2022 Western Medical Research Conference
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Adolescent medicine and general pediatrics I
Concurrent session
12:45 PM
Thursday, January 20, 2022
#1 Quality improvement increases community hospital smoke exposure screening, education, and referral
MY Hamline2,3
1Sutter Health, Sacramento, CA
2UC Davis Children’s Hospital, Sacramento, CA
3Adventist Health Lodi Memorial, Lodi, CA
Purpose of Study
Tobacco use starts young and is the leading cause of preventable disease, disability, and death in the United States. Secondhand smoke increases ear and respiratory infections, asthma attacks, and risk of Sudden Unexpected Infant Death. Few smoking cessation studies in inpatient pediatrics are formal quality improvement projects and most are at academic institutions. We sought to increase smoke exposure screening, smoking cessation education, and referrals in our community hospital pediatric population. By improving screening and documentation, we anticipate increased provider awareness and smoking cessation interventions.
Methods Used
All pediatric ward, newborn nursery, and Level II nursery admissions were eligible. Interventions were education on smoke exposure screening and Helpline referrals, standardizing documentation for screening and discharge instructions, visual reminders, and Helpline wallet cards.
The primary outcome measure was monthly percentage of pediatric inpatients screened for smoke exposure. Secondary outcomes were percentage of pediatric inpatients screening positive for smoke exposure who received discharge instructions or who received a Helpline referral [self or family member]. Length of stay [LOS] was monitored as a balancing measure.
Outcome measures were analyzed with statistical process control in SPC for Excel. Baseline and intervention periods for LOS were compared with t-tests.
Summary of Results
We increased baseline average smoke exposure screening rates from 14% to 73%, meeting criteria for special cause variation [figure 1]. Education on smoke exposure avoidance increased from 5% to 57%. Helpline referrals increased from 0% to 21%. There was no significant change in length of stay.
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Abstract #1 Figure 1
Vertical lines are timing of interventions. 1] Monthly Pediatrician education started 2] EMR documentation standardized, visual reminders posted 3] Helpline wallet cards available.UCL= Upper Control Limit, Avg= Average, LCL= Lower Control LimitBaseline: Dec 2019-Nov 2020. Intervention: Dec 2020-June 2021
Conclusions
Pediatrician-led smoking cessation interventions are feasible and effective in community hospital pediatric units with no significant impact on length of stay.
#2 Pilomatricoma in a child with turner syndrome: a rare entity
IS Horowitz
K Tappin*
Valley Children’s Healthcare, Madera, CA
Purpose of Study
Pilomatricoma is a rare, skin neoplasm that is often confused with dermoid or brachial cleft cysts. Julian et al., reported that pilomatricomas are commonly misdiagnosed pre-operatively in up to 75% of cases.
We report the case of a child with Turner’s syndrome with a pilomatricoma that was diagnosed on biopsy. We review the histopathologic features and emphasize its association with Turner’s syndrome.
Methods Used
Case Report.
Summary of Results
2 year old female with Turner Syndrome presented with a progressive mass above her right upper lip for 6 months.
On exam, she was well-appearing with phenotypical features of Turner’s syndrome. A 0.5 x 0.5 cm erythematous, verrucous, well circumscribed, nontender, mobile lesion was noted above her lip.
She underwent complete excision of the mass without complication. Excisional biopsy revealed the presence of viable basaloid cells and shadow cells confirming the diagnosis of pilomatricoma.
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Conclusions
A pilomatricoma, otherwise known as pilomatrixomas, are benign subepidermic tumors of the hair follicle matrix. The lesions occur on the face and neck with a mean age of onset between 5.8- 7 years old.
Lesions are usually asymptomatic but, inflammation and ulceration can occur. The most common clinical presentation is a firm, subcutaneous lesion with an irregular surface. The overlying skin may be red, blue, or display the tent sign. Studies have reported the initial development of pilomatricomas in children with Turner’s syndrome. The exact cause of this is unknown although animal studies suggest a genetic component.
Histopathologically, a pilomatricoma appears as a mass composed of viable basaloid cells, shadow cells, calcification, and ossification. The mainstay of treatment of a pilomatricoma is complete surgical excision as the lesions do not regress spontaneously. Early excision within 12 months of diagnosis is associated with better cosmetic outcomes. Recurrence and malignant transformation is rare.
