News Briefs

AACN Beacon Award logo

Pediatric Intensive Care Unit receives Silver Beacon Award for Excellence

AACN Beacon Award logo

The American Association of Critical-Care Nurses (AACN) recently awarded the Pediatric Intensive Care Unit (PICU) at Children’s National Health System with a silver-level Beacon Award for Excellence.

The Beacon Award for Excellence recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards.

The silver-level award signifies continuous learning and effective systems to achieve optimal patient care. The PICU at Children’s National earned its silver award by meeting the following evidence-based Beacon Award for Excellence criteria:

  • Leadership structures and systems
  • Appropriate staffing and staff engagement
  • Effective communication, knowledge management, learning and development
  • Evidence-based practice and processes
  • Outcome measurement

“The hard work and dedication of the nurses at Children’s National is shown through the quality care they provide every day to their patients,” says Linda Talley, M.S., B.S.N., R.N., NE-BC, vice president of nursing and chief nursing officer at Children’s National. “I’m so proud of all of the critical care nurses and clinical teams that worked so hard to receive this well-deserved prestigious recognition.”

Congratulations to all of our caregivers and leadership teams across our Intensive Care Units for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence.

Andrew Dauber

Andrew Dauber, M.D., joins Children’s National as Chief of Endocrinology

Andrew Dauber

“Researchers, clinicians and medical trainees are pressed for time,” says Andrew Dauber, M.D. “Merging these three arenas into a joint infrastructure powers institutional collaboration and fuels transformative, cutting-edge care.”

Imagine an endocrinology division staffed with endowed researchers, clinicians and specialists, that serves as an engine of innovation, making it easy for pediatricians to make the right referrals, based on the best research, to endocrinologists who can provide families with cutting-edge care.

Andrew Dauber, M.D., MMSc, the new chief of endocrinology at Children’s National, is turning this dream into a reality. Over the next few years, Dr. Dauber will work with a nationally-ranked endocrinology and diabetes center to build a clinical endocrinology research program, housing specialty clinics for Turner’s syndrome, thyroid care and growth disorders, amongst others.

“Researchers, clinicians and medical trainees are pressed for time,” notes Dr. Dauber. “Merging these three arenas into a joint infrastructure powers institutional collaboration and fuels transformative, cutting-edge care.”

To put his real-life hypothesis of providing an engine for innovation into practice, Dr. Dauber led the interdisciplinary growth center at Cincinnati Children’s Hospital Medical Center and organized a Genomics First for Undiagnosed Diseases Program to study genetic clues for undiagnosed diseases. At Boston Children’s Hospital, he was the assistant medical director for the clinical research unit and held academic appointments with Harvard Medical School.

Dr. Dauber finds it’s critically important to merge clinical practice with research and education. He received his medical degree and a Master’s of Medical Sciences in Clinical Investigation from Harvard Medical School. He has published more than 65 studies examining genetic clues to endocrine disorders, with a focus on short stature and growth disorders.

Dr. Dauber conducted the majority of his research – ranging from studying genetic clues for rare growth disorders and causes of precocious puberty to genes that regulate the bioavailability of IGF1, insulin-like growth factor – while counseling patients, advising students and fellows, managing grants, reviewing studies and speaking at international pediatric endocrinology conferences.

He’s harnessing this data by combining genomic insights with electronic health records and patient registries. While some of this information can be used immediately to identify a high-risk patient, other conditions may take years to understand. Dr. Dauber views this as an investment in the future of pediatric endocrinology.

“I’m excited to join Children’s National and to work in Washington, where we can power our city and the nation with premier partnerships and collaboration,” adds Dr. Dauber. “In addition to using genetic clues to investigate growth disorders, we’re just as enthusiastic about investing in and expanding access to youth-focused diabetes education and care.”

The Division of Diabetes and Endocrinology works with the National Institutes of Health, conducts independent research and received support from the Washington Nationals Dream Foundation for its diabetes program, the largest pediatric diabetes program in the region, which provides community education and counsels 1,800 pediatric patients each year.

Desiree de la Torre

Desiree de la Torre named to The Daily Record’s 2018 VIP List

Desiree de la Torre

Desiree de la Torre, MPH, MBA, director of Community Affairs and Population Health Improvement at Children’s National, has been named one of The Daily Record’s 2018 VIP List — Very Important Professionals Successful by 40 awards.

The VIP List recognizes professionals 40 years of age and younger who have been successful in Maryland. Winners, chosen by a panel of previous VIP List honorees and business leaders, were selected on the basis of professional accomplishments, community service and commitment to inspiring change.

“I’m so happy to be selected as a 2018 Very Important Professionals (VIP) Successful by 40 winner,” says Desiree. “My parents instilled in me the importance of hard work, giving back to my community and a commitment to inspiring change – exactly what this award is about! When I first received the news, I called my parents because I owe my success to them.”

As director of Community Affairs and Population Health Improvement at Children’s National, Desiree leads the organization’s community health improvement strategic planning process, including support for community organizations, health equity and compliance with federal and local community benefit regulations. She is responsible for the development of new models of care that improve the health of populations and impact the social determinants of health. This includes multi-sector collaborations with community organizations, schools, government agencies and payers.

Desiree is a member of several local and national councils and associations. She holds a master’s degree in Public Health from Boston University, a master’s degree in Business Administration from Johns Hopkins University and a bachelor’s degree in Psychobiology from the University of California, Los Angeles.

Desiree will be honored along with other awardees at a reception in September, hosted by The Daily Record.

Dr.-Jonas.-WSPCHS

Snapshot: The Sixth Scientific Meeting of the World Society for Pediatric and Congenital Heart Surgery

Dr.-Jonas.-WSPCHS

Dr. Richard Jonas shows surgical advancements using 3D heart models, which participants could bring back to their host institutions.

On July 22, 2018, more than 700 cardiac specialists met in Orlando, Fla. for the Sixth Scientific Meeting of the World Society for Pediatric and Congenital Heart Surgery (WSPCHS 2018).

The five-day conference hosted a mix of specialists, ranging from cardiothoracic surgeons, cardiologists and cardiac intensivists, to anesthesiologists, physician assistants and nurse practitioners, representing 49 countries and six continents.

