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UPMC Residency Programs Rank Nationally

Physician network Doximity, along with U.S. News & World Report, announced the first comprehensive national evaluation of residency programs. In these results, 11 UPMC programs ranked in the top 10.

To determine the rankings, 3,691 residency training programs were evaluated by combining over 50,000 peer nominations from board-certified US physicians. U.S. News & World Report, nationally known for their education and health care rankings, consulted on the methodology.

Here is a listing of UPMC programs in the top 10:

  • Anesthesiology: No. 10
  • Obstetrics and gynecology: No. 3
  • Plastic surgery (integrated): No. 3
  • Otolaryngology: No. 4
  • Emergency medicine: No. 7
  • Physical medicine and rehabilitation: No. 7
  • Psychiatry: No. 7
  • Orthopaedic surgery: No. 8
  • Pediatrics: No. 8
  • Neurological surgery: No. 9
  • Surgery: No. 10

The results are used in a free tool from Doximity called Residency Navigator. The tool is designed for third- and fourth-year medical students.

Children’s Brain Care Institute Experts Publish Paper that Supports Newborn Screening for Hurler Syndrome

PITTSBURGH, August 28, 2014 — Members of the Program for the Study of Neurodevelopment in Rare Disorders (NDRD) at Children’s Hospital of Pittsburgh of UPMC will have an article published in an upcoming issue of Annals of Neurology. The article, “Early Treatment is Associated With Improved Cognition in Hurler Syndrome,” was authored by Michele Poe, PhD, Sarah Chagnon, MD, and Maria Escolar, MD, of the Brain Care Institute.

Hurler syndrome is the most clinically severe form of an autosomal recessive lysosomal disorder characterized by the deficiency of α-L-iduronidase and is often fatal during childhood. Umbilical cord blood transplantation from unrelated donors has been shown to improve neurological outcomes of children younger than 2 years old, and extend the lives of these patients.

The authors followed 31 patients with Hurler syndrome who underwent umbilical cord blood transplantation between June 1997 and February 2013. Patients were evaluated at baseline and every six to 12 months thereafter. All 31 patients underwent complete neurodevelopmental evaluation and a median of seven evaluations. The authors found that younger age at transplantation was associated with improved cognitive function, receptive and expressive language, and adaptive behavior. Children younger than 9 months at the time of transplant showed normal cognitive development. These findings demonstrate that early diagnosis may be necessary for optimal outcomes and — because most patients are not identified at a young age — support the need for newborn screening.

Children’s Physician Receives PCORI Funding for Study on Early Rehabilitation in Pediatric Patients with Acute Brain Injury

PITTSBURGH, August 19, 2014 – Led by a Children’s Hospital of Pittsburgh of UPMC physician, a multidisciplinary research project to improve outcomes for children with acute brain injury was recently approved for a $1.9 million funding award by the Patient-Centered Outcomes Research Institute (PCORI).

The study, “Early Rehabilitation Protocol (ERP) in the Pediatric ICU for Children with Acute Brain Injury (ABI),” led by Ericka Fink, MD, of the Department of Pediatric Critical Care Medicine, will perform a needs assessment to further characterize the current practices, barriers to care, and resources for physical, occupational, speech, and behavioral assessment and therapies needed for ERP implementation in pediatric intensive care units (ICUs). It will also evaluate ERP versus usual care to improve outcomes for children admitted to the ICU with ABI.

The two-center, randomized, controlled trial and resource survey is one of 33 proposals PCORI approved for funding to advance the field of patient-centered comparative effectiveness research and provide patients, health care providers, and other clinical decision makers with information that will help them make better-informed choices.

Dr. Fink and Craig Smith, MD, a former pediatric ICU fellow at Children’s and the principal investigator at Lurie Children’s Hospital, expect that participating sites will perceive an inadequate use of rehabilitation in pediatric ICU patients with ABI and predict that children with ABI will benefit from early ICU rehabilitation rather than usual care.

Childhood Disability Rates Highest Recorded, Children’s Hospital of Pittsburgh of UPMC Finds

PITTSBURGH, Aug. 18, 2014 – The percentage of children with disabilities due to neurodevelopmental or mental health conditions continues to rise, particularly among children in more socially advantaged households, according to a Children’s Hospital of Pittsburgh of UPMC analysis that appears in the September issue of Pediatrics.

Results of the study, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital, found that while there has been a decline in physical health-related disabilities by approximately 12 percent, there was a large, nearly 21 percent rise in disabilities classified as neurodevelopmental or mental health in nature.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention between 2001 and 2011, evaluating each child’s ability to perform activities at home and school.

