Day 1 :
Keynote Forum
Jarret R Patton
DoctorJarret PLLC, USA
Keynote: Burnout, suicide, and career: The new face of the physician workforce
Time : 09:50-10:35
Biography:
Jarret “Doctor Jarret” Patton MD has served thousands of children in eastern Pennsylvania for nearly 20 years. Throughout his career, he has remained an advocate for children’s health issues. Over time, his servant leadership style led him to curtail clinical practice to become a change agent in the healthcare system. As a former President of the Medical Staff at an eight hospital system in eastern Pennsylvania he worked with other leaders to promote children’s health and health equity in a highly matrixed environment. He advised organizations on a national level including The Joint Commission, American Hospital Association and the American Academy of Pediatrics. He has published in the medical literature and is the #1 best-selling author of Licensed To Live and Whose Bad @$$ Kids Are Those? He is the founder and CEO of DoctorJarret PLLC, a coaching and consulting firm which helps educate, enlighten and improve healthcare
Abstract:
Physician burnout has long been a problem in the United States and abroad. The changing milieu of the healthcare environment in addition to the hostile environment towards physicians has made the career less desirable by many. With so many things that leave physicians vulnerable including patient satisfaction, disciplinary boards and criminal proceedings, it doesn’t surprise you that many physicians are choosing to refresh or restart their careers in other areas. With the current shortage of physicians in the US coupled with the reduction of physicians in the clinical pipeline, one can wonder what will happen with the profession as we know it. While physicians are leaving the clinical workforce, others are finding other options more feasible leading to suicide or substance abuse. Now is the time to keep yourself healthy and take a long look at your career so that it doesn’t take over your life entirely.
Keynote Forum
Lynn D Schaeber
Montgomery College, USA
Keynote: Impacting the medical narrative virtually - The power of connecting pediatric patients to the world outside their illness
Biography:
Abstract:
Keynote Forum
Sharon J Diskin
Children’s Hospital of Philadelphia, USA
Keynote: The genetic basis of neuroblastoma predisposition
Biography:
Sharon Diskin completed her PhD in 2008 from the University of Pennsylvania and postdoctoral studies at The Children’s Hospital of Philadelphia in 2012. She is an Assistant Professor of Pediatrics at the University of Pennsylvania and Children’s Hospital of Philadelphia. Her research program is focused on identifying the genetic basis of childhood cancers, including the complex interplay between germline and tumor genomics. She has published more than 47 papers in reputed journals and serves as a reviewer or editorial board member of multiple journals.
Abstract:
Neuroblastoma is a malignancy of the developing sympathetic nervous system which accounts for 12% of childhood cancer deaths. Appoximately 1-2% of cases are inherited in an autosomal dominant fashion and mutations in ALK and PHOX2B have been identified as the major drivers of this subset. Here, we report on efforts to identify the genetic basis of sporadic neuroblastoma (98% of cases) using a combination of genome-wide association studies (GWAS) and next generation sequencing. To date, we have genotyped 6,201 neuroblastoma cases and 32,240 healthy controls for GWAS and performed whole-genome or whole-exome sequencing (WGS or WXS) on matched tumor-normal DNA pairs from 776 cases to identify rare germline mutations. GWAS efforts have led to the publication of over a dozen susceptibility loci and the identification
of genes influencing both tumor initiation and progression. We have now performed a large multi-ethnic GWAS combining cohorts of European ancestry, African American and Hispanic populations. We identified eleven new susceptibility loci (P < 5.0 x 10-8) and discovered a rare 550-kb deletion on chromosome 16p11.2 enriched in cases vs. controls (Odds Ratio: 15.4; 95% C.I. 4.1-57.9). From sequencing studies, we observed enrichment of truncating BARD1 mutations in neuroblastoma cases (1.2%, p<0.001) and estimate that ~10% of children with neuroblastoma harbor a rare pathogenic germline mutation in a known cancer predisposition gene. Collectively, these studies are defining the landscape of genetic predisposition in neuroblastoma. Ongoing efforts are focused on identifying the functional significance of rare germline mutations and translating these findings to the clinic.