To advance the vision of WSPCHS – that every child born with a congenital heart defect should have access to appropriate medical and surgical care – the conference was divided into eight tracks: cardiac surgery, cardiology, anesthesia, critical care, nursing, perfusion, administration and training.

Richard Jonas, M.D., outgoing president of WSPCHS and the division chief of cardiac surgery at Children’s National Health System, provided the outgoing presidential address, delivered the keynote lecture on Transposition of the Great Arteries (TGA) and guided a surgical skills lab with printed 3-D heart models.

Other speakers from Children’s National include:

  • Gil Wernovsky, M.D., a cardiac critical care specialist, presented on the complex physiology of TGA, as well as long-term consequences in survivors of neonatal heart surgery, including TGA and single ventricle.
  • Mary Donofrio, M.D., a cardiologist and director of the Fetal Heart Program, presented “Prenatal Diagnosis: Improving Accuracy and Planning Delivery for babies with TGA,” “Systemic Venous Abnormalities in the Fetus,” “Intervention for Fetal Lesions Causing High Output Heart Failure” and “Fetal Cardiac Care – Can We Improve Outcomes by Altering the Natural History of Disease?”
  • Gerard Martin, M.D., a cardiologist and medical director of global services, presented “Is the Arterial Switch as Good as We Thought It Would Be?” and “Impact, MAPIT, NCPQIC – How and Why We Should All Embrace Quality Metrics.”
  • Pranava Sinha, M.D., a cardiac surgeon, presented the abstract “Cryopreserved Valved Femoral Vein Homografts for Right Ventricular Outflow Tract Reconstruction in Infants.”

Participants left with knowledge about how to diagnose and treat complex congenital heart disease, and an understanding of the long-term consequences of surgical management into adulthood. In addition, they received training regarding standardized practice models, new strategies in telemedicine and collaborative, multi-institutional research.

“It was an amazing experience for me to bring my expertise to a conference which historically concentrated on surgical and interventional care and long-term follow-up,” says Dr. Donofrio. “The collaboration between the fetal and postnatal care teams including surgeons, interventionalists and intensive care doctors enables new strategies to be developed to care for babies with CHD before birth. Our hope is that by intervening when possible in utero and by planning for specialized care in the delivery room, we can improve outcomes for our most complex patients”.

The Johns Hopkins University School of Medicine, Florida Board of Nursing, American Academy of Nurse Practitioners National Certification Program, American Nurses Credentialing Center and the American Board of Cardiovascular Perfusion provided continuing medical credits for eligible providers.

“I was so proud to be a member of the Children’s National team at this international conference,” notes Dr. Wernovsky. “We had to the opportunity to share our experience in fetal cardiology, outpatient cardiology, cardiac critical care, cardiac nursing and cardiac surgery with a worldwide audience, including surgical trainees, senior cardiovascular surgeons and the rest of the team members necessary to optimally care for babies and children with complex CHD. In addition, members of the nursing staff shared their research about advancements in the field. It was quite a success – both for our team and for all of the participants.”

Washington Adult Congenital Heart Program staff

The Washington Adult Congenital Heart Program earns national accreditation from the Adult Congenital Heart Association

Washington Adult Congenital Heart Program staff

The Washington Adult Congenital Heart Program (WACH), part of Children’s National, earns accreditation from the Adult Congenital Heart Association for providing high-level, integrated care to patients with congenital heart disease.

Anitha John, M.D., Ph.D., a congenital heart disease (CHD) specialist and the director of the Washington Adult Congenital Heart Program (WACH) at Children’s National Health System, is a master of creating and leading multidisciplinary teams and networks to drive innovative standards to accelerate personalized treatment for adults born with heart conditions.

The Adult Congenital Heart Association (ACHA), a national organization dedicated to advancing adult congenital heart disease (ACHD) care, announces WACH as one of 19 medical centers in the country – and the first in the Mid-Atlantic region – to earn its accreditation, which signifies a center that provides high-level, comprehensive care.

WACH receives this accreditation by meeting ACHA’s criteria, which includes medical services and personnel requirements, and going through a rigorous accreditation process, both of which were developed over a number of years through a collaboration with doctors, physician assistants, nurse practitioners, nurses and ACHD patients.

There are 1.4 million adults in the U.S. living with one of many different types of congenital heart defects, ranging among simple, moderate and complex.

“There are now more adults than children in the U.S. with CHD,” said Mark Roeder, President and CEO of ACHA. “Accreditation will elevate the standard of care and have a positive impact on the futures of those living with this disease. Coordination of care is key, and this accreditation program will make care more streamlined for ACHD patients, improving their quality of life.”

A study published in Circulation examined mortality rates among 70,000 patients living with CHD over a 15-year period, from 1990 to 2005, and saw mortality rates fall with referrals to specialized ACHD care centers.

“This accreditation lets patients and other specialists know what to expect if they visit our center,” says Dr. John. “While the field of congenital heart disease is small enough to personalize, it’s large enough to standardize. I’m grateful to work with a wonderful team to provide this type of high-level care.”

Dr. John has a unique background to elevate standards of ACHD care, while creating tailored prescriptions. She is one of a handful of physicians with subspecialty training in ACHD, which she completed at the Mayo Clinic. Her formal training in internal medicine and general pediatrics, completed at Brown University, fits well with the subspecialty training she received as a pediatric cardiology fellow at Children’s Hospital of Philadelphia. Her research now focuses on clinical outcomes in congenital cardiology and advancing multicenter research efforts in adult congenital cardiology.

From March 2016 to 2018, Dr. John led the Alliance for Adult Research in Congenital Cardiology, the major multicenter research group in the U.S. focused on ACHD research. She’s also working with experts and patient advocates to guide efforts to set up a future ACHD patient registry, which will continue to guide research efforts and educate providers about ACHD care.

To help facilitate collaboration, Dr. John guides quarterly meetings of the Mid-Atlantic ACHD regional group.  Established in 2011 through Children’s National, the group has expanded to include ACHD providers from over 18 programs/practices from across the East Coast. This group provides a forum for patient case discussion and programmatic support. More importantly, the professional collaboration has served to not only improve patient care but also provides support to providers as they continue to care for a growing population of patients. This type of collaboration fosters mutual understanding and sets the stage for a relaxed but collegial environment where questions flow and learning occurs.

