Impacts of a University Research Assistant Program: The First Decade.

Purpose: There is a declining number of physician-scientists. Little is published about the potential for university student experiences to contribute to the pipeline of future researchers. The purpose of this study was to describe a unique university research program and report the outcomes of the first 10 years.

Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting.

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care.

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents.

Predictors for Acute Appendicitis in Children.

Background: Acute appendicitis in children is the most common condition requiring urgent evaluation and surgery in the emergency department. At times, despite the appendix being seen on ultrasound (US), there can be discrepancy as to whether a patient has clinical appendicitis. Secondary findings suggestive of appendicitis can be helpful in identifying and evaluating these children.

Role of Patients and Parents in Pediatric Drug Development.

Patient engagement in health care has been an emerging priority in the global effort and move toward the consideration of patients as experts of their own conditions. However, the input of pediatric patients and their families have not been consistently requested nor regarded as valuable when deriving protocols for, as well as assessing the outcomes of, pediatric clinical trials. Extending this mutual collaboration further upstream is important, especially in the area of pediatric drug development where the lack of formalized trials for children and adolescents result in the increased use of off-label prescribing and risk of adverse effects.

Predictors of abnormal electrocardiograms in the pediatric emergency department.

Background: Electrocardiograms (ECGs) are ordered in the pediatric emergency room for a wide variety of chief complaints.

Objectives: Criteria are lacking as to when physicians should obtain ECGs. This study uses a large retrospective cohort of 880 pediatric emergency department (ED) patients to highlight objective criteria including significant medical history and specific vital sign abnormalities to guide clinicians as to which patients might have an abnormal ECG.

Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix.

Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. Objective: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized.

Pediatric Adapted Liking Survey: A Novel, Feasible and Reliable Dietary Screening in Clinical Practice.

Purpose: Rapid yet useful methods are needed to screen for dietary behaviors in clinical settings. We tested the feasibility and reliability of a pediatric adapted liking survey (PALS) to screen for dietary behaviors and suggest tailored caries and obesity prevention messages.

Methods: In an observational study, children admitted to a pediatric emergency department (PED) for nonurgent care were approached to complete the PALS (33 foods, 4 nonfoods including brushing teeth).

Asthmonia: A clinical definition of a commonly used colloquial term.

Objective: To describe the clinical characteristics of pediatric asthmonia, a syndrome in which children have both an acute asthma exacerbation and a concomitant diagnosis of community acquired pneumonia.

Methods: A retrospective chart review was conducted on children admitted to Connecticut Children's Medical Center in the pediatric emergency department from January 1, 2012 to December 31, 2012. Children with asthma and pneumonia were identified using ICD-9 codes 493 (asthma) or 482 (pneumonia).

Revisiting the Appendiceal Diameter via Ultrasound for the Diagnosis of Acute Appendicitis.

Objectives: This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis.

Methods: A retrospective chart review was conducted on patients (ages, 2-18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having "suspected acute appendicitis" if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis.

Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion.

Objectives: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed.

Methods: A convenience sample of 114 children aged 7 to 17 years presenting to an urban pediatric emergency department with a complaint of concussion was assembled.

Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis.

Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US) or computed tomography (CT) studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation.

iCAN: Providing a Voice for Children and Families in Pediatric Research.

Research and innovation are critical to improving the health and well-being of the world's children; clinical trials yield important information on a medical product's safety, dosing, and effectiveness. While the prescribing information available to pediatric providers has substantially improved, approximately 50% of medicines still do not have data on their labels to guide their appropriate use in children. Regulatory bodies have recently taken measures to ensure, if drugs have a potential pediatric indication, that the safety and efficacy clinical trials include the pediatric population.

CARES: improving the care and disposition of psychiatric patients in the pediatric emergency department.

Objectives: Pediatric psychiatric emergencies are a nationwide crisis and have contributed to an increase in behavioral health emergency department (ED) visits. A collaborative response to this crisis was the creation of the Child & Adolescent Rapid Emergency Stabilization (CARES) program. The objective of this study is to determine how the CARES unit influenced length of stay (LOS) and costs for psychiatric patients in the pediatric ED.

The feasibility of screening for violence in the pediatric emergency department.

Background: Youth violence is a significant public health concern. The objective of this study was to evaluate the feasibility of violence screening tools in a pediatric emergency department (PED).

Methods: Children between eight and 17 years presenting to the PED were prospectively enrolled.

Corticosteroid timing and length of stay for children with asthma in the Emergency Department.

