From Rounds to Downloads

Suicide is the second leading cause of death for children, adolescents and young adults ages 10 to 24. Roughly 7% to 8% of adolescents attempt suicide each year and 17% report significant suicidal ideation. However, while so many kids are affected, diagnosing them isn’t so simple. “We know the numbers have climbed significantly. If you look at the trends, we’re probably nearly double what we were 20 years ago,” Eric Sigel, MD, says. In this episode, we shine a light on how to clinically identify youth at risk for suicide and determine if they have access to lethal means, such as firearms or medications. In addition, we will discuss evidence-based approaches to reduce or eliminate access to lethal means. That includes counseling and safe storage device distribution. Our guest, Dr. Sigel, specializes in adolescent medicine at Children’s Hospital Colorado. He is the lead for firearm injury prevention, as well as a professor of pediatrics at the University of Colorado School of Medicine. In addition, he serves as co-chair of the American Academy of Pediatrics firearm injury prevention special interest group. “I think it’s an incredible privilege to sit down with a teenager, hear their story and understand a little bit what they may be going through, while being able to help them figure out a better direction to avoid harm,” Dr. Sigel says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include:   The prominence of adolescent suicide in today’s society Approaches to suicidal identification in a clinical setting How a change in easy firearm access can prevent suicide Evidence on counseling and safe storage of firearms For more information on Children’s Colorado, visit: childrenscolorado.org

9 Tammi 202436min

One goal in our healthcare improvement is to achieve equitable access to high quality emergency care for kids, regardless of where that child is physically located. Children have unique characteristics and needs, especially in the emergency setting, and the reality is that not all kids have access to specific pediatric care. In fact, 80% of children receive emergency care in general emergency departments, most of which see less than 15 pediatric patients a day. However, care in those adult settings is not specifically geared towards children. Research shows that pediatric readiness results in lower mortality rates among sick and injured kids. Fortunately, ongoing state and national initiatives are making strides in enhancing pediatric readiness. “The first piece of this is that the focus is on system design. This is not about the failings of a single provider, or the knowledge or skill set of healthcare providers. We are only as good as the system in which we work,” Katherine Remick, MD, says. In today’s episode we are joined by Dr. Remick as well as Kathleen Adelgais, MD. Dr. Remick joins us from Austin Texas, where she is a pediatric emergency medicine provider and an associate professor of pediatrics at the University of Texas at Austin Dell Medical School. She is also the Associate Chair for Quality, Innovation, and Outreach within the Department of Pediatrics. In addition, she is co-director of both the National EMS for Children Innovation and Improvement Center, as well as the National Pediatric Readiness Project. Dr. Adelgais is an emergency medicine physician here at Children’s Hospital Colorado and the project director of the Colorado EMS for Children Program. “There are a series of research studies coming out left and right, right now that show the real dramatic impact of pediatric readiness, Dr. Adelgais says. “The research we are getting from the rich data set of the pediatric readiness scores across hospitals, you’re hard pressed to find any treatment anywhere for anything that reduces mortality that dramatically.” Some highlights from this episode include:  What pediatric readiness is and how we achieve it The importance of system-level improvements  What COPPER is and how it aligns with national efforts  What the pediatric readiness score measures  Success through the data    For more information on Children’s Colorado, visit: childrenscolorado.org

2 Tammi 202434min

2023 has been an impactful year. We kicked it off by continuing to cover topics under our mental health series. The rise of teen substance abuse and addiction, the intersection between physical and mental health, as well as depression and other mood disorders are just a few of the topics we dove into. Season 6 wrapped up by discussing the trauma and care around gun violence and highlighting some incredible women in medicine.  Season 7 launched in August and if you haven’t noticed, we’ve started to make some prominent changes. Our audio is sharper, our show notes are more robust, and our attention to detail is more precise. We are taking all of these positive changes into 2024 and are excited to show you what else we have in store.  This episode was an opportunity to get all our hosts together, Drs. David Brumbaugh, Alison Brent and Dan Nicklas, and end 2023 the right way!  From all of us at Charting Pediatrics and Children’s Hospital Colorado, we wish you and your families a happy and healthy holiday season and New Year. Thanks for listening, we will see you next year!

