Patient Services announces recipients of its first research grants

Last summer, the Department of Patient Services announced a new research funding program aimed at engaging a growing number of professional staff in the Department of Patient Services in high quality, pediatric research with the ultimate goal of improving child health. The recipients of the first round of grants have been announced, and Children's Today is proud to present the details of the six exciting projects that were selected.

The awardees--who were notified by Children's Chief Nursing Officer and Senior Vice President of Patient Care Operations, Eileen Sporing, MSN, RN, CNAA-BC, FAAN (above)--will receive one year of funding. The program offers up to four awards to a maximum of $15,000 and two awards up to a maximum of $50,000 for direct costs. The awardees are, from left to right:

Tracy Curran, MS, senior clinical exercise physiologist, Cardiology
Encouraging Exercise in Preventive Cardiology Clinic

This pilot study seeks to compare the change in recorded physical activity and fitness levels of adolescent patients who are at risk for early atherosclerosis, seen in Children's Preventive Cardiology Program, receiving a combination of physical activity using the FITT principle (Frequency, Intensity, Type and Time) supported by an accelerometer with an online interactive tool, to patients followed in the Preventive Cardiology program receiving standard care provider-based exercise counseling.

Rachel Difazio, PhDc, RN, CPNP, Department of Orthopedics
Patient-Centered Outcomes of Orthopaedic Surgery in Children with Cerebral Palsy

The overall goal of the study is to determine if and how orthopaedic surgical interventions make a meaningful contribution to the health related quality of life (HRQOL) and functional abilities of children with severe non-ambulatory cerebral palsy (CP) and to determine the impact on caregivers including the unreimbursed financial costs associated with hospitalization. CP is the leading cause of physical disability and is defined as a group of permanent disorders of the development of movement and posture. The physical disabilities can range from mild to severe. Although CP is caused by a non-progressive lesion in the brain, many of the clinical manifestations--including the musculoskeletal disorders--are progressive and worsen over time. Many researchers have identified the successful radiographic and range of motion outcomes of orthopaedic surgical intervention, yet there has been little evidence to support the patient and family centered outcomes. Surgical interventions and post-operative care are costly, resource intensive and not without complications. Surgical decision making should be based on sound outcomes research that not only takes into consideration the physical and radiographic changes following surgery, but also the patient and family centered outcomes. The results of this study can be used by healthcare providers to guide patient education, set realistic expectations for the children and their families, and assist in surgical decision making. The results can also be used to inform policy development and resources allocation.

Michele DeGrazia PhD, RN, NNP-BC, neonatal nurse practitioner, nurse scientist, 7 North, NICU
Cranial Cup Use for the Prevention of Positional Head Shape Deformity in the NICU

Many hospitalized infants can develop a condition called positional head shape deformity. This condition develops gradually when an infant's head rests on a firm or semi-firm surface. Full term infants sleeping on their backs can develop brachycephaly. This type of positional head shape deformity causes the back of the infant's head to flatten. Premature infants are susceptible to scaphocephaly, which is a narrowing or elongated head shape. This happens because they may spend longer periods of time sleeping on their belly or on their sides. Nurses try to prevent positional head shape deformities by changing the positions infants sleep in. However, there is limited success with repositioning alone. Helmet therapy may be needed if severe head shape deformity develops. In this study, infants will receive one of two treatment protocols designed to help prevent positional head shape deformity while in the Neonatal Intensive Care Unit (NICU). The treatment ends when the infant is discharged or transferred from the hospital. This prospective single-blinded randomized clinical trial will evaluate the effectiveness of the cranial cup (a new positioning device) and Z flo (a traditional positioning device) versus the Z flo alone in preventing positional head shape deformity in the NICU patient population.

Pam Burke, PhD, RN, FNP, PNP, nurse practitioner, Division of Adolescent Medicine
Long Acting Reversible Contraception: Attitudes and Use

Burke is conducting this study with colleagues from Children's Adolescent Practice and Young Parents Program, Martha Eliot Health Center, Dimock County Health Center and Beth Israel/Deaconess Medical Center. They will explore young women's knowledge, attitudes and experiences related to long acting reversible contraception (LARC). LARC includes intrauterine devices (IUD) such as the Mirena or Copper T, and Implanon, which is a hormonal implant inserted under the skin in the upper arm. The researchers seek to understand young women's family planning preference, in particular for the use of LARC, which are safe, effective and convenient methods for preventing unintended pregnancies.

Elizabeth Wharff, PhD, MSW, LICSW, director of both the Emergency Psychiatry Program and the Social Work Training Program, and co-director of Outpatient Services
Family-Based Crisis Intervention for Suicidal Adolescents in the Emergency Department

In recent years, the Children's Emergency Department (ED) has seen a significant increase in patients who are assessed to need psychiatric hospitalization but for whom no inpatient psychiatric beds are available. These patients end up either staying in the ED or on a medical floor while waiting for transfer to an available psychiatric bed. This phenomenon is not unique to Children's or even to Boston, as there has been a national crisis of "psychiatric boarders."

In response to this crisis, Wharff and her colleagues designed and piloted a family-based crisis intervention (FBCI) for suicidal adolescents and their families in the ED in order to try to send more of these patients home, rather than having them board. Though the prevailing model in emergency psychiatric practice is to stabilize and hospitalize patients who are suicidal, Wharff hypothesizes that an effective emergency family intervention might prevent the need for inpatient hospitalization and increase adherence to follow-up recommendations once patients have been discharged from the ED. The following are the underlying assumptions that guide the Family-Based Crisis Intervention:

• Breakdown in family communication is often a contributing or precipitating factor in suicide ideation or attempt
• Most children do better at home with their families than in the hospital
• Families can be empowered to be the coaches and facilitators of their children's treatment
• Intervening during a state of disequilibrium can be beneficial--families are most open to change during a crisis

Wharff and her colleagues conducted an open trial to test FBCI and found a significant reduction in the psychiatric hospitalization rate for suicidal adolescents from 55 percent to 36 percent. On follow-up these patients were found to be doing well and most did not need further emergency care. Wharff and her colleagues have manualized the FBCI.

The primary goal of the current project is to conduct a randomized controlled trial of the effectiveness of the manualized FBCI. This research will study the effect of FBCI on presence/severity of adolescent suicidality, family connectedness and communication patterns, psychiatric symptoms and ED disposition patterns. The secondary aims are to examine patterns of service utilization after the ED visit and ED recidivism rates.

Megan Brenn, RD, LDN, CNSC, clinical nutrition specialist, Center for Advanced Intestinal Rehabilitation,
Copper Status in Infants with Prolonged Dependence on Parenteral Nutrition

This study aims to prospectively determine the frequency of copper deficiency as measured by abnormal serum copper and ceruloplasmin values in infants on long term parenteral nutrition as well as to identify clinical, demographic and nutritional risk factors for the development of copper deficiency.