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Progress Report

  1. 1. 2008-09 Progress Report Depar tment of Pediatrics and Communicable Diseases
  2. 2. CONTENTS Dear Friends and Colleagues, We are pleased to report on the progress of the Department of 3 Welcome Pediatrics and Communicable Diseases at the University of Michigan. In this report we provide updates on a number of key initiatives in 5 Clinical Care Medicine LETTER FROM our clinical, research and educational programs. General Pediatrics Cystic Fibrosis Center Palliative Care THE CHAIR In clinical care, significant advances are being made and include the addition of programs such as: M-POWER – the Michigan Child Behavioral Health Neurology Pediatric Outpatient Weight Evaluation and Reduction Program; Endocrinology the Michigan Molecular Medicine and Genetics Laboratory; and the Adolescent Care Michigan Center for Disorders of Sex Development. Gastroenterology Rheumatology In research, new progress in the fields of cystic fibrosis, genetic Congenital Heart Program testing, and neurological disorders promise to improve care for Neonatal Intensive Care Unit Cancer Care children. In addition, we recently launched the C.S. Mott Children’s Nephrology Hospital National Poll on Children’s Health to take the pulse of the Pediatric Genetics public on important issues. We are proud of the impact our health Infectious Diseases policy research is having on children’s health care. Nationally, we Weight Management Center are ranked among the top ten departments of pediatrics in National 15 Pediatric Research Institutes of Health funding. MCHORD Child Health Evaluation & Research In education, our residency and subspecialty fellowship programs Pediatric Genetic Research rank among the nation’s best. They prepare medical students, Hospitalist Services residents and fellows to become engaged, skilled, and compassionate Kidney Research primary care providers and physician scientists. Gastroenterology Research National Poll on Children s Health The new University of Michigan C.S. Mott Children’s Hospital Critical Care Neonatal–Perinatal Medicine complex scheduled for completion in 2012 will advance our efforts Neurology Research on behalf of children in the community, as well as those who travel Pulmonary Research Admissions great distances to seek care from us. Cardiology Research 6,972 C.S. Mott Children s Hospital Obesity Research All of these efforts in clinical care, research and education have been Endocrinology Research 798 Holden Neonatal Intensive Care Unit 2,695 Births recognized by national and international organizations devoted to the Infectious Disease Research health and well-being of children. Cancer Research Rheumatology Research Clinic Visits Pediatric Research Symposium 158,484 Pediatric Department Visits I invite you to learn more about the Department of Pediatrics and 108,339 Primary Care Visits Communicable Diseases, our faculty, the focus of their research, their 25 Education 50,145 Specialty Care Visits dedication to training new pediatricians, and the impact our collective Medical Students Residency Faculty & Staff efforts will have on the future of children. Fellows 186 Full-time Faculty 41 Adjunct Faculty With warm regards, Clinical Simulation Standardized Patient Program 305 Total Staff 28 Donor Highlights Grant Funding 17,011,836 Total Grant Funding (in dollars)* 29 Community Support *The University of Michigan-Ann Arbor s Department of Pediatrics Valerie P. Castle, M.D. and Communicable Diseases is ranked in the top 10 departments Ravitz Foundation Professor 30 Contact Information of pediatrics in National Institutes of Health-based grant awards. of Pediatrics and Communicable Diseases Chair, Department of Pediatrics 3
  3. 3. C L I N ICA L The Department of Pediatrics and Communicable Diseases at the University of Michigan serves the needs CAR E of children and their families – whether they hail from Ann Arbor, Michigan; Kalamazoo, Michigan; Toledo, Ohio; Topeka, Kansas; Shanghai, China; or as far away as the Arctic Circle in Sweden. Physicians and staff in 15 divisions treat complex medical problems with skill and compassion using state of the art treatments. Many of these professionals participate in clinical research protocols to improve the care of children where existing therapies are inadequate. As a result, new programs are continually being developed for young patients with unusual or difficult to treat conditions. We believe caring for our patients and their families is a serious responsibility, as well as an honored privilege. 5
  4. 4. CLINICAL CARE CLINICAL CARE Critical Care Medicine second), demonstrating that our CF patients have the best lung function of the more than 100 CF Care Centers in the United States. The Pediatric Intensive Care Unit (PICU) is both a clinical cornerstone and academic endeavor, enhancing and sustaining more than two dozen In addition, the U-M CF Center recently was chosen by the State of patient safety and quality-of-care projects. Multidisciplinary teams of Michigan to coordinate the screening of newborn infants for CF. physicians, nurses, respiratory therapists, and others have achieved Early diagnosis has been shown to improve outcomes in children with remarkable things, such as reducing intravenous infections by more the disease. than half, minimizing unplanned extubations and delayed discharges, nearly doubling the time between occurrences of ventilator-associated pneumonias, and improving the benchmarking tools of a national Palliative Care collaborative of 65 PICUs. The Pediatric Palliative Care Consultation Service helps improve the “Multi-disciplinary teams quality of life for children with life-limiting conditions, through pain We are a national leader in advancing patient quality indicators and management and spiritual comfort provided by a skilled team with outcome measures. In recognition, the Pediatric Intensive Care Unit experience in the most difficult situations. Pediatricians, clinical nurse have achieved remarkable was named Clinical Program of the Year at the University of Michigan specialists, a social