26 Joulu 202317min

In 2021, federal rules from the 21st Century Cures Act mandated that most clinical notes be made available in real-time, online and free of charge to patients. This practice, commonly known as “open notes,” was a significant step towards enhancing medical information transparency–– a vital step in reinforcing trust in the provider-patient relationship. However, it also introduced complexities, raising questions as to what to include in the notes. “The ethical analysis does not always align with the legal analysis, and these are conversations that ethicists are aware of,” Steven Bondi, MD, JD, says. Dr. Bondi, a lawyer turned doctor, is renowned for his expertise on the Cures Act, Open Notes and Electronic Medical Records. He specializes in pediatric medicine at Golisano Children’s Hospital and is an associate professor within the Department of Pediatrics at the University of Rochester Medical Center. “I think that knowledge is important, and we need to know what the law says and what its parameters are and when we can use the exceptions,” Dr. Bondi says. Dr. Bondi recommends multiple resources on this topic. He suggests visiting healthit.gov and navigating to their information blocking section for informative FAQs and webinars. He also recommends the Guttmacher Institute as a source for general knowledge around adolescent health and privacy. Lastly, he explains that he was recently a part of the American Academy of Pediatrics’ committee on medical liability and risk management where he helped produce a monthly column called ‘Pediatricians in Law.’ This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include:  How to navigate difficult situations and avoid labels  The role that ethics play in this discussion Confidentiality in adolescents by state Biggest pitfalls and gray areas  Disclaimer: Please note that Dr. Steven Bondi is not an attorney for Children’s Hospital Colorado and the information presented in this podcast does not constitute legal advice. Regarding interpretation or application of any of the laws and regulations referenced in this episode, it is recommended that you consult with legal counsel familiar with the laws and regulations applicable to your particular jurisdiction and/or service area. For more information on Children’s Colorado, visit: childrenscolorado.org

19 Joulu 202331min

Vaccines are so successful that many people have never seen the diseases they prevent, resulting in misperceptions that vaccines are not needed. While anti-vaccination sentiment and misinformation increased during the COVID-19 pandemic, about 88% of Americans still say they feel the overall benefits of childhood vaccines outweigh the risks. Communicating vaccine science to the public is even more crucial than in times past. It’s up to our doctors and medical experts to relay factual information that is backed by science and supported by research. Without receiving proper vaccinations, preventable diseases will keep recurring. In today’s episode, we are joined by Paul Offit, MD, whose path toward infectious disease prevention started at the young age of 5 when a failed foot operation landed him in a hospital in suburban Baltimore for nearly six weeks. “If you’re in a chronic care facility in the mid 1950s, because I was born in 1951, you’re in a polio ward. So, I remember that,” Dr. Offit says. Now Dr. Offit is a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania. He is an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, as well as the director of the Vaccine Education Center. “I think the scars of our childhood invariably become the passions of our adulthood. I think it’s the reason I became a doctor, I think it’s the reason my first book was about polio and the polio vaccine, I think it’s why I went into infectious diseases,” Dr. Offit says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition in Washington, DC. Some highlights from the episode include:  Reasons why people have become so hesitant about vaccines Some of the biggest misconceptions and stigmas around vaccine science Why we need more societal trust in vaccines The role of mRNA How we can use communication to better our future For more information on Children’s Colorado, visit: childrenscolorado.org

12 Joulu 202328min

For most of our careers, our treatments for genetic -based diseases have been supportive, not curative. Our medication recommendations for patients have been based on the expected response of the average individual, but as experts explain, these practices are going to change fast. We are on the cusp of a revolution for two main reasons. First, the ability to understand one’s unique genetic profile through genetic sequencing has become more accessible to clinical teams. Second, there are now mechanisms for manipulating one’s genetic code to overcome diseases. So what does this mean we can expect over the next decade? Scott Demarest, MD, shares his experience in precision medicine and what that foreshadows for treatments to come. “This is sort of the most extreme version of personalized care that you can imagine and it was something that redefined what we think of as possible within medicine,” Dr. Demarest says. Dr. Demarest is an associate professor of pediatric neurology at the University of Colorado School of Medicine and the clinical director of the Precision Medicine Program at Children’s Hospital Colorado. He’s a perfect expert for this topic, as his research has focused on the characterization of clinical features and clinical trial design for disease -modifying treatments, as well as the development of novel precision therapies for epilepsy and neurogenetic conditions. “I think it’s really important that we embrace the genomic era but that we do it very carefully and responsibly,” Demarest says. Some highlights from this episode include:  Explanation of precision medicine What types of treatments have evolved over time that allow us to manipulate someone’s genetic code Current barriers to more regular use of precision medicine How ethics play a role in this specified type of medicine Experience designing a treatment for one individual patient  For more information on Children’s Colorado, visit: childrenscolorado.org

