DEPARTMENT OF PEDIATRICS

RESIDENCY RESEARCH PROJECTS

AVAILABLE FOR

2017- 2018 PGY-1 RESIDENTS

Based upon descriptions of potential research projects solicited by Dr. McGovern from each division, residents are now able to choose their Residency Research project from this preselected list.

Residents will work with the project mentor listed and with their Division Chief who will oversee project execution.

The Wednesday, October 25th Research Fair provides you with a terrific opportunity to meet and speak with Division members whose projects are of interest to YOU.

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PROJECT DESCRIPTIONS

TABLE OF CONTENTS

DIVISION of PEDIATRIC PAGE_____

Advocacy………………………………………………………………………………………………………….. 5

Allergy & Immunology……………………………………………………………………………………… 5

Cardiology……………………………………………………………………………………………………….. 6

Critical Care……………………………………………………………………………………………………… 7

Development & Behavior…………………………………………………………………………………. 8

Emergency Medicine……………………………………………………………………………………….. 10

Endocrinology………………………………………………………………………………………………….. 10

Gastroenterology…………………………………………………………………………………………….. 11

Hematology – Oncology…………………………………………………………………………………… 13

Hospitalist Medicine………………………………………………………………………………………… 14

Infectious Diseases………………………………………………………………………………………….. 17

Neonatology …………………………………………………………………………………………………… 20

Nephrology …………………………………………………………………………………………………….. 22

Primary Care …………………………………………………………………………………………………… 23

Pulmonology ..………………………………………………………………………………………………… 24

Rheumatology ………………………………………………………………………………………………… 27

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DIVISION OF ADVOCACY

Study PI: Leslie M. Quinn

Study Title/Concept: Risk of ED Visits/Hospital Readmission for NAS babies in the First Two Years of Life for Injury/ Suspicion of Child Maltreatment.

Description of Research: This vulnerable population is known to be at risk for ACE’s including child maltreatment/neglect. There are currently no mandated services or required follow-up system in place for these patients/ families. In an effort to determine if we should have changes in hospital, county and state policy regarding mandated services for these infants/ families, we will do a retrospective chart review (2010-2016 .Possible inclusion of part of 2017) of all meconium positive NAS babies born at UHSB up through their second birthday identifying any ED visit or hospitalization for concerns of injury/possible maltreatment.

Role of Resident: Participation in an updated/ ongoing literature search on this topic -Since we are still in the planning phase, the resident can help with design in terms of identifying variables for pull out data for the chart reviews - The resident will help conduct the chart reviews and do data entryTimeline for Involvement: Resident can be involved from the beginning but with specific tasks as noted. We do need to apply for IRB approval and so chart reviews most likely will not start for at least six months. I envision the resident will identify at least one variable for data analysis and be able to report on this for their scholarly project in senior year.

Study PI: Rachel Boykan

Study Title & Description: Promotion of smoke-free environments in shelters that house women and children.

Role of Resident: As this project is just getting off the ground this is a good opportunity for someone who wants to have more input into the design of the project. Also someone who has an interest in community advocacy/public health. We may also involve public health students, so this is an opportunity to collaborate. Timeline for Involvement: We are in the middle of developing a plan. I anticipate we could start pilot work within the next 6 months, after obtaining IRB approval. Resident could be involved in needs assessment and analysis for a pilot.

DIVISION OF ALLERGY-IMMUNOLOGY

Study PI: Monika Woroniecka

Study Title: Confirmed versus Unconfirmed Penicillin Allergy Diagnoses in SB Children’s Hospital and Clinics pediatric population

Description of Research: An unverified Penicillin allergy status is currently recognized as a significant public health risk. Penicillin allergy diagnoses should be confirmed or removed from patients’ medical

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records. We will seek to determine the frequency of Stony Brook Children’s Hospital and Clinics EMR stated Penicillin allergy status. The study will consist of retrospective medical chart review. We will use the electronic medical records to identify all patients with EMR stated Penicillin, Amoxicillin, Cephalosporin allergy status over the past 2 years. We will collect data including: patient age, gender, race, ethnicity, atopy-related diagnosis like allergic rhinitis, asthma, eczema, food allergy, other than Penicillin drug allergy status, as well as family history of atopy, and Penicillin and other drug allergies. We will collect data on confirmed Penicillin allergy diagnoses (positive Penicillin allergy skin test, positive drug challenge, and allergy specialist diagnosed Penicillin allergy status), vs unconfirmed Penicillin allergy diagnoses (self-reported, other than allergy specialist diagnosed Penicillin allergy status).

Role of Resident: The resident will be involved in all aspects of this research project including background research, IRB submission, data collection, and data analysis.

Timeline for Involvement: Formulation of the study protocol with rationale, primary and secondary objectives, materials and methods, will require a few months in the 1st year of residency, after which study will be submitted to IRB for approval in summer, July-August 2018 (minimal risk study, 1-2 months for approval). Data collection will be from September to December 2018. Data analysis will be done in January- March 2019. The resident will present the study data at Resident Research day in May 2019.

DIVISION OF CARDIOLOGY

Study PIs: Kathleen Walsh /Laurie Panesar

Study Title: Evaluating LVH by echocardiography: M-mode versus 2D measurements compared to cMR as gold standard

Description of Research: Retrospective evaluation of LV mass in patients without CHD who had cMR and ECHO for hypertension. Measuring LV wall thickness by 2 common methods- directly on the 2D image and by m-mode. LV mass will be calculated by Devereux equation and compared to LV mass obtained by cMR (gold standard).

Timeline for Involvement: Identification of patients meeting inclusion criteria, performance of measurements on echocardiographic images, compliation and analysis of data, literature review New project

Study PIs: Stuart Holzer/Laurie Panesar

Study Title: Screening Evaluation for Sudden Cardiac Death: Assessing Regional Adherence to the 15 point AHA/AAP endorsed PPE form

Description of Research: Assessment of the PPE form utilized by 110 school districts on LI for deficiencies when compared to the 15 point PPE form endorsed by AHA/AAPTimeline for Involvement: Data collection and analysis, literature review Old project revisited & Enhanced

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DIVISION OF CRITICAL CARE

Study PI: Ilana Harwayne-Gidansky

Study Title: iPASS QI Project

Description of Research: This is an ongoing QI project aimed at improving communication during transition of care; specifically with handoffs. Two residents have already successfully completed their QI component, and two additional residents are currently being mentored by the study PI and are on track to complete their portion of the project.

Role of Resident: Participant, splinter studies (e.g. compliance improvement, EMR support for iPASS)Timeline for Involvement: 2-2.5 years

Study PI: Ilana Harwayne-Gidansky

Study Title: Apneic O2

Description of Research: Understanding and improving use of apneic O2 during intubation. We are on of 4 vanguard sites in the NEAR 4 Kids QI collaborative. We have finished the pilot phase, which will be expanded to all Near 4 Kids sites this year.

