supportFuture Project IdeasEffects of early school start time on daytime sleepiness, high school childrenThis will involve questionnairesDaytime sleepiness in children with obstructive sleep apnea: Those with obesity and without obesityChart review and subjective assessment of sleepiness with questionnaireSleep disruption (resulting in daytime sleepiness) from movement disorders such as periodic limb movements of sleep in childrenChart review and questionnaireContact: Dr. Samuel Dzodzomenyo - dzodzomenyos@childrensdayton.org2

3. Psychiatry/Behavioral Health Research:Proactive consult service-this is wrapping up-did show decreased LOS for patients with a secondary MH diagnosis when seen by psychiatry (vs no consult)Natural language processing-using the proactive consult model-the objective of the study is to create a machine learning system that can perform automated chart reviews-We are just getting started on this.  If you love technology/the land of Epic this may be a very interesting project for you.  Dr Omoloja guiding.   Unsure exact time commitment but will be working with Wright state graduates on this as well.  Goals would be to help with the IRB process, data gathering.Quality improvement:Proactive consult service: How to increase the percentage of patients that are eligible/should receive a consult—to a completed consultThis project really would benefit from a resident involvement.  We need someone to provide feedback on how this process works for you.  How do we make it more user friendly.  How do we convince families that there is value in addressing mental health while being physically ill.  1 hour every two weeks commitment (maybe some random emails/brainstorming requests in between) Readmission tracksGoal is to standardize tools we use in the BHU to try to help with decreasing the re-admissions.  Megan Calbro-program manager of therapy on the BHUCaring contacts- a text message program that Nationwide uses to reach out to patients that are discharged from inpatient with motivational images/quotes.  Goal is to implement this at DCH.Mindy Schultz-director of crisis services.  Winnerk@childrensdayton.org 3

4. NeurologyTitle: Longitudinal Empirical Genetic Neurology Database (LEGeND)Objectives: To identify the descriptive, genetic variability and clinical factors associated with neurological disease in patients seen at DCH.Study Design: Longitudinal Cohort – Retrospective and prospective data pullResident Involvement: abstraction of data, analysis, manuscript preparation and publicationTitle: Transition of youth with epilepsy to adult care: Challenges and outcomesObjectives: To evaluate the clinical and demographic variables that can affect clinical outcomes for those who are above 21 years of age and are being followed at the Pediatric Neurology Clinic at DCH. Study Design: Mixed methods – Retrospective data pull and prospective questionnaire studyResident Involvement: abstraction of data, analysis, manuscript preparation and publicationTitle: Quality of life in children with Epilepsy and comorbid Autism Spectrum DisorderObjectives: Our primary objective is to explore the descriptive statistics surrounding the quality of life in children with comorbid epilepsy and Autism Spectrum Disorder and compare it to children with a single diagnosis of epilepsy who do not have a comorbid diagnosis of ASD or any other neurological disorder.Study Design: Mixed methods qualitative study – Prospective data pull, questionnaires and semi-interviewsResident Involvement: abstraction of data, analysis, manuscript preparation and publicationTitle: Accidental ingestion of cannabis: Pediatric cohort aged 0-6 years oldObjectives: To explore the prevalence and descriptive characteristics of accidental ingestion of cannabis pre-2017 and post 2017 (date of legalization of marijuana in the state of Ohio).Study Design: Retrospective cohort study – data abstraction Resident Involvement: abstraction of data, analysis, manuscript preparation and publicationContact information: Dr. Gogi Kumar – Principal Investigator - kumarg@childrensdayton.org Laura D. Fonseca – Clinical Research Coordinator – fonsecal@childrensdayton.org 4

5. Developmental PediatricsTitle: Underinsurance in Pediatric Primary CareObjective: To estimate the prevalence of underinsured children in Southwestern OhioThis study involves survey collection that will assess whether the health of children has been affected due to their underinsurance This project will investigate the prevalence of underinsurance in children following implementation of the Patient Protection and Affordable Care Act (PPACA). The survey will also examine the impact of the COVID-19 pandemic on study children and their families.Primary care practices affiliated with the Southwest Ohio Ambulatory Research Network (SOAR-Net)Title: Parent/Pediatrician Inpatient Partnership ProjectObjective: To fill a void in the medical literature by identifying the factors that parents find important in the relationship with their child’s inpatient pediatrician and the factors that either promote or interfere with the relationshipIt is possible that an intervention to strengthen partnership could be developed based on the results of this surveyInclusion criteria: Parents or guardians of children who are patients of Dayton Children’s HospitalSurvey collection takes place on 3W at Dayton Children’s HospitalContact: Stephanie Hartke, BS, CCRP Sr. Clinical Research Coordinator Clinical Research Center HartkeS@childrensdayton.org/937-641-36355

