Episode 29: AHA Pediatric Post Cardiac Arrest Scientific Statement with Alexis Topjian

Cardiac Arrest, Critical Care, Emergency Medicine, Pediatric Emergency Medicine

On this episode, host Jason Woods talks with Alexis Topjian about the 2019 “AHA Pediatric Post–Cardiac Arrest Care Scientific Statement.” Dr. Topjian is the first author on the statement, which is the first pediatric post arrest care statement from the AHA (previously children had primarily been discussed as a special population within a primarily adult guideline). The document itself is long, but contains a large amount of useful information for bedside providers, health care administrators, and researchers.


Guests

Alexis Topjian MD, Associate Professor of Anesthesia and Critical Care Medicine, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia

References

  1. Topjian AA, de Caen A, Wainwright MS, et al. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation. 2019;140(6):e194-e233. doi:10.1161/CIR.0000000000000697

Additional Resources

  1. Previous Little Big Med podcast with Dr. Topjian on post arrest hypotension in children

Episode 28: Online Professionalism and Social Media in Medicine with Sarah Mojarad – Repost

Medical Education, Online Professionalism, Social Media

On this episode, host Jason Woods speaks with Sarah Mojarad, lecturer at USC with appoints in the schools of Medicine and Engineering. Professor Mojarad is an expert in online professionalism, social media use in STEMM (science, technology, engineering, mathematics, medicine), and science communication. This episode is all about how and why social media can be used in medicine (also the how not and why not!), strategies for successful communication to colleagues and patients, and mistakes to avoid.

Sarah has a number of online resources on these topics (listed below) and is a fantastic person to follow on social media. Her insights, topic highlights, and approach are invaluable to any health care practitioner looking to be involved on social media.

Guest

Sarah Mojarad, Lecturer of Engineering Writing, Viterbi School of Engineering and Keck School of Medicine, University of Southern California

Where to find Sarah:

Faculty bio

Twitter – @Sarah_Mojarad

Medium page

YouTube

Episode 27, Part 1: Gender Equity in Medicine with Nancy Spector

Medical Education

On this episode, host Jason Woods speaks with Dr. Nancy Spector, Professor of Pediatrics at Drexel University College of Medicine, and Executive Director of the Executive Leadership in Academic Medicine program, about gender equity issues in medicine. Dr. Spector is a frequent speaker on this issue and was the lead author on an article last year outlining the progress, barriers, and opportunities for women in pediatrics (see reference below).

This is part one of a two-part discussion. In part one, Dr. Spector focuses on outlining the scope of the issues and provides strategies for decreasing the equity gap and increasing opportunities for women at all levels of academic medicine.

I want to send out a big thanks to Kellen Vu, who serve as audio producer for this episode!

Guest

Nancy Spector MD, Professor of Pediatrics, Associated Dean for Faculty Development, Drexel University College of Medicine

References

  1. Spector ND, Asante PA, Marcelin JR, et al. Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion. Pediatrics. 2019;144(5):e20192149. doi:10.1542/peds.2019-2149.
  2. Cruz M, Bhatia D, Calaman S, et al. Senior author: Spector N. The Mentee-Driven Approach to Mentoring Relationships and Career Success: Benefits for Mentors and Mentees. MedEdPortal. 2015; Sept. doi:10.15766/mep_2374-8265.10201

Additional Resources – Things Dr. Spector mentioned for additional information

  1. ELAM Website
  2. Women Don’t Ask: The High Cost of Avoiding Negotiation – book from Linda Babcock and Sara Laschever
  3. Harvard Business Review – “What’s Holding Women in Medicine Back from Leadership”
  4. Be Ethical campaign

Episode 27, Part 2: Cross-gender Mentoring in Medicine with Nancy Spector

Education, Medical Education

On this episode, host Jason Woods speaks with Dr. Nancy Spector, Professor of Pediatrics at Drexel University College of Medicine, and Executive Director of the Executive Leadership in Academic Medicine program, about gender equity issues in medicine. Dr. Spector is a frequent speaker on this issue and is the lead author on an article published last year outlining the progress, barriers, and opportunities for women in pediatrics (see reference below).

This is part two of a two-part discussion. In part two, Dr. Spector focuses on mentoring across different genders. She provides strategies for successful mentorship, guidance on being a genuine ally without appropriating, and how to help your mentee seek out additional mentorship in areas where you may not have sufficient skill.

I want to send out a big thanks to Kellen Vu, who serve as audio producer for this episode!