Role of Resident: Currently: 1 resident involved with Compliance and knowledge interventionTimeline of Involvement: 2-2.5 years

Study PI: Ilana Harwayne-Gidansky

Study Title: In-Situ Simulation

Description of Research: This is a single center educational and qi research project aimed at improving patient safety with regards to recognition and intervention of pediatric emergencies.

Role of Resident: Currently: opening for resident involvement at several different levels. Timeline of Involvement: 2-2.5 years

Study PI: Ilana Harwayne-Gidansky

Study Title: PECARN Education Study

Description of Research: Five-site RCT looking at simulation vs. case discussion for superiority of several educational metrics including knowledge acquisition, mastery learning, medical decision making and patient outcomes

Role of Resident: prior resident success with splinter study (selected for presentation at peds research day), opening available for additional segments of study. Timeline of Involvement: 2 years

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Study PI: Rahul Panesar; Resident Leader: Jennifer Lutz

Study Title: Use of Modified TRACS Scoring Tool to Assess team Performance of Pediatric Mock Codes Before and After “Ideal Code” Video Intervention”

Description of the Research: We will assess team performance using a validated scoring tool (TRACS) of pediatric residents in simulated mock codes before and after implementation of a video teaching tool over a span of 3 academic years

Role of Resident: IRB Protocol, Data Collection and Analysis, Poster Presentation Timeline of Involvement: Fall 2017: IRB approval

January 2018: Data collection and analysis completedSpring 2018: Abstract submission for institutional and regional conferencesSummer 2018: Manuscript preparation

DIVISIONS OF DEVELOPMENTAL & BEHAVIORAL PEDIATRICS AND GASTROENTEROLOGY

Study PIs: Anupama Chawla and Janet Fischel

Study Title: Improvement in Cognitive and Psychological Functioning Following Initiation of a Gluten Free Diet in Pediatric Patients Newly Diagnosed with Celiac Disease

Description of the Research: Dr. Chawla and Dr. Fischel have been collaborating over the past several months on a prospective study of children’s attentional, cognitive and behavioral changes as well as clinical changes as a function of adherence to a celiac diet for children carefully diagnosed with celiac disease. There are several claims about attentional improvement with gluten-free diets, and some supportive case reports in that regard. The sole study which utilized a methodology more robust than case reports in the literature to date addressing this topic has a significant flaw. Parents in that group research were asked to complete a rating scale about their children’s attentional characteristics after several months on a gluten-free diet, and to retrospectively think back to rate their child’s attentional characteristics before the dietary change. In contrast, our study, with fellows in Pediatric Gastroenterology, is utilizing a prospective methodology. Dr. Chawla is overseeing the celiac disease evaluation, diagnosis, laboratory requirements, and medical management; I am overseeing the use of a rigorous and broad set of cognitive, psychological and behavioral evaluations before treatment begins and at the six (6) month point of treatment. The Pediatric GI fellows on this study have trained on the standardized administration of the psychometrically sound intellectual evaluation (the K-BIT), computer-assisted attentional evaluation (Conners CPT 3) and the validated, standardized and extensively utilized parent rating scale, the Achenbach Child Behavior Checklist (CBCL) for the psychometric arm of this study. The study has active IRB approval. Currently 13 patients have been enrolled. Each patient has completed GI evaluation for celiac disease with a positive diagnosis, and pretesting has been completed with the psychometric instruments listed above. A small set of children have completed their second psychometric evaluations at the 6-month point.

Role of Resident: A resident interested in this project would be expected to:

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1) Review and organize literature on the psychometric instruments that have been utilized in published reports on change as a function of gluten free diet usage, both in children and adults, as well as the literature on the utilization of the K-BIT, Conners CPT and CBCL as indices of change as a function of interventions for other pediatric somatic concerns. This would include measures of behavioral change (anxiety, attention, somatic complaints, affective concerns – aligned with the CBCL factors), intellectual change, or specific performance attentional challenges (aligned with the CPT 3). Additionally, a comparable review of the literature related to attentional change as a function of red dyes and food additives would enhance our broader perspective and contextualize this research well. This will provide the resident with excellent context for joining the project, and provide us all with additional suggestions for analytic strategies beyond those currently planned;2) Train to accuracy on scoring the several measures we are currently using for the psychological arm of the study, and complete scoring of the psychometric data for the study;3) If available, the resident may join the fellows as an observer to their test administration, which is typically post clinic time in early evening, at each family’s convenience;4) Participate in spreadsheet data entry and monitoring, data analysis, and preparation of the research presentation for Pediatric Research Day;5) We anticipate this study to be ongoing for a number of years to collect an adequate sample for our analytic requirements. Thus the resident will likely be presenting data on the work-in-progress on Pediatric Research Day, not a complete data set for the study.

Timeline for involvementYear 1:A resident with interest in this project may initiate participation promptly upon completion of CITI and Human Subjects training to responsibly work with patient data. A thorough literature review as described above should be completed. This will require preparation and key word identification, review with Dr. Fischel, an organized method of reporting what has been disseminated in the literature relevant to our expanding view of this project. The initial year of participation should produce a robust mastery of previously reported work, extracted from a thorough literature review. Our current literature review has focused exclusively on the impact of gluten-free diet; this expanded view will provide valuable context.Concurrent with the above, the resident can begin training on scoring and our spread sheet entry methodology. Once trained to accuracy, the resident should begin scoring subject psychometric data, both pre dietary change and post (the 6-month evaluation. Typically, such data are double scored for research purposes to assure accuracy, so this will be continued. Access to the CBCL computer scoring is restricted by single user license, so will need to be conducted at Dr. Fischel’s office.Year 2: The resident is expected to continue with data scoring, participate in group planning for statistical analysis, and join in subject evaluation (time permitting, as this is at parent convenience). The literature search and review should be organized by the resident into narrative to help us guide the expanded view of statistical analysis.Year 2 and 3:The resident is expected to contribute to on-line analyses of project data, prepare in winter and early spring of Year 3 for Pediatric Research Day with project results-to-date for poster or platform presentation.

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DIVISION OF EMERGENCY MEDICINE

Study PI: Jeffrey Hom

Study Title: Case-control study assessing risk factors associated with surgical reduction for intussusception

Description of Research: Case-control study to evaluate risk factors for association of need for surgical reduction for intussusception

Role of Resident: Preliminary literature search, data collectionTimeline for involvement: 1-2y

Study PI: Carl Kaplan

Study Title: Improving the value of in-hospital care for children with asthma (QA Initiative)

Description of Research: AAP Quality Collaborative for improving asthma care with set goals for the ED component of care of decreased chest xray use to 15%, achieving 90% compliance with asthma score documentation at the time of triage

Role of Resident: collecting and analyzing data, identification of barriers, participation in designing the interventions

Timeline of Involvement: 1-2years

DIVISION OF ENDOCRINOLOGY

Study PI: Jennifer Osipoff; Resident Leader – Caitlin Keane

Study Title: Exploration of the occurrence of eating disorders in transgender adolescents, and the influence of endocrine interventions upon eating disorders.