6. Foster Care PediatricsStudy the association of Behavioral Emotion Rating Score (done by resiliency coordinators at Dayton public schools) with ED utilization grouped into categories:  injuries/trauma, illness, emotional-behavioralHypothesis:  Children with lower resiliency scores visit the frequency more often than children with higher resiliency scores controlling for age, sex, and insurance type (Medicaid vs. Private) and increase in ED visits is across all types of visits Resident involvement: As much as you can commit to including data entry, statistics and/or writing Contact: Vishn@childrensdayton.org6

7. PulmonologyThe Medical Resident Research Award is part of the Cystic Fibrosis Foundation’s Physician Scientist Training Program and is designed to introduce residents to research through participation in a CF-relevant research project with the goal to develop and maintain interest in a career in CF research or as a CF care provider.Research Focus Areas include:Understand the biological mechanisms of and advance new and improved treatments to address the many complications of CF, including:Infections affecting people with CFLung transplant and advanced lung diseaseInflammation, impaired airway hydration, and mucus clearanceSerious complications of CF outside the lungs, such as GI complications (including in the liver, the pancreas, and the impact of nutritional deficiencies), endocrine system dysfunction (including CF-related diabetes and CF bone disease)Mental healthSinus diseaseSexual and reproductive healthCharacterize the best CF care and treatment regimens to provide optimal, individualized care as the CF treatment landscape evolvesImprove understanding of system-level and societal barriers to optimal CF care and explore opportunities to minimize their effects, including racial disparities and socioeconomic barriers to equitable care7

8. PulmonologyResearch Focus Areas Continued:Treat the underlying cause of CF for all people with the disease and drive progress toward a cure. In particular, we are interested in research related to evaluating genetic-based therapies that may have clinical impact for people with CF, developing therapies that address the underlying cause of CF for individuals with nonsense and rare mutations, and improving and increasing our understanding of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies.Ensure that the CF care model adapts to meet the future needs of people with CF across their lifespan. This includes considerations for the aging CF population and the increasing utilization of remote care.Funding priority will be placed on those projects that will lead to a better understanding of disease mechanisms, pathophysiology, and prevention, and the development of treatment strategies.The CF Foundation offers funding of up to $10,000 for one year. (Indirect costs are not allowable.)8

9. Pulmonary Division StudiesStudy NameCF Study?PIRCReg Packet ReceiptBudget /Contract statusConsentSubmitted to DCH PRCSubmitted to IRBIRB ApprovalSIVStart Up CompleteEnrolling?Number ScreenedNumber EnrolledActive PatientsIRB Approval #Date for continuing reviewCommentsSIMPLIFY-IP-19yes MuellerSandy1/31/2020executedyes2/6/2020completeDCH and Advarran/a, sponsor approval to enroll 9/11/20completeno22monthly questionnaires onlyDCH 2020-036/SSU001248712/8/2023protocol to test the impact of discontinuing chronic therapiesVX Next Gen: VX17-445-105yes MuellerSandy2/8/2018executedyesn/ayesDCH and Advarracompletecompleteno341DCH 2018-023/SSU000470961/20/2023evaluate safety and tolerability of VX-445 in triple combo therapy w/tezacaftor and ivacaftorClofazimine Emergency Useyes Mueller/PolenakovikSandyn/an/ayesn/ayesyesn/an/an/an/a422017-032n/aTx of M. abscessusSEA-Phages Compassionate Useyes PolenakovikSandycompleteexecutedyesn/ayesyesn/ayesn/an/a11DCH-21-0366/14/2023bacteriophage for tx. of M. abscessusCF Registryyes MuellerSandyCompleteFinalapprovedn/aCompleteapprovedcompleteyesyes continued 03-0521/16/2023CF Foundation patient registry data entry websiteVertex VX20-121-102yes MuellerSandyyesexecutedyes6/2/2021DCH DCH and Advarracompleteyesyes433DCH 21-048/SSU001624625/23/2023once daily modulator w/greater restoration of CFTR fxn. F/MFVertex VX20-121-103yes MuellerAmyyesexecutedyes9/27/20211/5/2022DCH and Advarracompleteyesyes322DCH 21-064/SSU001721265/23/2023once daily modulator w/greater restoration of CFTR fxn. F/F, F/G, F/RFVertex VX20-121-104yes MuellerAmyyesexecuted n/a, waivedDCH and AdvarraDCH done, Advarra pending   96 week open-label extensionHERO-2yes MuellerSandyyesexecutedyes9/27/20213/14/2022yesn/ayesno1111DCH 22-014n/aassess the impact of Trikafta on changes in chronic CF txSTOP360-IP-22yes MuellerAmyyes  yes training at NACFC  aminoglycoside (AG) study, evaluating IV AG + β-lactam vs. β-lactam only for PExIndoor Air Quality Asthma ProjectnoEvansAmydraftedexecutedyesn/a, waivedyes   relationship between indoor air quality mitigation and asthma severity10/4/2022       potential studyin start upstudy in progressDue for IRB CRclosing soon 9