To further facilitate education, she created an inaugural patient day at the 7th Annual Adult Congenital Heart Disease in the 21st Century conference this past year, allowing patients to have their own educational summit – while opening the opportunity to providers to stay an extra day to learn about patient-centered care. The conference relies heavily on the participation of the Mid-Atlantic ACHD regional group of providers.

Patients learned as much about 3D heart models, pacemakers and noninvasive surgical techniques as they did about personalized approaches to lifestyle care, from practicing mindfulness to hearing about communication strategies to use with their medical teams and families. A variety of experts, from cardiac surgeons to clinical social workers, led the panels and breakout sessions.

“We’re empowering patients to become an active participant and an engaged member of their medical care team,” adds Dr. John.

ACHA supports WACH’s efforts and spoke at the conference, complementing its mission to serve and support the more than one million adults with CHD, their families and the medical community.

The WACH team includes not only Dr. John, but ACHD cardiologists Seiji Ito, M.D., and Tacy Downing, M.D.; Pranava Sinha, M.D., surgical director; Rachel Steury, R.N.P., advanced practitioner; Nancy Klein, R.N., clinical coordinator; Emily Stein, M.S.W., social worker; Whitney Osborne, M.P.H., clinical research coordinator, and Ruth Phillippi, M.S., program coordinator. The team works together seamlessly to fulfill the program mission of achieving clinical excellence, promoting research and providing education in the care of adults of with CHD.

For more information about WACH or to take advantage of resources for ACHD providers, please contact 202-821-6289 or visit www.ChildrensNational.org/WACH.

Children’s National Health System named as member of the Parent Project Muscular Dystrophy’s (PPMD) Certified Duchenne Care Centers

mitochondria

Children’s National Health System is now part of a growing Duchenne care network, becoming the newest member of the Parent Project Muscular Dystrophy’s (PPMD) Certified Duchenne Care Centers.

The certification process to become a Certified Duchenne Care Center (CDCC) was grounded in the idea that comprehensive Duchenne care and services should be available and accessible to as many families as possible. By joining the network of PPMD Certified Duchenne Care Centers and standardizing care, Children’s National’s Neuromuscular Medicine Program is also improving Duchenne research and clinical trials by decreasing variability in care and increasing the quality of clinical trial outcome measures. This results in accelerating the time it takes therapies to reach the patients who need them.

By allowing neuromuscular patients of all diagnoses access to the comprehensive teams of sub-specialists serving the Duchenne population, Children’s National and other PPMD Certified Duchenne Care Centers will improve the care of all patients with neuromuscular diagnoses.

Yanxin Pei awarded St. Baldrick’s Foundation Research Grant for Childhood Cancer

Yanxin Pei, Ph.D., assistant professor at the Children’s Research Institute, was a recipient of a $100,000 grant that is being named the “Benicio Martinez Fund for Pediatric Cancer Research Grant” from the St. Baldrick’s Foundation, the largest private funder of childhood cancer research grants in the United States.

Dr. Pei studies medulloblastoma – one of the most common malignant brain tumors in children – and has identified a subpopulation of tumor cells that contribute to metastasis after radiotherapy. Her lab is now determining whether targeting these cells can eliminate or prevent the spread of medulloblastoma, thereby improving the outcome of patients with this disease.

In their latest round of funding, the St. Baldrick’s Foundation awarded 76 grants totaling more than $19.1 million to support physician-scientists studying innovative treatment options in the pediatric cancer space. The grants from St. Baldrick’s deliver on its commitment to support the most promising childhood cancer research and work to provide the best solutions possible for kids. The next St. Baldrick’s grant cycle will be announced in fall 2018.

“At St. Baldrick’s, we focus on funding research that has the best potential of giving kids the healthy childhoods they deserve,” said Kathleen Ruddy, CEO of the St. Baldrick’s Foundation.  “I’m proud to say that we have now funded more than a quarter billion dollars since 2005 to support lifesaving childhood cancer research.

Randi Streisand

Randi Streisand, Ph.D., appointed Chief of Psychology and Behavioral Health at Children’s National Health System

Randi Streisand

Children’s National Health System announces that Randi Streisand, Ph.D., will become the chief of Psychology and Behavioral Health within the Center for Neuroscience and Behavioral Medicine. Dr. Streisand is a behavioral scientist, child health researcher and certified diabetes educator. She is a tenured professor of Psychology and Behavioral Health, and Pediatrics at The George Washington University School of Medicine and Health Sciences, and serves as the director of Psychology Research for Children’s National Health System.

“Dr. Streisand’s acceptance of this leadership position will play an integral role in our approach to improve research methods and providing comprehensive approaches to psychological treatments” says Roger J. Packer, M.D., senior vice president of the Center for Neuroscience and Behavioral Medicine.

As chief, Dr. Streisand will lead our team of nationally recognized educators, research leaders and specialists who are experts in the care of children and teens with emotional and behavioral disorders. She will also continue to lead an extensive research portfolio, focusing on parent-child adjustment to chronic disease, behavioral interventions to prevent and control disease and treatment complications and adherence to pediatric medical regimens.

Before joining the faculty at Children’s National in 2000, Dr. Streisand received her doctorate in clinical psychology from the University of Florida, completed her internship at Brown University and a fellowship at the Children’s Hospital of Philadelphia. She has written numerous publications in the areas of child health and serves on several grant review committees through Children’s National, NIH and the American Diabetes Association. At Children’s National, she is an active participant in the psychology training program, and mentors undergraduates, graduate students, interns, fellows and junior faculty members.

audience members at the 2018 Gluten Free Expo keynote

Dispelling gluten-free myths and patient education headline the 2018 Washington DC Gluten-Free Education Day and Expo

audience members at the 2018 Gluten Free Expo keynote

On June 10, 2018, some of the brightest minds in the field gathered at the 2018 Washington DC Gluten-Free Education Day and Expo to discuss opportunities and challenges associated with living a gluten-free life.

The one-day expo focused on how the food we eat affects our brains, how to dispel gluten-free myths and how to think outside the box with new recipes and cooking demonstrations from local restaurants, bakeries and chefs.