Description of Research: Obesity and perhaps disorders of undernutrition are common in youth with gender dysphoria. It is not clear whether these conditions are more or less common than among the general population. Nor is it known whether endocrine interventions, such as blockers of puberty or cross sex steroid therapy, influence these eating disorders.

Role of Resident: This is a retrospective chart review looking at BMI as an index of eating disorder in adolescents with gender dysphoria over the time interval that they are followed and treated with endocrine medications. NHANES data will be used as comparator for the general population.

Timeline of Involvement: Consult with PI.

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Study PI: Andrew Lane Study Title: Risk Factors for Transient Hyperinsulinemia in Neonates

Description of Research: Intent of study is to determine if there is a correlation or threshold between severity of known risk factors (Hypoxemia, IUGR\SGA, maternal glycemic status) and severity\duration of transient neonatal hyperinsulinemia. This would be a retrospective chart review of Stony Brook NICU neonates with documented hyperinsulinism during 2013–2016. Timeframe may be expanded or contracted depending on numbers of subjects available.

Role of Resident: Resident will meet with Mentor to review background literature, developed project, write and submit IRB documents, gather and statistically analyze data including glucose values, insulin values, birthweight, Apgar scores, measures of hypoxia at birth and subsequently, maternal weight, markers of gestational diabetes, degree of glucose control in those with abnormal glucose metabolism, dose and length of treatment of diazoxide in neonate. Resident would prepare project for presentation at residents’ research day, regional or national meetings, and write manuscript for submission.

Timeline for Involvement: Year 1: IRB approval Year 2: data collection and analysis Year 3: data presentation and submission

Study PI: T. Wilson; Resident Leader: Sashka Luque

Study Title and Description of Research: Role of surgical interventions and whether they influence depression scales that are being completed serially in a population of adolescents undergoing transgender reassignment. CORIHS approval has been obtained for this project.

Role of Resident: Current resident may or may not continue to be involved. as she wishes. Open to additional resident participation.Timeline of Involvement: Consult with PI

DIVISION OF GASTROENTEROLOGY

Study PI: Anupama Chawla

Study Title: The Effect of Proton Pump Inhibitors on the Fecal Microbiota Description of Research: Gastroesophageal reflux disease (GERD) produces bothersome symptoms and/or complications. Treatment of GERD includes lifestyle changes, use of pharmacological agents and, in resistant cases, surgery. While protein pump inhibitors (PPIs) are considered superior to histamine-2 receptor (H-2) antagonists, they are not currently approved for use in children and are prescribed off-label. These medications may have unknown effects on overall health, particularly in neonates and infants. There has been growing awareness of the relationship between the human gut microbiota and our health. Adult studies have shown that alterations in the gastric pH, such as those induced by use of acid-suppressing PPIs, decrease bacterial diversity in the gut, especially those bacteria with known anti-inflammatory effects.This study is a prospective, non-randomized, non-blinded case controlled study of infants aged 2 weeks - 6 months. Patients in the gastroenterology clinic who are initiating therapy for reflux with PPIs, as well as those currently on therapy, will be invited to participate in this study. The control group will consist of

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patients seen in the general pediatric clinic. Study subjects will be provided with a kit for stool collection. Stool samples will be shipped overnight to our laboratory. DNA will be extracted in order to characterize the bacterial profile of the samples. In addition to stool analysis, information will also be collected on patient’s type and quantity of feeds, corrected gestational age, mode of delivery, maternal medication use if breast feeding, maternal dietary restrictions, and use of pro- or prebiotics. Role of Resident: This study is currently on going. The resident will be expected to have a thorough understanding of the protocol. The resident will be required to have certification for human subject research. Specimens will be collected by the GI team as the resident will not be on our team at all times. Stool samples will be stored in a -80oC freezer until analysis. Resident will extract DNA from the collected stool samples in batches using the MO BIO DNA micro kit per the manufacturer’s recommendations (MO BIO Laboratories, Inc). Illumia 100-150 base pair (BP) paired end sequencing will be performed. Sequencing, preliminary sequence classification, and analysis to characterize the bacterial profile of the fecal samples will be completed in collaboration with Dr. Dan Frank. The resident in addition to the stool analysis, will also collect data on patient’s type and quantity of feeds, corrected gestational age, mode of delivery, maternal medication use if breast feeding, maternal dietary restrictions, and use of pro- or prebiotics. Paired analysis will be conducted by the resident between patient’s demograghics, feeds and stool microbiome between control group and infants on proton pump inhibitors. Timeline for Involvement: Human subject research certification- 1 day.Reviewing and understanding protocol and reviewing references of existing literature – 2 weeks.Learning the lab process to extract DNA-1 weekActual stool processing will be conducted during resident’s research month as it can be conducted once all samples are collected. Data entry will be on going from clinic notes to excel sheets. 30 patients anticipated to be enrolled. 15 minute data entry on each patient.Statistical analysis and abstract/manuscript writing – 2 weeks. Likely over a year and a half the resident will be able to present data.

Study PI: Anupama Chawla

Study Title: Is an abdominal x-ray an adequate tool to assess stool retention in the colon and inter observer variability in the read of an abdominal x-ray?

Description of Research: Constipation is a common problem in children. Diagnosis is based on clinical features. In case of doubt about the presence of constipation, the existence of fecal retention is often evaluated on plain abdominal radiography. The best-evidence synthesis has yielded conflicting evidence for an association between a clinical and a radiological diagnosis of constipation. The limited amount of data available shows conflicting evidence for an association between clinical symptoms of constipation and fecal loading on abdominal radiographs in children. The recommendation to perform a plain abdominal radiograph in case of doubt of the presence of constipation in a child is not supported by evidence based medicine. Yet the practice continues. Aggressive constipation therapy is often initiated and several referrals from urgent centers and emergency room are made to pediatric gastroenterologists based on abdominal X ray findings. These findings are often not confirmed by the radiologist’s read of the same X rays.

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Our study will be a retrospective study of abdominal X rays obtained in the emergency department. X rays will be blindly read by an experienced ER physician, experienced pediatric gastroenterologist and pediatric radiologist, all with at least 10 years of clinical experience. Initial subjective read will be noted followed by objective Barr and Leech scoring of the retained stool. ER record will be accessed to seek the X ray read at the time of the ER visit and also stooling history if available.Both intra observer and inter observer evaluations will be assessed to assess the reliability of the use of an abdominal X ray to assess colonic fecal retention

Role of Resident: Literature review (that we already have collected for background). Writing of the protocol with our current second year fellow and submission of an IRB application for expedited review (1 month of research month)Once approved retrieving 50 abdominal X rays of the children presenting to the ER with abdominal pain and in whom no abdominal surgical causes were noted.Each X ray will be presented to the 3 specialists for subjective as well as objective scoring. Resident will collect the data. Data will also be collected from the ER visit note relating to the X ray read and any stooling history.Timeline for Involvement The resident can begin on this project at any time. I expect the resident to be able to report on the data at the research day during their second year of residency.