Objective: The aim of this study was to evaluate the relationship between time of corticosteroid administration to children with asthma exacerbations in the Emergency Department (ED) and length of stay (LOS). We hypothesized administration within 60 minutes would be associated with a 10- minute or greater decrease in mean LOS.

Methods: A retrospective chart review of 882 patients was conducted.

Factors associated with attaining coaching goals during an intervention to improve child asthma care.

Purpose: To examine parent and child characteristics associated with engagement in a coaching intervention to improve pediatric asthma care and factors associated with readiness to adopt and maintain targeted asthma management behaviors.

Methods: Using methods based on the Transtheoretical Model, trained lay coaches worked with 120 parents of children with asthma promoting adoption and maintenance of asthma management strategies (behaviors). Coaches assigned stage-of-change (on continuum: pre-contemplation, contemplation, preparation, action, maintenance) for each behavior every time it was discussed.

A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children.

Objectives: To investigate whether asthma coaching decreases emergency department (ED) visits and hospitalizations and increases outpatient asthma monitoring visits.

Design: Randomized controlled trial.

Setting: Urban tertiary care children's hospital.

"Be quick": a systems response to overcrowding in the pediatric emergency department.

Objective: The purpose of this study was to evaluate the combined effects of focused system changes on several key measures of emergency department (ED) quality (length of stay, waiting time, rate of leaving without being seen, and patient satisfaction) in a children's hospital ED.

Methods: System-wide ED changes were made and implemented during a 6-month period. The combined changes are called "be quick"--BEQK.

A fever of unknown origin workup in the emergency department reveals an unusual pathogen.

The cause of a fever of unknown origin (FUO, fever of >21 days without an identified etiology) may be a common illness, an atypical presentation of a common illness, or an unusual illness. A patient with an FUO occasionally presents to the emergency department (ED). The differential diagnosis of an FUO is extensive.

Recombinant human hyaluronidase-enabled subcutaneous pediatric rehydration.

Objectives: The Increased Flow Utilizing Subcutaneously-Enabled (INFUSE)-Pediatric Rehydration Study was designed to assess efficacy, safety, and clinical utility of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous rehydration in children 2 months to 10 years of age.

Methods: Patients with mild/moderate dehydration requiring parenteral treatment in US emergency departments were eligible for this phase IV, multicenter, single-arm study. They received subcutaneous injection of 1 mL rHuPH20 (150 U), followed by subcutaneous infusion of 20 mL/kg isotonic fluid over the first hour.

Acute asthma management by a pediatric after-hours call center.

To describe an asthma management protocol used in a nurse-staffed pediatric After-Hours Call Center (AHCC) that incorporates severity-based home treatment recommendations and follow-up call assessments. Call records for asthma advice from January 1, 2004 to June 30, 2004 were identified retrospectively and reviewed. Descriptive statistics were used to report patient demographics, frequencies of symptom severity zones (Red, Yellow, or Green) at initial calls, frequencies of call dispositions designating care advice provided (including home treatment recommendations and seeking emergency department [ED] care), and changes in severity zones between initial calls and follow-up calls when nurses reassessed patients after recommended home treatment.

Home use of albuterol for asthma exacerbations.

Background: To reduce symptoms and emergency department (ED) visits, the National Asthma Education and Prevention Program (NAEPP) guidelines recommend early treatment of acute asthma symptoms with albuterol and oral corticosteroids. Yet, ED visits for asthma are frequent and often occur several days after onset of increased symptoms, particularly for children from low-income, urban neighborhoods.

Objectives: To describe home use of albuterol and identify factors associated with appropriate albuterol use.

Does oncotype DX recurrence score affect the management of patients with early-stage breast cancer?

Background: Oncotype DX is a 21-gene assay that calculates a risk of distant recurrence in women with estrogen-receptor-positive, lymph node-negative breast cancer. The purpose of this study was to determine whether the results of Oncotype DX influence the decision to administer chemotherapy.

Methods: A retrospective study was performed on 85 consecutive patients with estrogen-receptor-positive, lymph node-negative breast cancer who had an Oncotype DX recurrence score (RS) obtained.

Pilot study of oral montelukast added to standard therapy for acute asthma exacerbations in children aged 6 to 14 years.

Objective: We hypothesized that children with moderate acute asthma exacerbations receiving oral montelukast with standard therapy will have at least 12% greater forced expiratory volume in 1 second (FEV1) improvement in 3 hours than those receiving standard therapy alone.

Methods: In this randomized, double-blind, placebo-controlled study, we enrolled emergency patients aged 6 to 14 years with moderate acute asthma exacerbations (peak expiratory flow rate, 40%-70% predicted). Subjects received montelukast 5 mg or placebo orally then standard therapy.