171 Ashley Ave.
Charleston, SC 29425
843-792-1414
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November 2004
This edition:
Letter from the Chair
Dear Faculty, Staff, and Friends of the Children's Hospital:
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| L. Lyndon Key, MD |
We are making progress in many areas of the Children's Hospital. In the clinical arena, new policies are being put into place to improve patient care and satisfaction by getting patients in and out of the hospital expeditiously. Phil Saul, MD, medical director, has done a wonderful job in developing templates for these policies which will now receive comment from the various constituency groups. This year we are trying to move from good to GREAT. These changes will allow us to provide the best service. Making this jump will take a new approach to excellence including listening to each other and working together as a cohesive, caring group. Clearly, reducing errors and making the leap to evidence-based therapy will require us to be open to new ideas.
NEW IDEAS must become the basis of our effort for greatness. We will maximize this effort in the area of patient care, as we move towards a true hospitalist group. We will develop new ideas as we research the basis of development and genetic control of the body, marrying this to our understanding of disease mechanisms and therapeutics. We will learn new ways to do simple things better, ensuring that orders are entered accurately and medications are dispensed faithfully.
As you have probably noticed, there will be less need for the pronoun, "I," and more emphasis on "We." The "We" must not just include our normal panel of experts, but must include parents and patients, referring physicians and housekeepers. We will know that this team is fully empowered, when the housekeeper is willing to point out that hands were not washed, and the parents feel free to ask why we are not providing enough pain medication for their child. We want everyone to strive for perfection. Such a team will move ever closer and will always value the relentless pursuit for greatness.
In this issue, we are showcasing the future of pediatrics, our residents. They have a hard road ahead, facing the limits of 80 workweeks, while not forgetting that medicine cannot be practiced by the clock. It is up to each of us--faculty, staff, patients and parents to help this new generation expand their competence and further develop their gift of compassion. Their success will define our worth and shape the children's hospitals of the future.
We cannot look beyond the here and now. George Johnson's story on the flu vaccine provides us with a reminder that while we are growing, building, improving, we must always remember to practice in the moment. These are ever-changing and challenging times. There is a need for each of us to keep our eyes open. We must also think of ways to improve our hospital and ourselves. Finally, we cannot ignore, or be held back by the thousand demands of the present.
We can all be physicians, leaving each person we meet, feeling better. (paraphrased from Bernard Lown, The Lost Art of Healing.)
L. Lyndon Key, MD
Chair, Department of Pediatrics
Letter from the Medical Director
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| J. Philip Saul, MD |
Winter is a busy time for the Children's Hospital. Not only do we have all the "usual" care for children with complex medical problems, but we add on the acute seasonal illnesses. Last year those combined factors led to a high census throughout the winter. However, this year may be much worse due to a variety of factors - less flu vaccination, a new pediatric ER through which we admitted a record number of patients in October, and an increase in the number of community pediatrician's admitting or sending their patients to MUSC. A good problem to have, but one which is already stressing the capacity of the Children's Hospital.
We are addressing this capacity problem prospectively with a few initiatives. Since we have a fixed number of beds, our biggest opportunity is to cut length of stay, which can be done most expeditiously through a more efficient discharge process. Consequently, working with Jimmy Roberts, MD, medical director of 8D, Adrian Lavery, MD, one of our chief residents, Kim Harris, 8D's nurse manager and Susan Beason, clinical care manager for general peds, we have developed a new set of discharge guidelines. Further, we now have a 6-bed "same day" unit on the 6th floor open from 7 a.m. to 11 p.m., which can be used for patients who are medically ready for discharge, but not quite ready to go for one reason or another. A goal has been set to have 25% of discharges occur before 11 a.m., which will require moving 15% of the admissions currently occurring in the late afternoon to the morning. Achieving this goal will require more than guidelines. The most important factor will be that all our team members - attendings, residents, nurses, clerks and housekeeping - take individual responsibility, work together and communicate.