5 Joulu 202335min

Our medical community stretches far and wide, with experts that wear many hats. One prevalent group making an impact on the future of childhood medicine is our pediatric trainees. In 1989, the American Academy of Pediatrics (AAP) founded the Section on Pediatric Trainees with a goal to empower and enable pediatric trainees to be strong leaders and advocates for the health and well-being of children. This group aims to be the central source of information, education, and networking for their peers. With over 16,000 members to date, medical students, residents, and fellowship trainees are learning to make a difference in the lives of each child they work with. We recorded this episode at the 2023 AAP National Conference and Exhibition, which couldn’t have served as a more perfect place to discuss this topic. “For the medical students listening out there, if you have any interest or if you think you know what specialty you’re interested in, just going to these conferences and getting plugged in with these organizations really opens your eyes to a lot of networking opportunities,” Amundam Mancho, MD, MPH, says. Today we are joined by Dr. Mancho, a resident physician at Boston Children’s Hospital and Boston Medical Center. She also leads the Section on Pediatric Trainees as the executive coordinator on equity, diversity, and inclusion, or DEI. DEI work is central to her advocacy, and she hopes to expand opportunities for other students making their way through their medical education. “We want trainees to feel like even though that representative isn’t necessarily there, that people feel empowered they feel culturally competent and also have that understanding to recognize differences that our patients bring to the space,” Dr. Mancho says. Some highlights from this episode include:   How DEI plays a role within the Section on Pediatric Trainees  Exposing medical students and residents to advocacy opportunities within pediatrics  The benefits organizations like AAP can provide for medical students   For more information on Children’s Colorado, visit: childrenscolorado.org

28 Marras 202321min

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood respiratory illness, resulting in annual outbreaks among all age groups. In the United States, an estimated 60,000 to 80,000 children, the majority of whom are under 6 months of age, are hospitalized each year. Approximately 100 to 300 kids die from this infection each year. RSV is the single most common cause of death from respiratory illness, after the newborn period, in developing countries. This year, the medical community has made history with the first RSV vaccine approvals for pregnant individuals, infants and the elderly. In this episode, we are taking a deep dive into RSVpref, which is the first RSV vaccine for use in pregnant individuals to protect newborns and infants from severe RSV in the first six months. We are also discussing nirsevimab, a monoclonal antibody, which protects infants and some children against RSV. That includes children 8 –19 at increased risk for severe disease. This is a significant milestone for the scientific community and for public health. “I think now, in another two or three years, we will decrease ER visits, we will decrease hospital visits and I hope we decrease ICU visits. And the next phase of course, hopefully in my lifetime, we get it into developing countries and see impacts on mortality,” Eric Simoes, MD, says. Dr. Simoes has been a part of the creation of these vaccines since the beginning and is our guest for this highly requested topic. He is a clinical professor of pediatrics and infectious disease at the University of Colorado School of Medicine, as well as a professor of epidemiology at the Colorado School of Public Health. He is currently an active clinical infectious disease physician at Children’s Hospital Colorado. Of important note, Dr. Simoes served as the global primary investigator for the RSVpreF and lead investigator for the development of nirsevimab. Some highlights from this episode include:  How these vaccines received approval and became available on market  Indications to delivering this vaccine to a pregnant person  Benefits of receiving these vaccines The future of this vaccine and its impact on people of different ages    For more information on Children’s Colorado, visit: childrenscolorado.org

21 Marras 202340min