Childrens Mercy - Kansas City

Approximately 10 to 15 percent of childhood cancer cases are due to a genetic predisposition. Children’s Mercy Kansas City is searching within the genetic code to not only identify genes that may lead to cancer, but to find answers in how to better treat or cure pediatric cancer. Erin Guest, MD, Director of Cancer Genomics at Children’s Mercy, discusses the growing role of cancer genomics and how big data, new tests, and personalized treatments could change the future of pediatric cancer treatment.

Thanks to the research being done in CKid, we know that children diagnosed with chronic kidney disease progress over time to dialysis and transplantation. That makes it very important to address therapies which can mitigate the progression of chronic kidney disease. Joining the show today is Tarak Srivastava, MD, he has been awarded R01 funding from the National Institutes of Health to work on targeting EP2, one of the four PGE2 receptors to mitigate hyperfiltration–mediated kidney injury as a way to delay the progression of chronic kidney disease in children born with congenital anomalies of kidney and urinary tract (CAKUT).

In pediatrics care most often supports life-sustaining treatment to promote the best interests of the child. But in some circumstances (after weighing the balance of benefits and burdens of a range of treatment choices) continuing life-sustaining treatment is decided to no longer be in the child’s best interests. Collaboration and clear communication are essential in these difficult discussions. Join Bioethicist and Neonatologist Brian Carter, MD at Children’s Mercy Kansas City, as he provides insights on his recommendations and contributions to the American Academy of Pediatrics’ newly updated policy statement on how to promote the best possible end-of-life care for children.

It’s well-accepted that there are a variety of complex pathways that contribute to abdominal pain in children; but what are these pathways, and how can they be measured? By combining the data from mobile body sensors and self-reporting from participants, researchers at Children’s Mercy Kansas City were able apply “big data” to identify pain triggers for each individual patient. The results were very encouraging. Join Dr. Jennifer Schurman with the Division of Gastroenterology at Children’s Mercy Kansas City as she introduces us to the importance of monitoring and collecting data on triggers for abdominal pain and the value that data holds for individualizing pain treatment in the clinic setting, real-time.

Did you know over 17,000 children are treated for lawnmower injuries each year in the US, resulting in 4,000 trips to the ER. About 75 children die annually from these injuries.Our Guest Dale Jarka, MD is leading a first of its kind research study at Children’s Mercy to better define the causes, patterns and effects of Lawn Mower injuries, identify predictors of severe injuries in order to elevate public education and prevent injuries.

Manometry has long been the standard to measure colorectal activity, but it’s a lengthy and invasive test. Doctors at Children’s Mercy Kansas City wanted to know if there was a better, non-invasive way to monitor colonic activity. The search for an answer led to a promising innovation. Along with a scientific partner, John Rosen, MD, developed a device that monitors colorectal activity using electrical bio-impedance with electrodes on the skin. Join Dr. John Rosen with the Division of Gastroenterology at Children’s Mercy Kansas City, as he introduces us to colonic monitoring, his pre-clinical findings presented at a major gastroenterology conference in 2017, and the potential the new device holds to make colorectal activity detection more accessible to patients.

What are the risk factors for CKID progression? Should children with CKID be screened for cardiovascular risks? Can we predict relative time to a composite event? These are a few of the questions being answered by the CKID study. To date, the translational research study has resulted in more than 90 publications. Listen as Dr. Warady highlights some of the key findings that are shaping care and providing answers that matter now to pediatric patients with CKID.

Children’s Mercy was one of the first pediatric cardiac surgery programs in the nation to voluntarily share surgical outcomes with the public via the Society of Thoracic Surgeons’ (STS) website.That level of transparency is critical to quality improvement for patients, families and staff, as well as for pediatric heart surgery programs nationwide.Today of the approximately 120 pediatric heart surgery programs belonging to the database, about half voluntarily share data publicly.Children’s Mercy has been an early adopter of transparency.In this podcast James E. O'Brien Jr, MD, explains that evaluating this objective information, Children’s Mercy has improved the care we provide patients and their families, helping us rank among the top programs in the country.

Since opening as one of the first fetal centers based in a children’s hospital, the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy has delivered nearly 1,000 high-risk babies, with more than one third having complex heart disease. The addition of Emmanuel “Mike” Vlastos, MD further expands the center’s fetoscopy experience, which includes open myelomeningocele repair and other advanced in-utero procedures. While fetal surgery has been around for decades, the hope has not always lived up the hype. In this podcast, Dr. Vlastos discusses the current status of open and minimally invasive fetal procedures, where we’ve seen success, and where the field is heading.

How can technology improve adherence and control for children and their families dealing with type 1 diabetes? Mark Clements, MD, PhD, Endocrinologist and Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, and Susana Patton, PhD, Psychologist and Professor of Pediatrics, University of Kansas Medical School, are working in partnership on three unique collaborative projects funded by the National Institutes of Health which are utilizing technology to investigate innovative approaches to adherence and control of type 1 diabetes in young children. Join us to learn more about this collaborative research and preliminary results.

