Charting Pediatrics

In a busy outpatient practice, timely access to up-to-date clinical resources is crucial to delivering evidence-based care. In the olden days, books and journal articles were the go-to method. Today, technology creates a more user-friendly method of receiving the most recent information. Say goodbye to having to order the latest edition of a book and hello to automatic updates. Our Children's Hospital Colorado antimicrobial stewardship team, clinical effectiveness and pathways teams, along with other local and state partners have partnered with Firstline, a health technology company, to design a mobile version of our infectious disease guidance. "It is another way to bring clinical decision support directly into somebody's hand if they are not sitting at a computer, which a lot of times you are not," Leigh Anne Bakel, MD, says.

A technology like this can change the future of treating patients. With new information comes new treatment choices, and this app is a way to put all of that content in the palm of a provider's hand. "It's really about judicious use, so using the right antibiotic for the right length of time but also only in the right patient and then the right dose; I think we understand overtime that antibiotics have a lot more side effects than we previously appreciated," Sarah Parker, MD, says.

Joining us to talk about this innovative technology are Drs. Sarah Parker and Leigh Anne Bakel. Dr. Parker is the Medical Director of the Antimicrobial Stewardship Program here at Children's Colorado, as well as a professor of pediatrics in the Division of Infectious Diseases at the University of Colorado School of Medicine. Dr. Bakel is the Medical Director of Clinical Effectiveness here at Children's Colorado, as well as a practicing pediatric hospitalist. She is also an associate professor of pediatrics.

Some highlights from this episode include:

• How the Firstline app works
• Why Firstline is beneficial for providers everywhere
• How Firstline will enhance rural healthcare
• The future of technology for treating patients

For more information on how to download the app visit https://firstline.org/colorado/. Drs. Parker and Bakel would like to acknowledge the brains behind this operation.

With Children's Colorado:

• Sarah Parker, MD
• Leigh Anne Bakel, MD, MSc
• Michael J Bozzella, DO, MS
• Joana Dimo, DO
• Matthew Weber, Research Assistant, MPH
• Christine MacBrayne, PharmD, MSCS
• Matt Miller, PharmD

With Denver Health:

• Tim Jenkins, MD
• Katie Shihadeh, PharmD
• Maggie Cooper, PharmD

With CDPHE:

• Chris Czaja, MD, DrPH
• Lauren Biehle, PharmD
• Rachel Schaefer, MPH

Other:

• Local and regional providers, infection preventionists and pharmacists who gave feedback
• Firstline
• Pfizer Global Bridges Grant
• Daniel Dodson, MD, MS

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

In today's fast-paced work environment, it can be easy to feel overwhelmed. Due to that intense pace, it's important for employees and employers alike, to promote healthy working behaviors and surroundings. Healthy employees are more productive, have fewer absences, are less prone to work-related injury and are less likely to burn out. "Leading others is how you support them when they show up to work. Showing thanks, giving appreciation, valuing your staff," Jennifer Shaer, MD, says. A 2021 survey tells us that 79% of employees believe their company's wellbeing programs help them be productive employees, but a lot of work still needs to be done.

In today's episode, Jennifer Shaer, MD, joins us to discuss wellness in the workplace and how to nurture a positive culture. Dr. Shaer is the Chief Wellness Officer of Allied Physicians Group in Melville, New York, as well as a board-certified pediatrician, an International Board-Certified Lactation Consultant and a certified executive and life coach. "Sometimes you just need a change in your working environment, physically. Sometimes you need a change in your internal world. I've worked with lots of people who have been able to change their mindset around their work and suddenly enjoy their work and extend their working years," Dr. Shaer says. Dr. Shaer has her own podcast called 'Reinventing the White Coat' which you can find here.