Keynote speakers for this year’s symposium included Benny Kerzner, M.D., medical director, Celiac Disease Program at Children’s National, Jocelyn Silvester, M.D., director of Research, Celiac Disease Program at Boston Children’s Hospital and Ian Liebowitz, M.D. from Pediatric Specialists of Virginia.

Additionally, Edwin Liu, M.D., from Colorado Children’s Hospital and Ilana Kahn, M.D., from Children’s National gave a joint keynote on the autoimmune connection, focusing on conditions related to celiac disease and the gut-brain connection.

Teen mentors gave a panel discussion for the 13+ age group attending the conference in a session called “For Teens from Teens!” during which they discussed the challenges of navigating a gluten-free lifestyle as a teen.

In addition to the useful educational sessions, attendees visited many of the 57 vendor tables with gluten-free product samples voting for the best sweet and savory winners.

The Celiac Disease Program at Children’s National Health System started in 2009 to improve the way pediatric celiac disease is diagnosed and treated. Working in partnership with concerned members of our community, our Celiac Disease Program brings together a team of expert physicians, nurses, nutritional consultants and professional counselors dedicated to developing a national model for detecting and treating celiac disease in children.

Tonya Kinlow

Children’s National Health System hosts School Health Symposium

Tonya Kinlow

The Child Health Advocacy Institute at Children’s National Health System held its first School Health Symposium, designed to strengthen relationships between the education and health care sectors. Led by Tonya Vidal Kinlow, M.P.A., vice president of Community Engagement, Advocacy and Community, Children’s National welcomed more than 150 regional health and education partners, community members and Children’s National staff to support the mission of helping kids grow up stronger.

In a day of panel discussions and breakout sessions, education, government and health professionals tackled the many societal challenges children face. The panel discussions at this year’s symposium focused on the following topics:

  • Caring for the whole child using a trauma-informed approach
  • Children’s National regional school-based programs
  • Local government role in school health
  • How a health system advocates for school health
  • How organizations are working with schools to address the social determinants of health

Participants also had the option to attend one of the following breakout sessions:

  • Mental wellness & self-care for school and health care professionals
  • School-based research: engaging families, empowering students
  • How an anchor institution is addressing the social determinants of health
  • School health legislation update

Outreach programs focused on strong community partnerships were recognized for serving diverse communities including infants and their caregivers, primary care clinicians, high school students, child care providers and teachers. Three programs were chosen as recipients for the Community Health Improvement Award through an application process where a panel of judges with expertise in public health and policy evaluated against an established criteria set.

“Our Community Health Improvement Awards recognize all efforts to conduct community outreach programs and shape public policies that benefit children and families in the Washington D.C.  area,” says Kurt Newman, M.D., president and CEO of Children’s National. “The award also recognizes the physicians and clinicians here at Children’s who go above and beyond to provide quality care to kids and their families.”

This year’s recipients actively play a role in contributing to school health:

The School Health Symposium was followed by a networking reception to allow participants an opportunity to connect with colleagues and discuss the sessions.

photos used for facial analysis technology

Facial analysis technology successful in identifying Williams-Beuren syndrome in diverse populations

photos used for facial analysis technology

Image Credit: Darryl Leja, NHGRI.

In an international study led by the National Human Genome Research Institute (NHGRI), researchers have successfully identified Williams-Beuren syndrome in diverse populations using clinical information and objective facial analysis technology developed by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National.

The technology, which was featured by STAT as an ‘Editor’s Pick’ finalist in their recent competition to find the best innovation in science and medicine, enables users to compare the most relevant facial features characteristic of Williams-Beuren syndrome in diverse populations.

Williams-Beuren syndrome affects an estimated 1 in 7,500 to 10,000 people, with the most significant medical problems being cardiovascular, including high blood pressure. Though the syndrome is a genetic condition, most cases are not inherited. Signs and symptoms include intellectual disability and distinctive facial features including puffiness around the eyes, a short nose with a broad tip, full cheeks and a wide mouth with full lips.

Using the facial analysis technology, the researchers compared 286 African, Asian, Caucasian and Latin American children and adults with Williams-Beuren syndrome with 286 people of the same age, sex and ethnicity without the disease. They were able to correctly identify patients with the disease from each ethnic group with 95 percent or higher accuracy.

“Our algorithm found that the angle at the nose root is the most significant facial feature of the Williams-Beuren syndrome in all ethnic groups and also highlighted facial features that are relevant to diagnosing the syndrome in each group,” said Marius George Linguraru, D.Phil., developer of the facial analysis technology and an investigator in the study from Children’s National.

Linguraru and his team are working to create a simple tool that will enable doctors in clinics without state-of-the-art genetic facilities to take photos of their patients on a smartphone and receive instant results.

The technology was also highly accurate in identifying Noonan syndrome according to a study published in Sept. 2017, DiGeorge syndrome (22q11.2 deletion syndrome) in April 2017 and Down syndrome in Dec. 2016. The next study in the series will focus on Cornelia de Lange syndrome.

Rebecca Zee

Children’s urology fellow wins best basic science award

Rebecca Zee

Rebecca Zee, a Children’s urology fellow, was awarded the best basic science prize at the Societies for Pediatric Urology annual meeting for her abstract describing a novel treatment to prevent ischemia reperfusion injury following testicular torsion.

Occurring in 1 in 4,000 males, testicular torsion occurs when the testis twists along the spermatic cord, limiting blood supply to the testicle. Despite prompt surgical intervention and restoration of blood flow, up to 40 percent of patients experience testicular atrophy due to a secondary inflammatory response, or ischemia reperfusion injury. Cytisine, a nicotine analog that the Food and Drug Administration approved for smoking cessation, recently has been found to activate a novel anti-inflammatory cascade, limiting the post-reperfusion inflammatory response.

“Administration of cytisine was recently found to limit inflammation and preserve renal function following warm renal ischemia,” Zee says. “We hypothesized that cytisine would similarly prevent ischemia reperfusion injury and limit testicular atrophy following testicular torsion.”