DIVISION OF HEMATOLOGY/ ONCOLOGY

Study PIs: R. Parker / L. Hogan

Study Title/Concept: Correlation of tumor type & chemotherapy with post-Rx Bone Mineral Density

Description of Research: Retrospective analysis of patient dataRole of Resident: Data extraction from patient charts; data/statistical analysisTimeline for Involvement: Available to start now

Study PIs: R. Parker / L. Hogan

Study Title: Correlation of vitamin D parameters/pathway with post-Rx Bone Mineral Density

Description of Research: Retrospective analysis of patient dataRole of Resident: Data extraction from patient charts; data/statistical analysisTimeline for Involvement: Available to start now

Study PIs: R. Parker / L. Hogan

Study Title: Evaluation of coagulopathy during induction therapy for ALL

Description of Research: Prospective & retrospective analysis of patient data

Role of Resident: Data extraction from patient charts; data/statistical analysis

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Timeline for Involvement: May require IRB approval; potential for waiver of consent

Study PI: R. Meyer

Study Title: Development of a palliative care checklist for assessment of patients to undergo an elective tracheostomy

Description of Research: Review of literature into long-term consequences of tracheostomy in children and development of a tool to best inform parents of these factors

Role of Resident: Literature review and synthesis of known health effects of chronic tracheostomy Timeline for Involvement: Available to start now

Study PI: D. Prakash

Study Title: Assessment of dietary anticipatory guidance provided to children <4yrs of age ultimately diagnosed with iron deficiency anticipatory g

Description of Research: Prospective analysis of patient data

Role of Resident: Resident will extract pertinent data from patient medical records, including records for community pediatricians when needed Timeline for Involvement: Available to start now

HOSPITALIST MEDICINE

Study PI: Rachel Boykan

Study Title: Nicotine Exposure from ENDS and Tobacco Products among Youth

Description of Research: Intramural grant-funded project currently underway looking at use of electronic cigarettes and other tobacco products (ENDS) and marijuana among youth ages 12 – 21. We are recruiting participants from Research Way, Patchogue and Islip offices. Participants complete a survey about their use of ENDS and provide a urine sample, which is being sent to Roswell Park Cancer Institute for evaluation of NNAL and Cotinine, metabolites of nicotine. Primary question is how reported usage correlates with levels of metabolites in nicotine. We will also analyze surveys for other usage patterns.

Role of Resident: Analysis of surveys for ENDS and also marijuana usage. Many secondary questions can be asked of this data set.Timeline for Involvement: We are approx. halfway through recruitment. No analysis has been done yet. Analysis could be done on the approx. 250 – 300 surveys we have and at any time in the future as we continue recruitment.

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Study PI: Rachel Boykan

Study Title: Coupling Breast Feeding and Smoking Cessation

Description of Research: Quality initiative project; initial pilot complete. Nurses in newborn nursery were trained in motivational interviewing (MI). Mothers who smoked were given a brief survey regarding their intention regarding breast (BF) vs formula feeding and smoking status. Then they were given a brief MI session to encourage BF and referral to NYSSQL through Opt to Quit. They were called a week and a month post discharge to follow status. Preliminary results showed improved referrals. We are hoping to continue this with lactation consultants if more are hired. Other thoughts include training more nurses.

Role of Resident: Implementation of second phase of this study. Would like to expand in survey reasons smoking mothers do not breast feed. Resident could work on this survey and possibly follow intervention if it is put into place. Timeline of Involvement: Waiting for new lactation consultants to be hired; could do survey at any time.

Study PI: Rachel Boykan

Study Title & Description: This is a concept still, no IRB has been written but planning talks are underway. Together with Leslie Quinn, Lisa Romard and Catherine Messina, PJ Tedeschi |Director, Tobacco Action Coalition of LI), Alexandra Kranadis, Suffolk Care Collaborative), we are looking to promote smoke-free environments in shelters that house women and children. We will likely do focus groups first to identify where and how to focus our efforts. There will be an opportunity to gather data about smoking status in shelters and advocate at a public health level for change.

Role of Resident: As this project is just getting off the ground this is a good opportunity for someone who wants to have more input into the design of the project. Also someone who has an interest in community advocacy/public health. We may also involve public health students, so this is an opportunity to collaborate. Timeline of Involvement: We are in the middle of developing a plan. I anticipate we could start pilot work within the next 6 months, after obtaining IRB approval. Resident could be involved in needs assessment and analysis for a pilot.

Study PI: Josette Bianchi

Study Title: Examining relationship between weight status and comorbid illness (primarily asthma and Type 2 Diabetes (T2D)) --- retrospective data analysis of EMR.

Description of Research: EMR retrospective dataset review looking at both inpatient/outpatient comorbid asthma and T2D with weight status

Role of Resident: We currently have a MPH student looking at the asthma variables for this dataset but a resident could explore the T2D variables or look at the dataset to find other potential questions related to weight status (i.e length of stay, number of visits)Timeline of Involvement: Consult with PI.

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Study PI: Josette Bianchi

Study Title: Examining relationship between weight status and comorbid illness (primarily asthma and T2D) --- prospective dataset based on caregiver survey data and child anthropometrics

Description of Research: On-going caregiver survey distribution in all clinics exploring many variables and concepts including asthma score/weight status, T2D control/weight status, prenatal factors related to weight status and co-morbid illness, parental preferences for interventions (i.e technology based vs traditional)

Role of Resident: A resident could parse out a project from this dataset we are prospectively developing. The surveys are already developed and data collection is on-going. We have collected nearly 250 surveys at this point for analysis. The resident could help with future data collection, develop a hypothesis based on the available variables and analyze for presentation. This is a very comprehensive survey that has variables related to weight status and co-morbid illness, technology pref of parents, prenatal factors, etc. Also a resident could look at distributing an abbreviated survey in the inpatient setting (currently only outpatient setting) as another project possibility for a project.Timeline of Involvement: Consult with PI.

Study PI: Josette Bianchi

Study Title: Attrition factors in Pediatric Weight Management

Description of Research: Examining attrition factors in the Pediatric Weight Management Clinic

Role of Resident: Comprehensive dataset with several variables to assess regarding attrition in our weight management center. Past residents have used this dataset to successfully complete projects.Timeline of Involvement: Consult with PI.