Keynote Forum
Igor Klepikov
Emeritus Professor, USA
Keynote: The new doctrine of acute pneumonia: A guaranteed way of prevention of purulent complications
Biography:
Igor Klepikov who is now retired has worked as a Professor in Kemerovo State Medical Academy, Russia.
Abstract:
Treatment of acute pneumonia (ÐÐ ) in recent decades focused solely on antibiotic therapy, does not include pathogenetic, specific methods of assistance and repeats the principles of treatment of other inflammatory diseases. Reducing the effectiveness of antimicrobial drugs, the emergence and the increasing number of antibiotic-resistant pathogens and a gradual increase in the frequency of purulent complications attach importance and urgency to the solution of this problem. The first step in this decision is a revision of ideas about the nature and mechanisms of ÐP. This work has been done and tested in a clinical setting in the years 1976-1984 in Novokuznetsk State Institute for postgraduate doctors (USSR, Russia). The basis of the new doctrine ÐP was based on the following scientific medical axioms, already having previous scientific justification.
1. The body's response to any stimulus, including the initiation of inflammation, is highly individual and unique.
2. The basis for the inflammatory transformation of the body tissue is a vascular reaction with a specific stage sequence.
3. Small and big circles of blood circulation not only have a direct relationship but an inverse relationship.
4. Among the nonspecific forms of inflammation, AP is the only process occurring in the system of lesser circulation.
5. The same medical procedure can have different effects on inflammation in the small or big circles of blood circulation.
Following private studies were additionally performed:
1. An experimental model of AP (4 series of experiments, 44 animals) obtaining a model of pleural complications (certificate for invention No 1631574, A1,1 November 1990, USSR).
2. X-ray examination 56 lung anatomical preparations with different forms of the AP, taken from the dead patients.
3. Record comparative rheopulmonography before and after performing medical procedures(36 patients).
Analysis of the observation and treatment of 994 children with AP and it's various destructive and pleural complications. The revised treatment guidelines were applied in 101 patients in the initial period of aggressive forms of ÐP. The received results allow speaking about the possibility of the guaranteed prevention of suppurative and destructive complications of the disease. A more detailed presentation and justification of the new doctrine AP, the results of these studies and clinical trials can be found in the published book: Igor Klepikov-"Acute pneumonia: A new look at the old problem", Lambert Academic Publishing, 2017, ISBN (978-3-330-35250-6). This book gives a detailed understanding of the unique mechanisms in the development of AP and the existing ways of influencing them in the direction of stimulation and inhibition. Materials give a real idea about the possibility of guaranteed prevention of suppurative and destructive complications of the disease.
- General Pediatrics & Pediatric Cardiology | Pediatric Neurology & Endocrinology | Pediatric Psychology | Pediatric Gastroenterology | Pediatric Allergy and Infectious Diseases | Neonatal | Intensive and Critical Care | Pediatric Oncology and Hematology
Chair
Jarret R Patton
DoctorJarret PLLC, USA
Session Introduction
Tammy Camelli
Walsh University, USA
Title: The incidence of delirium in hospitalized children with cancer
Biography:
Tammy has completed her DNP at the age of 49 years from Walsh University. She is a Pediatric Nurse Practitioner in the Pedicatric Intensive Care Unit at Akron Children’s Hosptial, Akron, Ohio.
Abstract:
Objective: Delirium in children is associated with increased neurocognitive impairment and mortality. There is limited data on the incidence of delirium in hospitalized children with cancer. Incidence is hypothesized to be 10%. The objective of this study is to assess the incidence of delirium in hospitalized children with cancer and if age or hospital admission diagnosis carries increased risk.
Study Design: This is a prospective, cohort study incorporating a validated delirium screening tool, Cornell Assessment of Pediatric Delirium (CAP-D), to identify delirium in hospitalized children with cancer. This was a convenience sample of children admitted to a single center pediatric oncology unit. Bedside nurses completed education on the CAP-D score and a 0.90 nursing inter-rater reliability was achieved. CAP-D scores were assessed twice a day throughout the child’s admission.