Using an established experimental model, Zee and colleagues induced unilateral testicular torsion by anesthetizing the adult male experimental models and rotating their right testicles by 720 degrees for two hours. In the treatment arm, the preclinical models were given cytisine as a 1.5 mg/kg injection one hour before or one hour after creating the testicular torsion. Eighteen hours after blood flow was restored to the right testis, total leukocyte infiltration and inflammatory gene expression were evaluated. Thirty days later, the researchers measured testicular weight and evaluated pro-fibrotic genes.

“We found that the administration of cytisine significantly decreases long-term testicular atrophy and fibrosis following testicular torsion,” says Daniel Casella, M.D., a urologist at Children’s National Health System and the study’s senior author. “What is particularly exciting is that we found similar long-term outcomes in the group that was given cytisine one hour after the creation of testicular torsion. This scenario is much more clinically applicable, given that we would not be able to treat patients until they present with testicular pain,” Dr. Casella adds.

Additional research is needed to determine the optimal cytisine dosing and administration regimen, however the researchers are hopeful that they can transition their findings to a pilot clinical trial in the near future.

In addition to Zee and Dr. Casella, the multi-institutional team included Children’s co-authors Nazanin Omidi, Christopher Bayne, Michael Hsieh, M.D., and Evaristus Mbanefo, in addition to Elina Mukherjee and Sunder Sims-Lucas, Ph.D., from the University of Pittsburgh.

Financial support for this work was provided by the Joseph E. Robert Jr. Center for Surgical Care.

Laura Sanapo

Children’s fetal medicine fellow named ‘Outstanding graduate student’

Laura Sanapo

Laura Sanapo, M.D., M.S.H.S., told the graduating class that two guiding themes defined her experience as a GW student: diversity and momentum.

Laura Sanapo, M.D., M.S.H.S., a fetal medicine fellow at Children’s Fetal Medicine Institute, was named “Outstanding graduate student” at The George Washington University School of Medicine & Health Sciences (GWSMHS) and was among two student speakers to address fellow graduates during the ceremony held May 19, 2018.

Dr. Sanapo was selected from a competitive field of top-tier graduate students from an array of academic programs, says Samar A. Nasser, Ph.D., M.P.H., PA-C, director of Clinical and Translational Research and Clinical Health Sciences at GWSMHS, who nominated her for the award. “She is one of the brightest students I have encountered. Because of her exceptional background, I recruited Dr. Sanapo to become an adjunct professor in our Clinical and Translational Research program and I look forward to co-teaching a course with her this fall.”

“I am extremely humbled and honored by this recognition for my ongoing research,” Dr. Sanapo says. “It is a privilege to join the GW faculty and contribute to the growth of an outstanding academic team and diverse group of students. I feel energized by such a collegial and dynamic environment.”

She told the graduating class that two guiding themes defined her experience as a GW student: diversity and momentum. Diversity, she told the group “means the spark that generates new ideas and growth” and momentum is the feeling of being “propelled forward by being part of a university that feels like a lively workshop of ideas.”

Prior to joining Children’s National Health System in 2014, Dr. Sanapo served with distinction at the University of Maryland School of Medicine and Thomas Jefferson University School of Medicine, conducting original research and frequently publishing in peer-reviewed journals.

Under the mentorship of Adré J. du Plessis, M.B.Ch.B., M.P.H., chief of Children’s Division of Fetal and Transitional Medicine, Dr. Sanapo investigated the role of advanced ultrasound techniques in assessing fetal vasoreactivity in pregnancies complicated by such conditions as intrauterine growth restriction, Dr. Nasser wrote in the nomination letter. In that study, the research team is trying to better understand how a healthy fetus controls blood flow throughout the body, including to the lungs and brain.

In addition to evaluating and counseling in high-risk pregnancies complicated by complex fetal malformations, Dr. Sanapo performed research and clinical ultrasounds daily. What’s more, Dr. Sanapo often scheduled appointments after-hours for patients unable to complete ultrasounds during normal business hours and was an integral part of the team that counseled women through difficult pregnancies.

“‘These women are especially vulnerable and they deserve 100 percent of my time, knowledge, energy and empathy,’  ” Dr. Nasser recalls Dr. Sanapo explaining. “Laura often goes above and beyond her responsibilities as a fellow to assist these women in need.”

Dr. du Plessis notes that Dr. Sanapo has been a valued clinical leader at Children’s Fetal Medicine Institute, shepherding a multidisciplinary team that includes genetic counselors, specialists in maternal-fetal medicine, radiologists, pediatric neurologists and nurses.

“When Children’s National and Inova announced a three-year, $2.8 million research and education collaboration in maternal, fetal and neonatal medicine last January, Laura’s contributions were pivotal in ensuring the research collaboration’s early success,” Dr. du Plessis adds.

Gerard Gioia

Concussion prevention and better management of youth concussions headline Sports Neuropsychology Society Concussion Symposium

Gerard Gioia

Gerard Gioia, Ph.D., an internationally recognized expert in pediatric concussion management, was named president of the Sports Neuropsychology Society at the conclusion of this year’s meeting.

“We know how critical it is to identify and appropriately treat every concussion, particularly when they happen early in an athlete’s career,” Children’s National President and CEO Kurt Newman, M.D.,  told a crowd of nearly 300 sports concussion experts gathered in Washington, D.C. for the Sports Neuropsychology Society’s (SNS) 6th Annual Concussion Symposium.

Children’s National served as a title sponsor of the conference, which serves as the annual meeting for SNS. Each year, members from around the world meet to share best practices in sports-related concussion management through presentation of evidence-based studies on a wide range of related topics. This year’s presentations included topics such as:

  • Sex differences in sport-related concussion: Incidence, outcomes and recovery
  • Concussion Clinical Profiles and Targeted Treatments: Building the Evidence
  • Legislative advocacy and the sports neuropsychologist
  • Treatment of concussion in kids: What we know, what we think we know, and what we need to learn

“This meeting and its agenda, held in D.C. where we’ve done so much work on understanding concussion management for children, is particularly meaningful for me because it really drives home our key message of a link between active participation in sports, appropriate recognition, management of youth concussions and the developing  athlete’s brain health,” says Gerard Gioia, Ph.D., division chief of neuropsychology and director of the Safe Concussion Outcome, Recovery and Education (SCORE) program at Children’s National.