Although children living in poverty have the highest rates of disability, children living in families at or above 400 percent of the federal poverty level reported a 28.4 percent increase in disabilities over the past 10-year period.

Dr. Houtrow and the researchers offered four reasons that may explain the increased rates of disability related to neurodevelopmental or mental health conditions:

  • shifts in diagnostic criteria
  • overall increases in rates of certain problems including autism
  • increased awareness of these conditions
  • the need for a specific diagnosis to receive services such as early intervention

“This study demonstrates what a lot of pediatricians have been noticing for several years – that they are seeing more neurodevelopmental and mental health problems in their clinical practices,” said Dr. Houtrow, who also is an associate professor of Physical Medicine & Rehabilitation and Pediatrics and vice chair in the University of Pittsburgh School of Medicine’s Department of Physical Medicine and Rehabilitation. “As we look toward the future, the pediatric health care workforce and system needs to adapt to assure the best possible health and functional outcomes for children with disabilities related to neurodevelopmental and mental health conditions.”

The authors concluded that documenting the changes in childhood disabilities is an important step in developing better prevention and treatment strategies and in determining how to create and deliver services to best meet the needs of all children.

Co-investigators were: Kandyce Larson, Ph.D., and Lynn M. Olson, Ph.D., American Academy of Pediatrics; Paul Newacheck, Dr.P.H., University of California San Francisco; and Neal Halfon M.D., M.P.H., University of California Los Angles.

The research was funded by grants K12H133B031102 and T76MC000141900 from the National Institutes of Health and Department of Health and Human Services.

For more information on Dr. Houtrow and the Division of Pediatric Rehabilitation Medicine, visit http://www.chp.edu/rehab.

Children’s Brain Care Institute Expert Receives Grant for Mitochondrial Disease Research

PITTSBURGH, July 28, 2014 — The United Mitochondrial Disease Foundation (UMDF) recently awarded nearly $500,000 in grants to researchers investigating potential treatments for mitochondrial disease. The research grant awards were presented at the UMDF’s annual symposium, Mitochondrial Medicine 2014: Pittsburgh.

Michael Bell, MD, of the Brain Care Institute (BCI) at Children’s Hospital of Pittsburgh of UPMC, received a grant of $25,000 for his project, “Improving CNS delivery of brain antioxidants after acute metabolic decompensation in mitochondrial disease,” which will investigate a combination of two FDA-approved drugs for their effectiveness in treating children and young adults with Leigh’s Syndrome. This work has the potential to improve brain function in patients with a mitochondrial disease for which there are currently no proven treatments. Dr. Bell is working on this project with Amy Goldstein, MD, of the Division of Child Neurology, and Bob Clark, MD, and Hülya Bayir, MD, from the Department of Pediatric Critical Care Medicine, who all are part of the Brain Care Institute.

Dr. Bell is also director of Pediatric Neurocritical Care and the Pediatric Neurotrauma Center at Children’s. He is associate director of Pediatric Neurointensive Care and Perinatal Brain Injury at the Safar Center for Resuscitation Research at the University of Pittsburgh, and associate professor of Critical Care Medicine and Neurological Surgery at the University of Pittsburgh School of Medicine.

The UMDF is the largest, non-governmental contributor of grants focused on mitochondrial disease research. Since 1996, the UMDF has funded more than $13 million dollars in research projects.

UPMC Clinicians Win Beckwith Institute Grants to Engage Patients, Improve Care

PITTSBURGH, July 25, 2014 –To experiment with changes big and small that might better engage patients and improve health care, The Beckwith Institute recently awarded 11 new grants to UPMC clinicians and other staff.

The wide-ranging projects include an effort to develop a shared decision-making tool for family members of patients in intensive care units (ICUs) and the creation of an interactive, Web-based “thermometer” to monitor the mood and energy of adolescents with bipolar disorder.

Supported by UPMC Chairman G. Nicholas Beckwith and his wife, Dotty, with matching funds from UPMC, the Beckwith Institute annually provides grants to improve clinical outcomes by empowering both clinicians and patients to explore innovative ways of transforming health care.

“Through the inspiring leadership and generous financial assistance of Nick and Dotty Beckwith, we are able to empower clinicians and other staff to experiment with new methods for transforming care delivery,” said Tami Minnier, UPMC chief quality officer. “At the heart of every project chosen for this program is an emphasis on engaging and educating patients and families so that they can play a meaningful role in the health care decisions that affect them.”

The grants are administered through two complementary efforts: The Frontline Innovation Program, which focuses on improving the patient bedside experience, and the Clinical Transformation Program, which supports comprehensive redesign of processes to put the involvement of the patient and their loved ones at the core.

