171 Ashley Ave.
Charleston, SC 29425
843-792-1414
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March 2005
This edition:
Letter from the Chair
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L. Lyndon Key, MD
Professor and Chairman
Department of Pediatrics |
Very exciting changes are taking place in pediatrics this spring. The CRI is now up and going. The "Fast Track Program" is providing an option for acutely ill, otherwise healthy children to be seen quickly and efficiently. When spring arrives, the chairman's mind and heart turn towards education, due in part to the emphasis on the residency match.
MUSC Children's Hospital is going to be starting a hospitalist service. We have three major goals:
- To improve the outcomes and safety of our inpatient care
- To improve bed turnover, increasing hospital bed availability
- To improve education for our students and residents
This program is quite exciting, building on the success that has resulted from the adult hospitalist program and jumping on the leading edge of a new pediatric trend. Over the coming weeks we will want all of our faculty, staff, residents, and referring physicians to give us their view on how this program should evolve and grow. This program will hopefully fuel another revolution, an opportunity to create an educational paradigm shift.
Johns Hopkins began a revolution in medical education when his will dictated that a Hospital should be located adjacent to a medical school. This insight seems so absurdly obvious to us now that we cannot imagine anyone doing otherwise. However,the Flexner report and the work of many forward-thinking physicians were needed to actuate this change.
Today, the revolution in medicine is based upon evidence--evidence that therapies work, are the best avaiable, and are being employed properly. However, the majority of physicians are not yet well-versed in the techniques needed to make evidence-based assessments, much less, to be able to design, carryout and analyze an evidence-based study. In the future, the very idea that we would treat patients without a clear evidence-based treatment plan will seem ludicrous.
For this reason, our department will be putting an evidence-based curriculum into place this July. In the first year of residency, each categorical pediatrics resident and each med/peds resident will begin to learn evidence-based analysis techniques and study design. This curriculum will provide a basis for the residents to analyze clinical studies, access and understand evidence-based repositories, and define best practices. However, this approach is only the beginning.
In subsequent years, the students will take their unanswered questions and design studies to assess these questions. In year three, the studies performed will be analyzed and written into clinical reports. Some will be publishable manuscripts and some will be short reports used as pieces of positive or negative evidence in designing future clinical pathways.
During years one and two, faculty will be the teachers and preceptors (akin to the captains of a team, teaching, but also developing the projects). In the third year, however, the residents will become the teachers and from there on, this program of evidence-based learning will belong to the residents, not the faculty. Indeed, I expect that in this endeavor, the faculty will become the learners. Hopefully, we teachers will be able to become lifelong learners, realizing that just as we do not have computer skills of children, we will need to bow to the next generation for their knowledge of evidence-based decision making.
May we live in exciting times,
L. Lyndon Key, MD
Chair, Department of Pediatrics
Feature Story: MUSC Children's Hospital's Neonatal Intensive Care Unit Earns Top 10 National Ranking
By: Jessica Kersey
South Carolina parents and children are fortunate to have the resources of a top-10 ranked Neonatal Intensive Care Unit (NICU) at MUSC Children's Hospital, a national award given by Child magazine.
For the past five years, Child magazine has provided a vital tool for parents - a survey presenting an annual ranking of the nation's children's hospitals. They not only evaluate the overall hospital, but subspecialties as well, including neonatal care. To receive this prestigious honor, hospitals must be a full-voting member of the National Association of Children's Hospitals and Related Institutes. From these 144 qualifying hospitals, the field is narrowed down to 100 by an in-house evaluation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Finally, selected hospitals complete a 164-question survey focusing on factors such as nurse-to-patient ratio, research funding, and overall hospital experience by both child and parent. The recently released 2005 rankings place MUSC Children's Hospital in the top 10 for neonatal care.
The NICU has 38 intensive care beds, 20 Level II nursery beds and is the region's largest and most sophisticated critical care facility for newborns. Directed by David Annibale, MD, and Dilip Purohit, MD, the NICU admits approximately 900 patients each year. The dedicated staff, superior patient care, and continuous training all played an integral role in receiving this top honor. Their excellent nursing staff has the capability of providing one-to-one care for patients if necessary. And the NICU relies on its extremely coordinated patient care as well. All staff place emphasis on excellence, quality improvement, and safety to provide patients with top-notch care. Every team member works to develop and update procedures with the latest information using national guidelines.
"It is a wonderful morale booster for the NICU team," states Dr. Purohit. "In our heart we know that we are dedicated and provide the best care, but to be recognized by an independent agency reinforces what we already know."
Consistent with the Medical University's focus on patient care, research, and education, the NICU participates in both clinical and bench research studies. Neonatal-perinatal fellows receive clinical exposure, as well as opportunities to participate in administration and research.
Dr. Annibale is extremely proud of all the internal factors that helped to rank the NICU nationally, but he also mentions the external factors that contributed to the success of the NICU, such as an efficient transport program.
"Meducare, MUSC's emergency air transport, allows prompt and stable delivery of the infants to the NICU," he explains.
He also stresses that other departments contribute to this award as well. "The NICU's improved outcomes are a direct result of MUSC's excellent high-risk OB services," he notes. "Our mothers and babies come to the NICU stabilized and ready for neonatal care."
The news of this top ranking comes during recent talks of construction on a brand new NICU facility here at MUSC Children's Hospital. "If we are meeting and exceeding the criteria for this ranking with our current NICU, I can only imagine how a more advanced facility will enable us to perform," comments Dr. Purohit.
