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In The News: COVID Projections, Tracheostomy Tubes, Ortho Chief, Rheumatologist Award, Pain in Children

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Nov 6, 2020
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In the News

In The News: COVID Projections, Tracheostomy Tube Change, New Role for Ortho Chief, Rheumatologist Award, Musculoskeletal Pain

shafere1 [at] email.chop.edu (By Emily Shafer)

This week in In the News, find out PolicyLab's new COVID-19 projections as the colder weather moves in. Learn whether earlier tracheostomy tube change is beneficial for children. Find out what new role the Chief of Orthopaedics has, and who was honored by the American College of Rheumatology. Rounding out this week's highlights is a study highlighting the differences in pain manifestation in children.

COVID-19 Cases Projected to Increase Over Next Four Weeks

Updated PolicyLab projections on COVID-19 indicate that all states, with the exception of Hawaii, will see increased cases over the next four weeks. At least half of the states are expected to have substantial case growth. The projected growth of this fall wave may overwhelm contact-tracing efforts and may lead to schools needing to revert to online learning.

"As test positivity rates, hospitalizations, and case incidence rise, school leaders throughout the country will need to consult with their local health departments to make thoughtful, localized, decisions … about when distanced learning may become necessary for some or all of the study body until this fall wave diminishes," said David Rubin, MD, MSCE, director of PolicyLab and professor of Pediatrics at the University of Pennsylvania's Perelman School of Medicine.

The Northeast is expected to see significant COVID-19 resurgence as the colder weather moves in, threatening the success achieved in New York City, New Jersey, and the Philadelphia region. The researchers also note concern about resurgence growing more quickly than anticipated in the warmer climate zones in the southern U.S. In addition, the growth in case numbers has been accompanied by rapid increases in hospitalization rates.

Read more about the projections in a PolicyLab press release.

Early Tracheostomy Tube Change is Safe, Leads to Fewer Complications

Changing the first tracheostomy tube four days after placement can occur without adverse events. This timing of the procedure results in fewer significant skin wounds around the opening and earlier discharge from intensive care, according to findings that appeared in Otolaryngology—Head and Neck Surgery. Previously, most surgeons performed the tube change between five and seven days after placement, though the best timing has not been established.

"Confidence that clinicians can perform the first tracheostomy tube change safely remains paramount to both clinicians and patients," said study co-author Rosemary Patel, MSN, CRNP, a nurse practitioner in the Division of Otolaryngology and the Center for Pediatric Airway Disorders, a CHOP Frontier Program. "The results from this small trial highlight the benefits of an earlier first changes, with no adverse events of a first tube change at four days and few complications when compared to a first tube change at seven days."

The study included 16 patients ages 24 months or younger. Ten patients underwent tracheostomy change at four days, and six patients underwent the change at seven days. Fewer patients in the four-day group developed significant wounds (10% vs. 83%), and more patients were discharged from the intensive care within five weeks (90% vs. 33%).

Read more about the study in the CHOP press release.

Ortho Chief Named Vice President of ABOS

John M. "Jack" Flynn, MD, chief of the Division of Orthopaedics at CHOP, was elected vice president of the American Board of Orthopaedic Surgery (ABOS), where he will serve a one-year term.

"It is a great honor to work for ABOS to both protect the public and serve the field of orthopaedic surgery," said Dr. Flynn, who is the Richard M. Armstrong Jr. Endowed Chair in Orthopedic Surgery at CHOP, and professor of Orthopedic Surgery at the Perelman School of Medicine at the University of Pennsylvania.

Dr. Flynn has served as President of the Pediatric Orthopaedic Society of North America and the Children's Spine Study Group, run by the Children's Spine Foundation. He is also a member of several international, multicenter scoliosis research networks. Some of Dr. Flynn's research interests include improving the results and safety of pediatric and adolescent spine surgery; early-onset scoliosis and thoracic insufficiency; preventing surgery in children with spine deformities; and optimal treatment of pediatric fractures.

Learn more about Dr. Flynn's new role in the CHOP press release.

CHOP Rheumatologist Recognized by American College of Rheumatology

Pediatric rheumatologist Pamela Weiss, MD, MSCE, is the recipient of this year's American College of Rheumatology (ACR) Henry Kunkel Early Career Investigator Award. This award acknowledges an early career physician-scientist who is 12 years post-Rheumatology certifying examination eligibility and has made outstanding and promising independent contributions to basic, translational, or clinical research in the field of rheumatology.

"I do the work I do each day because it is impactful for the patients and families, without any expectation for recognition – but it is certainly uplifting when it happens," said Dr. Weiss, who is clinical research director in the Division of Rheumatology, and associate professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. "Since this award is rarely given to pediatric rheumatologists – I'm only the fourth in the 32-year history of the award – it is especially heartening to see the value of clinical research in pediatrics recognized by the ACR."

Dr. Weiss is also a core faculty member in the Center for Pediatric Clinical Effectiveness at CHOP. Some of her research focuses include finding effective therapies for spondyloarthritis and ankylosing spondylitis in children, and serologic and imaging predictors of disease remission in these patients.

Researchers Identify Spectrum of Musculoskeletal Pain Among Children

Researchers in CHOP's Division of Rheumatology found a wide spectrum of pain manifestations among children who have amplified pain. The findings appeared in Pediatric Rheumatology. David D. Sherry, MD, attending rheumatologist at CHOP and professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine; Maitry Sonagra, MPH, clinical research coordinator at the Center for Pediatric Effectiveness and the Center for Amplified Musculoskeletal Pain Syndrome; and Sabrina Gmuca, MD, MSCE, attending rheumatologist at CHOP and instructor of Pediatrics at the University of Pennsylvania Perelman School of Medicine, conducted the study.

They analyzed 636 patients and found that 54% had diffuse pain, but only 58% of those met criteria for fibromyalgia. They also found that patients with diffuse pain vs. those with localized pain, had a longer duration of pain, reported greater pain intensity, had poorer function, and had greater mental health burden.

"Studies focusing on fibromyalgia may miss the full extent of childhood amplified pain," the researchers concluded. "Additionally, research limited to those meeting the fibromyalgia criteria likely underestimate the significant impact of amplified pain among the pediatric population."

ICYMI

Catch up on our headlines from our Oct. 23 In the News:

  • October is for Football Concussion Papers
  • Symposium for Bone Marrow Failure Community – A Virtual Success
  • Disparities in Early Intervention Referrals for Developmental Delays
  • CHOP Researchers Develop Standards for Mitochondrial DNA Variant Interpretation
  • CHOP Endocrinology Chief Featured on Panama TV

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