The projects awarded 2014-2015 grants include:

  • a novel “mood and energy” tracking application for patients with pediatric bipolar disorder
  • a mobile application that allows patients to track and navigate the complex organ transplant process
  • a Web-based communication and decision support tool to improve the quality of shared decision-making in the ICU and to prepare family members for the role of surrogate decision maker
  • use of personal health monitoring devices for elderly patients with heart disease to promote patient engagement and prevent complications
  • an effort to assess patients for readmission risk and to ensure appropriate outreach after hospital discharge
  • resources to engage pediatric patients in diabetes care
  • standardization of sexual assault care at UPMC facilities
  • an asthma education program for children that includes a nurse hotline and online patient portal
  • a decision-making tool to help patients with chronic obstructive pulmonary disease make informed treatment decisions
  • development of a protocol that can be used to safely identify and discharge blunt trauma patients who have sustained no significant injury
  • a multidisciplinary effort to reduce unnecessary hospital readmissions for patients with complex health needs

Telemedicine Effective in Delivering International Cardiac Care, Children’s Hospital Study Shows

PITTSBURGH, July 22, 2014 – After studying more than 1,000 pediatric consultations offered in Latin America through telemedicine, researchers at Children’s Hospital of Pittsburgh of UPMC found that physicians in those countries were highly satisfied with Children’s service and believed telemedicine had improved patient outcomes.

The study, led by Ricardo A. Muñoz, M.D., FAAP, FCCM, FACC, chief, Cardiac Intensive Care Division, at Children’s, was published online in the July issue of Telemedicine and e-Health.

“Lack of skilled physicians is a widespread problem, particularly those with expertise in patients with complex medical problems, such as congenital heart disease,” said Dr. Muñoz, also medical director, Global Business and Telemedicine, at Children’s. “The use of telemedicine services within pediatric cardiac intensive care units (CICUs) can be used as an assisting technology, allowing more expertise and knowledge to be shared with remote centers in need.”

Although a growing body of evidence suggests that telemedicine is associated with improved patient outcomes, the technology remains a relatively new tool in health care, particularly in pediatric critical care. In surveying the Latin American centers, the Children’s researchers hope to design a common approach for future tele-consultations.

“Little is known about the optimal method of telemedicine service delivery in the international setting,” said Dr. Muñoz. “Ideally, a consistent approach should be used for centers with similar organizations, skill level and patient populations. One size does not fit all.”

The study showcased Children’s unusual multicenter experience in telemedicine at three hospitals in Colombia and one in Mexico from July 2011 to June 2013. Children’s physicians provided 1,040 consultations for 476 patients, with a real-time intervention taking place in 23 percent of those encounters, including echocardiography, adjustment of pacemaker settings and pharmacologic therapy. In 6 percent of the tele-consultations, a different diagnosis was suggested based on the interpretation of cardiac or imaging studies.

The number and type of patients seen by Children’s e-CICU were selected by local physicians at each hospital. Although Children’s physicians in Pittsburgh did not have remote access to the children’s electronic medical records, relevant patient data was provided in a secure database and telemedicine hardware was used for real-time consultations. A CICU physician from Children’s participated in all the encounters, with some being joined by other specialists, including cardiac surgeons and neonatal intensivists.

Based on anonymous surveys of physicians participating at the international centers, 96 percent of respondents reported being satisfied or highly satisfied with the telemedicine service, while 58 percent rated the promptness and time dedicated by the tele-intensivist as very high. Physicians reported that they changed their clinical practice sometimes in relation to the telemedicine encounters, with changes in surgical management noted most frequently.

“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Dr. Muñoz. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education. With continuing improvements in telemedicine technology and our own practices, we will continue to expand access to the world’s best health care for children around the world.”

Children’s Hospital is leading the way in the development of telemedicine services to meet the needs of young patients regionally and around the world. The state-of-the-art video conferencing technologies provide complex pediatric cardiac care through remote and virtual examinations — whenever and wherever expertise is needed. Experts from Children’s CICUs currently oversee international programs and provide consultations and care management in Cali, Bucaramanga and Medellin, all in Colombia, as well as in Mexico City, Mexico.

For more information on telemedicine services, please visit www.chp.edu/CHP/international+services+telemedicine.