Study PI: Maribeth Chitkara

Study Concept: Mobile Learning in the Clerkship Setting: Use of ExamSoft Exam Management on the iPad to facilitate Team-Based Learning Modules in the Pediatric Clerkship

Description of Research: A Team-Based Learning approach has been incorporated into the clerkship teaching sessions for third year medical students since 2014. During the 6-week clerkship, students participate in 6 TBL sessions (Nutrition, anemia, abdominal pain, asthma, fever/pneumonia, toxicology) using a traditional paper/pen format. In 2016, matriculating medical students at Stony Brook Medicine were given iPads as part of a School of Medicine initiative to migrate all curricular materials for UME Phase 1 (pre-clinical education) to electronic devices. The Clerkship in Pediatrics has been selected as part of a pilot project to widen the implementation into the clinical phase of their medical education.

Role of Resident: Conduct literature review for prior evidence regarding the effectiveness of e-learning devices in clinical medicine. Help enroll subjects, collect surveys and analyze data. Timeline for Involvement:1/2018: Research question defined, human subjects online course complete

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2/2018: Study protocol delineated, IRB application submitted4/2018-4/2019: Study subjects enrolled4/2019-7/2019: Data analysis8/2019: Abstract generation with submission to PAS, COMSEP

DIVISION OF INFECTIOUS DISEASES

Study PIs: Christy Beneri, Harriet Hellman (outside NP)

Study Title: Chagas Disease Prevalence StudyResident: OpenFellow: Andrew HandelDescription of Research: Primary Objective: Assess seroprevalence in community with large Central American population at riskSecondary Objective: Review risk factors for disease in the population. This study involves a screening questionnaire and then a screening test (finger stick) and if screen positive venipuncture for confirmatory testing at CDC with treatment of those patients confirmed positive and referral to GI and cardiology to assess for complications of disease.

Role of Resident: Open for participation (Fellow also participating)Timeline of Involvement: Consult with PIs

Study PIs: Christy Beneri, Luis Marcos

Study Title: Congenital Study

Description of Research: Primary Objective: Assess seroprevalence in mother-infant pairs with large Central American population at risk. This study involves a screening questionnaire and then a screening test (finger stick) for the mothers and if screen positive venipuncture for confirmatory testing at CDC with treatment of those patients confirmed positive and referral to GI and cardiology to assess for complications of disease. Infants will be tested via cord blood or venipuncture and all testing done at CDC and if positive will be treated.

Role of Resident: Open for participation.Timeline of Involvement: Consult with PIs.

Study PIs: Christy Beneri, Scott Campbell (Suffolk DOH)

Study Title: Rickettsia ambylommii

Description of Research: Work with DOH to review all DOH reports that are positive for Rickettsia rickettesii. We see high rate of false positives though these may be other spotted fevers given we have the lone star tick in our area and mat be seeing Rickettsia ambylommii. Consider contacting patients for retesting.

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Role of Resident: Open for participation.Timeline of Involvement: Consult with PIs.

Study PI: Christy Beneri

Study Title: QI Project on Travel

Description of Research: Review current travel advice and handouts. Then send post travel surveys to review pervious advice and then created new handouts based on feedback. Use new handouts in new cycle and then send post travel surveys again to review any additional modifications.

Role of Resident: Open for participation.Timeline of Involvement: Consult with PI.

Study PI: Christy Beneri

Study Title: EQI Project on Lyme Testing Interpretation

Description of Research: There is a lot of misunderstanding about tick testing, specifically Lyme test results interpretation. Consider developing a mini workshop on the topic and bring to the community practice and/or offer after Grand Rounds one day. Also could incorporate Lyme education to the schools. Senator Serino (NYS) may be willing to give small amount of financial support for Lyme education.

Role of Resident: Open for participation.Timeline of Involvement: Consult with PI.

Study PI: Saul Hymes

Study Title: Evaluation of the impact of antibiotic awareness posters on patients and providersb. Current project, just beginningDescription of Research: Posters with provider faces and statements committing to judicious antibiotic use have been shown to lower inappropriate antibiotic prescribing within the practice utilizing them. What is not known is:

i. Why? Is it impact on parents or on provider practices?ii. Do parents just go get antibiotics elsewhere?iii. How can this be rolled out at Stony Brook with minimal impact on current flow?

Role of Resident: Open for participation.Timeline of Involvement: Consult with PI.

Study PI: Saul Hymes

Study Title: Current QI project with (at least) 2 residents to place posters in (at least) 2 clinic sites and assess the questions above with provider and parental surveys.

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Description of Research: Opportunity exists for more residents to get involved via eitheri. More clinic sites ORii. More opportunities for data analysis

A semi-independent question worth answering is the extent to which parents who don’t receive antibiotics at 1 site, just travel elsewhere for an Rx.

Role of Resident: Open for participation.Timeline for Involvement: Now or at data analysis phase in a year or so

Study PIs: Saul Hymes and Susmita Pati

Study Title: Implementation and Evaluation of the Impact of an Outpatient Antibiotic Care Set

Description of Research: Work is being begun on a Cerner PowerChart order care set to streamline outpatient antibiotic use for otitis media. It will be a pilot and if it is implemented successfully, will lead to other outpatient care sets.Opportunities exist for this as one or more clinical research/QI projects around the following questions:

i. The care set’s impact on outpatient antibiotic useii. Technical implementation details on use of the EMR as a stewardship tool from a

bioinformatics standpointiii. QI Research on provider response to the care set via surveys, with subsequent refinement of

the care sets

Role of Resident: Open for participationTimeline for Involvement: Any time from now, to aid in care set development, and/or pre-post survey development, to beginning in 12-18 months when we have better post-use data.

Study PIs: Saul Hymes and Ilana Harwayne-Gidansky

Study Title: Use and Impact of a Pediatric Social Media Curriculum

Description of Research: Opportunity exists to implement a Stony Brook Pediatrics social media curriculum utilizing Twitter, Figure 1, Instagram and/or other networks. Resident response and utilization of the curriculum would be tracked and there is the potential for impact on ITE scores or other assessments to be used to assess educational impact.