Results: A total of 94 consecutive admissions, included 43 patients and 581 hospital days. Of the 94 admissions, there were 49girls and 44 boys, age distribution 6 months to 17.5 years, with a mean age 6 (sd=4.7). Delirium diagnosed in 11 children, for an incidence of 11.7% with recurrence rate of 27.2% (n=3). Patients with primary cancer diagnosis of ALL(27.2%,n=3) and
neuroblastoma(27.2%,n=3) carried higher risk for delirium along with admitting diagnosis of new onset cancer(45.4%,n=5) and chemotherapy(36.4%,n=4). Children between ages of 1-3(54.55%,n=6) and 3-6(36.3%,n=4) are most at risk.
Conclusion: In this study, children with cancer are at risk for developing delirium during hospitalization. Further studies are needed to explore short term and long-term outcomes to improve the care we provide.
Oluwakemi Rachel Ajayi
University of Kwa-Zulu Natal, South Africa
Title: Factors associated with the health and cognition of 6-year old to 8-year old children in Kwazulu-Natal, South Africa
Biography:
Abstract:
Aim: The objective of this paper was to examine factors associated with children’s development in a prospective study which investigated the health and cognitive outcomes of children living in a resource-poor area in Kwazulu-Natal, South Africa in order to identify key factors associated with health and cognition, so that remedial action may achieve optimal development.
Methods: A Cohort study of 1383 children investigating the association of demographic variables (area of residence, sex, preschool education, HIV status, height for age and hemoglobin level) and family variables (socioeconomic status, maternal and paternal level of education), with children’s cognitive performance. The latter was measured using the Grover-Counter Scale of Cognitive Development and subtests of the Kaufman Assessment Battery for Children, second edition (KABCII) General linear models were used to determine the effect of these predictors in a univariate and multivariate context. Linear regression analysis of the test scores was performed to examine the associated factors.
Results: The child’s HIV status, gender and their socioeconomic status were not significant in any of the cognitive tests, nor was the maternal level of education but the effects of site and paternal level of education were significant in all three cognitive test results. The effects of pre-school education, the area of residence and height-for-age was significant for the children’s cognitive scores.
Conclusion: Children with low cognitive scores tended to be stunted (low height-for-age scores), lacked pre-school education and were younger. Area of residence and their parents’ educational level also influenced their cognition. There is a need to improve the health of children in this region of KwaZulu- Natal and ensure the provision of pre-school education in order to improve their cognitive outcomes.
Ellen M Levy and Anne Wohlschlaeger
Children’s Hospital of Philadelphia, USA
Title: Completing the circle of pediatric hematopoietic stem cell transplant care; revaccinations: When and how
Biography:
Ellen M. Levy is a nurse practitioner in the Cancer Center at The Children’s Hospital of Philadelphia. Her Areas of Expertise: Childhood leukemia, Neuroblastoma, Psychosocial effects of chronic illness.
Anne Wohlschlaeger is a nurse practitioner in the Cancer Center at The Children’s Hospital of Philadelphia. Her Areas of Expertise: Blood and marrow transplantation.
Abstract:
Apoorva T Raju
Safdarjung Hospital, India
Title: Clinical spectrum and outcome of lower respiratory tract infections due to viruses in children (<5years)
Biography:
Apoorva T Raju is a third year post graduate student in Paediatrics in Vardhman Mahavir medical college and Safdarjung Hospital.
Abstract:
Statement of the Problem: Acute respiratory tract infections are leading cause of morbidity and mortality in children worldwide accounting for about 30% of all childhood deaths in the developing the world. Viruses account for 50–90% of acute lower respiratory tract infections (ALRI) in young children. The increased sensitivity of polymerase chain reaction (PCR) over conventional methods for the diagnosis of respiratory viral infections has been established previously. There are conflicting results regarding multiple viral coinfections and its association with severity of the disease. This study reviews clinical spectrum and outcome of lower respiratory tract infections due to viruses in children of age <5 years with an emphasis on the influence of multiple respiratory virus detection versus single respiratory virus detection on the clinical spectrum and outcome.
Methodology: Children admitted with ALRI were tested for respiratory viruses after taking informed consent from the parents/ guardian. A pre-designed proforma was used to record details of demographic profile, clinical presentation, underlying disease, laboratory investigations, treatment and course in the hospital and final outcome. A total 410 nasopharyngeal aspirates were and subjected for Multiplex RT PCR.