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

• How to nurture a positive workplace culture
• Implementing discipline appropriately
• Identifying a toxic situation
• How to advocate for yourself

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

Suicide is the second leading cause of death for children, adolescents and young adults ages 10 to 24. Roughly 7% to 8% of adolescents attempt suicide each year and 17% report significant suicidal ideation. However, while so many kids are affected, diagnosing them isn't so simple. "We know the numbers have climbed significantly. If you look at the trends, we're probably nearly double what we were 20 years ago," Eric Sigel, MD, says.

In this episode, we shine a light on how to clinically identify youth at risk for suicide and determine if they have access to lethal means, such as firearms or medications. In addition, we will discuss evidence-based approaches to reduce or eliminate access to lethal means. That includes counseling and safe storage device distribution.

Our guest, Dr. Sigel, specializes in adolescent medicine at Children's Hospital Colorado. He is the lead for firearm injury prevention, as well as a professor of pediatrics at the University of Colorado School of Medicine. In addition, he serves as co-chair of the American Academy of Pediatrics firearm injury prevention special interest group. "I think it's an incredible privilege to sit down with a teenager, hear their story and understand a little bit what they may be going through, while being able to help them figure out a better direction to avoid harm," Dr. Sigel says.

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

• The prominence of adolescent suicide in today's society
• Approaches to suicidal identification in a clinical setting
• How a change in easy firearm access can prevent suicide
• Evidence on counseling and safe storage of firearms

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

One goal in our healthcare improvement is to achieve equitable access to high quality emergency care for kids, regardless of where that child is physically located. Children have unique characteristics and needs, especially in the emergency setting, and the reality is that not all kids have access to specific pediatric care. In fact, 80% of children receive emergency care in general emergency departments, most of which see less than 15 pediatric patients a day. However, care in those adult settings is not specifically geared towards children. Research shows that pediatric readiness results in lower mortality rates among sick and injured kids. Fortunately, ongoing state and national initiatives are making strides in enhancing pediatric readiness. "The first piece of this is that the focus is on system design. This is not about the failings of a single provider, or the knowledge or skill set of healthcare providers. We are only as good as the system in which we work," Katherine Remick, MD, says.

In today's episode we are joined by Dr. Remick as well as Kathleen Adelgais, MD. Dr. Remick joins us from Austin Texas, where she is a pediatric emergency medicine provider and an associate professor of pediatrics at the University of Texas at Austin Dell Medical School. She is also the Associate Chair for Quality, Innovation, and Outreach within the Department of Pediatrics. In addition, she is co-director of both the National EMS for Children Innovation and Improvement Center, as well as the National Pediatric Readiness Project. Dr. Adelgais is an emergency medicine physician here at Children's Hospital Colorado and the project director of the Colorado EMS for Children Program. "There are a series of research studies coming out left and right, right now that show the real dramatic impact of pediatric readiness, Dr. Adelgais says. "The research we are getting from the rich data set of the pediatric readiness scores across hospitals, you're hard pressed to find any treatment anywhere for anything that reduces mortality that dramatically."

Some highlights from this episode include:

• What pediatric readiness is and how we achieve it
• The importance of system-level improvements
• What COPPER is and how it aligns with national efforts
• What the pediatric readiness score measures
• Success through the data

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

2023 has been an impactful year. We kicked it off by continuing to cover topics under our mental health series. The rise of teen substance abuse and addiction, the intersection between physical and mental health, as well as depression and other mood disorders are just a few of the topics we dove into. Season 6 wrapped up by discussing the trauma and care around gun violence and highlighting some incredible women in medicine.

Season 7 launched in August and if you haven't noticed, we've started to make some prominent changes. Our audio is sharper, our show notes are more robust, and our attention to detail is more precise. We are taking all of these positive changes into 2024 and are excited to show you what else we have in store.

This episode was an opportunity to get all our hosts together, Drs. David Brumbaugh, Alison Brent and Dan Nicklas, and end 2023 the right way!

From all of us at Charting Pediatrics and Children's Hospital Colorado, we wish you and your families a happy and healthy holiday season and New Year. Thanks for listening, we will see you next year!