Role of Resident: This is very much in the preliminary phase but would be a great opportunity for a resident with an interest in medical education and technology to get in on a project at the ground floor and help build and track the impact of a new curricular device with PI’s who have established expertise in social media and medical education.Timeline for Involvement: Could be now or at any point in the future, as the project is unlikely to begin without a resident or a fellow due to time constraints of the PI’s existing projects and commitments

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DIVISION OF NEONATOLOGY

Study PI: Echezona Maduekwe

Study Title: The Reliability of Oxipneumogram for the Diagnosis of Gastroesophageal Reflux Disease in Preterm Infants

Description of Research: Gastroesophageal reflux (GER) which is defined as the involuntary backward movement of the stomach content into the esophagus. When it affects the quality of life gastroesophageal disease (GERD) replaces GER as the diagnosis. The diagnosis of GERD in preterm infants by clinical presentation is more difficult due to similarity of symptoms for other disease conditions like apnea of prematurity, chronic lung disease spells and even sepsis. This therefore, underscores the importance of a diagnostic testing to evaluate the relationship between the observed symptoms and GERD prior to therapeutic intervention. In the preterm infants, the 2 most common technique for evaluation of reflux are: Intraluminal Impedance test (gold standard) and oxipneumogram. Time consuming nature of Impedance testing and the result analysis made clinical application unrealistic in most settings. These limitations however are eliminated with the use of oxipneumogram. Though the use of oxipneumogram in diagnosing GERD is on the rise, no study has evaluated the accuracy of oxipneumogram in the diagnosis of GERD. We are therefore, hypothesizing that that non-invasive oxipneumogram would reliably identify GERD as compared to multichannel intraluminal impedance in infants admitted to the neonatal intensive care unit that were less than ≤ 32 weeks gestational age at birth

Role of Resident: a) Will be involved in the application to IRB for approval b) Obtaining informed consent from parents prior to conducting the study c) Compilation of the data collected on excel sheet d) Will be involved in the data analysis and presentation e) Will be involved in writing the manuscript and will be the first author.Timeline for Involvement: 1.5 year project.

Study PI: Echezona Maduekwe

Study Title: The Prediction of Infant of Diabetic Mother with likelihood of Requiring Intravenous Dextrose (Retrospective study)

Description of Research: Transfer of newborns infant of gestational diabetic mothers from the newborn nursery to the neonatal intensive care unit (NICU) is on the rise. Though there is a practical guide from the American Association of Pediatrics for the screening and management of neonatal hypoglycemia, there the knowledge of which infants receive intravenous dextrose infusion is lacking. Also different protocols exist in different hospital about the best place to admit these infants. As a result, some of these newborn infants end up with either very low glucose level, or very prolonged low glucose levels. Since the knowledge of the level of glucose that can potentially result in acute or chronic irreversible neurologic damage is lacking, most of these patients end up being followed for a variable period (2- 3 years) in the NICU graduate out-patient clinic. The possible neurological sequelae and the cost of these 2-3 year out-patient clinic follow up can be minimized if there is a pragmatic system of early identification of the at-risk infant, decision of best place for admission and the institution of prophylactic measures to prevent severe or prolonged neonatal hypoglycemia. An at risk assessment tool has been

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developed to identify these infants so that can be targeted for interventions aimed at reducing the severity and/or the duration of hypoglycemia. This study therefore, aims to evaluate the utility of the hypoglycemia score in predicting infants of diabetic mothers with increased likelihood of needing intravenous dextrose.

Role of Resident: a) Will be involved in the application to IRB for approval b) Obtaining informed consent from parents prior to conducting the study c) Compilation of the data collected on excel sheet d) Will be involved in the data analysis and presentation e) Will be involved in writing the manuscript and will be the first author.Timeline for involvement: 1 year project.

Study PI: Echezona Maduekwe

Study Title: The Use of Handheld Doppler Device for Monitoring Heart Rate in Preterm Infants (Prospective study).

Description of Research: Monitoring of preterm infants in the immediate post delivery period remains the standard of care for newborn resuscitation, and heart rate during the first minute of life in infants who require resuscitation, may be a predictor of early neonatal mortality and moderate to severe brain injury in those who survive. As a result, assessment of heart rate immediately after birth is critical for the guidance of resuscitation efforts. Underestimation might result in the initiation of unrequired resuscitation, and overestimation might lead to undue delay in interventions. The current method of auscultation with the stethoscope or palpation of the umbilical cord has been shown to underestimate the hearts rate by an average of 14 and 21 beats per minute respectively. In addition, auscultation of the heart rate in very low birth weight infants can be challenging, leading to either delayed or incorrect interventions. The pulse oximetry-derived heart rate on the other hand, is not usually available within the first minute of life. Therefore, it is not surprising that 2015 guideline of neonatal resuscitation program which was implemented in January 2017 recommended the application of electrocardiogram (ECG) leads at birth as adjunct to pulse oximetry since studies have shown that the median time required to achieve a reliable heart rate after application of ECG leads was 4 seconds. However, despite this recommendation, the application of ECG continues to be sparse in most delivery rooms. Perhaps the need of plastic wrappings without drying for temperature regulation in infants <32 weeks gestation, the fragile skin of the extremely low birth weight infants, and a pulseless electrical activity that will be interpreted as heart rate on an ECG, which are all potential limitations of ECG might play a role in the reluctance of most delivery rooms in its implementation. Current data comparing ECG and Doppler in predominant term neonates showed no difference in reliability of heart rate acquisition, but to our knowledge, no study to date has determined whether handheld Doppler can produce an early reliable heart rate in preterm infants <1500 grams where this technology would be most beneficial. We therefore, hypothesize that a handheld Doppler device would provide a reliable heart rate as compared to pulse oximetry and cardiac monitor in infants <32 weeks gestational age admitted into the neonatal intensive care unit.

Role of Resident: a) Will be involved in the application to IRB for approval b) Obtaining informed consent from parents prior to conducting the study c) Compilation of the data collected on excel sheet d) Will be involved in the data analysis and presentation e) Will be involved in writing the manuscript and will be the first author.

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Timeline for Involvement: 1.5 year project.

Study PI: Joseph Decristofaro

Study Title: Maturation of Oxygen Extraction Responses to Positional Stressors in Premature NeonatesDescription of Research: The reliability of oxipneumogram for the diagnosis of gastroesophageal reflux disease in preterm infants Sensitivity and Specificity of the Oxipneumogram test in Neonatal ICU to Diagnose Gastroesophageal Reflux in a Retrospective Study Creation of a Neonatal Sepsis Trigger Tool Measurement of Intraoperative CO2 in Neonates and Infants by Two Methods Synergistic Pharmacologic Intervention for Prevention of ROP (SPIPROP STUDY)Active studies- sepsis trigger QI project

Role of Resident and Timeline for Involvement: Consult the PI

Study PI: Shanthy Sridhar

Study Objective: Comparing Finnegan scoring paper vs EMR scoring and Length of stay in infants diagnosed with NAS

Description of Research: Retrospective study evaluating use if Finnegan scoring system before and after introduction of EMR in our NICU influenced length of stay in a level III NICU. Data Analysis Includes compiling Finnegan scores, need for dosing increments, average length of stay and feeding problems

Role of Resident: a) Will be involved in the application to IRB for approval b) Compilation of the data collected on excel sheet c) Will be involved in the data analysis and presentation e) Will be involved in writing the manuscript and will be the first author.Timeline for Involvement: 1.5 year project

Study PI: Jonathan Mintzer Study Concept: Effects of Initiating a “Nutritional Care Package”

Description of Research: Before-after study to evaluate effects of initiation of “nutritional care package” – earlier fortification of breastmilk, avoiding checking gastric residuals without a clinical indication, staying on TPN until enteral feeds up to 120cc/kg/d, etc. We could look at a variety of outcomes (first enteral feed, enteral volume at which fortification to 22kcal and 24kcaloccurs, days on TPN, days to full enteral feeds, NEC rates, discharge weight percentiles, etc.).