Dr. Gioia, an internationally recognized expert in pediatric concussion management, was named president of the society at the conclusion of this year’s meeting, which was held in Washington, D.C. from May 3-5, 2018. During his two year term, he will work with members to advance the mission of SNS, which seeks to advance the field of neuropsychology to generate and disseminate knowledge regarding brain-behavior relationships as it applies to sports, and to promote the welfare of athletes at all levels.

“The way we can really help our youth athletes is by understanding how we can maximally prevent concussions in sports, and how we can manage those earliest concussions more effectively to minimize the negative long term consequences,” says Dr. Gioia.

Susannah Jenkins

Guiding a new path for emergency medical care training

Susannah Jenkins

Susannah Jenkins, PA-C, guides a new training program for physician assistants.

Susannah Jenkins, PA-C, lead physician assistant with the emergency medicine and trauma services department at Children’s National Health System, celebrates three years at Children’s National this September and she’s glad she transitioned from an adult surgical environment to the fast-paced, dynamic environment of working in pediatric emergency medicine (PEM).

With 25 years of health care experience, 13 years as a physician assistant and 12 years as a nurse, Jenkins has worked in a variety of settings, inclusive of adult neurosurgery and high-risk OBGYN care.

“My passion is helping everyone heal, but I particularly enjoy working with children,” notes Jenkins. “Children have an extraordinary ability to bounce back after a fall and recover from a bout of seasonal, flu-like illness. A dose of medication or the correct diagnosis, paired with the right treatment, can sometimes make everything better, almost instantaneously, which is one of the most rewarding parts of working in this field. You get to help and see children heal.”

In addition to providing treatment for a range of pediatric patients, Jenkins works with Deena Berkowitz, M.D., M.P.H., a pediatric emergency medicine physician and assistant professor of pediatrics and emergency medicine at Children’s National and the George Washington University School of Medicine and Health Sciences, to train physician assistants, or PAs, to respond to urgent care needs within a Level 1 trauma center. With the encouragement and guidance of Dr. Berkowitz and Robert J. Freishtat, M.D., M.P.H., chief of emergency medicine at Children’s National, Jenkins expanded on an emergency medicine training program for PAs, which started at Children’s National in 2012.

Jenkins presents the 12-month module at the American Academy of Physician Assistants 2018 Annual Conference in New Orleans on Saturday, May 19, 2018.

Jenkins’ poster presentation, coauthored by Dr. Berkowitz, details the objectives, timeline, curriculum components and results that correspond with providing eight PAs with a 12-month training program to treat low-acuity pediatric patients at a Level 1 trauma center.

The eight PAs who completed the 12-month program in 2017-18 saw 14 percent of the emergency care department’s low-acuity pediatric patients – patients seeking treatment for basic care, such as ear infections, conjunctivitis or strep throat – after 12 months of exhibiting competency in the program. The structured curriculum includes a two-month orientation followed by a 10-month provisional training module, inclusive of CME submissions, scientific literature reviews, journal discussions, case studies, chart reviews, team-based care and competency reviews.

“This is all about education,” notes Jenkins. “We’re here to support the PA and we aim to answer questions they have about education goals, competency goals and practice goals in an institutional setting. This template provides the foundation to bridge the gap between post-graduation studies with the skills PAs need and are eager to develop throughout their career.”

Jenkins is currently working with Dr. Berkowitz to develop guidelines for PAs treating medium-acuity patients, inclusive of patients seeking a higher level of primary care, such as for appendicitis, and for PA-training-programs that extend past one year. Jenkins notes the 12-month program she presents at the American Academy of Physician Assistants 2018 Annual Conference is a template that can be applied to any PA subspecialty and is a desirable program for both employers and PA applicants.

“Ultimately, I sought to provide a guide that answered all of my questions I had as a new graduate and as a seasoned PA entering the new subspecialty of pediatric emergency medicine,” says Jenkins. “This program blends the academic science with clinical case studies and practice competencies, making it a modifiable learning platform that’s beneficial for everyone – but specifically designed for PAs. Remember, they enter the field with the desire to support physicians and their patients.”

Her guiding question isn’t on the final test but it helps her with the program design: How can we train PAs to provide the kind of care we want for our children, for our families and for our neighbors?

“I am proud of all of the PAs in this program and of all of the PAs I work with,” Jenkins concludes. “I actively refer them to family members and friends seeking urgent pediatric care. I am confident in the abilities of my group. They represent the type of provider I would send my family and my friends to see, and ultimately your family and friends to see, if they were in need.”

Dr. Berkowitz agrees and is happy with the success the program has had in preparing an average of six to eight PAs each year with the tools they need to launch their career.

Download a copy of “Bridging the post-graduation gap: A 12 month curriculum for PAs entering Pediatric Emergency Medicine.”

Dorothy Bulas

Dorothy Bulas, M.D., receives the Society for Pediatric Radiology’s highest honor

Dorothy Bulas

Dorothy Bulas, M.D. F.A.C.R., F.A.I.U.M., F.S.R.U., chief of diagnostic imaging and radiology in the Division of Diagnostic Imaging and Radiology at Children’s National Health System, is being recognized at the 2018 Society for Pediatric Radiology Annual Meeting with their most distinguished honor, the Gold Medal.

The Society of Pediatric Radiology (SPR) Gold Medal is awarded to pediatric radiologists who have contributed greatly to the SPR and their subspecialty of pediatric radiology as a scientist, teacher, personal mentor and leader.

Initially, Dr. Bulas completed her residency in pediatrics. During a pediatric radiology rotation at John Hopkins University, she realized how much she loved problem solving and using emerging imaging modalities and went on to complete her radiology residency at Albert Einstein Hospital. Soon after, Dr. Bulas moved to Washington, D.C. to complete a pediatric radiology fellowship at her professional home, Children’s National.

Since the completion of her fellowship, Dr. Bulas views her role in the advancement of fetal imaging as her most significant professional contribution. She has published 131 papers, one of her most recent as a co-author on “Neuroimaging findings in normocephalic infants with Zika virus” in Pediatric Neurology. Dr. Bulas is also a co-author of the textbook entitled Fundamental and Advanced Fetal Imaging and has authored 35 book chapters.

