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Children's National News - Summer 2010

Children's National Medical Center receives first NIH Clinical and Translational Science Award given to a children's hospital

The Clinical and Translational Science Institute at Children's National receives a $20 million award to foster innovations in solving health problems of children and families

Children's National Medical Center, in partnership with The George Washington University Medical Center, has received a prestigious Clinical and Translational Science Award (CTSA) from the National Center for Research Resources of the National Institutes of Health.

“Both Children’s National and The George Washington University have long invested significant resources in investigating and understanding the health needs of the children and families of metropolitan Washington,” said Jill Joseph, MD, PhD, principal investigator of the CTSA and Director of the Clinical and Translational Science Institute at Children’s National. “The families of our area, and across the country, have already benefited from what we’ve learned about better clinical treatments and improved community education for common diseases like asthma. We look forward to even greater breakthroughs in providing that care, now bolstered by new research collaborations with consortium institutions.”

The award, which totals $20 million over five years, is the first CTSA given directly to a children's hospital. The Clinical and Translational Science Institute at Children's National will now join the nationally renowned CTSA consortium, which is composed of institutions that work to transform the local, regional, and national environment to increase the efficiency and speed of clinical and translational research across the country.

Many other CTSA member institutions have research tracks that include pediatric research, but this collaboration will be the first in the history of the award to focus specifically on how scientific breakthroughs from the laboratory bench can be brought more quickly and efficiently to the bedsides of young patients locally and around the world.

The Clinical and Translational Science Institute at Children’s National focuses on three main areas of research:

  • Diseases of childhood, such as cancer, birth defects, developmental disabilities, asthma;
  • Childhood diseases that persist into adulthood, or adults living with childhood diseases long term—for example congenital heart disease, cystic fibrosis, and muscular dystrophy; and,
  • Diseases of adulthood that begin in childhood and are worsened or develop with age, such as hypertension, type 2 diabetes and obesity.
This NIH CTSA will boost the infrastructure of the Institute, helping it to design effective, efficient, systems that encourage research collaboration across disciplines, track effectiveness, and report results; address health disparities; promote multidisciplinary team science; grow collaborations with community partners to tackle pressing pediatric health issues; and build better education and training for those interested in translational and collaborative approaches to pediatric research.

“We’re grateful to the National Center for Research Resources for recognizing the importance of fostering research programs that are designed to address health issues on multiple levels at once, especially in pediatrics,” said Mark Batshaw, MD, Chief Academic Officer at Children’s National. “As we’ve learned through our collaborative models in diseases like asthma, when it comes to pediatric health, particularly in urban health settings, the team science model is most successful at ensuring that families who need innovative treatments can access them sooner.”

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Children's National Holds Second Annual Obesity Institute Symposium

More than one hundred pediatricians, researchers, policy makers, and other stakeholders from around the Washington, DC region turned out on May 20, 2010, to discuss the importance of community-wide involvement to combat childhood obesity as part of Children’s National’s second annual Obesity Institute symposium.

“The saying ‘It takes a village’ is absolutely true when it comes to childhood obesity,” said Evan Nadler, MD, co-director of the Obesity Institute. “To make an impact, we need the entire community—from doctors and researchers to policymakers, industry, the private sector, community leaders, schools, teachers, and families—all working together, to help these kids now.”

The one-day symposium built on the recent local and national discussions around childhood obesity through presentations focused on barriers to success and the qualities of successful programs.

Presentations included:

  • Nazrat Mirza, MD, presented the successes and challenges of her full-scale clinical-based program at Children’s National. As with many other diet and exercise interventions, the rate of adherence is difficult for families to maintain over a long period of time after frequent doctor visits taper off. She underscored the importance of early intervention and linking clinical interventions to community supports that can help families sustain the effort required for healthy lifestyles.
  • Joseph Wright, MD, MPH, on how academic medical centers, like Children’s National, can serve as a voice for the most vulnerable populations, including children.
  • Anita Chandra, DrPH, a lead investigator on the Children’s commissioned RAND Pediatric Health Needs in Washington, DC, report, highlighted some of the access challenges for many residents of Washington, DC, including: few grocery stores, the large number of food carryouts that lack healthy options in urban neighborhoods, and the lack of places for children to exercise safely in inner-city areas.
  • An assessment of current policy, and the next steps to move forward, from Christine Ferguson, JD, of George Washington University.
  • Examples of how behavior modification models, when properly targeted can have a significant impact if applied early on in life. Marian Tanofsky-Kraff, PhD, of the Uniformed Services University of Health Sciences, presented an intervention that helps curb binge eating in childhood to prevent the establishment of this eating disorder before it becomes an ingrained habit.
Attendees were also challenged by speakers to engage at all levels, starting with providing effective and accessible care to families, researching comprehensive solutions, educating the community about how to have an impact, and advocating for policies that will reinforce the importance of healthy lifestyles.