I appreciate everyone's effort in this new initiative and know that with your hard work we will be able to deliver care to all the patients who need it during the upcoming season.
J. Philip Saul, MD
Medical Director, MUSC Children's Hospital
Director, Pediatric Cardiology
News from the Administrator
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| John Sanders |
The Ronald McDonald House has provided invaluable support to families of children that we care for at the MUSC Children's Hospital. It's caring atmosphere has made the house a great place for families from outside the Charleston area. The Ronald McDonald Family Room provides a special environment within the hospital for local families and those who cannot leave the facility because of the needs of their children. The Children's Hospital staff is excited to work with the Ronald McDonald House, providing the best care for our children and a caring environment for their families.
Children's Research Institute News Brief
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Bernard L. Maria, MD, MBA
Executive Director of the CRI |
The Children's Research Institute (CRI) now has occupants on the second, third, and fourth floors. We project occupancy of the fifth and sixth floors by December 2004. Since Kids Connection was published in October, the following programs have started moving into the fourth floor space:
- Cancer and Blood Disorders
- Pharmacogenetics
- Molecular Genetics
- Pediatric Neuropsychiatry
- Developmental Neuroscience
Children's research at MUSC includes a broad array of activities both within and without the CRI. All such research activities share the common goal of improving child and adolescent health. One of the programs that moved into the second floor of the CRI is the Pediatric Obesity, Insulin Resistance, and Diabetes Program, led by Joseph Senn, MD. After hearing about the CRI, Dr. Senn left California to join his longtime mentor, Richard W. Furlanetto, MD, who joined the Department of Pediatrics last year. Their laboratory focuses on understanding the mechanisms by which obesity leads to insulin resistance and type-2 diabetes and the role of inflammation in this process. Obesity and insulin resistance have been associated with a chronic state of inflammation. This inflammation is characterized by an increase in multiple pro-inflammatory stimuli, in particular - cytokines. Cytokines have been shown to directly induce insulin resistance in cells and animal models. However, two major questions remain unanswered: how do cytokines induce insulin resistance and diabetes and how does obesity lead to increased inflammation? They hypothesize that cytokine-induced insulin resistance results from increased expression of a particular family of proteins, the Suppressors of Cytokine Signaling (SOCS). This recently discovered family of proteins has been shown to directly inhibit insulin action in cells and in animals and has been shown to be elevated in insulin resistant patients.
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| Paul Darden, MD |
In addition to research activities programmed for the CRI, MUSC has nationally prominent clinical children's research activities. One such research program directed by Paul Darden, MD, has the theme of improving delivery of primary care to children.
The most effective aspect of primary care is immunization delivery. His research agenda includes pharmaceutical research, researcher training, provider education and health services research. Dr. Darden is testing antibiotics and Hepatitis A vaccine in phase III clinical trials. In researcher training funded by the HRSA Bureau of Health Professions and the Agency for Healthcare Research and Quality (AHRQ), Dr. Darden directs the innovative academic generalist fellowship program for post-doctoral fellows (medicine, pharmacy and nursing). In provider education activities funded by the CDC's National Immunization Program, Dr. Darden is training practitioners, nurses and physicians to deliver immunizations to children. In funded health services research, Paul is examining and ameliorating racial disparities in the delivery of immunizations to children. This is a nationwide study administered through the American Academy of Pediatrics practice-based research network, Pediatric Research in Office Settings (PROS) and is funded by the CDC's National Immunization Program. In summary, Dr. Darden's high quality research and training projects directly contribute to our vision of being a leading regional, national and international resource in children's research.
Finally, we are pleased to report excellent progress in the campaign led by Dr. Key to honor Dr. Charles P. Darby and to establish the Children's Hospital Faculty Conference Room in the CRI. Drs. Darby and Key wish to express their heartfelt gratitude to all who are contributing.