She has served as program director of the Radiology Fellowship Program at Children’s National since 2005 where she has impacted medical students, residents and fellows from the United States and abroad.

As a previous chair member for numerous organizations, Dr. Bulas currently co-chairs the American College of Radiology’s pediatric radiology education committee. She is a founding member of the Image Gently Alliance, where she chaired the outreach campaign to parents and wrote brochures, web material and articles. Dr. Bulas is also a founder of the World Federation of Pediatric Imaging.

Dr. Bulas was honored as an outstanding teacher with the Edward Singleton-Hooshang Taybi Award for Excellence in Education from the SPR and this past fall and as the Outstanding Educator in 2017 by the Radiological Society of North America.

Brian Stone with baby

Collaborative approach to NICU care leads to improved quality and safety across hospitals

Brian Stone with baby

Parents with sick or premature newborns want and need the best care possible, making quality and safety in the neonatal intensive care unit (NICU) a top priority. Over the past decade, Children’s National Health System has provided top quality NICU care to the Washington, D.C. community and surrounding areas. As part of this commitment, the institution developed an extensive network of partnerships in the Mid-Atlantic region where Children’s National neonatologists and advanced practice providers collaborate with other hospitals in the region to share best practices in the NICU.

Together, Children’s National and partner hospitals aim to improve NICU care for patients and families. To carry out this commitment, Children’s National neonatologists fully integrate themselves into local community hospitals to provide services such as neonatal care, delivery room attendance, consultations to obstetricians and local pediatricians, and serve as educators to the hospital team.

Integrating pediatric specialists into community hospitals that treat both adults and children helps strengthen the infrastructure and refine practices to specifically understand pediatric biology and development to enhance existing care. Using the Dyad leadership model, the team forms interdisciplinary care committees, led by a physician and nursing champion, to empower everyone who interacts with the NICU and has a stake in a child’s care. All policies and procedures are vetted by these committees to ensure high-quality, cohesive care for the patient.

Through this collaboration, Children’s National neonatologists oversee newborn care for more than 10,000 births per year. Outcomes include:

  • Partner NICUs consistently perform in the top quartile for key performance benchmarking measures in national networks.
  • Partner NICUs have lower than predicted rates of morbidity, infection, lung disease and necrotizing enterocolitis which are major determinants in overall neonatal outcome.

Based on this success, Children’s National created the Division of Pediatric Outreach in 2017, led by Brian Stone, M.D., M.B.A. This division focuses on ensuring that neonatal and pediatric patients have access to and can receive expert care from Children’s National specialists in their local community birth hospital. Additionally, the division works closely with local obstetricians and maternal-fetal-medicine specialists to develop birth and post-natal plans for high-risk pregnancies to ensure that newborns have the best possible start.

“Over the years, we have been able to leverage our internal expertise as reflected in our current number one ranking in U.S. News & World Report and extend the same high level of care to patients born within our extended network to improve population health as a whole within the region,” said Dr. Stone.

Cara Lichtenstein

Children’s Community Health Track receives prestigious APA Teaching Program Award

Cara Lichtenstein

“As a community-focused health system, one of our central missions is to train a new generation of residents to create successful community partnerships and integrate public health concepts into the everyday practice of medicine to improve the health of underserved communities,” says Cara Lichtenstein, M.D., MPH.

The Children’s National Community Health Track (CHT) has been recognized by the Academic Pediatric Association with its prestigious Teaching Program Award. The honor was made public at the Pediatric Academic Societies (PAS) annual meeting on May 7, 2018 in Toronto, Ontario. The purpose of the award is to foster interest in the teaching of general pediatrics by giving national recognition to an outstanding general pediatric program. The PAS selection committee chose Children’s CHT for demonstrating excellence in educational teaching methods, acceptance by the community, its adaptability and the outstanding quality of residents trained in the program.

“As a community-focused health system, one of our central missions is to train a new generation of residents to create successful community partnerships and integrate public health concepts into the everyday practice of medicine to improve the health of underserved communities,” says Cara Lichtenstein, M.D., MPH and director of Children’s Community Health Track.

Children’s CHT focuses on underserved populations and the development of skills in health policy, advocacy and community healthcare delivery. Residents spend their outpatient time learning to use public health techniques to identify and address community health needs, becoming a physician advocate and learning more about the sociocultural determinants of health and health disparities. Training for CHT is integrated with Children’s overall pediatrics residency program to ensure excellence in attainment of clinical skills, and to allow residents the opportunity to work with Children’s top-rated primary care, specialty and hospital-based physicians and care teams.

This is the third time in recent years that Children’s National has been honored by the Academic Pediatric Association. In 2013, Mary Ottolini, M.D., MPH and vice chair of medical education was recognized for her leadership of Children’s Master Teacher Leadership Development program. In 2009, Denice Cora-Bramble, M.D., MBA accepted the APA Health Care Delivery Award for the Goldberg Center for Community Pediatric Health at Children’s National.

Children’s offers up to eight residency positions each year designated as Community Health Track positions. The goals of the track are centered on the core competencies of community pediatrics as described by the American Academy of Pediatrics. Primarily to train residents to:

  • Grasp the breadth of diversity inherent in the pediatric population and be familiar with health-related implications of cultural beliefs and practices of groups represented in the community.
  • Recognize the role of the pediatrician in identifying needs and facilitating access to resources for patients, families and communities.
  • Be aware of the risks to health and barriers to care for underserved children in Washington, D.C., and demonstrate skill in improving access to continuous comprehensive health maintenance.
  • Appreciate key issues related to the pediatrician’s role and interactions with local community agencies and advocacy groups.
  • Value the role of schools and childcare settings in supporting the educational and psychosocial development of children and adolescents.
  • Apply key principles about health promotion and disease prevention for children and adolescents over a set period of time.
  • Observe, interpret and report observations about the communities in which they serve.

The fundamental difference in this track compared to the more traditional Categorical Track lies in the outpatient experiences that occur in all three years of training. The CHT utilizes these outpatient experiences to help residents to attain a well-rounded community pediatrics experience.

