Charting Pediatrics

You've likely heard of CRISPR, the comprehensive gene editing technology that emerged in the 2010s and has since revolutionized biological research. Additionally, the medical community has long been using the concept of gene therapy. What's new is that both approaches have now successfully been harnessed for the treatment of human disease. In December 2023, the FDA approved two therapies for the treatment of sickle cell disease; one utilizing CRISPR technology and the other using a gene transfer therapy approach. These therapies now have the opportunity to change the life course of this terrible disease.

Our guest for this episode is Christopher McKinney, MD, who specializes in pediatric hematology here at Children's Hospital Colorado. Dr. McKinney has been the hospital's site principal investigator in some of the clinical trials that are contributing to these new sickle cell therapies, and he is an assistant professor of pediatrics at the University of Colorado School of Medicine.

Some highlights from this episode include:

• How these treatments work for diseases like sickle cell
• What we know about the effectiveness of these therapies thus far
• Important side effects and risks to take into consideration
• Regardless of FDA approval, what barriers are in place
• Powerful patient examples

For more information on Children's Colorado, visit: childrenscolorado.org

In its 7th season, Charting Pediatrics has hit 2 million lifetime downloads! What an accomplishment. Our podcast team wants to thank each of you, our listeners, for tuning in each week to learn about the latest and greatest in pediatric healthcare. This accomplishment would not be possible without each of you, and we are thrilled to have you on this journey. 2024 has a lot of unique opportunities in store. Get ready for more content, new ideas, and further educational opportunities.

In this special episode, our hosts, David Brumbaugh, MD, Alison Brent, MD, and Dan Nicklas, MD, reflect on the growth of this podcast and the advancements that have happened since its inception. "And I am 100% convinced that we are, right now, in what will eventually be referred to as a golden era of pediatric medicine in terms of developing new treatments," Dr. Brumbaugh says.

Here's to 2 million more lifetime downloads, with listeners who are changing the realm of pediatric medicine every day. Thank you for all that you do!

For more information on Children's Colorado, visit: childrenscolorado.org

Children and their families need a healthcare system that serves them wholeheartedly. Having their unique needs prioritized creates an important opportunity for lifelong health and wellbeing. However, the current health system in our country and globally has massive gaps to fill, especially as it pertains to children of color. The medical community is focusing on preventative measures and connections between children, families, communities and the systems they interact with regularly. While large efforts are being made across the child healthcare field, there is strong agreement that child health transformation, with a focus on family -centered pediatric care, needs to be accelerated.

At the forefront of this work is Hala Durrah, MTA, a patient-family engagement consultant and advocate. Joining us virtually from San Marcos California, she discusses her role on the advisory group of national experts in the pediatric field of accelerating child health transformation initiative. She also has professional experience as a national speaker who has served on a number of national committees. Beyond her professional accomplishments, this topic resonates with her much more personally. Her current work in patient-family-centered care stems from her experiences as a mother of a child who has undergone two liver transplants and a bone marrow transplant. "What I realized when I first knew my daughter was sick, was that this was going to be a journey that required me to be as fully knowledgeable and as fully engaged as possible to advocate for her," Durrah says.

Some highlights from this episode include:

• How providers and practices can partake in this work
• The importance of acknowledging patient-family engagement to best care for kids
• What gaps exist and how this method helps to fill them

This episode is underwritten by Aegon Transamerica Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Aegon Transamerica Foundation helps build a better world by committing to the improvement of wellness throughout their communities. Their partnership with Children's Colorado addresses the youth mental health crisis to help create a better mental health future for children. Thank you to Aegon Transamerica Foundation for investing in Children's Colorado.

For more information on Children's Colorado, visit: childrenscolorado.org

Facts and fiction can overlap in movies and television. That's especially prevalent in medical dramas where the details seem so real but often don't portray the full picture. While the intention may be to create powerful entertainment, sometimes a storyline can misinform the viewer. Unrealistic circumstances, overexaggerated outcomes and the bending of scientific truth, create confusion. When it comes to food allergies, how a situation is handled can be the difference between a routine medical occurrence and a lifesaving episode. "This is where we see some really dramatic portrayals because you generate that emotional kind of connection and we see it both from how reactions are portrayed inappropriately or very severe consequences or frankly people make fun of food allergies a lot," David Stukus, MD, says.

In this episode, we dig into how portrayals in the media landscape can impact patient families in the medical community. We are joined by Dr. Stukus, who is otherwise known as the allergy kids doc on social media. Dr. Stukus is the director of the Food Allergy Treatment Center at Nationwide Children's Hospital, as well as a professor of clinical pediatrics in the division of allergy and immunology. In addition, we have Vivian Hernandez-Trujillo, MD, with us. Dr. Hernandez-Trujillo is the director of the Division of Allergy and Immunology at Nicklaus Children's Hospital, as well as a clinical professor of pediatrics at Florida International University Herbert Wertheim College of Medicine. These two doctors are at the forefront of important conversations for change. "I honestly think education is just important. Once we're armed with accurate information, that's powerful. I can speak as a patient, as a mom of two girls with food allergies, and as someone who is a physician for patients with food allergies, my cup is always half full," Dr. Hernandez-Trujillo says.