Findings: The occurrence of viral LRTI in our study group is 46% with multiple virus detection rate of 14% and RSV was the most common causative agent. Though there were no significant differences in the clinical severity at presentation between those with LRTI due to the single virus and LRTI due to multiple viruses, there was a significantly longer duration of hospital stay in patients with LRTI due to multiple viruses.
Conclusion: Broadening viral diagnosis in respiratory tract infections may help clinicians to decrease unnecessary prescriptions of antibiotics, implement early antiviral treatments when available and prevent virus transmission. These data might be useful for planning the study of future respiratory virus vaccines or other interventions to reduce the disease due to viral LRTI.
Isabel Straw
North Central London NHS Trust, United Kingdom
Title: Investigating the sexual health needs of female refugee children and suggested improvements for service provision
Biography:
Isabel Straw is a London doctor who has dedicated her junior years to studying the effects of social circumstance on health. She has developed her global outlook
through her experience abroad, working domestically and internationally with children in the asylum system. Isabel is pursuing an education in Public Health to
further her understanding of global health inequalities and of the effects of social disempowerment on health.
Abstract:
At a time of record-level global forced displacement, the health needs of migrant populations pose a challenge to our existing healthcare systems. Unaccompanied refugee children have specific healthcare needs, particularly surrounding sexual health due to higher rates of historic sexual trauma. In light of this our team of doctors, who volunteer with asylum-seeking children at ‘Community Action for Refugees and Asylum Seekers’ (CARAS) in London, conducted a series of educational sessions. This work draws material from the first of a series of on-going sexual health workshops that explore the existing barriers to care, gaps in knowledge and myths surrounding sexual health for these teenagers. Data were collected through semi-structured interviews carried out as part of the teaching session. The group consisted of seven girls, with an age range of thirteen to nineteen, who were predominantly from east Africa and the Middle East. The domains explored included; puberty, female anatomy and FGM, pregnancy, sexually transmitted infections and relationships and consent. The results of our study demonstrate vast knowledge gaps of the female anatomy, contraception, STDs and, of particular significance, relationships and sexual consent. Our study highlights the need for; further research into the discrepancies between the health literacy of migrant and nonmigrant children targeted public health interventions and increased primary care awareness regarding the health challenges faced by these teenagers.
Oluwakemi Rachel Ajayi
University of Kwa-Zulu Natal, South Africa
Title: Survival analysis: A tool for the epidemiological study of in-hospital patients in the intensive care unit
Biography:
Oluwakemi Rachel Ajayi is a Postdoctoral researcher at the University of KwaZulu-Natal Medical School. She had her PhD (Statistics) from the University of KwaZulu-Natal, research focused on of cognitive development in children, aged 4-8 years living in KwaZulu-Natal, South Africa. Her MSc and BSc (Statistics) from the University of Lagos an Ilorin respectively. She has taught statistics to university undergraduate students, invigilated tests and exams checked and collated exam scores/reports. She is a member of European Academy of Allergy and Clinical Immunology, a Chartered Member of Management and Biometrics and Statistical Sciences Facilitation, she has served in the position of a Biostatistician, Data analyst and Consulting Statistician. She has published papers in reputed journals while there are some others under review and has been serving as an editorial board member of repute.
Abstract:
Background: Statisticians and healthcare practitioners rely on information based on data, to generate indices that best present situations, progress and areas of need. Ability to understand the process is key into inequities, understanding the underlying causes and gaining insights into the mechanisms that link conditions to relevant outcomes. Though the event ‘outcome’ is of importance in medicine, sometimes the time to such is unknown; when at the end of a study, some subjects have not had the event of interest and what is known on a subject is that it survived to time (t), then many other statistical methods of analysis become inappropriate. Also, many data are rarely normally distributed but skewed and violate the assumptions of another statistical method of analysis, these are typical survival data.
Objectives: (a) To describe the survivals times of patients with fungal infection and those without. (b) To compare time-to-death between patients with fungal infection and those without.
Methods: The current paper provided an overview of survival analysis in epidemiological studies. With a view to comparing survival among patients in a case study, Kaplan Meier survival curve displayed the time to death of patients, how it compared fungal infection status and Log-rank tested for statistical group difference on the survival times of (1042) in-hospital patients.
Results: Kaplan-Meier survival curve showed a significant difference in mortality between those with and without fungal infection. Cumulative survival proportion appeared to be much higher among patients without fungal infection compared to those infected.