This case highlights the importance of considering pilomatricoma as a cause of solitary skin nodules, especially when on the head, neck or upper extremities. Additionally, physicians caring for children with Turner syndrome should be aware of the prevalence of pilomatricoma in this population.
#3 Mental health hopscotch: improving adolescent mental health one hop at a time
AS Rodriguez1*
M Flores1
T Fildes1
J Charbonnet1
K Colwell1
R Kinman2
1Fresno High School, Fresno, CA
2University of California San Francisco Fresno, Fresno, CA
Purpose of Study
Fresno High Women ‘s Alliance students continue to collaborate with UCSF Fresno pediatricians to create community action research projects on topics of adolescent concern using a ‘youth as partner’ approach. Given the social isolation and increasing depression students noticed amongst themselves and their peers due to COVID19, the Women’s Alliance teens chose to focus this last year on improving mental health amongst their peers. Mental Health Hopscotch was chosen for its simplicity and ease of use. The fact that it was created by an adolescent in response to the COVID19 pandemic provided further impetus for its use.
Methods Used
Students collaborated with the school’s Social Emotional Wellness and Support team, choosing to do their mental health intervention during National Mental Health Month. They created a Mental Health ‘Sunshine’ at their school entrance, chalking positive affirmations in a sun-shaped diagram for all to see, and chalked a Mental Health Hopscotch on the sidewalk in the front of the school. Silicone bracelets with motivational quotes and mental health awareness pencils, stickers, and mini buttons were handed out to those who completed the Hopscotch. A QR code linked to Google Forms was used to survey students who completed the Hopscotch.
Summary of Results
42 students were surveyed. 12% of students reported their average stress level was ‘just right’, 38% reported they could ‘handle’ their stress, 21% felt that they were ‘getting stressed’, 19% reported they were ‘starting to lose it’, and 10% described their stress as ‘getting out of control’. Students primarily dealt with stress by listening to music [31%], exercising [19%], and sleeping [14%]. Half of students surveyed reported difficulty sleeping at night, while 90% of students felt that doing Mental Health Hopscotch helped boost their mood.
Conclusions
Although only a limited number of students were surveyed due to restricted numbers of students present on campus, the majority of students felt stressed with half the students reporting difficulty sleeping at night. Mental Health Hopscotch provided a simple, quick, yet no-cost approach to boost students’ mood, thus empowering teens concerned about the mental health of their peers to stage a mental health intervention on their own school grounds.
#4 Daylight savings and pediatric emergencies
V Wong1,2*
P Enarson1,2
J Lee1,2
1The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
2BC Children’s Hospital, Vancouver, BC, Canada
Purpose of Study
Daylight Savings Time [DST] is a biannual time change where during ‘spring forward,’ clocks are set forward one hour, potentially resulting in sleep deprivation for much of society. During ‘fall back,’ the opposite occurs. Circadian rhythm disruption has been shown to have effects on cardiovascular, neuropsychiatric, metabolic, immune-related and accidental events in adults. A 2018 study showed increased emergency department [ED] visits for adults in the time after DST. These findings have not been verified in pediatric populations and if extant, may have implications on managing ED patient volume and expectations. We hypothesized that the large-scale sleep deprivation following spring time change would result in increased ED presentations, particularly among certain presentations [neurologic, psychiatric, accidental/traumatic] that may be especially susceptible to sleep deprivation, and that the fall time change would have an opposite effect.
Methods Used
We retrospectively collected and analyzed the primary medical complaint of all children [0–16 years] presenting to BC Children’s Hospital ED in the 2 weeks before and 3 weeks after the biannual DST time changes during 2011 to 2019. Incidence ratios [IR] of ED presentations were calculated over day 0 [day of time change] to day 7. IRs were calculated for all presentations and broken down by specialty.
Summary of Results
After excluding infectious presentations, the IR was increased during the first week following spring time change: Monday by 6%, Tuesday by 7% and Wednesday by 6%, though the results were statistical insignificant [p>0.05]. There were significant decreases [p