Tuesday, December 18, 2012

What’s working for teens with severe obesity?

A new study online in the Archives of Pediatric and Adolescent Medicine (a JAMA Network publication) finds that although weight-loss surgery for teenagers saw a big jump from 2000 to 2003, after that, the numbers of teens undergoing these procedures plateaued to about 1,000 per year in the United States.

The study, conducted by Children’s National surgeons and experts from several divisions, including lead author and Surgery Research Fellow Deirdre Kelleher, MD, as well as pediatric bariatric surgeon and investigator from the Sheikh Zayed Institute Evan Nadler, MD, and the Chief of the Division of Trauma and Burns at Children’s, Randall Burd, MD, sought to quantify the number of surgeries, the types of surgeries (open vs. minimally invasive), and the demographic of the patients electing to undergo these procedures.

The hard data findings of a plateau in the number of surgical procedures contradicts several high profile commentary pieces citing an increase in the use of bariatric surgery for teens over the last 10 years.

In truth, the data from the Children’s study, which used the AHRQ’s KID database to track inpatient bariatric procedures, finds that, since 2003, the numbers of teens undergoing these procedures has remained static, even while the rate of children with morbid obesity continues to rise.

Interestingly, in the same journal edition, a 3 year longitudinal study out of Sweden found that the more traditional weight-loss interventions involving diet, exercise, and other lifestyle interventions, while successful with teens who have moderate obesity, were not effective at all for adolescents with morbid/severe obesity—the population who has the greatest number of obesity-related comorbidities and would benefit from direct intervention.

“New studies are being published every day, including this one, that show traditional behavioral interventions are not effective for adolescent patients with morbid obesity,” said Dr. Nadler. "If we aren’t treating them successfully with diet and exercise, and they aren’t undergoing surgery, how are we going to help these patients and how will the obesity epidemic end?”

Read the media release at ChildrensNational.org. 

Friday, December 14, 2012

Pediatric health care innovations presented by Children's at World Health Care Congress Middle East

During this week's World Health Care Congress Middle East, Children’s National held a special pediatric session featuring best practices in several key areas of children’s health that will help eliminate unnecessary complex procedures and reduce pain for children. Attendees included leaders in clinical care and policy development from the across the Middle East and Gulf region.The topics were selected based on requests from regional physicians, who were seeking more information about these subjects, including: 
    Dr. Atabaki presents research to regional
    physicians about assessing traumatic
    brain injury in children.
  • More precise and effective diagnosis of traumatic head injury, by Shireen Atabaki, MD, MPH, a pediatric emergency medicine specialist and director of Medical Student Education in the Division of Emergency Medicine at Children’s National.
  • The reduction of preventable pain during and after surgery through the use of advanced minimally invasive surgical approaches tailored for children, by Craig A. Peters, MD, division chief of Surgical Innovation, Technology, and Translation at Children’s National, and lead of the Innovation and Education Initiative at the Sheikh Zayed Institute.
  • The development of new integrated tools to diagnose, treat, and manage ongoing pain in children, by Julia Finkel, MD, associate division chief of Anesthesiology and Pain Medicine and lead investigator of the Pain Medicine Initiative at the Sheikh Zayed Institute.
Dr. Finkel demonstrates the pain algometer
to reporters in Abu Dhabi.
Drs. Finkel and Peters also had a little time to spend with the Abu Dhabi media to talk about the latest work of the Sheikh Zayed Institute in pain medicine and minimally invasive surgery. As this work is largely made possible by the historic gift from the government of Abu Dhabi on behalf of the people, there was much excitement and curiosity from the local media about the institute's recent and upcoming developments.

Thursday, December 13, 2012

Building quality health systems is a key focus of the World Health Care Congress Middle East

This week, a delegation from Children’s National and the Sheikh Zayed Institute joined the 3rd Annual World Health Care Congress Middle East in Abu Dhabi, United Arab Emirates. The primary themes for this year's congress focused on collecting and using data transparently and effectively to improve the overall quality of health care providers around the world. In his opening remarks, H.E. Engineer Zaid Al Siksek, the CEO of the Health Authority Abu Dhabi, noted that technology advances are allowing providers to collect more information than ever before, and that health systems like those in Abu Dhabi are now learning how to use that information to truly improve care for patients.