Conclusions: Though the prevalence of fungal infection was low in the study, there was significantly higher in-hospital death, fungally infected patients spent long days on admission than those without. To improve the outcomes of patients in this population, more attention to health care should be paid to those diagnosed with fungal infection receiving intensive care.
Aarti Rathore
Safdarjung Hospital, India
Title: Hypothermia at admission in the Neonatal Intensive Care Unit: Incidence and risk factors
Biography:
Aarti Rathore is a third year post graduate student in Paediatrics in Vardhman Mahavir medical college and Safdarjung Hospital.
Abstract:
Statement of the problem: Thermoregulation is a critical aspect of new born care. The close association of hypothermia with increased morbidity and mortality has been well documented. It is associated with increased morbidity from infection, abnormal coagulation, post-delivery acidosis, delayed adjustment from fetal to newborn circulation.
Methodology: A Cross-sectional study over a period of 18 months was carried out at the NICU unit at Safdarjung hospital. All deliveries are attended by Obstetrician, nursing personnel and a resident Paediatric doctor posted in the labor room or Operation theatre. The thermoregulation guidelines are followed which involves the use of multiple modalities divided into three phases: Pre-delivery preparation, resuscitation and NICU admission. Neonate’s axillary temperature was measured using a digital thermometer at admission, by placing the bulb of thermometer against the roof of the dry axilla, free from moisture. Baby's arm was held close to the body to keep a thermometer in place and temperature recorded when thermometer beeped. Results: Incidence of hypothermia at admission to NICU was found to be -27%. The results are indicative of progressively increasing hypothermia with a decrease in birth weight. Similar results were seen with decreasing gestation.
Conclusion: Incidence of hypothermia at admission to NICU-27%.The results are indicative of progressively increasing hypothermia with a decrease in birth weight and decreasing gestation and obtained results are statistically significant. Hypothermia was seen more commonly in babies born by caesarian and assisted vaginal deliveries compared to vaginal deliveries. Presence of malformation did not turn out to be a risk factor for hypothermia. Majority of the times pre-warmed linen was used to transfer baby from Labour Room or OT to NICU, but no difference in the incidence of hypothermia was observed.
Isabel Straw
North Central London NHS Trust, United Kingdom
Title: The knife crime epidemic in London: A youth perspective
Biography:
Isabel Straw is a London doctor who has dedicated her junior years to studying the effects of social circumstance on health. She has developed her global outlook through her experience abroad, working domestically and internationally with children in the asylum system. Isabel is pursuing an education in Public Health to further her understanding of global health inequalities and of the effects of social disempowerment on health.
Abstract:
Background: In 2017 the UK saw a 22% increase in crime with knives and sharp weapons. Since then there have been 37 deaths from stabbings, 11 of which were teenagers. Admission to hospitals with stabbing injuries is at its highest rate for 7 years, with a shift towards younger victims: the youngest victim being just 13.
Methods: As a team of doctors running health workshops at ‘Community Action for Asylum Seekers and Refugees’ (CARAS) in London, we have access to a ‘hard to reach’ cohort of teenagers. Our team undertook qualitative research drawn from an educational session focused on knife crime and CPR. Participants were recruited on a voluntary basis to join a practice session and discussion that explored perceptions of knife crime in an informal setting. Sixteen boys took part, aged twelve to seventeen, who were predominantly from east Africa. Two hour-long semi-structured interviews were used to explore the perspectives, ideas and knowledge surrounding street violence.
Findings and Interpretations: Four researchers undertook a thematic content analysis of the session transcripts. The most commonly vocalized ideas were extracted from this data resulting in three key identified themes: distrust of public services, a lack of knowledge of the justice system and differing perspectives on the underlying causes of crime. Interpreting these results suggested anxieties around the role of the police were heightened due to children’s experience within the asylum system. Similar to previous youth work on knife crime, common misconceptions about the consequences of knife violence were elicited. Our study highlights gaps in unaccompanied minors knowledge, potential areas of vulnerability and the need for targeted public health interventions to support these teenagers. IS, HF & FH developed the experimental design, JD contributed to post interview filtering of transcripts and MT & NK contributed to the