In 2021, federal rules from the 21st Century Cures Act mandated that most clinical notes be made available in real-time, online and free of charge to patients. This practice, commonly known as "open notes," was a significant step towards enhancing medical information transparency–– a vital step in reinforcing trust in the provider-patient relationship. However, it also introduced complexities, raising questions as to what to include in the notes. "The ethical analysis does not always align with the legal analysis, and these are conversations that ethicists are aware of," Steven Bondi, MD, JD, says.

Dr. Bondi, a lawyer turned doctor, is renowned for his expertise on the Cures Act, Open Notes and Electronic Medical Records. He specializes in pediatric medicine at Golisano Children's Hospital and is an associate professor within the Department of Pediatrics at the University of Rochester Medical Center. "I think that knowledge is important, and we need to know what the law says and what its parameters are and when we can use the exceptions," Dr. Bondi says.

Dr. Bondi recommends multiple resources on this topic. He suggests visiting healthit.gov and navigating to their information blocking section for informative FAQs and webinars. He also recommends the Guttmacher Institute as a source for general knowledge around adolescent health and privacy. Lastly, he explains that he was recently a part of the American Academy of Pediatrics' committee on medical liability and risk management where he helped produce a monthly column called 'Pediatricians in Law.'

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

• How to navigate difficult situations and avoid labels
• The role that ethics play in this discussion
• Confidentiality in adolescents by state
• Biggest pitfalls and gray areas

Disclaimer: Please note that Dr. Steven Bondi is not an attorney for Children's Hospital Colorado and the information presented in this podcast does not constitute legal advice. Regarding interpretation or application of any of the laws and regulations referenced in this episode, it is recommended that you consult with legal counsel familiar with the laws and regulations applicable to your particular jurisdiction and/or service area.

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

Vaccines are so successful that many people have never seen the diseases they prevent, resulting in misperceptions that vaccines are not needed. While anti-vaccination sentiment and misinformation increased during the COVID-19 pandemic, about 88% of Americans still say they feel the overall benefits of childhood vaccines outweigh the risks. Communicating vaccine science to the public is even more crucial than in times past. It's up to our doctors and medical experts to relay factual information that is backed by science and supported by research. Without receiving proper vaccinations, preventable diseases will keep recurring.

In today's episode, we are joined by Paul Offit, MD, whose path toward infectious disease prevention started at the young age of 5 when a failed foot operation landed him in a hospital in suburban Baltimore for nearly six weeks. "If you're in a chronic care facility in the mid 1950s, because I was born in 1951, you're in a polio ward. So, I remember that," Dr. Offit says.

Now Dr. Offit is a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania. He is an attending physician in the division of infectious diseases at Children's Hospital of Philadelphia, as well as the director of the Vaccine Education Center. "I think the scars of our childhood invariably become the passions of our adulthood. I think it's the reason I became a doctor, I think it's the reason my first book was about polio and the polio vaccine, I think it's why I went into infectious diseases," Dr. Offit says.

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

• Reasons why people have become so hesitant about vaccines
• Some of the biggest misconceptions and stigmas around vaccine science
• Why we need more societal trust in vaccines
• The role of mRNA
• How we can use communication to better our future

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

For most of our careers, our treatments for genetic -based diseases have been supportive, not curative. Our medication recommendations for patients have been based on the expected response of the average individual, but as experts explain, these practices are going to change fast. We are on the cusp of a revolution for two main reasons. First, the ability to understand one's unique genetic profile through genetic sequencing has become more accessible to clinical teams. Second, there are now mechanisms for manipulating one's genetic code to overcome diseases. So what does this mean we can expect over the next decade? Scott Demarest, MD, shares his experience in precision medicine and what that foreshadows for treatments to come. "This is sort of the most extreme version of personalized care that you can imagine and it was something that redefined what we think of as possible within medicine," Dr. Demarest says.

