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  Nephrotoxic Medication Induced Acute Kidney Injury in Hospitalized Pediatric Patients

  Emelie-jo Nappo and Neal Blatt

  Publication Date: 5-2025

  Acute kidney injury (AKI) is a sudden decrease in kidney function that can lead to fluid imbalance and waste accumulation. AKI is a significant clinical challenge, particularly in pediatric patients, where AKI can lead to longterm consequences like chronic kidney disease. A key cause of AKI is exposure to nephrotoxic medications. The incidence of nephrotoxic-induced AKI is notably high in hospitalized children, with studies indicating that up to 86% of pediatric patients are exposed to at least one nephrotoxic medication during their stay.1 Nephrotoxic-induced AKI can lead to increase length of stay, cost of care, and higher morbidity and mortality rates.1,2 Given these risks, it is essential to understand the impact of nephrotoxic medications have on kidney function during hospitalization in the pediatric population. We hypothesize that nephrotoxic AKI is an underrecognized condition, with patients not being adequately evaluated for AKI following exposure to three or more nephrotoxic medications, despite the increased risk. Thus, we suspect that medication-induced AKI in hospitalized pediatric patients at Corewell Health is significant, yet underreported due to insufficient creatinine monitoring after medication exposure.

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  The Impact of COVID-19 on Adolescent Eating Disorders

  Caroline Desler, Eberly Lewis, and Jaime L. Taylor

  Publication Date: 5-2024

  Higher rates of eating disorders (EDs) were reported during COVID among adolescents,1 as well as other mental health disorders, such as anxiety and depression.

  Lockdown measures created changes to daily routines and schooling that limited in-person social interactions, putting adolescents at greater risk of isolation and loneliness – both of which have been linked to increased risk of depression and anxiety,3 and impairments in normative adolescent development.

  Taken together, this project aims to further explore the impact of the pandemic on adolescents with newly diagnosed EDs, specifically through a psychosocial lens. We investigate factors including family dynamics and psychiatric comorbidities.

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  The Effects of Untreated Reflux on the Incidence of Feeding Difficulties in Neonates

  Anne Grossbauer, Anya Costeloe, and Prasad J. Thottam

  Publication Date: 5-2024

  • Gastroesophageal reflux (GERD) is the involuntary regurgitation of gastric contents into the esophagus and commonly occurs in infants.
  • It is associated with various consequences related to feeding difficulty, such as feeding resistance, oral aversion, dysphagia, laryngomalacia, and failure to thrive.2
  • There is a paucity in the literature regarding the incidence rate of feeding difficulties in latepreterm and full-term neonates in the neonatal intensive care unit (NICU).
  • Many NICUs employ the use of anti-reflux medications, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2As), to treat GERD.3
  • The use of these medications is debated and variable due to perceived adverse effects and relative lack of evidence in treatment efficacy.3

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  From Data to Benchmark Distinction –Empirical Data Utilization in the PICU

  Tammy Muczinski, Beth Kring, Christine Batchelder, and Paras Khandhar

  Publication Date: 5-6-2024

  Virtual Pediatric Systems [VPS ] is the largest international pediatric intensive care database & largest international collaborative for care improvement. There are over 1.7 million cases in VPS for comparative analysis.

  VPS is more than just a data source. It’s a beacon of trust in the healthcare community. By assisting members of the VPS community to improve practice and operations using high-quality clinical data, it has earned its reputation as a trusted clinical and operational data source. With robust quality control and data management systems, VPS ensures exceptional data integrity, making it a powerful tool for clinicians, leaders, researchers, and accreditation bodies.

  Corewell Health Children’s Hospital, Royal Oak [CHE] PICU began entering data into VPS in August 2015. This project aims to utilize comparative analytics to drive process and quality improvements for the CHCH Pediatric Intensive Care Unit [PICU].

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  What Exactly is a Patient's Best Interest

  Saketh Akula, Joshua Jones, Jason Wasserman, Mark C. Navin, and Abram Brummett

  Publication Date: 5-2023

  In any clinical setting, the patient’s preferences are respected and valued by the medical team. As clear as that may seem, that can be tough when considering all the perspectives of what makes up a patient’s best interest (BI), especially for a minor. In the literature, there is wide disagreement about the interpretation of BI. The primary goal of this project is to unearth the perspectives that play into a pediatric patient’s best interest and delineate how and whether family interests should be considered.