Sessions focused on improving health
delivery and quality for patients.
The data and response generated by Abu Dhabi's Weqaya system, which provides health care to Emirati citizens of Abu Dhabi, is a good example of successful application of data to improve health outcomes. In 2008, Weqaya enrollees underwent a series of routine health screenings. It was found that 23 percent of the Emirati population had diabetes. Even more suprising, 30 percent of that group were not aware they had diabetes. The data about diabetes assessment and treatment in the emirate has resulted in an ability to compare quality at the patient level and improve effectiveness across the entire system. Today, the Health Authority has launched several educational programs and made policy changes to help providers do a better job of diagnosing and treating diabetes before it escalates into dangerous complications.

H.E. Al Siksek noted that this is simply the start, and successful health systems will need to use this data to transition to what he refers to as a "4P" health model to advance to the next level of health care: Predictive, personalized, preventive, and participatory. Not only that, but these systems will also need to begin measuring their progress and overall health care delivery by a measure of "quality divided by cost."

Doctors Peters and Finkel pose
in the Children's National/Sheikh Zayed
Institute booth at the World Health Care
Congress Middle East exhibition.  
These themes were echoed throughout the congress, with special emphasis on how the countries of the Middle East, especially the United Arab Emirates, could pioneer new models in research, clinical care, and data collection/analysis to revolutionize health care around the world.

Monday, December 3, 2012

Crowdfunding website with child health focus launched by Sheikh Zayed Institute

The Sheikh Zayed Institute recently launched the first child health focused crowdfunding website. The website, ChildrensNational.org/Crowdfunding, gives the general public access to directly support any of the four featured research projects. This pediatric crowdfunding program is designed as a pilot project to gauge both the need for additional funding sources from investigators and the interest of the general public in supporting specific research aimed at helping children.

“We know that government and philanthropic research funding is more competitive than ever before,” said Floortje Blindenbach-Driessen, PhD, head of the crowdfunding initiative. “We also know through our institute’s focus on pediatric innovation that there are many, many good project ideas out there that are either too small to qualify for that funding or need additional assistance to begin.”

Read the full media release, or visit www.ChildrensNational.org/Crowdfunding to learn more about the project.

Thursday, November 8, 2012

Pain Medicine and Peter Kim Featured in Children's Hospitals Today

Peter C.W. Kim, MD, CM, PhD, Vice President of the Sheikh Zayed Institute for Pediatric Surgical Innovation was recently spotlighted in the fall 2012 issue of Children’s Hospitals Today. Below is an excerpt from the publication highlighting the institute's latest advances in pediatric surgery and the development of a pain algometer by principal investigator Julia Finkel, MD.

“For Peter C.W. Kim, M.D., C.M. Ph.D., surgery has always been an art form. This vice president of the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National says that while pediatric surgery has seen its fair share of advances, the technical aspects have barely changed in the last 50 years. But at the Sheikh Zayed Institute, it’s a new day.

Kim’s job is to unearth areas for improvement in pediatric surgery and connect with clinical, academic and corporate partners to help devise technologies and approaches that solve those problems and improve surgical outcomes for children. In just a short time, he and the Institute’s multidisciplinary teams of biologists, mathematicians, physicians and engineers have been able to accomplish things doctors could only dream of just a decade ago …”

An investigator at Children’s National demonstrates an image fusion technique designed to enhance the image-guided surgical tools available in pediatric surgery

Read more about the Sheikh Zayed Institute’s accomplishments to date in the latest issue of Children’s Hospitals Today.

Wednesday, October 31, 2012

Student Innovator: Scrubbing In--My First Robotic Surgery and the Role of Technology in Innovation

As part of the institute’s commitment to education, each year we host a class of Student Innovators who spend the summer working side by side with our investigators. Larry Kim, one of those student innovators, periodically shares commentary about his time with us.

I recently observed my first surgery at Children's National and let me tell you, it was absolutely unreal. To stand side by side with the best surgeons, nurses, and technicians in the world was an honor. As a public health professional with little clinical experience, this was an unbelievable opportunity to learn about pediatric surgical innovation. It was an experience that would have otherwise be unavailable to me had it not been for the Summer Student Innovators Program.

The surgery performed was to create a flap valve at the base of the ureter near the bladder. A ureter is a tube that transports urine from the kidneys down towards the bladder. Vesicoureteral reflux, or kidney reflux, is caused when there is an abnormal flow of urine from the bladder back up towards the kidneys (Figure 1). The newly created flap valve would allow urine to move freely from the kidney down to the bladder, but prevent the back flow of urine.

