PedsCrit

Steven Loscalzo, MD, FAAP is an Attending Physician in the Division of Pediatric Critical Care Medicine and an Assistant Professor of Anesthesiology, Critical Care, and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He completed his residency and chief residency in Pediatrics at St. Christopher’s Hospital for Children, followed by a critical care fellowship at the Children’s Hospital of Philadelphia. He is now an attending physician in the Division of Critical Care Medicine at Children's Hospital of Philadelphia.

Elorm Avakame, MD, MPP recently completed his Pediatric Critical Care Medicine fellowship at New York-Presbyterian Hospital/Columbia University Medical Center. His areas of professional interest include clinical teaching in the ICU and mentoring and professional identity formation. This August, he will begin his faculty career as an attending physician in the Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia.

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Define “emotional intelligence” and discuss relevant conceptual frameworks.
2. Identify examples of emotional intelligence competencies.
3. Describe existing data supporting the importance of emotional intelligence in clinical practice.
4. Discuss strategies for teaching emotional intelligence competencies in critical care training.

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Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Ayse Akcan Arikan, MD is a dual trained pediatric intensivist and nephrologist and an Associate Professor of Pediatrics with tenure at Baylor College of Medicine. She is the Associate Chief (Research) of the Division of Critical Care Medicine. Dr Arikan is a clinician-scientist whose research focus is on the recognition and management of acute kidney injury in the critically ill, pharmacokinetics in extracorporeal therapies, management of multiple organ failure, as well as sepsis resuscitation and outcomes. Dr Arikan also serves as the Medical Director of the Critical Care Nephrology and Inpatient Dialysis and the Medical Director of the Extracorporeal Liver Support programs at Texas Children’s Hospital. She is an international leader in pediatric extracorporeal renal and liver support. 

Learning Objectives:

By the end of this podcast, listeners should be able to discuss:

1. The rationale for using extracorporeal liver support in patients with acute liver failure.
2. The various modalities of extracorporeal liver support and their advantages and disadvantages.
3. An expert’s approach to utilization of extracorporeal liver support in patients with acute liver failure.

References:

Akcan Arikan, Ayse MD1,2; Srivaths, Poyyapakkam MD1; Himes, Ryan W. MD3; Tufan Pekkucuksen, Naile MD1; Lam, Fong MD2; Nguyen, Trung MD2; Miloh, Tamir MD3; Braun, Michael MD1; Goss, John MD4; Desai, Moreshwar S. MD2. Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*. Pediatric Critical Care Medicine 19(7):p e342-e349, July 2018. | DOI: 10.1097/PCC.0000000000001546 

Mitzner SR. Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS). Ann Hepatol. 2011 May;10 Suppl 1:S21-8. PMID: 21566251.

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Ayse Akcan Arikan, MD is a dual trained pediatric intensivist and nephrologist and an Associate Professor of Pediatrics with tenure at Baylor College of Medicine. She is the Associate Chief (Research) of the Division of Critical Care Medicine. Dr Arikan is a clinician-scientist whose research focus is on the recognition and management of acute kidney injury in the critically ill, pharmacokinetics in extracorporeal therapies, management of multiple organ failure, as well as sepsis resuscitation and outcomes. Dr Arikan also serves as the Medical Director of the Critical Care Nephrology and Inpatient Dialysis and the Medical Director of the Extracorporeal Liver Support programs at Texas Children’s Hospital. She is an international leader in pediatric extracorporeal renal and liver support. 

Learning Objectives:

By the end of this podcast, listeners should be able to discuss:

1. The rationale for using extracorporeal liver support in patients with acute liver failure.
2. The various modalities of extracorporeal liver support and their advantages and disadvantages.
3. An expert’s approach to utilization of extracorporeal liver support in patients with acute liver failure.

References:

Akcan Arikan, Ayse MD1,2; Srivaths, Poyyapakkam MD1; Himes, Ryan W. MD3; Tufan Pekkucuksen, Naile MD1; Lam, Fong MD2; Nguyen, Trung MD2; Miloh, Tamir MD3; Braun, Michael MD1; Goss, John MD4; Desai, Moreshwar S. MD2. Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*. Pediatric Critical Care Medicine 19(7):p e342-e349, July 2018. | DOI: 10.1097/PCC.0000000000001546 

Mitzner SR. Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS). Ann Hepatol. 2011 May;10 Suppl 1:S21-8. PMID: 21566251.

