Browsing by Author "Wilson, Don P."
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Item Hospital Admission Rates for Children with Diabetic Ketoacidosis (DKA)(2015-03) Deleeuw, Peter M.; Thornton, Paul; Gonzalez, Jose L.; Hsieh, Susan; Wilson, Don P.Background and Objective: Diabetic Ketoacidosis (DKA) is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Following stabilization in the ED, patients are generally discharged home for outpatient management or hospitalized for continued care. Our objective is to gain a better understanding of the patient characteristics and treatment/disposition strategies used by ED physicians to improve care of children with DKA. Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – Aug 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection. Results: During the study, 401 children were seen in the ED with a diagnosis of DKA. Ten percent (40) of patients were transferred from an outside facility to the ED for assessment and treatment; 90% (361) were not transferred. Of the total patients seen in the ED, 16.2% (65) were discharged for home management after initial assessment and treatment (1 transfer; 64 non-transferred); 83.8% (336) were admitted to the hospital (transfer 39; non-transfer 297). Of the patients who were admitted, the majority (66.9%) were admitted to the inpatient unit (inpatient 225 vs. PICU 111). Conclusion: A large number of children with DKA are evaluated and treated in Emergency Departments. Continuing research on the characteristics of these children and the treatment strategies used by ED physicians can help improve care of children with DKA.Item Integrating Medical Research into the Undergraduate Medical Education Curriculum(2015-03) Shah, Deep; Bowman, W. Paul; Smith-Barbaro, Peggy; Jorden, Debra; Wilson, Don P.Purpose: Medical research is an important, yet often under represented, component of undergraduate medical education (UME). Though acknowledged, the fundamentals of biomedical research and its application to clinical medicine are infrequently part of the UME curriculum. To address this need, in 2013 – 2014 University of North Texas Health Science Center (UNTHSC) faculty and Cook Children’s Medical Center (CCMC) medical staff came together to formalize a mentored research program for medical students. A collaborative Pediatric Research Program (PRP) was established, with the goal of providing a mentored research experience for medical students designed to enhance research awareness and knowledge through systematic investigation, including research development, testing and evaluation. Methods: Medical Students completing the first year of UME who expressed an interest in pediatric research were eligible to participate in the PRP. Students were given options in various areas of Pediatrics. All of the students were able to participate in their first or second preferred research area in Pediatrics. All administrative procedures and requirements were completed before the program started, including Collaborative Institutional Training Initiative (CITI) and Best Clinical Practices certification. A four week didactic course, which included- i) Research Design and Protocol Development; ii) Literature Review / Copyright and Plagiarism Issues; iii) Data Collection and analysis; and iv) Presentation and Publication Guidelines and Tips, took place during the students’ summer break of 2014. Results: 25 students joined PRP with mentorship of 19 faculty mentors. The faculty mentors were either General/Specialist in Pediatrics (MD/DO) or Doctor of Philosophy (PhD) with research-focused in Pediatrics. Out of 25 students, only 3 chose not to continue their research project in Year II of medical school. The students, who continued research during Year II of medical school, presented status reports of their projects to group of research mentors, administrative staff and fellow students in fall 2014. Conclusions: Majority of students were very satisfied with their mentors’ contributions in helping them achieve their research goals. Most of the students were very satisfied with accessibility to their faculty mentors and research coordinators. Almost all of the students were satisfied with clarity and practicality of program requirements and found the didactic course beneficial.Item Primary Pigmented Nodular Adrenocortical Disease: A Rare Condition of Cushing's Syndrome(2015-03) Prakash, Sameer; Maxey, Nicole; Russ, Melanie; Friedman, James; Miller, James; Castro-Silva, Fernando; Wilson, Don P.Purpose (a): Cushing’s syndrome (CS) in uncommon in children and may be either ACTH dependent or independent. The most common cause of CS is exogenous administration of glucocorticoids. We present an unusual case of ACTH-independent CS in a 14-1/2 year old Caucasian male. Methods (b): A 14-1/2 year old Caucasian male was referred for accelerated weight gain, which first became apparent at 8 years of age. In the past 2 years he gained ~50 pounds, during which time he reported intermittent fatigue, vague abdominal pain, and pain in his lower back. There was no history of muscle weakness, hypertension or diabetes. Diurnal cortisol and ACTH levels, 24-hour urinary free cortisol, and overnight 0.5 mg dexamethasone suppression studies were performed. To further determine the etiology of Cushing’s syndrome and localize the source of excess glucocorticoids production, additional studies were performed. Results (c): There was no suppression of adrenal steroids following 2 days of high dose dexamethasone. CT scan showed a slight nodular adrenal contour bilaterally. Further workup was consistent with primary pigmented nodular adrenal disease (PPNAD) without evidence of Carney Complex. A bilateral adrenalectomy was performed and the patient maintained on oral adrenal hormone replacement therapy. Conclusions (d): PPNAD accounts for only 2% of ACTH-independent CS. Absence of adrenal suppression following high dose dexamethasone and nodular changes of the adrenal with CT scanning aid in the clinical suspicion of PPNAD. Bilateral adrenalectomy is the treatment of choice and, in the absence of Carney complex, should be curative.Item Universal Cholesterol Screening of all 9 - 11 year old Children in Community Based Ambulatory Pediatric Clinics(2015-03) Mou, Margaret; Wilson, Don P.; Davis, Sharon; Matches, Sarah; Shah, Deep; Leung-Pineda, Van; Suzuki, Sumihiro; McNeal, Catherine; Bowman, W. PaulIntroduction: In the U.S. and in most Western countries, coronary artery disease (CAD) is theleading cause of death, linked to hypercholesterolemia, especially in familial hypercholesterolemia (FH). Early identification and treatment of children with hypercholesterolemia has been shown to be effective and safe in reducing morbidity and mortality, especially in those with FH. However, few children with FH are currently being identified. Thus, the National Heart, Blood and Lung Institute (NHLBI) issued a guideline recommending universal cholesterol screening (UCS) of all 9 – 11 year old children in November 2011. We report a comparison of the number of 9 - 11 year old children screened for hypercholesterolemia 1 year prior to and 1 year following publication of the NHLBI’s screening guidelines in 5 community-based ambulatory pediatric clinics. Methods: Five (5) community-based ambulatory pediatric clinics (4 hospital affiliated and 1 university affiliated) were recruited for this study, with retrospectively obtained data that was de-identified. Cholesterol screening results 1 year prior to publication of the NHLBI’s screening guidelines acted as the baseline for each clinic. Rates and results of lipid screening performed by each clinic in all 9-11 year old children at the time of scheduled or un-scheduled clinic visits was measured. Results: Of all eligible 9–11 year-old children, 489 (17.1%) were screened 1 year prior to publication of recommendations, and 686 (20.1%) were screened 1 year following publication of recommendations for universal cholesterol screening. Specifically, Clinic 1 increased screening from 24.2% to 32.3%, Clinic 2 decreased screening from 19% to 16.1%, Clinic 3 decreased screening from 14.7% to 11.9%, Clinic 4 increased screening from 23.1% to 28.5%, and Clinic 5 increased screening from 8.8% to 14.3% of target population. Conclusion: There was a significant increase in the rates of lipid screening for the five clinics in our study following publication of the NHLBI’s recommendations for universal cholesterol screening compared to the year previous to recommendations. Given the high prevalence of premature CVD associated with familial hypercholesterolemia, additional strategies are needed to improve screening rates. The ability to identify this vulnerable population creates the opportunity for prevention of future cardiovascular disease by encouraging healthy lifestyles and the use of lipid lowering medication.