This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include:

• Common examples of allergy inaccuracies within media
• The narrative around nut allergies
• How we remove the stigma around allergies and change how they are portrayed
• Undoing outdated practices and updating our information

For more information on Children's Colorado, visit: childrenscolorado.org

As doctors, curiosity can be the driving factor to a long, successful, and fulfilling career. It can be the difference between daily repetition and years of practicing evolved education. For Barton Schmitt, MD, curiosity has been a transformative force for over 50 years, influencing his approach to teaching residents, patient encounters and career development. Otherwise known as a true icon of pediatrics, Dr. Schmitt's humble, down-to-earth nature helped create one of the most prestigious pediatric guidelines in our industry. "Feedback from a variety of sources is really the life blood of all of this. At least 100 to 150 of the protocols are updated every year," Dr. Schmitt says.

For more than five decades, Dr. Schmitt has elevated the Children's Hospital Colorado name while creating an honorable legacy of his own. Many of you know him as the author of the 'Pediatric Telephone Triage Guidelines' used in our Pediatric Call Center. Those decision-support tools are now used worldwide and have been translated into multiple languages. Throughout his career he's had numerous other titles such as the Faculty Attending for the Child Health Clinic and the medical director of the Child Protection Team. Now on the brink of his next chapter, we reflect on his incredible legacy and find out what's next.

"I'm hoping to retire when I'm 90. I've got to because I have other things I want to do, including some books I want to write about teaching residents," Dr. Schmitt says.

Some highlights from this episode include:

• Details about the creation and expansion of the Pediatric Telephone Triage Guidelines
• The impact that curiosity has had on his career
• His hopes for the future
• Advice for doctors, nurses and medical professionals

"Continual quality improvement is a team sport," Dr. Schmitt says.

Dr. Schmitt wants to thank the many health care professionals who help him keep the pediatric telehealth guidelines, parent handouts and symptom checker up-to-date. Most of all, his dedicated pediatric editorial team:

• Medical editors: Sam Wang, MD, and Julia Bruckner, MD.
• Nurse editors: Kelli Massaro, RN and Lisa Swerczek, RN.
• Specialists at Children's Colorado, who provide expert reviews of new topics.
• The many triage nurses who have worked in the Children's Colorado call center since 1988 and made observations that led to change.
• David Thompson, MD FACEP and the Adult Editorial Team
• The nurse leadership at over 40 other U.S. and Canadian call centers who provide the annual user feedback that keep the guidelines reality-based and evolving.

For more information on Children's Colorado, visit: childrenscolorado.org

Digital content is at the center of our society and its prevalence continues to grow. Storytelling on digital platforms allows the medical community to showcase groundbreaking research and connect with audiences, who otherwise may not be privy to this information. Experts like Joshua Williams, MD, are at the forefront of some of this innovation. In October 2023, he received the Advancement in Research Award at the American Academy of Pediatrics National Conference.

Dr. Williams is an assistant professor of pediatrics at the University of Colorado School of Medicine, as well as a practicing primary care pediatrician with Denver Health. He is the principal investigator on a National Institutes of Health grant to examine the impact of digital storytelling on influenza vaccination equity. In addition, he is a co-investigator at the Denver Health for the Centers for Disease Control and Prevention Vaccine Safety DataLink Project. "And what I hope comes from it is improvement in equity, improvement in the rate of influenza vaccination uptake in groups that historically haven't had high uptake," says Dr. Williams

Some highlights from the episode include:

• The larger goals of these data- and digital-based projects
• How to merge medicine and storytelling
• Advice for young doctors and medical professionals
• Finding success from rejection

Dr. Williams will be presenting on this very topic at the PAS 2024 meeting in Toronto, Canda.

For more information on Children's Colorado, visit: childrenscolorado.org

Pediatricians, families, and pharmacists are faced with increasing drug costs and a vast array of complex biologic therapies. Up-to-date knowledge on prescribing practice is constantly a need, specifically regarding generics and the availability of biosimilar and interchangeable biosimilar agents. According to a report from the Association for Accessible Medicines, the U.S. healthcare system saved $408 billion from using generic and biosimilar drugs in 2022, a huge jump from the $195 billion in savings accumulated in 2013. In today's episode, we have a rare opportunity to learn critical knowledge about this topic from renowned experts in the field.

We are joined by John Routt Reigart, MD, and Dr. Siu. Dr. Reigart is professor emeritus at the Medical University of South Carolina as well as the chairperson for the American Academy of Pediatrics' (AAP) Committee on Drugs. "I have been recognized in my state, and to some extent nationally, as being an advocate for improved health for children. I feel that it's very important that pediatricians be advocates for effective regulations for their patients," Dr. Reigart says.