Role of Resident and Timeline of Involvement: Consult with PI

DIVISION OF NEPHROLOGY

Study PI: Robert Woroniecki

Study Title: Blood pressure outcomes in neonatal intensive care unit (NICU) graduates with idiopathic hypertension

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Description of Research: Hypertension (HTN) can be detected in 1% to 2.5% of all neonates admitted to neonatal intensive care units (NICU), and the risk of hypertension is likely correlated with the degree of prematurity. The majority of hypertensive NICU survivors without apparent secondary causes for HTN will eventually be able to discontinue their blood pressure medications. However, the long-term outcome data on resolution of “idiopathic” neonatal hypertension is missing. It is essential to identify risk factors of persistent HTN in infants who were diagnosed and treated for idiopathic HTN in the NICU so that appropriate recommendations for clinical follow up and management can be made. This is a retrospective, IRB-approved study of infants who were diagnosed with “idiopathic” hypertension and started on anti-HTN medications in the NICU and subsequently discharged from NICU between 1/1/2012 to 05/31/2016. Clinical data, including demographics, clinical presentation, and medical history of the pregnancy, delivery and NICU stay, relevant family history and laboratory values will be obtained by electronic chart review of subjects followed by Pediatric Nephrology and High Risk clinics at SBUH.

Role of Resident: The resident will be tasked to identify the subjects from Cerner SBUH database who were discharged from NICU between 1/1/2012 to 05/31/2016 and who were on anti-HTN medications during NICU admission. The primary outcomes are: changes in BP and anti-HTN medication usage over time; kidney function; and practice patterns of Ped Nephrologist in diagnosing, treating and following up idiopathic neonatal HTN. The secondary outcomes are comorbidities of NICU graduates with idiopathic HTN; and significant events such as documented adverse effects of anti-HTN medication, renal replacement treatment or death. Study end point is: 1. Last Pediatric Nephrology follow up for hypertension at or before 24 months post NICU discharge; 2. Subject death. The resident will conduct the chart review and do data entry. Resident will participate and learn data analysis and data presentation.Timeline for Involvement: Resident can be involved at any time now. I expect the resident will be able to report on this scholarly project in the 2nd or 3rd year of their residency.

DIVISION OF PRIMARY CARE

Study PI: Jonathan Tolentino

Study Title: Exposure to Cystic Fibrosis among Pediatric and Internal Medicine Residents

Description of Research: Evaluating the amount of types of exposures of current residents in internal medicine, pediatrics, and med-peds related to CF, and their comfort caring for patients with CF.

Role of Resident: Design and execution of surveyTimeline for Involvement: 6 months 

Study PI: Susan Walker

Study Title: Resident Education in Pediatric Primary Care

Description of Research: Creation of monthly educational modules for the primary care resident continuity clinic curriculum

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Role of Resident: May encompass creation, implementation and/or assessment of modules, study of resident/attending perceptions, and effect of supervision on attending knowledge.

Timeline for involvement: Intern year: clarify project/IRB approval2nd year: create/implement3rd year: assess/prepare results for dissemination

DIVISION OF PULMONOLOGY

Study PI: Catherine Kier; Co-PI: Carl Kaplan

Study Title: Improving Asthma Care from the Pediatric Emergency Department 

Description of Research: Asthma is the most common chronic illness in children. Data from the Centers for Disease Control and Prevention showed the overall prevalence of asthma in American children 0-17 years to be 8.4%, in 2015 (most updated per CDC website). New York State Department of Health reports a prevalence of asthma of 11% in children age 0-17 years.

The NIH EPR-3 report has specific guidelines for the management of both acute and chronic asthma in children. The Stony Brook Long Island Children’s Hospital Pediatric Emergency Department encounters approximately 21,000 visits per year of which asthma-related illness accounts for approximately 10% of this volume. Despite the growing prevalence and awareness, many infants and children present for acute care due to under-treatment by primary care providers (PCP) and many times due to misdiagnosis.

In the ED, patients routinely receive acute care and education, but chronic care is reliant on follow-up with PCP. Pediatric Asthma literature supports the use of educational initiatives for parents and patients in the ED to improve this but little data exists on outcomes of children prescribed controller medications from the ED.

Determining the chronicity of symptoms in the group presenting to the pediatric emergency department and initiating appropriate controller therapy in addition to standard acute care may potentially reduce the rate of acute asthma exacerbations and unscheduled visits. Communication of this information to the PCP will also assist in their awareness to maintain the patients’ medical home.

Role of Resident: The resident will be tasked to renew the existing IRB application for this project. This is a prospective randomized controlled trial of a combined educational and medical intervention on a cohort of subjects aged 1-17 years presenting to the pediatric emergency department (PED) for acute care of asthma. Resident will assist in enrollment of subjects during the current hours of operation of the PED and randomized the subjects to either standard therapy group or intervention group. Resident will supervise a project aide to collect and input data into a spreadsheet from questionnaires and intake forms. Resident and project aide will make follow up phone calls with subjects to monitor compliance with medications and follow up with their PCP.

Primary outcome: proportion of children coming back to PED for re-visitsSecondary outcomes: Asthma control test and quality of life questionaires; compliance with controller medications at 2 weeks, 3 months, 6 months and 12 months follow-up among the intervention.Study end point: 12 months from enrollment of each subject.

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The resident will learn the IRB process, will conduct subject enrollment and do data entry. Resident will participate and learn data analysis with the help of the statistician and will learn to write the abstract and data presentation.

Timeline for Involvement: Resident can be involved at any time now. We expect the resident will be able to report on this scholarly project in the 2nd or 3rd year of their residency.

Study PI: Catherine Kier

Study title: Asthma-Related Hospitalizations and Emergency Department (ED) Visits in Hispanic Limited English Proficiency (LEP) Families: Language, Health Literacy, or Both?

Description of Research: Asthma hospitalization rate and ED visit rate per 100 children (0-17 years) is highest in the Hispanic population compared to other ethnicities (including non-Hispanic white, non-Hispanic black, non-Hispanic other) in New York State. The prevalence of asthma in children residing in areas with minorities and foreign-born populations in Suffolk County exceeded the rate of the New York State. This may be attributed to the fact that in Suffolk County, while 4.5% of children are living with asthma, 20.8% of Suffolk County’s population speaks a language other than English at home, and 17.3% of Suffolk County’s population is Hispanic. Given this information, it is likely that a significant portion of Suffolk County’s asthmatic children live in a household that speaks Spanish. Furthermore, coupled with the language and health literacy barrier, the seriousness and potential morbidity of this disease is significantly exacerbated. Therefore, this research project seeks to explore hospitalizations and ED visits of children with asthma living in Hispanic LEP households, as well as discern between language barrier and health literacy as confounding factors to ineffective health care.Primary outcome: EP and LEP groups will be compared for ED visits and hospitalizations Secondary outcomes: confounding factors of limited English proficiency and health literacy.Study end point: caregivers should have completed demographics and validated English proficiency and health literacy questionnaires after obtaining consent/assent.Role of Resident: The resident will learn the IRB process, will conduct subject enrollment and do data entry. Resident will participate and learn data analysis with the help of the statistician and will learn to write the abstract and data presentation.