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  Conceptualization of Effective Surrogate Decision Making

  Zachary Armstrong, Michael Bourgoin, Abram Brummett, Jason Wasserman, Mark C. Navin, and Stephanie Swanberg

  Publication Date: 5-2023

  Surrogate decision making is a key component in the hierarchy of medical decisions, whereby an assigned individual makes choices on behalf of a patient incapable of making the decision themselves. Although this is common in healthcare, there are still many questions about best surrogate practices and ethical credibility. This capstone project aspires to map these concepts and discuss issues related to the current landscape of surrogate decision making with regards to medical ethics through the use of a systematic literature review.

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  Differences in Rational and Relational Autonomy during End-of-Life Care

  Michael Balce, Mark C. Navin, Abram Brummett, and Jason Wasserman

  Publication Date: 5-2023

  Within biomedical ethics, the principle of autonomy focuses on a patient’s right to make choices about his or her medical decisions and care. Along these lines, patients can then make decisions based on their own beliefs, attitudes, and customs, which is referred to as rational autonomy. However, shared-decision making is often more complicated than this, and patients often desire input from their spouse, family, and other trusted individuals, which is termed relational autonomy. These two concepts of autonomy drive different approaches to an individual’s perceptions and choices regarding medical-decision making during the end of one’s life.

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  The Ethics of Medical Interventions Against Parental Consent

  Corey Carney, Mark C. Navin, Jason Wasserman, Abram Brummett, and Kaitlyn Hanson

  Publication Date: 5-2023

  Between an adult patient and physician they are the only two people that have a say in the patient’s medical treatment with the patient having the final say. In pediatrics, there is a patient, parent, and physician which adds a third party that is a proxy decision maker for the child but lacks absolute authority over the child’s treatment. The goal of this study is to give a sense of the diversity of the pediatric ethics literature regarding parent/physician disagreements and to address ambiguities about pediatric interventions.

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  Concern for Authenticity in Rational and Relational Autonomy

  Joshua J. Daniel, Abram Brummett, Mark C. Navin, and Jason A. Wasserman

  Publication Date: 5-2023

  The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether a trend exists for the inclusion of authenticity in rational or relational autonomy. A secondary goal is to determine whether a trend exists with the use of autonomy and the highest degree of the authors.

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  Conceptualization of Intervention in Pediatrics Systematic Review

  Kaitlyn Hansen, Mark C. Navin, Jason Wasserman, and Stephanie Swanberg

  Publication Date: 5-2023

  Navigating when to intervene against parents’ wishes is a difficult task in pediatrics. Different frameworks have been proposed, but disagreements remain. One problem debated about in pediatric intervention principles often refer to different kinds of interventions (e.g. calling Child Protective Services, consulting the Ethics Committee). This project reports results of a critical scoping review of recent bioethics literature about the concept of pediatric intervention principles.

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  'Best Interest' in Clinical Medicine: A Critical Scoping Review

  Joshua R. Jones, Saketh Akula, Jason Wasserman, and Mark Navin

  Publication Date: 5-2023

  The Best Interest Standard (BIS) has been a much-debated guidance principle in clinical ethics with ambiguous definition and application. In this study we focus on the conceptions of best interests that differ according to which kinds of interests are included. While there is wide agreement that ‘best interests’ include the physiological welfare of a patient, there is still substantial disagreement about which other interests are included in wider accounts of welfare, the balancing of those other interests, and whether interests are objective or subjective.

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  The Meaning of Pediatric Assent: A Critical Scoping Review

  Natalie Liogas, Amelia Najor, Jason Wasserman, Stephanie Swanberg, Abram Brummett, and Naomi Levanthal

  Publication Date: 5-2023

  The moral obligation to include children and adolescents in medical decisions has been long recognized. Soliciting pediatric assent is a component essential to this effort. Despite the AAP characterization of assent (AAP 1995; AAP 2016), there appears to be a lack of consensus regarding the operational and conceptual meanings of pediatric assent. This this critical scoping review provides an analysis of the varied meanings of pediatric assent in the clinical context.