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

James E. Squires MD, MS, is a pediatric hepatologist and is certified in pediatric gastroenterology and advanced/transplant hepatology by the American Board of Pediatrics. He is an Associate Professor in Pediatrics and is the Associate Director of Hepatology and the Program Director for the Advanced/Transplant Hepatology Fellowship at the University of Pittsburgh School of Medicine. He received his medical degree from University of Texas in Galveston and completed his residency followed by his fellowships in Pediatric Gastroenterology and Advanced/Transplant Hepatology at Cincinnati Children’s Hospital Medical Center.

Dr. Maria Pliakas is a critical care fellow at the University of Michigan, she is interested in the way we can best sedate patients with acute liver failure as we bridge them to transplant. We are SO grateful that she reached out to us, and that she was able to recruit Dr. Squires for this episode. 

References:

Hobby recommendation: https://www.platformtennis.org/

Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M, Squires RH. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure. J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):138-158. doi: 10.1097/MPG.0000000000003268. PMID: 34347674.

Squires JE, Rudnick DA, Hardison RM, Horslen S, Ng VL, Alonso EM, Belle SH, Squires RH. Liver Transplant Listing in Pediatric Acute Liver Failure: Practices and Participant Characteristics. Hepatology. 2018 Dec;68(6):2338-2347. doi: 10.1002/hep.30116. Epub 2018 Nov 1. PMID: 30070372; PMCID: PMC6275095.

https://www.pedsalf.com/ 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

James E. Squires MD, MS, is a pediatric hepatologist and is certified in pediatric gastroenterology and advanced/transplant hepatology by the American Board of Pediatrics. He is an Associate Professor in Pediatrics and is the Associate Director of Hepatology and the Program Director for the Advanced/Transplant Hepatology Fellowship at the University of Pittsburgh School of Medicine. He received his medical degree from University of Texas in Galveston and completed his residency followed by his fellowships in Pediatric Gastroenterology and Advanced/Transplant Hepatology at Cincinnati Children’s Hospital Medical Center.

Dr. Maria Pliakas is a critical care fellow at the University of Michigan, she is interested in the way we can best sedate patients with acute liver failure as we bridge them to transplant. We are SO grateful that she reached out to us, and that she was able to recruit Dr. Squires for this episode. 

References:

Hobby recommendation: https://www.platformtennis.org/

Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M, Squires RH. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure. J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):138-158. doi: 10.1097/MPG.0000000000003268. PMID: 34347674.

Squires JE, Rudnick DA, Hardison RM, Horslen S, Ng VL, Alonso EM, Belle SH, Squires RH. Liver Transplant Listing in Pediatric Acute Liver Failure: Practices and Participant Characteristics. Hepatology. 2018 Dec;68(6):2338-2347. doi: 10.1002/hep.30116. Epub 2018 Nov 1. PMID: 30070372; PMCID: PMC6275095.

https://www.pedsalf.com/ 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Martin Kneyber is Chief of the Division of Paediatric Critical Care Medicine at the Beatrix Children’s Hospital, University Medical Center the Netherlands. He is interested in better understanding the respiratory pathophysiology in mechanically ventilated children. His basic science research focuses on ventilator-induced lung injury and its relationship with multiple system organ failure, he is also a principal investigator for PROSpect–Prone and Oscillation pediatric clinical trial. 

Learning Objectives:

By the end of this podcast, listeners should be able to discuss:

1. The physiologic rationale supporting the use of high frequency oscillatory ventilation (HFOV).
2. Patient populations most likely to benefit from HFOV.
3. Key published evidence that informs our use of HFOV in pediatric critical care.
4. An expert approach to managing a patient with HFOV.
5. Next steps in research that will direct our understanding of the use of HFOV in pediatric critical care.

References:

Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO; OSCILLATE Trial Investigators; Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013 Feb 28;368(9):795-805. doi: 10.1056/NEJMoa1215554. Epub 2013 Jan 22. PMID: 23339639.

de Jager P, Curley MAQ, Cheifetz IM, Kneyber MCJ. Hemodynamic Effects of a High-Frequency Oscillatory Ventilation Open-Lung Strategy in Critically Ill Children With Acquired or Congenital Cardiac Disease. Pediatr Crit Care Med. 2023 Jun 1;24(6):e272-e281. doi: 10.1097/PCC.0000000000003211. Epub 2023 Mar 6. PMID: 36877029; PMCID: PMC10226461.

https://prospect-network.org/ 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Martin Kneyber is Chief of the Division of Paediatric Critical Care Medicine at the Beatrix Children’s Hospital, University Medical Center the Netherlands. He is interested in better understanding the respiratory pathophysiology in mechanically ventilated children. His basic science research focuses on ventilator-induced lung injury and its relationship with multiple system organ failure, he is also a principal investigator for PROSpect–Prone and Oscillation pediatric clinical trial. 