10. Child Advocacy Possible new research (all with potential for resident involvement):Understanding and enacting child death review recommendations in the communityCommunity-based implementation project partnering with health departmentEarned-income tax credit and poverty policy impacts on child maltreatmentEcological level, using publicly available dataSentinel injuries and skeletal survey complianceRetrospective chart review, based on TRAIN studyCost implications of medical child abuseDescriptive study on prior MCA cases, costs pre- and post- diagnosisCK levels, outcomes (AKI incidence), thresholds for inpatient care, IVFRetrospective chart review, descriptiveRacial disparities in child advocacy consults, maltreatment evaluations, reportingRetrospective chart reviewCollaborative projects with other services as primary (e.g. ortho, hematology, trauma surgery)Resident involvement dependent on time commitment but very flexibleContact information: Child Advocacy coordinator, Erika Peralta, x3050PeraltaE@childrensdayton.org10

11. Gastroenterology: ResearchIBD disease burdenMulticenter project, collaboration with State of OhioCincinnati Children’s, Cleveland clinic Children’s, Rainbow babies and Children’s,  Nationwide Children’sCost of hospitalization, surgeries and medical careResident can help with data collection, literature review and manuscriptCost analysis & utilization research projectContact: Kelly Sandberg, sandbergk@childrensdayton.orgSchool causes constipation: decrease in emergency department visits for constipation during covid-19 pandemic school closuresData already collected from 2017 to 2021Poster presented at NASPGHAN conference Dec 2021Further data analysis needed for 2021-2022Manuscript to be written after data analysisRetrospective reviewContact: Krishna Mutyala, MD mutyalar@childrensdayton.org11

12. Gastroenterology: QI projectsOngoing Projects:Constipation care improvement in primary care settingColonoscopy bowel cleanout process improvementpH/Impedance probe process improvementContact: Krishna Mutyala, MD - mutyalar@childrensdayton.org12

13. Cardiology ProjectsAssessing the risk of hypoglycemia secondary to propranolol therapy for the treatment of supraventricular tachycardia in infantsRetrospective chart reviewDr. Flowers is principal investigator, 2 additional investigatorsData collection nearly compete Patent Ductus Arteriosus Ligation Outcomes at Dayton Children’s Hospital Retrospective chart reviewDr. Rasch principal investigator, Dr. Friedl secondary investigatorData collection in process, reach out to Dr. Rasch if interested in helping with data collectionMarfan syndrome referrals from primary care providers and likelihood of ultimate diagnosisRetrospective chart reviewMedical student complete a literature review May need resident involvementContact: bugnitzc@childrensdayton.org; 614-256-7278; X817413

14. EndocrinologyInsulin CalculatorA quality improvement project to improve insulin administration on floor -goal 80% by end of October 2023Qualitative study working towards hospital wide implementation of insulin calculatorResident involvement: participate in weekly insulin calculator meeting, bringing in resident concerns/ propose solutions for issues identified during launch, organize education sessions for residents and participate in education of other potential staffContact: Mallika Mutyala, MD mutyalak@childrensDayton.orgUrine Microalbumin ScreeningQuality improvement project with aim of improving percentage of yearly screening of urine microalbumin in both type 1 and type 2 diabetes patientsResident involvement: participate in monthly meeting, data analysis and data presentationStatus: current and ongoingContact: Mallika Mutyala MD mutyalak@childrensDayton.org14