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  Pediatric Assent in Clinical Practice: A Critical Scoping Review on the Ethical Justifications for Assent

  Amelia Najor, Natalie Liogas, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Laventhal, and Mark C. Navin

  Publication Date: 5-2023

  Pediatric assent is an important ethical construct, yet there is little agreement on what precisely it means, including the ethical justifications for assent. The term is used to indicate everything from acquiescence to an analogue of informed consent itself. The primary goal of this study is to assess the range of ways that pediatric assent is specified in the clinical ethics literature, as well as what different conceptions intimate about its moral value. This systematic review will summarize the normative claims about pediatric assent in recent literature. Analysis will map divergent constructs and various moral and ethical justifications for pediatric assent.

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  Pediatric Obesity: A Survey Study of Patients and Caregivers’ Concern and Interest in Specialized Programs

  Dina Abdo, Ryan Rogers, Susan Edlibi, Aimee Pollak, Stacey Shubeck, and Kerry P. Mychaliska

  Publication Date: 5-2-2022

  INTRODUCTION
  Body mass index (BMI) ≥ the 85th percentile for age and sex is considered overweight in the pediatric population. Pediatric obesity is defined as a BMI at or above the 95th percentile. According to the Centers for Disease Control (CDC), obesity prevalence has tripled over the past 50 years; 1 in 5 school-aged children has a diagnosis of obesity. The purpose of this study is to survey caregivers’ perceptions and concerns about their child’s weight and patient and caregiver interest in a comprehensive healthy lifestyle program.

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  Death Exposure Influence on Medical Students’ Attitudes Toward End-of-Life Care

  Sara J. Barlow, Nelia Alfonso, and Jason A. Wasserman

  Publication Date: 5-5-2022

  INTRODUCTION
  Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding end-of-life care develop during physician’s education.

  
  
  

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  Detection of Enterotoxin Gene Cluster in Staphylococcus epidermidis Recovered from Neonatal Liver Abscess

  Bishara J. Freij, Barbara E. Robinson-Dunn, and Patrick M. Schlievert

  Publication Date: 6-2022

  • Neonatal pyogenic liver abscesses are rare • Potential routes of hepatic infection include: portal vein, biliary ducts, hepatic artery during sepsis, or direct spread from infected contiguous structures • Risk factors may include bloodstream infection, abdominal surgery, umbilical vein catheterization, total parenteral nutrition, necrotizing enterocolitis, and/or immune deficiencies • More common in premature infants at present • Variety of etiologic agents for neonatal liver abscess: Staphylococcus aureus (methicillin-susceptible and resistant), coagulase-negative staphylococci (CONS), streptococci, Escherichia coli, Klebsiella, Pseudomonas, Enterobacter, Serratia, and Candida • Umbilical stump and catheter exit site hub often colonized with CONS • CONS colonize nearly all human skin and are often considered contaminants when recovered from blood cultures and may be dismissed as non-pathogens when isolated from tissues and other body fluids • CONS, including Staphylococcus epidermidis, have been found to harbor genes that encode for adhesion factors and exotoxins, among others • Staphylococcal superantigens are exotoxins produced by S. aureus strains which contribute to the pathology of various serious diseases such as toxic shock syndrome, infective endocarditis, and other conditions such as Kawasaki disease and atopic dermatitis; some have been identified in CONS, including S. epidermidis • We describe a premature newborn with hepatic abscess from whom a S. epidermidis strain was isolated that harbored multiple superantigen genes

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  Vampirism for the Microbiologist

  Joudeh B. Freij and Bishara J. Freij

  Publication Date: 6-2022

  Vampirism has been a means to explain the cause of communicable diseases throughout the centuries.