“Washington, D.C. is an incredibly diverse community with large numbers of vulnerable children and families from D.C. and all over the world. Given our location in our nation’s capital, residents and faculty have the unique opportunity to work with national professional and advocacy organizations that are influencing policy – both locally and nationally – as it relates to children, families and health care,” says Mark Weissman, M.D., chief of general pediatrics and community health at Children’s National. “We’re thrilled to be recognized with the Academic Pediatric Association’s Teaching Program Award and grateful to Dr. Lichtenstein for her leadership and commitment to improving the health of D.C.’s children and training the next generation of pediatricians and advocates.”

Presidnet's Award for Innovation in Research

President’s Award highlights innovative work by early-career researchers

Presidnet's Award for Innovation in Research

As part of Research and Education Week 2018, two Presidential awardees were recognized for their research contributions, Catherine “Katie” Forster, M.D., M.S., and Nathan Anthony Smith, Ph.D.

Catherine “Katie” Forster, M.D., M.S., and Nathan Anthony Smith, Ph.D., received the President’s Award for Innovation in Research honoring their respective research efforts to explore an understudied part of the microbiome and to shed light on an underappreciated player in nerve cell communication.

Drs. Forster and Smith received their awards April 19, 2018, the penultimate day of Research and Education Week 2018, an annual celebration of the excellence in research, education, innovation and scholarship that takes place at Children’s National Health System. This year marks the fifth time the President’s Award honor has been bestowed to Children’s faculty.

Dr. Forster’s work focuses on preventing pediatric urinary tract infections (UTIs). Frequently, children diagnosed with illnesses like spina bifida have difficulty urinating on their own, and they often develop UTIs. These repeated infections are frequently treated with antibiotics which, in turn, can lead to the child developing antibiotic-resistant organisms.

“The majority of the time if you culture these children, you’ll grow something. In a healthy child, that culture would indicate a UTI,” Dr. Forster says. “Children with neurogenic bladder, however, may test positive for bacteria that simply look suspect but are not causing infection. Ultimately, we’re looking for better ways to diagnose UTI at the point of care to better personalize antibiotic treatment and limit prescriptions for children who do not truly need them.”

Powered by new sequencing techniques, a research group that includes Dr. Forster discovered that the human bladder hosts a significant microbiome, a diverse bacterial community unique to the bladder. Dr. Forster’s research will continue to characterize that microbiome to determine how that bacterial community evolves over time and whether those changes are predictable enough to intervene and prevent UTIs.

“Which genes are upregulated in Escherichia coli and the epithelium, and which genes are upregulated by both in response to each other? That can help us understand whether genes being upregulated are pathogenic,” she adds. “It’s a novel and exciting research area with significant public health implications.”

Smith’s work focuses on the role of astrocytes, specialized star-shaped glial cells, in modulating synaptic plasticity via norepinephrine. Conventional thinking describes astrocytes as support cells but, according to Smith, astrocytes are turning out to be more instrumental.

Norepinephrine, a neurotransmitter that plays an essential role in attention and focus, is released by a process known as volume transmission, which is a widespread release of a neurotransmitter at once, says Smith, a principal investigator in Children’s Center for Neuroscience Research. Astrocytes, which outnumber neurons in the brain, are strategically and anatomically located to receive this diffuse input and translate it into action to modulate neural networks.

“We hypothesize that astrocytes are integral, functional partners with norepinephrine in modulating cortical networks,” Smith adds. “Since astrocytes and norepinephrine have been implicated in many central nervous system functions, including learning and attention, it is critical to define mechanistically how astrocytes and norepinephrine work together to influence neural networks. This knowledge also will be important for the development of novel therapeutics to treat diseases such as attention deficit hyperactivity disorder and epilepsy.”

Dr. Jackson and colleagues with D.C. City Council

Shining a light on child abuse, how to prevent it and help kids recover

Dr. Jackson and colleagues with D.C. City Council

Dr. Jackson and colleagues from Children’s National Health System and the District’s Multidisciplinary Team join resolution sponsor Councilmember Vincent Gray and the D.C. City Council for the presentation of the Child Abuse Prevention Month Recognition Resolution of 2018.

In recognition of Child Abuse Prevention Month, Children’s National Health System joined the DC City Council on Tuesday, April 10, 2018, to present the Child Abuse Prevention Month Recognition Resolution of 2018. According to Councilmember Vincent Gray, who sponsored it, the unanimous resolution “recognizes all the community partners who work to prevent the tragedy of child abuse before it happens, and who keep the children of the District of Columbia as safe as we can.”

He mentioned the many years that the District of Columbia fell in the top five for child abuse victims per capita, and that, while the city still ranks highly, the number of victims per  1,000 children has declined significantly since 2009. He attributes this decline to the communities and agencies who work together to protect children and strengthen families.

Allison Jackson, M.D., MPH, chief of the Child and Adolescent Protection Center at Children’s National, expressed her sincere appreciation for all the people who care for and protect children.

“Every day we see the scores of children who have experienced maltreatment,” she says. “We are so thankful for the recognition of the small voices, and grateful to Councilman Gray and the other supportive councilmembers for helping us to remove the veil of secrecy that burdens so many children and families who have experienced child abuse.”

The Child and Adolescent Protection Center at Children’s National Health System was started in the mid-1970s to provide medical care, forensic medical evaluations by pediatric trained forensic professionals, and mental health treatment for children. Dr. Jackson notes that in the 1990s, the District established a multi-disciplinary team to implement the trauma-informed response framework across all agencies in the District addressing these issues.

She also cites that years of research into adverse childhood events have shown that childhood abuse, exploitation, and neglect has long term medical and brain health consequences that last throughout life and can shorten lives, as well.

However, that research also shows that trauma-informed care and interventions can reduce the exposure to maltreatment, and also reduce the long lasting impacts of maltreatment on a child.

“Child abuse can be prevented if we can all commit to promoting safe, stable and nurturing relationships for children and youth,” Dr. Jackson points out. “I encourage each of you to learn how to recognize child abuse and the appropriate response if you suspect it. Parenting is difficult, so support and encourage parents and caregivers.  Remember that ‘discipline’ means ‘to teach,’ so find constructive ways to teach children right from wrong. And SPEAK UP for children and families.”

The presentation occurs at 33:00 minutes of the 22nd Legislative Meeting of the D.C. City Council.