Experimental Baby Formula Doesn’t Prevent Development of Antibodies Associated with Type I Diabetes in Early Childhood

First Large Trial of Type I Diabetes Prevention Approach Still Underway

PITTSBURGH, June 10, 2014 – Early findings from the first large international trial to try to prevent type I diabetes show that infants at risk for the disease who were fed a special baby formula that lacks complex cow milk proteins still made antibodies against the insulin-producing cells of the pancreas by the time the youngest children studied were six years old. Previous studies suggested the experimental formula might prevent the development of the auto-antibodies, which represent inflammatory changes in the organ.

But that doesn’t mean the children will definitely develop type I diabetes, also known as insulin-dependent diabetes mellitus (IDDM), as they get older, caution researchers at Children’s Hospital of Pittsburgh of UPMC, which is the coordinating center for the American arm of the study. The findings were published today in the Journal of the American Medical Association.

In type I diabetes, the body’s immune system attacks its own pancreatic beta cells, which make insulin to regulate blood sugar levels. That autoimmune process is thought to start very early in life, explained U.S. principal investigator Dorothy Becker, MBBCh, professor of pediatrics at Children’s Hospital and the University of Pittsburgh School of Medicine. Some smaller studies and animal experiments have shown that exposure during infancy to complex foreign proteins, such as the cow milk proteins in conventional baby formula, is associated with the presence of these autoimmune antibodies in children who have a parent or sibling with the condition and other indications of genetic risk.

“This has been a controversial issue, in part because different natural history studies have come to different conclusions,” Dr. Becker said. “We hope that when our intervention trial concludes in February 2017, which is when all the participating children will be at least 10 years old, we should have enough evidence to say whether or not this experimental formula can prevent them from getting Type I diabetes.”

From 2002 to 2007 at 78 study sites in 15 countries, the “Trial to Reduce IDDM in the Genetically at Risk,” or TRIGR, research group randomly assigned 1,078 high-risk infants to be weaned to a “hydrolyzed” formula made almost completely with smaller, less complex casein proteins and 1,081 to get conventional formula, which is made with 80 percent cow milk proteins and 20 percent of the hydrolyzed casein protein. The two formulas were similar in taste and smell so that neither the parents nor researchers could tell the difference between them. Each baby’s parents made their own decisions about breastfeeding and age of weaning to formula.

Blood samples from the umbilical cord and at three, six, nine, 12, 18 and 24 months of age, and yearly after that to age 10, were tested for antibody levels. After an average of seven years of follow-up — the youngest participants are now six — the researchers found no differences in antibody levels between the two groups.

“This tells us that the kind of formula the baby drinks doesn’t affect the inflammatory changes going on in the pancreas,” Dr. Becker said. “But it doesn’t tell us yet whether they will develop diabetes. In one animal study, mice that were fed the experimental formula had the inflammatory markers, but diabetes was almost totally prevented using the same experimental formula. That could be the case with these children, too.”

The TRIGR study group includes the Data Management Unit and researchers from six centers in the U.S., centers in Scandinavia led by the University of Helsinki, and centers throughout Canada, Australia and Europe.

The project was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Special Statutory Funding Program for Type 1 Diabetes Research and Digestive and Kidney Diseases, both part of the National Institutes of Health (grant numbers HD040364, HD042444 and 338 HD051997); the Canadian Institutes of Health Research; the Juvenile Diabetes Research Foundation International; and the Commission of the European Communities.

Children’s Hospital of Pittsburgh of UPMC Named One of America’s Top 10 Children’s Hospitals

PITTSBURGH, June 10, 2014 – Children’s Hospital of Pittsburgh of UPMC has been named one of America’s Best Children’s Hospitals by U.S. News & World Report.

Children’s Hospital ranks ninth on the magazine’s 2014-15 Honor Roll of America’s Best Children’s Hospitals, which was released today. Children’s also ranks in each of the 10 pediatrics specialties ranked by U.S. News. This is the fifth consecutive year Children’s has been named to U.S. News’ Honor Roll.

The Best Children’s Hospitals rankings highlight the top 50 U.S. pediatric hospitals in each of 10 specialties: cancer; cardiology and heart surgery; diabetes and endocrinology; gastroenterology and GI surgery; neonatology; nephrology; neurology and neurosurgery; orthopaedics; pulmonology; and urology.

Children’s ranked in the top 25 of all 10 specialties, including fifth in diabetes and endocrinology; sixth in gastroenterology and GI surgery; sixth in pulmonology; eighth in neonatology; and ninth in neurology and neurosurgery.

“Our inclusion on the honor roll and our rankings in each of the 10 specialties speaks to the breadth and depth of our clinical programs,” said Christopher Gessner, Children’s president. “It speaks to the expertise and commitment of our physicians, nurses and other staff who make Children’s Hospital a global leader in pediatric health care.”