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  Prehospital Use of Ketamine in the Pediatric Population

  Ashima Goyal, Revelle Gappy, Remle Crowe, John Frawley, Nai-Wei Chen, and Robert Swor

  Publication Date: 1-2022

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  Effect of SARS-COV2 on Adolescent PHQ-9 Screening Result

  Anisah Hashmi, Aimee Pollak, Leah Ludwig, Kerry P. Mychaliska, Mara Rubenstein, Olufunke Adeyemo, Stacey Shubeck, Liu Qu, and Mary Coffey

  Publication Date: 5-2-2022

  INTRODUCTION
  The SARS-COV2 pandemic created numerous stressors for adolescents including financial insecurities, family illness or death, home schooling, discontinuation of group activities, and decreased peer interaction. Prior studies have shown an increased risk for self-reported depression symptoms in pediatric patients following traumatic events. The purpose of this study is to compare rates of newly diagnosed depression in adolescents and self-reported depression symptoms prior to and during the pandemic.

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  Development of Verbal Behavior in Early, Intensive Behavioral Therapy for Autism Spectrum Disorder

  Mthya Jayakumar, Lesly Hendershot, Lori Warner, and James F. Grogan

  Publication Date: 5-2-2022

  INTRODUCTION
  The current study will explore the relationships between motor imitation (MI) and verbal requesting skills in children who are diagnosed with autism spectrum disorder (ASD). With nearly half of children with ASD evidencing minimal verbal skills, supporting language development is crucial in interventions. Early, intensive behavioral intervention (EIBI) is recommended to help children achieve better developmental outcomes. Functional language training often begins with the verbal requesting skill, MAND. Research suggests that a series of rapid motor imitations before a vocal model could facilitate vocal speech, but little is known about how MI can longitudinally influence functional language development. This retrospective, cohort study with MI skill level subgroups (low, medium and high) will explore whether the development of MI skills correlates with greater MAND progress in pediatric patients with ASD.

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  ConstiPatED: Evaluation in the Pediatric ED – Practice Patterns and Trends Amongst Provider Types

  Dharshana Krishnaprasadh, Margaret Samberg, Lara Fawaz, Sara Grant, and Margaret Menoch

  Publication Date: 4-28-2022

  Objectives

  -The aim of this study is to describe practice trends by provider type: Pediatric Emergency Medicine (PEM) physicians, Emergency Medicine (EM) physicians, advanced practice providers (APP) and resident/fellows for evaluation and treatment of pediatric constipation.

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  Emergency Department Recidivism Due to Skin Lesions Among the Homeless Population

  Kylee JB Kus and Jason A. Wasserman

  Publication Date: 5-2-2022

  INTRODUCTION
  Ample research supports the correlation between homelessness and poor health generally. Individuals experiencing homelessness face a higher risk of dermatological health problems due to exposure and sanitation concerns and comprise a disproportionately large share of emergency department (ED) visits. This study assesses whether and how the interaction between homelessness and dermatological health contributes to ED recidivism.

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  Nasopharyngeal Swabs Gone Wrong: An Unexpected Complication of a Common Procedure

  Moyosoreoluwa Laditan, Riya Kalra, Laurene Reed, and Paras Khandhar

  Publication Date: 10-2022

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  Factors Influencing Reintubation in Self Extubated Pediatric Intensive Care Unit Patients

  Ahmed Naseem, Ameer Al-Hadidi, Morta Lapkus, Patrick Karabon, Begum Akay, and Paras Khandar

  Publication Date: 5-2-2022

  NTRODUCTION
  Intubated pediatric patients that self-extubate may be particularly susceptible to reintubation. Identifying factors that increase risk of reintubation allows for better monitoring and response in cases of self-extubation and can potentially identify patients needing reintubation.

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  The Influence of BLM and the Death of George Floyd on Medical and Pre-med Students and Their Views on Institutional Racism

  Asia Susko and Jason A. Wasserman

  Publication Date: 5-2-2022

  INTRODUCTION
  Racial inequalities present in medical education in a multitude of ways, including basing disease prevalence on majority populations and using images that disproportionately represent white patients. George Floyd’s death was not only a sentinel event of police violence, but underscored broader systemic racism, including medicine’s potential for complicity. This study highlights the perspectives of premedical and medical students in light of George Floyd’s death and the Black Lives Matter movement. Their views help elaborate ways to better support students and staff of color in medical education.