Influenza Vaccine Crisis
Written by: George Johnson, MD
Influenza viruses causing human infection are classified into three types (A, B and C). Influenza type A or B viruses cause epidemics of respiratory disease almost every winter. In the United States, these winter influenza epidemics can cause illness in 10 to 20 percent of the population and are associated with an average of 36,000 deaths and 114,000 hospitalizations per year. Getting a flu shot can prevent illness from types A and B influenza. Influenza type C infections cause a mild respiratory illness and are not thought to cause epidemics. The flu shot does not protect against type C influenza.
Everyone is aware of the influenza vaccine shortage in the United States and the concerns that the shortage has raised of increased disease and mortality in this country, resulting from influenza infections. Since seasonal surveillance started on October 3, the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories have tested a total of 4,736 specimens for influenza viruses and 40 (0.8%) were positive. Among the 40 influenza viruses, 30 (75%) were influenza A viruses and 10 (25%) were influenza B viruses. Fourteen states from seven of the nine surveillance regions** have reported laboratory-confirmed influenza this season. As of October 30, no influenza infections have been confirmed in South Carolina and nationally no influenza-associated pediatric deaths have been reported to the Centers for Disease Control and Prevention (CDC).
On October 5, 2004, the CDC was notified by Chiron Corporation that none of its influenza vaccine (Fluvirin®) would be available for distribution in the United States for the 2004-05 influenza season. The Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom suspended the company's license to manufacture Fluvirin vaccine in its Liverpool facility for three months, preventing any release of this vaccine for this influenza season. This eliminated 48 million doses, effectively reducing by half the supply of trivalent inactivated vaccine (flu shot) available in the United States for the 2004-05 influenza season.
The remaining supply of influenza vaccine expected to be available in the United States this season is nearly 58 million doses of Fluzone® (inactivated flu shot) manufactured by Aventis Pasteur, Inc., with 33 million of these doses already distributed. In addition, approximately 3 million doses of live attenuated influenza vaccine (LAIV/FluMist ®) manufactured by MedImmune will be available this season.
Confronted with this urgent situation on October 5, 2004, the CDC and its Advisory Committee for Immunization Practices (ACIP) issued interim recommendations for influenza vaccination during the 2004-05 season. The recommendations identified the priority groups for vaccination with inactivated influenza vaccine this season. On November 9, 2004 federal health officials announced a plan for reallocating the remaining 10 million doses of flu vaccine to the states based on the number of high-risk people in each state and the number of doses already received. The vaccine will be targeted to people most in danger of serious complications from influenza, such as the elderly and young children.
Recently researchers reported that there is a possibly of extending the scarce U.S. supply of flu vaccine by diluting it and injecting it differently. Two articles comparing reduced vaccine dose administration and intradermal (between skin layers) administration to regular intramuscular injection will be reported in the November 25, 2004 edition of the New England Journal of Medicine (NEJM). The studies found that the lower-dose intradermal vaccine worked well in adults 18 to 60 years of age with strong immune responses to the influenza viruses. However the studies found that the approach was not successful for one group at the most risk from influenza, people over 60.
These two articles with an editorial are available through the NEJM Web site at
http://content.nejm.org/early_release/index.shtml#11-3-04.
Additional information about influenza, the high priority groups and the vaccines can be found on the CDC Web site at
http://www.cdc.gov/flu/.
Meet Our Residents
There are 44 residents at MUSC Children's Hospital. These residents are all unified by their exceptional training in pediatrics; yet they are a diverse group representing different backgrounds, cultures and perspectives. The residents and interns have been on medical missions to South Africa, Vietnam and South America. Some are horse trainers, competitive track and field athletes or US Senate interns. One graduated cum laude in French literature and another studied glass blowing in Paris for a year. Some have even been on JEOPARDY and wagered a true daily double! While joined by a common goal to become pediatricians, each resident brings a breadth of experiences that makes each of them unique. Spend some time talking with them and you will find how special they really are.
Chris Pruitt, MD
Chris attended medical school at MUSC. While he may not be certain about which pediatric field he'll go into, there is one thing Chris is sure of - he's one heck of a dancer.