Guest

Nancy Spector MD, Professor of Pediatrics, Associated Dean for Faculty Development, Drexel University College of Medicine

References

  1. Spector ND, Asante PA, Marcelin JR, et al. Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion. Pediatrics. 2019;144(5):e20192149. doi:10.1542/peds.2019-2149.
  2. Cruz M, Bhatia D, Calaman S, et al. Senior author: Spector N. The Mentee-Driven Approach to Mentoring Relationships and Career Success: Benefits for Mentors and Mentees. MedEdPortal. 2015; Sept. doi:10.15766/mep_2374-8265.10201

Additional Resources – Things Dr. Spector mentioned for additional information

  1. ELAM Website
  2. Women Don’t Ask: The High Cost of Avoiding Negotiation – book from Linda Babcock and Sara Laschever
  3. Harvard Business Review – “What’s Holding Women in Medicine Back from Leadership”
  4. Be Ethical campaign

Episode 26: EVALI

Emergency Medicine, Pulmonology, Uncategorized

On this episode, host Jason Woods speaks with Dr Heather Hoch DeKeyser, pediatric pulmonologist, about EVALI (e-cigarette or vaping product use-associated lung injury). This recently recognized condition has caused numerous people to suffer severe lung disease. We discuss the definition, current approach, remaining mysteries, and potential causes.

All treatment discussed is based on the most recent CDC EVALI guideline at the time of recording – available here

Guest:

Heather Hoch DeKeyser MD – Assistant Professor, Dept. of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado

Additional Resources:

References:

  1. Layden JE, Ghana I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. N Engl J Med. 2019 Sep 6. doi: 10.1056/NEJMoa1911614. [Epub ahead of print]
  2. Butt YM, Smith ML, Tazelaar HD. Pathology of Vaping Associated Injury. Letter to the Editor. N Engl J Med. 2019; 381:1780-1781. doin: 10.1056/NEJMc1913069
  3. Marsden L, Michalicek ZD, Christensen, ED. More on the Pathology of Vapid Associated Lung Injury. Letter to the Editor. N Engl J Med 2020; 382:387-39 doin: 10.1056/NEJMc1914980.
  4. Diaz CD, Carroll BJ, Hemyari A. Pulmonary Illness Related to E-Cigarette USe. Letter to the Editor. N Engl J Med 2020; 382-386. doi: 10.1056/NEJMc1915111

Episode 25: Sticky Education

Education, Uncategorized

On this episode, host Jason Woods speaks with Dr. Janet Corral, medical education expert, about some high yield tips to improve the success of your education! We also discuss the state of medical education as a whole and how to adjust the delivery for the needs of the current learners.

Guests

Janet Corral, Associate Professor, University of Colorado School of Medicine, PhD Educational Technology

Episode 23: Nephritis

Education, Emergency Medicine, Medical Education, Nephrology, Pediatric Emergency Medicine

What is it and why are there so many names?

On this episode, host Jason Woods speaks with Dr. Danielle Soranno, pediatric nephrologist, about nephritis in children. What is it, why are the terms so confusing, how do we diagnosis it, and when should we involve a nephrologist? Did the nephrologists invent terminology just to confuse us?

Guests

Danielle Soranno MD,  Assistant Professor, Pediatrics, Bioengineering & Medicine
University of Colorado and Children’s Hospital Colorado

References

  1. Floege J, Amann K. Primary glomerulonephritides. Lancet. 2016 May;387:2036-2048.
  2. Brogan P, Eleftheriou D. Vasculitis update: pathogenesis and biomarkers. Pediatr Nephrol. 2018 Feb;33:187-198.
  3. Chadban SJ, Atkins RC. Glomerulonephritis. Lancet. 2005 May;365:1797-1806.

Episode 22: Risk Factors for Bronchiolitis Care Escalation

Bronchiolitis, Emergency Medicine

On this episode, host Jason Woods speaks with Dr. Gabrielle Freire about her work with PERN (Pediatric Emergency Research Network) and evaluation of predictive risk factors for escalation of care in bronchiolitis.

THE BOTTOM LINE:

Multiple risk factors were found that predicted escalated care in infants. Infants aged < 12 months old with bronchiolitis but without predictors have a low risk of receiving escalated care (<1%) and may be candidates for outpatient management. Infants with increasing numbers of predictors are at a increasing risk of requiring escalated care and need consideration for in patient care with expertise in paediatric airway support.

The highlights:

  • Background
    • Bronchiolitis is responsible for ~ 16% of all hospitalizations in the first year of life
    • The cost incurred from bronchiolitis admissions is thought to be ~ $1.78 billion every year in the US and Canada
  • Study methods
    • Retrospective cohort study of a previously collected database of infants aged < 12 months with clinical diagnosis of bronchiolitis
    • Inclusion
      • Bronchiolitis defined as viral respiratory infection with respiratory distress
      • Age 12 months or younger
      • Visits from Jan – Dec 2013 collected as part of PERN
      • First episode of bronchiolitis only
    • Exclusion
      • Comorbidities such as chronic lung disease, congenital heart disease, immunodeficiency, renal or liver insufficiency, neuromuscular disorders
      • Prior episode of diagnosed bronchiolitis
  • Results
    • 2722 patients included
    • 261 (9.6%) required escalated care
    • Predictors included in the final model
      • O2 sats < 90 (OR 8.9)
      • Nasal flaring/grunting (OR 3.76)
      • Apnea (OR 3.01)
      • Retractions (OR 3.02)
      • Age < 2 months (OR 2.1)
      • Concomitant dehydration (OR 2.13)
      • Poor feeding (OR 1.85)
  • Discussion points (detailed in the audio)
    • Respiratory rate and retractions were co-linear, so RR was not included in the final model
    • The risk score “points” were assigned by diving the OR by 2 to give a total score of 14
    • Duration of illness was not found to be a significant predictor – this may be due to the lack of granularity of the data (only available in days rather than hours)
    • Oxygen saturation had the highest OR by a substantial margin