Congratulations to the NICU staff on this special recognition. With more than 900 babies being treated each year, the NICU meets the important, critical needs of children and parents in our state and our local community.
For more information on Child's annual hospital survey, go to www.child.com.
Update from the Administrator
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John Sanders, MHA
Administrator
MUSC Children's Hospital |
South Carolina's Only Children's Burn Program
We use the slogan, "Kids are different, so are we," meaning that the care children and their families need is different than what is found in adult facilities. That fact is very true in treating burned children. Burns are very frightening and traumatic for all involved and children need special care from professionals trained in taking care of these cases. Unfortunately, many of the burned children in our state are sent to adult facilities for treatment and have difficulties because they are treated in the same manner as adults .
We are fortunate at MUSC Children's Hospital to have a very accomplished pediatric burn program. The team that provides the care is composed of surgeons, intensivists, nurses, child life specialists, social workers, occupational therapists, pharmacists and nutritionists who are all dedicated to the care of burned children. As the only comprehensive burn program in South Carolina, we have the ability to care for the full spectrum of burns, from minor to the most severe.
Burns are injuries that we don't like to think about and fortunately, most of us don't experience them. However, for those children who are burned in South Carolina, there is a place where they can get specialized care and that is MUSC Children's Hospital.
Pediatric Burn Center
Children's Research Institute News Brief
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Bernard L. Maria, MD, MBA
Executive Director
Children's Research Institute |
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Inderjit Singh, PhD
Scientific Director
Children's Research Institute |
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On March 17-19, 2005, the Cardiovascular Developmental Biology Center (CDBC) will host its 5th Annual Symposium on "Animal Models in Cardiovascular Developmental Biology." The symposium includes a lecture by Jeff Robbins, MD, PhD, from the Cincinnati Children's Hospital Medical Center and the TABER Lecture will be by Parker Antin, MD, PhD. For more information about the symposium, see http://cba.musc.edu/cdbc/workshop2005.
The pediatric heart research program on the 6th floor of the Institute is directed by Drs. Roger Markwald and J. Philip Saul. The overarching goals are:
- to identify the genetic causes of congenital heart disease and the impact of the genome on the cardiac phenotype;
- to better understand abnormal coronary vascular development;
- to explore potential approaches for in vivo repair of heart defects in children;
- and to engineer tissue replacements for structurally defective newborn hearts or diseased adult cardiac structures .
More than 20 faculty members from MUSC, the University of South Carolina (USC) and Clemson University are affiliated with the CDBC. They have collaborated to successfully compete for two funded program projects, a pediatric cardiology research training grant, a Center of Biological Research Excellence (COBRE) in developmental cardiovascular sciences, as well as 22 collaborative NIH R01 (plus R21, R03) proposals and NSF and NASA awards. They have also encouraged national and international collaborations, such as a Fogarty FIRCA award.
The CDBC hosts a major annual international research forum that focuses on animal models this year. In additions, as part of the move into the Children's Research Institute, the CDBC is refining a morphogenetics scientific theme that includes use of adult bone marrow or human cord blood stem cell technology for regeneration. Bioengineering faculty from the MUSC-Clemson Program are applying principles of developmental biology to the regeneration of new cardiovascular tissues.
NIH director Dr. Elias Zerhouni has said that through the Roadmap Initiative ..."we hope to remove some of the biggest roadblocks that are keeping research findings from reaching the public as swiftly as possible."
It seems clear that children's heart researchers in the CRI are extremely well positioned to swiftly move scientific discoveries from the 'benchtop' to Children's Hospital 'bedsides.'
Mental Health Resource News Brief
Substance Use Assessment
Pediatric substance use is one of the most commonly missed pediatric diagnosis according to our recent Grand Rounds speaker, Himanshu Upadhyaya, MD, director of the Substance Use Fellowship and assistant professor of Psychiatry and Behavioral Sciences.
Although 8th to 12th grade students using substances has decreased from 19.4 percent to 16.1 percent in recent years, it remains a significant problem with the percentage of 8th graders reporting lifetime use of inhalants increasing to almost 18 percent. At least 80 percent of smokers become addicted prior to age 18 and 3,000 adolescents start to smoke tobacco each day.
Primary care providers and parents must recognize risk factors such as peer drug use and poor academic achievement. Our young people need to be taught the seriousness of associated health problems and the risk of decreased success with life goals, with a focus on the reality that occasional substance use has consequences.
The associated morbidity and mortality is evident when one realizes that almost 21 percent of youth aged 16 to 20 reports driving under the influence of either alcohol or illicit drugs. Use of the CRAFFT (Knight, 1999) questions (use in car, used to relax, while alone, forget things while using, family/friends want you to cut down use, trouble while using) can help with assessment.
Call Erin at (843) 792-8514 for information regarding the adolescent smoking cessation study. See
http://www.musc.edu/asap, http://teens.drugabuse.gov and http://www.smokefree.gov for more information.
Health care providers are invited to join our Promoting Happy and Healthy Youth Breakfast study group the third Tuesday of each month at 8 a.m. in room 377 Rutledge Tower for discussion of strategies to address mental health issues in medical settings. The Maternal and Child Health Bureau supports this group and Shire pharmaceutical company generously provides breakfast.
Contact spratte@musc.edu or maciasm@musc.edu for additional information.
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; Bernard Maria, MD; John Sanders and Jessica Kersey
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