The recent trend in infants born exposed to neurotropic substances during pregnancy is increasing at an alarming rate across the United States, posing a public health threat in the form of neonatal abstinence syndrome (NAS). Jodi Jackson, MD, Children’s Mercy Neonatologist and Medical Director of the Shawnee Mission Medical Center (SMMC) level III NICU, has implemented family-centered care initiatives that have improved outcomes for these infants. This family-centered protocol for NAS has been implemented at the other community hospitals where Children’s Mercy neonatologists serve as medical directors, and now Dr. Jackson is chair of the Kansas perinatal quality collaborative (KPQC) and working on a state wide initiative for NAS. Hear from Dr. Jackson as she discusses the program and impact it is having on the neonatal population.

As a consortium partner of the NCI-designated University of Kansas Cancer Center and Stowers Institute for Medical Research, Children’s Mercy Kansas City is part of an elite group of pediatric cancer research centers. The strength in pharmacogenomics and genomics at Children’s Mercy, opens up new avenues for diagnosis and treatment of various forms of childhood cancer. Combining these strengths with the full range of expertise at The University of Kansas Cancer Center offers hope for current and future patients fighting cancer. Join us as Alan Gamis, MD, discusses the importance of NCI designation and what it means to pediatric research and patient care.

Bradley Warady, MD, Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City is an international leader in pediatric dialysis. In addition to being one of the principal investigators for CKiD, the largest study of pediatric chronic kidney disease ever conducted in North America, Dr. Warady is the lead editor of two authoritative textbooks: Pediatric Dialysis Case Studies and Pediatric Dialysis. He is also on the international committee developing new pediatric dialysis guidelines. In this podcast, Dr. Warady discusses the state of pediatric dialysis today, where improvements can and are being made, and next steps for improving care.

Acute lymphoblastic lymphoma is the most common childhood cancer, with about 3,100 patients younger than 20 diagnosed every year, according to the National Cancer Institute. Children’s Mercy contributed to the trial of the first U.S. approved cancer gene therapy, Kymriah, for children and young adults with acute lymphoblastic leukemia that is resistant to treatment or has relapsed. Doug Myers, MD, Children’s Mercy oncologist, was an early investigator of immunotherapy using chimeric antigen receptor t-cells to treat pediatric cancer and led the hospital’s participation in the Kymriah trials. Join us as Dr. Myers discusses immunotherapy, the science behind chimeric antigen receptor technology, and it significance for patients now and in the future.

The management of fever in infants has been a topic of much ambiguity for decades. Project REVISE – Reducing Excessive Variability in the Infant Sepsis Evaluation – was developed by an expert group comprised of emergency and inpatient physicians with expertise and interest in febrile infant management. The AAP Value in Inpatient Pediatrics (VIP) Network – an established inpatient pediatric quality improvement (QI) network – has built a 133-team international QI collaborative designed to improve and standardize care for febrile infants between the ages of 7 to 60 days. Russell McCulloh, MD is here to explain that this QI effort will provide inpatient and emergency room physicians with education about evidence-based best practice, strategies for implementation, and tools to bring about sustainable change. Project REVISE also has implications for follow-up care by primary care providers.

Special cases require specialty care. The new Children’s Mercy Adolescent Medicine Specialty Clinic is a clinic designed specifically to treat the extensive and complex needs of teenagers. This team of specialists utilizes a whole care approach, evaluating physical, social, environmental and psychological needs of each teen, recognizing the unique difficulties faced during this stage of life development, including mental health, gynecological and reproductive health, POTS, chronic fatigue, medication adherence and transition to adult care. Michaela Voss, MD is here today to explain how they are working to expand their reach in the community and develop further clinics based on need, with the aim of supporting the primary care provider through collaboration and consulting.

Voiding dysfunctions comes in all shapes, sizes and symptoms. With so many presentations, sometimes the common feels uncommon, but you are not alone! Mary Langston, RN, MSN, CPN, PPCNP-BC discusses voiding dysfunctions and what strategies primary care providers and families can use to help a child before referral to a specialist.

Medications are critical to treat diseases. Unfortunately medications do not come without risks and their use can result in adverse drug reactions.Listen in as Jennifer Goldman MD, MS discusses the importance that providers understand how to classify adverse drug reactions, how these reactions influence future prescribing of medications, and the importance of informing patients about adverse drug reactions.

In patients with sickle cell concurrent pulmonary issues such as asthma, allergies, sleep apnea and acute chest syndrome are common. Alvin Singh, MD, is helping save these sickle cell patients an extra trip to the hospital through the multidisciplinary sickle cell pulmonary clinic. Dr. Singh ensures that patients are well oxygenated, ventilated and that pulmonary issues don’t affect their sickle cell disease.Listen in as Alvin Singh, MD explains that although acute chest syndrome is the second most common complication of sickle cell disease, it can be difficult to determine the source of the problem, especially in young patients with a predilection for asthma.

Opportunities to optimize use of antibiotics in pediatric practice have focused on targeted interventions in acute respiratory infections. Practice based strategies to improve unnecessary or inappropriate antibiotic prescribing in pediatric urinary tract infection (UTI) are also necessary. Practitioners should develop a process in their practice to appropriately identify those with clinical features of UTI, to optimize specimen collection, to appropriately interpret urinalysis results and to target the initial antibiotic therapy. Listen in as Mary Anne Jackson, MD explains that pitfalls that may result in injudicious testing and antibiotic use in the child with suspected UTI will be discussed and specific practice based interventions to improve outcomes will be reviewed.