Guests

Gabrielle Freire MD, Paediatric Emergency Physician, The Hospital for Sick Children, Department of Paediatrics University of Toronto, Toronto, Ontario, CA.

Important Resources

  1. PERN website

References

  • Freire G et. al. for the Pediatric Emergency Research Networks (PERN). Predicting Escalated CAre in Infants with Bronchiolitis. Pediatrics. 2018 Sept 142;3. PMID: 30126934.

Little Big Little: What is Vaping?

Adolescent Medicine, Education, Emergency Medicine, Podcast, Pulmonology, Uncategorized

This is the first segment in a series of “shorts” – smaller quick hit episodes on a focused topic. I’m going to affectionately call them “Little Big Littles”.

On this Little Big Little, host Jason Woods speaks with Dr. Heather Hoch about what we might need to know about vaping to take care of our patients.

Guests

Heather Hoch MD – Assistant Professor, Dept. of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado

Important Resources

  1. CDC Electronic Cigarette Information
  2. Smokefree.gov

Episode 21: HIV Screening in the Pediatric ED

Adolescent Medicine, Emergency Medicine, Infectious Disease, Uncategorized

On this episode, host Jason Woods speaks with Dr. Amy Grover about HIV screening in the pediatric emergency department. Dr. Grover works in both the section of emergency medicine and hospital medicine and has an interest in HIV screening.

The highlights:

  • An estimated 50% of adolescents with HIV do not know they have contracted HIV
  • Acute retroviral syndrome has many non specific symptoms and can be difficult to diagnosis but includes the following
    • Fever
    • Fatigue
    • Myalgias
    • Nausea, vomiting, and/or diarrhea
    • Rash that can involve the hands and feed
    • Pharyngitis is typically not as exudative as EBV
  • CDC guidelines recommend that EVERY person ages 13-64 who is sexually active be screened for HIV at least once in their lives, and yearly if ongoing risk for exposure
  • One of the difficult aspects of setting up a screening program is deciding who is responsible for follow up of the results. Each institution will have to discuss what is appropriate for their setting
  • Do not forget to evaluate for risk of other STI, including Syphilis (prevalence is rising in the US)
  • Most rapid screening tests that do not use whole blood can not detect HIV infection until there is an antibody response (3 weeks – 3 months)
  • The 4th generation HIV test can detect infection starting as early as 15 days after infection. Note that there is still a latent period when detection is not possible.
  • One of the important reasons to screen patients is that there is evidence that knowledge of HIV infection decreases high-risk behavior.
  • The benefit and effect of HIV screening may depend on the regional HIV rates

Guests

Amy Grover MD – University of Colorado School of Medicine, Sections of Emergency Medicine and Hospital Medicine, Children’s Hospital Colorado

Important Resources

  1. CDC HIV Resource Library

References

  1. Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatric Adolesc Med. 2000 Apr;154(4):361-5.
  2. Kitahadta MM, et al. Effect of Early vs Deferred Antiretroviral therapy for HIV on Survival. NEJM 2009;360(18):1815-26.
  3. Marks G, et al. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr.2005 Aug 1;39(4):446-53.
  4. Cohen MS, et al. Antiretroviral Therapy for the prevention of HIV-1 Transmission. NEJM 2016; 375(9):830-839.
  5. Marks G, et al. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS.2006 Jun 26;20(10):1447-50.
  6. Wood E, et al. Does this Adult Patient have Early HIV infection? JAMA 2014; 213 (3): 278-285.
  7. Mehta AS, et al. Practices, Beliefs, and Perceived Barriers to Adolescent Human Immunodeficiency Virus Screening in the Emergency Department. Pediatr Emerg Care 2015; 31:621-626.
  8. Akhter A, et al. Rapid Human Immunodeficiency Virus Testing in the Pediatric Emergency Department: A National Survey of Attitudes Among Pediatric Emergency Practitioners. Pediatr Emerg Care 2012; 28:1257-1262.
  9. Haines CJ, et al. Pediatric emergency department – based rapid HIV testing: adolescent attitudes and preferences. Pediatr Emerg Care.2011 Jan;27(1):13-6.