Learning Objectives:

By the end of this podcast, listeners should be able to discuss:

1. The physiologic rationale supporting the use of high frequency oscillatory ventilation (HFOV).
2. Patient populations most likely to benefit from HFOV.
3. Key published evidence that informs our use of HFOV in pediatric critical care.
4. An expert approach to managing a patient with HFOV.
5. Next steps in research that will direct our understanding of the use of HFOV in pediatric critical care.

References:

Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO; OSCILLATE Trial Investigators; Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013 Feb 28;368(9):795-805. doi: 10.1056/NEJMoa1215554. Epub 2013 Jan 22. PMID: 23339639.

de Jager P, Curley MAQ, Cheifetz IM, Kneyber MCJ. Hemodynamic Effects of a High-Frequency Oscillatory Ventilation Open-Lung Strategy in Critically Ill Children With Acquired or Congenital Cardiac Disease. Pediatr Crit Care Med. 2023 Jun 1;24(6):e272-e281. doi: 10.1097/PCC.0000000000003211. Epub 2023 Mar 6. PMID: 36877029; PMCID: PMC10226461.

https://prospect-network.org/ 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.

Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children’s Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.
2. Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.
3. Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.

References:

1. Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.
2. Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. 
3. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.
4. Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. 
5. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. 
6. https://coreultrasound.com/ 
7. https://coreultrasound.com/5ms/ 
8. https://www.youtube.com/@perccus 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.

Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children’s Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.
2. Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.
3. Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.

References:

1. Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.
2. Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. 
3. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.
4. Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. 
5. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. 
6. https://coreultrasound.com/ 
7. https://coreultrasound.com/5ms/ 
8. https://www.youtube.com/@perccus 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Yigit Guner earned his Doctor of Medicine degree from the Rosalind Franklin University of Medicine and Science at the Chicago Medical School. He completed his internship and residency in general surgery at UC Davis Medical Center, where he served as chief resident. Dr. Guner’s training continued with a fellowship in pediatric surgery at the University of Texas, Houston. In addition, he finished a post-doctoral research fellowship at the USC-CHLA Department of Pediatric Surgery. Dr. Guner continues to publish articles in peer-reviewed journals, presents lectures at nationally recognized conferences, has collaborated on book chapters, and is a member of several professional associations and hospital leadership committees. He also serves as an assistant professor of surgery at UC Irvine.

Dr. Amir Ashrafi is an expert in neonatology and neonatal-cardiac physiology. His primary focus is treating newborns with congenital heart disease. He holds the national distinction of being one of the few physicians to receive formal training in both neonatal intensive care and cardiac intensive care. Dr. Ashrafi is the co-founder of the conference NeoHeart: Cardiovascular Management of the Neonate which is an international collaboration dedicated to advancing the care of newborns with complex heart disease. He attended medical school at the University of Utah and completed pediatric residency training at Emory University in Atlanta. He spent time in the Emergency Dept at Children’s Hospital of Los Angeles prior to completing his neonatal intensive care fellowship at UCLA, where he was recognized as the chief fellow. Dr. Ashrafi then completed a second fellowship in cardiac intensive care in Boston Children’s Hospital at Harvard University. His research focus includes Neonatal-cardiac physiology, non-invasive tissue perfusion monitoring, neurodevelopment outcomes in infants with congenital heart disease, and targeted neonatal echocardiography.

By the end of this podcast, listeners should be able to discuss:

1. The clinically relevant anatomic and physiologic consequences of CDH.
2. The relevant prenatal evaluation and interventions for unborn babies with CDH.
3. The core aspects of neonatal resuscitation and cardiopulmonary support for neonates with CDH.
4. The role of ECMO in neonates with CDH.
5. The timing, general approach and relevant complications of CDH surgical repair.
6. The expected long-term outcomes of neonates with CDH.

Reference:
Guner et al. Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the ELSO. ASAIO J. 2021 Feb 1;67(2):113-120. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!