BJ Smith, MD
BJ attended medical school at East Tennessee State in Johnson City, Tenn. and came to MUSC because of the variety of cases and excellent teaching. BJ plans to go back to the mountains of Tennessee and practice general pediatrics. He enjoys backpacking, skiing, and most other outdoor activities. BJ's goal before leaving Charleston is to be able to stand up on a surfboard.
Jennifer Janzen, MD
Jennifer completed medical school at the University of Oklahoma and is considering a career in GI, pulmonary or general pediatrics. Her favorite hobbies include watching the Sooners play football, going to church, trying new recipes, doing home-improvement projects with her husband, and exercising.
Dino Copses, MD
Dino attended medical school at MUSC and is hoping to go into private practice. Dino enjoys French and mediterranean cooking, oenology, water sports, running, poetry, music, yoga, glass blowing, tennis, literature/philosophy, mycology, chinese/japanese tea tasting, and medical history.
Cameron Anderson, MD
Cameron completed medical school at East Carolina University in Greenville, North Carolina and plans to eventually use her skills in the mission field. Her hobbies include long runs with her golden retriever, reading books on the beach and pretending to be a tourist around Charleston with her husband. Cameron and her husband are especially thankful to be expecting a baby.
Liso Gallo, MD
Liso attended medical school at the University of Florida in Gainesville, Fla. and is hoping to do a fellowship in pediatric endocrinology. Liso is a devoted Gator football fan and in her spare time she enjoys karate, step aerobics, hiking and mountain climbing.
James McElligott, MD
James attended Wake Forest University and is interested in a subspecialty but is currently undecided. He plays in a band called Moonlight Ale and enjoys playing soccer. James tries to get back to his homeland, Ireland, whenever possible.
Nancy Monestime-Williams, MD
Nancy attended the MUSC after obtaining her undergraduate degree at Harvard University and her masters degree in public health from Columbia University in New York. Nancy is undecided about what area of pediatrics she will focus on but is leaning towards general pediatrics, with some time spent concentrating on international medicine since her family is from Haiti. Nancy enjoys dancing, teaching dance and spending time with her new puppy.
Joyce Peebles, MD
Joyce attended undergraduate and medical school at the University of South Carolina in Columbia where she participated in track and field. Joyce grew up in Pendleton, South Carolina and her hobbies include running, swing dancing and a newly revitalized interest in surfing.
Melinda Penn, MD
Melinda completed medical school at Eastern Virginia Medical School and is very interested in pediatric endocrinology. After reviewing the most recent pediatric endocrine literature, Melinda enjoys playing with her dog, Auri and driving her Vespa.
Juli Schneider, MD
Juli attended medical school at the University of Kentucky and is considering a career in either neonatology or general pediatric practice. Juli's hobbies include riding her bike around Charleston, having long dinners with good friends and watching CSI - all three iterations.
Johnathan Slaughter, MD
Johnathan attended Wake Forest University and is interested in neonatology. For fun, he goes on long runs to see the sights of Old Charleston. Because he has always been interested in American history, Johnathan feels that Charleston is the perfect place for him.
Phillip Warr, MD
Phillip attended the Medical College of Georgia and says that when he grows up he would like to specialize in sports medicine. Phillip enjoys tennis, running and long walks along Folly Beach. Every year his family gets together to celebrate Festivus.
Heather Will, MD
Heather received her undergraduate degree at Virginia Tech and attended Eastern Virginia Medical School. She grew up in Culpeper, Virginia and enjoys horseback riding, biking, and tennis.
A special thanks to the following individuals for their efforts in putting together Kids Connection each month.
Managing Editor: Bernard L. Maria, MD, MBA
Assistant Editor: Mary Jacobs
Publisher: Jessica Munday (Trio Solutions Inc.)
Web design: Jennifer Cherock (Trio Solutions Inc.) and Brian Dadin (MUSC IT Lab)
Contributing Writers: Lyndon Key, MD; Phil Saul, MD; George Johnson, MD and John Sanders
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