Role of Resident: This is an existing resident research project, IRB renewal has been recently submitted and we are awaiting approval. Preliminary results presented by a senior resident last year has been promising. Due to our small sample size to date, we were not able to compare asthma hospitalizations and ED visits between LEP and EP subjects. However, it is interesting that our preliminary findings show that limited English proficiency does not directly correlate to inadequate health literacy. Even in LEP subjects, a significant percentage have adequate health literacy. It may be beneficial to focus efforts on continued health education with easy to understand materials, especially in the preferred language. The resident who is interested to continue this project will be tasked to increase subject enrollment. The target sample size of 100 is representative of this population, based on 766 Hispanic children with asthma exacerbations at SBCH in the past year.

Timeline for Involvement: Resident can be involved at any time now. We expect the resident will be able to report on this scholarly project in the 2nd or 3rd year of their residency.

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Study PI: Katharine Kevill; Co-PI: Candice Foy

Study title: The Asthma Journey Game- Creating an easy and fun mechanism for multi-lateral communication at the patient’s bedside.

Description of Research: Asthma is one of the most common chronic disease of childhood, and one of the most common reasons for hospital admission. Communication among patients and health care team members is the backbone of patient-centered care. There is a complex ecosystem of stakeholders that are involved in the care of a single patient when admitted to the hospital. Health care members often deliver information individually to patients and communicate with each other separately- either in person or through the electronic medical record. This fragmented process leaves open the potential for large gaps in communication about essential elements of the patient’s home management plan. A retrospective chart review of patients admitted to SBCH for asthma from 01/2017-04/2017, identified opportunities for improvement in the coordination and communication of individualized asthma education in the inpatient setting. We are creating an asthma journey game that will provide a fun, centralized, visual mechanism to disseminate essential elements of an individual patient’s asthma education among all members of the patient’s team

Role of Resident:Current Resident Role: The resident is working with the Family Advisory Council and interdisciplinary colleagues to design and implement the game. Her academic project is a retrospective chart review evaluating documentation of individualized asthma education before and after implementation. The hypotheses is that once we provide an easy means to improve communication, improved documentation of individualized asthma education will follow. Potential role of future resident: In the future, a resident may choose to evaluate the effects of the game upon such areas as: family knowledge of asthma; hospital surveys of patient satisfaction; perception of intra-team communication among stakeholders; accuracy of intra-team communication. Timeline for Involvement: An intern could start involvement at any time by working as a team with the current resident.

Study PI: Katharine Kevill

Study Title: MyAsthma MyPlan- communication of the AAP via a customized, interactive asthma management web application.

Description of Research: Asthma is among the most common chronic diseases of childhood, affecting 1 in 11 children nationally. Effective communication of an asthma home self-management plan is an essential element of asthma care. Despite its importance, accurate and reliable measurement of communication has been elusive in health care. Although the literature addresses some aspects of patient-provider communication related to asthma self- management and patient adherence to the AAP, no studies have investigated specifically the measurement of communication of the AAP throughout an individual patient’s entire journey across locations and time. In 2013, there were over 191 mobile apps available to English-speaking people with asthma. However, even the most accurate of the apps provided only a portion of the information needed for the effective self-management of any individual child. In this study, we are piloting a Web application that simultaneously facilitates communication of individual asthma self-management plans among all stakeholders, and measures the

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patient experience of that communication process. We are currently in the “alpha” phase of testing in which alpha testers evaluate the app using fictional patients. We are releasing the app in iterative cycles, with each cycle improving on the last based upon feedback from the alpha testers. We expect that it will be available to actual patients by the end of 2017. All data gathered is being pushed automatically to a REDcap database. The initial patient study will be conducted as a nested study within the Keeping Families Healthy Program. The app, MyAsthma Myplan can be found at the link below. https://asthmaplan.herokuapp.com/

Role of Resident: The resident may choose to do a retrospective study in which data already gathered is analyzed in order to determine which elements of the app are more effectively communicated. For example what subgroups of end-users had the most/least difficulty navigating the app or answering questions correctly? If the app gets additional funding, then there may be the potential to do a prospective study. Alternatively, the resident may choose to study some technical aspect of implementation of the app within a specific setting, such as an ambulatory site or inpatient setting.

Timeline for Involvement: Residents may alpha test the app currently. This provides an opportunity to learn more about the project, and also to win prizes such as gift cards. By early 2018, the app will be more mature and ready for consideration as a resident project.

DIVISION OF RHEUMATOLOGY

Study PI: Julie Cherian; CO-PI: Devina Prakash

Study Title: Clinical and Serologic Factors to discern malignancy masquerading as Juvenile Idiopathic Arthritis (JIA)

Description of Research: It is estimated that 15-30% of patients with underlying malignancy (in particular acute lymphoblastic leukemia (ALL)) may initially present with symptoms of joint pain or swelling. Early on in their disease course they may not have significant features such as cytopenias or weight loss that may alert a physician to the possibility of a malignancy. Children with occult malignancies and joint pains may present to the rheumatologist or pediatrician and may be misdiagnosed as having Juvenile Idiopathic Arthritis. This is further compounded by the lack of definitive laboratory testing that supports a diagnosis of JIA as it is a clinical diagnosis and one of exclusion. A high index of suspicion must be present as therapies for JIA can partially treat malignancies. This would delay appropriate diagnosis and prompt treatment paramount to the possibility of remission.

Study Objective: Identify risk factors associated with initial presentation of arthralgia or arthritis that may be secondary to malignancy. We hypothesize clinical and serologic factors that may support arthralgia/arthritis related to a malignant process:

Pain out of proportion to physical findingsNight painBone pain or pain around the jointLack of response to NSAIDsLow normal platelet count

Role of Resident: Retrospective chart review of outpatient and inpatient charts from the divisions of Hematology/Oncology and Rheumatology with diagnoses of ALL or other malignancies who presented

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with joint complaints and JIA. Patients will be divided into either the Malignancy group or JIA group. The resident will evaluate characteristic clinical and serologic features of arthralgia and arthritis in these two groups.

Timeline for Involvement: 6 months for chart review; 6 months for organizing data; 6 months for putting together poster/abstract for research day

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