Dr. Demarest is an associate professor of pediatric neurology at the University of Colorado School of Medicine and the clinical director of the Precision Medicine Program at Children's Hospital Colorado. He's a perfect expert for this topic, as his research has focused on the characterization of clinical features and clinical trial design for disease -modifying treatments, as well as the development of novel precision therapies for epilepsy and neurogenetic conditions. "I think it's really important that we embrace the genomic era but that we do it very carefully and responsibly," Demarest says.

Some highlights from this episode include:

• Explanation of precision medicine
• What types of treatments have evolved over time that allow us to manipulate someone's genetic code
• Current barriers to more regular use of precision medicine
• How ethics play a role in this specified type of medicine
• Experience designing a treatment for one individual patient

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

Our medical community stretches far and wide, with experts that wear many hats. One prevalent group making an impact on the future of childhood medicine is our pediatric trainees. In 1989, the American Academy of Pediatrics (AAP) founded the Section on Pediatric Trainees with a goal to empower and enable pediatric trainees to be strong leaders and advocates for the health and well-being of children. This group aims to be the central source of information, education, and networking for their peers. With over 16,000 members to date, medical students, residents, and fellowship trainees are learning to make a difference in the lives of each child they work with. We recorded this episode at the 2023 AAP National Conference and Exhibition, which couldn't have served as a more perfect place to discuss this topic. "For the medical students listening out there, if you have any interest or if you think you know what specialty you're interested in, just going to these conferences and getting plugged in with these organizations really opens your eyes to a lot of networking opportunities," Amundam Mancho, MD, MPH, says.

Today we are joined by Dr. Mancho, a resident physician at Boston Children's Hospital and Boston Medical Center. She also leads the Section on Pediatric Trainees as the executive coordinator on equity, diversity, and inclusion, or DEI. DEI work is central to her advocacy, and she hopes to expand opportunities for other students making their way through their medical education. "We want trainees to feel like even though that representative isn't necessarily there, that people feel empowered they feel culturally competent and also have that understanding to recognize differences that our patients bring to the space," Dr. Mancho says.

Some highlights from this episode include:

• How DEI plays a role within the Section on Pediatric Trainees
• Exposing medical students and residents to advocacy opportunities within pediatrics
• The benefits organizations like AAP can provide for medical students

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

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood respiratory illness, resulting in annual outbreaks among all age groups. In the United States, an estimated 60,000 to 80,000 children, the majority of whom are under 6 months of age, are hospitalized each year. Approximately 100 to 300 kids die from this infection each year. RSV is the single most common cause of death from respiratory illness, after the newborn period, in developing countries. This year, the medical community has made history with the first RSV vaccine approvals for pregnant individuals, infants and the elderly. In this episode, we are taking a deep dive into RSVpref, which is the first RSV vaccine for use in pregnant individuals to protect newborns and infants from severe RSV in the first six months. We are also discussing nirsevimab, a monoclonal antibody, which protects infants and some children against RSV. That includes children 8 –19 at increased risk for severe disease. This is a significant milestone for the scientific community and for public health. "I think now, in another two or three years, we will decrease ER visits, we will decrease hospital visits and I hope we decrease ICU visits. And the next phase of course, hopefully in my lifetime, we get it into developing countries and see impacts on mortality," Eric Simoes, MD, says.

Dr. Simoes has been a part of the creation of these vaccines since the beginning and is our guest for this highly requested topic. He is a clinical professor of pediatrics and infectious disease at the University of Colorado School of Medicine, as well as a professor of epidemiology at the Colorado School of Public Health. He is currently an active clinical infectious disease physician at Children's Hospital Colorado. Of important note, Dr. Simoes served as the global primary investigator for the RSVpreF and lead investigator for the development of nirsevimab.

Some highlights from this episode include:

• How these vaccines received approval and became available on market
• Indications to delivering this vaccine to a pregnant person
• Benefits of receiving these vaccines
• The future of this vaccine and its impact on people of different ages

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