15. Endocrinology: Future Projects Comparison of ED visits/hospitalizations for DKA/Ketosis in patients pre and post launch of sick day magnetRetrospective chart review Contact: Dr. Stacy Meyer - Meyers@childrensdayton.orgRetrospective chart review of Type 1 diabetes hospital admissions for the past year to identify percentage of patients with delay in hospital discharge due to ketosis Goal of project: facilitate launch of blood ketone testing for timely ketone result and ketone correction  Resident role: data collection analysisContact:  Dr. Mallika Mutyala - mutyalak@childrensDayton.orgRetrospective chart review to compare weight changes and Hemoglobin A1c in patients with T2D on insulin and Metformin vs modifiers with out insulin Contact: Dr. Yelena Nicholson - nicholsony@childrensdayton.org

16. Endocrinology: Future Projects Retrospective chart review on BHU patients to identify thyroid dysfunction identified on routine screening on mental health patientsContact:  Dr. Susan  Almazan - Almazans@childrensdayton.orgQuality improvement project –improving enrollment /A1C of type 1 diabetes  patients in care co -ordination program Contact: Dr. Mallika Mutyala - mutyalak@childrensDayton.orgQuality improvement project- improving transition care of type 1 diabetes patients Contact: Dr. Susan Almazan - Almazans@childrensdayton.org

17. Lactation Support – A Role for (Inpatient) Providers?”My doctor told me to – supplement, pump and dump, avoid breastfeeding, stop because…”3-month observational cohort study3 residents, 3 attendings – control by age/diet vs provider (resident/attending)Age / dietAAP periodic survey’s / ST and Lactation consultsPre and post test knowledge, attitudes, confidenceAdd a single history question H&P template ages 0 – 2 yrsHas there been any breastfeeding along the way?Two follow-up questionsIf yes: when was the last time infant breastfed or received (breast) milkFree textDietary screening: Impact medical management? If yes: clinical interventions ordered? Consults? Referrals?Data collection: reported diet, % of supplementation, latch vs EBM, diet at discharge, consultations, referrals, KAC providers, formative feedbackContact: Dr. Janet Wasylyshen-Velasco – wasylyshen-velascoj@childrensdayton.org Incorporating breastfeeding care into daily newborn rounds and pediatric office practice Pediatr Clin North Am 2001 Apr;48(2):299-319ABM Clinical Protocol #36: Supporting Breastfeeding During Maternal or Child Hospitalization Breastfeeding Medicine 202117

18. Pediatric Hospital MedicineContact information: neumeiers@childrensdayton.orgProject Title: Indications for Antibiotic Treatment of Community Acquired Pneumonia in patients <5 years oldType: RetrospectiveResident Involvement: Lit review, Chart review18

19. NephrologyProject: Improving pneumococcal immunization counselling in children with nephrotic syndrome.Background: 1- Immunization is essential in preventing life –threatening    pneumococcal infections in children with nephrotic syndrome2- Despite the consensus recommendation to administer the PPSV23 in children with nephrotic syndrome, many children do not receive the vaccine Aim of the project: The goal of the study is to improve rate of PPSV23 vaccination counselling in children with nephrotic syndrome.Contact: Dr. Ahmad Al Dughiem - aldughiema@childrensdayton.org 

20. Hematology/OncologyDr. Lionel Chow – Neuro-Oncology, Laboratory-based researchMAPK pathway activation in CNS Embryonal TumorsCNS ET are a heterogeneous group of high-grade pediatric brain tumorsThe MAPK pathway is involved in driving tumor growth in a number of different pediatric brain tumors, such as ATRT, one of the CNS Embrclarkl1yonal TumorsSeveral FDA-approved and investigational MAPK pathway inhibitors are availableWe would like to profile a group of CNS ET for MAPK pathway activity via in vitro and in vivo methodsImmunohistochemistry, Western Blot, PDX modelsPI3K pathway activation in CNS Embryonal TumorsContact: Dr. Lionel Chow – chowl@childrensdayton.org Dr. Jordan Wright – Thrombosis and Hemostasis Clinical researchDr. Mukund Dole – Sickle Cell Disease and HemoglobinopathiesDr. Rachael Courtney – Resident Education

21. Neonatology Holding feeds during pRBC transfusions QIStandardizing time enteral feeds held during pRBC transfusionsVarious NICU-Surgical QINecrotizing enterocolitis diagnosis and treatment standardizationFeeding regimens post bowel resectionOpen to new project ideasProtocol for ventilator weaning QICreating a protocol to guide ventilator weaning based on blood gasesIn intubated babies with a weaning protocol in place how often is the protocol followed?Can be involved in project QI teamHelp with data collection and monitoringHelp with preparing QI project for possible publicationSarah Van NostrandEmail: vannostrands@childrensdayton.org21