"This symposium captured the spirit of the national 'Let's Move' campaign by recognizing that good health is much more than simply health care. Successfully contending with childhood obesity requires that the best scientific evidence on weight control informs clinical practice but also that public policy and community programs reinforce these best practices," said Michele Mietus-Snyder, MD, also a co-director of the Obesity Institute. "Parents need the empowerment and energy that accompanies good health, which increases with every healthy change they make for their families. Medical professionals, together with the community, can help families get this message."

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Study: New Prediction Rules Will Help Emergency Department Doctors Decide When CT Scans are Necessary for Children with Head Injuries

Pediatric emergency physician at Children’s National, Shireen Atabaki, MD, and Nathan Kuppermann, MD, have shown through study results that following a prediction rule for children with head injuries will likely improve how emergency department doctors decide when a child with head trauma does not require a CT scan.

“Doctors in the emergency department often take a ‘better safe than sorry’ approach when it comes to ordering CT scans for children with mild head trauma,” said Dr. Atabaki.”

The doctors assert that applying better criteria to pinpoint the small percentage of children who truly need the CT scan may reduce unnecessary tests and lower the number of children exposed to a CT scan’s radiation levels for no reason. The prediction rules are a set of clinical criteria designed from the largest prospective study of pediatric head injuries ever completed, and its effectiveness in practice was the focus of an abstract from Children’s National presented at the Pediatric Academic Societies Annual Meeting as well as the Society for Academic Emergency Medicine.

Drs. Atabaki and Kuppermann showed that compared to emergency department doctors’ clinical judgment of risk of important head injuries, application of the prediction rules was significantly more successful at predicting which children truly required a CT for further diagnosis and which children did not. Prior to the publication of the Pediatric Emergency Care Applied Research Network (PECARN) study published last October in The Lancet, no large scale research-based prediction rule existed to help doctors rule out the need for a CT for children. Doctors relied on their training and clinical intuition to decide when to prescribe a CT, and the study confirmed that the rate of non-essential CT scans for children remains high.

“This study shows us that data-driven criteria actually can help doctors in the field to avoid a CT on children that do not meet high risk criteria, and therefore avoid unnecessary exposure to the radiation that accompanies the scan, without the risk of missing important brain injuries,”

Although these criteria in no way replace clinical judgment, they can help physicians supplement their clinical judgment and instincts, when evaluating children with head trauma, with a set of evidence-based criteria for the first time.

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Sheikh Zayed Institute for Pediatric Surgical Innovation: Building the Foundation for Discovery

Children’s National is proud to announce two recent hires to the Sheikh Zayed Institute for Pediatric Surgical Innovation. The team includes medical visionaries who are coming together to re-imagine the entire pediatric surgical experience and create a new standard for surgical instruction and research.

Zena Quezado, MD

Zena Quezado, MD, is director of the Pain Neurobiology Laboratory, and her research will focus on the mechanisms of pain response and response to novel drugs. In addition to her research duties, Dr. Quezado also is a pediatric anesthesiologist within the Center for Surgical Care. She will work closely with Julia Finkel, MD, a preeminent pain medicine physician-scientist and leader in the field of pain medicine.

Dr. Quezado comes to Children’s and the Sheikh Zayed Institute from the National Institutes of Health, where she served as Chief of the Department of Anesthesia and Surgical Services at the Warren Grant Magnuson Clinical Center. An active researcher, Quezado has published more than 50 peer-reviewed manuscripts in clinical and scientific medical journals.

“Unanswered questions drive me,” said Dr. Quezado, a pediatric anesthesiologist. “We are research advocates for those with no voice – infants, premature infants, and developmentally disabled children.”

Nabile Safdar, MD

Nabile Safdar, MD, is principal investigator of the Bioengineering Initiative of the Institute. He is a musculoskeletal radiologist and imaging informaticist whose research will focus on improving pre- and post-surgical evaluation through biomedical imaging and computational sciences, and improving the training of radiologists and surgeons in these advanced methods, including the use of computer assisted surgery. “Before a surgeon ever operates, they review all available data to make sure they know where they’re going and what they’ll be seeing,” Dr. Safdar said. “Today, most of our views of the body, to draw an analogy, resemble a basic road map. We want to use advanced visualization, simulation and modeling techniques to make a quantum leap forward in how we view a patient’s body before surgery. We want to give surgeons a three-dimensional street-level view that’s more precise and enables the best outcomes for every patient.”

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Learn more about what is happening in the Sheikh Zayed Institute for Pediatric Surgical Innovation, including a recently released study on the use of propofol, a well-known anesthesia medicine, and its effect in children. The study, led by Zena Quezado, MD, now at Children’s National found that propofol poses low risk in pediatric imaging research studies, but the risk increases with anesthesia duration.

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Children's National is One of America's Best Pediatric Hospitals

Children's National Medical Center is proud to once again be ranked as one of America’s best pediatric hospitals by U.S. News & World Report. For 2010, Children’s National ranked in the top 30 in 7 categories:

  • Neonatology: 8
  • Cancer: 14
  • Heart/Heart Surgery: 15
  • Kidney- 15
  • Neurology and Neuro Surgery: 15
  • Urology: 19
  • Respiratory: 24
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