The Da Vinci Surgical System (DVSS) was utilized to create this flap valve to treat vesicoureteral reflux. The DVSS is a minimally-invasive surgical robot that requires only three small puncture sites (two for the surgical arms and one for the video camera) to operate successfully. The surgeon operates the DVSS and its surgical arms from an operation console located across the operating room. Through the operation console, the surgeon can manipulate two controllers, one with each hand, and have each surgical arm of the DVSS move concurringly.

To see the DVSS in action was a thrill. To have the opportunity to sit behind a secondary operation console and watch the surgeon operate in live in 3-D was a dream. It was astonishing for me to see the collaboration between man and machine. I was impressed with how the DVSS could become the extension of a brilliant surgeon’s hand, and in turn, elevate the skills, experience and expertise of that surgeon.

This endearing relationship between man and machine reminded me of the popular movie "Iron Man." In the movie, an engineering prodigy named Tony Stark develops a super human suit. Alone, Tony Stark is an intellectual genius. But it was only when his skills, experience, and expertise were combined with the limitless potential of technology that he elevated himself to superhuman levels.

Today, I watched a pediatric surgeon by the name of Craig Peters, MD, accomplish this same super-human feat. Dr. Peters on his own is an accomplished and well-respected surgeon in the field of pediatric urology. The DVSS allows Dr. Peters to perform these surgeries without the need for a large incision site and allows the patient to recover sooner and with less pain than with traditional open procedures. This example illustrates the early stages of the limitless potential for technology to change medicine. Technology can make a surgeon super human, and has the capability of making the impossible possible.

Tuesday, October 16, 2012

Washington Post: Kids and needles is sometimes a good match: Acupuncture can help with pain

Recently, Sarah Rebstock, MD, Children’s anesthesiologist and clinical director of the Pain Medicine Clinic, a program of the Pain Medicine Initiative at the Sheikh Zayed Institute, was part of an article about the increasing use of acupuncture to treat pediatric pain.

The story focused on one patient, Victoria Rust, who has been seen by the institute’s pain team and also received acupuncture from another Children’s anesthesiologist, Jennifer Anderson, MD. The acupuncture treatments helped Victoria’s pain. Additionally, Victoria reports that since starting a comprehensive pain medicine program, including acupuncture and other integrated therapies like psychological support with the pain team, she has been able to avoid a lengthy hospital stay (something she’s had many of in the past).

Dr. Rebstock advocates for the inclusion of research-based alternative therapies, including acupuncture and aromatherapy, that can help children cope with their pain. A comprehensive pain medicine program is designed for each child who is treated by the pain team, based on the unique needs of that child and his or her family.

Read the article here, and stay tuned for more news about our pediatric pain initiative in the coming months.

Tuesday, October 9, 2012

Immunology research: More clues to why the body can't fight tumors

A joint research study published in the Journal of Immunology from researchers in the Immunology Initiative of the Sheikh Zayed Institute for Pediatric Surgical Innovation and the Center for Cancer and Immunology Research at Children’s National has identified gangliosides as another piece in the puzzle around why the body’s natural immune system, led by CD8+ T-cells, or “killer white blood cells,” is unable to effectively combat tumors. Gangliosides are a constituent of all cells, but are shed in tremendous amounts by tumor cells as they grow and divide. They have been shown in previous studies to have inhibitory properties, but this study is the first to definitively show how they diminish the function of the killer t-cells.

“Our next step with these results is to find a way to alter CD8+ T-cells so they are not susceptible to these inhibitors,” said Sasa Radoja, PhD, from the Immunology Initiative.

Read the press release for more.

Read about Dr. Radoja's previous research studies.

Monday, October 1, 2012

WUSA9: Robotic Surgery in Pint-Sized Patients

Our robotic surgery expert, Craig Peters, MD, recently was featured in a story about surgery using the da Vinci Surgical System at Children’s National. The robot was made possible by the Sheikh Zayed Institute, and Dr. Peters came to Children’s in 2010 specifically to work with our bioengineers to improve robotic surgical options for kids. As you can see from the video, this work is already benefiting children. Watch it at WUSA9 by clicking on the image above.