The 2014-15 Best Children’s Hospitals rankings will be released online today and also will be published in the U.S. News Best Hospitals 2015 guidebook, available in August.

In addition to Children’s Hospital of Pittsburgh of UPMC, the other hospitals named to U.S. News’ Honor Roll of Best Children’s Hospitals for 2014-15 are:

  • Boston Children’s Hospital
  • Children’s Hospital of Philadelphia
  • Cincinnati Children’s Hospital Medical Center
  • Texas Children’s Hospital, Houston
  • Children’s Hospital Los Angeles
  • Children’s Hospital Colorado, Aurora
  • Nationwide Children’s Hospital, Columbus, Ohio
  • Ann and Robert H. Lurie Children’s Hospital of Chicago
  • Johns Hopkins Children’s Center, Baltimore

Children’s Hospital of Pittsburgh Foundation Receives $2.5 Million Gift from the Mario Lemieux Foundation to Establish New Lymphoma Center

PITTSBURGH, June 4, 2014Children’s Hospital of Pittsburgh Foundation announced today that it has received a $2.5 million gift from the Mario Lemieux Foundation to establish a new center for rare and hard-to-treat lymphomas that is expected to benefit children and young adults from around the world.

UPMC will provide matching funds to support the creation of the Mario Lemieux Lymphoma Center for Children and Young Adults at Children’s Hospital of Pittsburgh of UPMC.

The center will focus on clinical care as well as laboratory and clinical research surrounding difficult-to-treat childhood lymphomas. It will be led by Linda McAllister-Lucas, M.D., Ph.D., chief of the Division of Pediatric Hematology/Oncology at Children’s Hospital. She is an internationally recognized expert in lymphoma whose laboratory research has provided new insights into the molecular basis of these types of diseases.

Representatives from the Mario Lemieux Foundation, including Mario Lemieux, joined leaders from Children’s Hospital and its Foundation for today’s announcement. The Mario Lemieux Foundation will donate $2.5 million over seven years, with $2.5 million in matching support from UPMC.

“We are grateful to Mario and Nathalie Lemieux and to the Mario Lemieux Foundation for sharing our vision of a center that capitalizes on our unique expertise to offer hope to a group of patients with a devastating diagnosis,” said Greg Barrett, president, Children’s Hospital of Pittsburgh Foundation.

Lymphoma is the third most common type of childhood cancer, and in the United States, more than 1,500 children are diagnosed per year with some form of the disease, according to the American Cancer Society. While standardized treatment protocols are used for the majority of pediatric lymphoma cases, currently there is no effective treatment for up to 20 percent of patients.

“I was fortunate to have a type of lymphoma that has proven treatments with good outcomes,” Mario Lemieux said. “I want to create a place of hope for kids and young adults and their families who are diagnosed with lymphomas that have no known cures.”

In addition to the research of Dr. McAllister-Lucas, who has studied rare lymphomas with her husband, Peter Lucas, M.D., Ph.D., since 1999, Ed Prochownik, M.D., Ph.D., and J. Anthony Graves, M.D., Ph.D., both physician scientists within pediatric oncology at Children’s, direct research laboratories investigating the mechanisms that underlie the development of lymphoma. The Lemieux gift will now allow Children’s to also recruit an expert clinical researcher who can coordinate clinical trials of cutting-edge treatments for lymphomas, improving research that can have a global impact on care. In addition, the gift will foster the growth of the hospital’s Survivorship Program to support our patients who survive childhood cancer, the majority of whom have had leukemia and lymphoma.

“Children’s and Pittsburgh already had a strong infrastructure in place to provide treatment for lymphomas and other childhood cancers, including a renowned bone marrow transplant program, a cancer program dedicated to adolescents and young adults, and a close collaboration with the University of Pittsburgh Cancer Institute,” said Dr. McAllister-Lucas, who joined Children’s and the University of Pittsburgh School of Medicine in 2012 from the University of Michigan. “The support of the Mario Lemieux Foundation gives us the ability to enhance our basic and clinical research in a way that could lead to improved and potentially new treatments for patients from around the world who currently have very limited options.”

The Mario Lemieux Foundation has been an important supporter of Children’s for many years. The Foundation endowed a fund for pediatric cancer research, has helped to build beautiful spaces within the hospital that help all our patients, including an Austin’s Playroom that is open to all inpatients and offers extended hours, and the Lemieux Sibling Center for young brothers and sisters of patients who have to accompany the family to the hospital, as well as partnered with local Microsoft employees to outfit over 100 inpatient rooms with Xboxes to help distract kids during long hospital stays.

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