Dr. Siu is a clinical professor, the vice chair for teaching and learning, and the director of faculty mentoring at the Ernest Mario School of Pharmacy at Rutgers University. She is a pediatric pharmacy clinical coordinator and practices at the K. Hovnanian Children's Hospital and Jersey Shore University Medical Center. She has also been appointed to the board of directors of the Board of Pharmacy Specialties and the Pediatric Pharmacy Association liaison for the AAP Section on Clinical Pharmacology and Therapeutics executive committee. "We want to make sure that medications are easily accessible to families and we also want to make sure that they are also cost effective," Anita Sui, PharmD, says.

This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include:

• The difference between biologics and generics
• What the orange and purple books are and their roles in the industry
• What an interchangeable product is
• Patents and exclusivity
• What savings could look like with an uptick of biologics and generics

For more information on Children's Colorado, visit: childrenscolorado.org

For the second time in Charting Pediatrics history, we brought a live audience together to watch the taping of an episode with a guest who has made an everlasting impression on our hospital system. This time, the show was for our colleagues here at Children's Hospital Colorado. Our guest is one of the top healthcare executives within pediatric hospitals in North America. Don't just take our word for it; she was recently selected to be the chair of the board of trustees for the entire Children's Hospital Association. Under her leadership, Children's Colorado has been routinely identified as one of the country's top 10 pediatric healthcare systems. In recent years, her advocacy for greater pediatric behavioral healthcare is a notable example of her dedication to research and innovation.

In today's episode, we welcome Jena Hausmann, the CEO and president of Children's Colorado. "I think leaders really should be authentic and should role model, always, their true leadership self and impact. I do think it is important for any of us to see ourselves reflected in whether it's gender or race or ethnicity or age or you name it," says Hausmann.

Some highlights from this episode include:

• Jena's career evolution and how she landed in her current role
• How to make an impression in healthcare administration
• The role that mentors play in career growth
• The example she aims to set for women in leadership
• How Jena's authenticity and vulnerability enhance her leadership
• The trends in U.S. healthcare that will impact how we care for kids

For more information on Children's Colorado, visit: childrenscolorado.org

Every day, we see patients whose medical hurdles land them at hospitals like Children's Hospital Colorado. There are many answers our providers and specialists can provide when giving patient families a medical diagnosis, but many of those same children are facing gaps and inequities socially. Often, they fall into different minority groups facing disparities in healthcare equality. Medical insurance may cover labs and procedures, but it doesn't cover the need for food or housing. Those are just two examples of social barriers that greatly affect one's health. While many questions remain on best practices for social care programs and how we bring them to fruition, experts, like our guests today, are working hard to use them effectively. "We can't meet family's needs if we don't know what they are. So, the first step is assessing what those needs are," says Lisa DeCamp, MD.

In today's episode we are joined by Lisa DeCamp, MD, a practicing general pediatrician at Children's Colorado and an associate professor at the University of Colorado School of Medicine. Her research focuses on increasing healthcare engagement of Spanish -speaking Latino families and reducing disparities in healthcare equality and safety for patients and families with limited English proficiency. Julie Beaubian is an operations manager here at Children's Colorado within the community health department. She manages community benefits for the hospital. "So we're constantly trying to balance what is reasonable, what does the family need and how can we continue to support that family," Beaubian says.

Read the paper mentioned in this episode.

Some highlights from this episode include:

• Outlining this Children's Colorado social care program
• How this program can influence other communities and hospitals
• Social barriers and how that impacts healthcare
• How we can bridge gaps for communities facing inequities

For more information on Children's Colorado, visit: childrenscolorado.org

While considerable progress has been made in reducing cigarette smoking among our nation's youth, the tobacco product landscape continues to evolve. It includes a variety of tobacco products, including smokeless and electronic products such as e-cigarettes. E-cigarettes entered the U.S. marketplace around 2007, and since 2014 they have been the most used tobacco product among youth. E-cigarette use, among middle and high school students, remains unacceptably high and sets youth up for lifelong nicotine addiction and the effects of toxin exposure.

In today's episode, we are joined by Brian Williams, MD, a pediatric and adult hospitalist. He is an assistant professor of pediatrics and internal medicine at the University of Wisconsin School of Medicine and Public Health. Dr. Williams has a research interest in how we promote vaping cessation in young people. "As a resident at UC San Diego, I grew sort of tired and frustrated by seeing patients suffering complications from secondhand smoke exposure," Dr. Williams says.

In San Diego, he founded a program that trained nurses to screen for tobacco exposure among the parents of pediatric patients. It worked, increasing screenings from 66% to nearly 100%. "The popularity of e-cigarettes is concerning, and we are seeing rising rates in both middle schoolers and high schoolers," says Williams.

This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include:

• Why are e-cigarettes so appealing to youth
• Harmful ingredients in e-cigarettes
• Potential impacts on brain development
• How advertising impacts behavior

For more information on Children's Colorado, visit: childrenscolorado.org