worker, and a hospital chaplain work together to Health System. offer physical and emotional support. They also help families determine things — such as reducing the goal of care, make difficult decisions, and find care resources. General Pediatrics The Palliative Care Service cares for children with severe neurological intravenous infections by The Division of General Pediatrics provides outstanding primary care disease, complex congenital heart disease, liver disease, kidney disease, to patients living in four southeast Michigan counties. A range of and complex birth defects. more than half, and nearly services is available to infants, children, and adolescents at nine sites throughout the region. Annually, the Division’s caregivers participate in doubling the time between more than 110,000 patient care visits. Child Behavioral Health We believe successful partnerships play a key role in assuring that Behavior can be a barometer of underlying medical concerns. For this occurrences of ventilator- reason, the Division of Child Behavioral Health takes into account the children from all socio-economic groups have access to quality medical physical as well as the emotional, behavioral, and developmental health care. For example, at the Ypsilanti-based Corner Health Clinic, physi- associated pneumonias.” of children, adolescents, and their families. cians treat a high-risk population of pregnant teens and their children. At two special community health clinics for migrant workers, we serve Problems addressed include Attention Deficit Hyperactivity Disorder families who spend the summer months working in the nearby commu- and its related school issues, autism, sleep difficulties, behavior-related nities of Adrian and Manchester, Michigan. feeding issues, poor weight gain in young children, pain management, problems with elimination (bed-wetting, constipation, and soiling), and Last year faculty and residents traveled to Accra and Kumasi in Ghana, psycho-social care for children and adolescents born with endocrine and to Jinotega and Esteli in Nicaragua, to develop academic collabora- conditions such as sex development disorders that affect their physical tions with other pediatricians, as well as to provide direct care for these appearance. children. Programs like this demonstrate the Department’s commitment to caring for children who live outside the reach of traditional health The Division also sponsors or participates in multidisciplinary clinics care systems. for children undergoing monitoring and treatment: infants and young children born prematurely or who are otherwise considered high risk; Cystic Fibrosis Center children with diabetes, growth failure, sleep disorders, obesity, eating disorders, elimination disorders, sickle cell disease, and cystic fibrosis; The U-M Cystic Fibrosis (CF) Center is the largest in Michigan, with children born with fetal alcohol syndrome; children with cancer and more than 400 patients – 240 children and 170 adults. The Cystic childhood cancer survivors; and children requiring an organ transplant. Fibrosis Foundation’s 2007 data ranks the U-M CF Center first in the nation for median FEV1 (forced expiratory airflow volume in one 6 7
  5. 5. CLINICAL CARE CLINICAL CARE Neurology Gastroenterology The Division of Neurology evaluates and treats infants, children, and The Division of Gastroenterology recently initiated several new clinics adolescents who have a broad range of neurological disorders including to care for children with specialized GI problems. In collaboration epilepsy, headache, movement disorders, brain tumors, pediatric sleep with Pediatric Surgery, we created a multi-specialty clinic focusing on disorders, development disorders, neuromuscular disorders, and neuro- patients with intestinal failure. We also developed a multi-disciplinary logical complications stemming from other pediatric diseases. clinic to address the unique needs of children with inflammatory bowel disease, and to assist adolescent patients’ with their transition to adult Faculty members recently implemented several new multidisciplinary care providers. clinical programs and sub-specialty clinics: a Pediatric Neuromuscular Disorders/Muscular Dystrophy Association Clinic, a Pediatric Move- ment Disorders Clinic, and a Tuberous Sclerosis Clinic. Rheumatology “Kids get arthritis, too!” is the message our Pediatric Rheumatology team members emphasize as they educate medical professionals about Endocrinology diagnosis and treatment of juvenile arthritis and related diseases. As The Division of Endocrinology offers several new initiatives to manage physicians and other medical providers learn how to recognize juvenile childhood diabetes: a program for school nurses and administrative arthritis and other childhood rheumatologic diseases, they diagnose personnel; a refresher program for parents, patients, and caregivers on those conditions more frequently and refer their patients to the Pediatric current principles and care; and a new outreach program for teens with Rheumatology Clinic— which now receives nearly 2800 visits yearly. diabetes. The State of Michigan and the American Diabetes Association A new Pediatric Rheumatology Outreach Clinic at Munson Medical recently recertified our diabetes education program. Center in Traverse City, Michigan, was initiated in July, 2007. The Division also organized a new support network for families with In our new Integrated Systemic Inflammation Clinic (ISIC), experts in children diagnosed with congenital adrenal hyperplasia (CAH), a Pediatric Rheumatology and Pediatric Nephrology provide care to disorder involving enlarged adrenal glands. The network includes the children with a wide variety of inflammatory diseases that impact creation of the Michigan chapter of CARES (Congenital Adrenal kidney function. The ISIC has been restructured to make optimal use of Hyperplasia Research Education and Support Foundation) and the the patient’s and family’s time. All medical personnel participate as a national and educational support groups for CAH families. group, to more efficiently obtain a complete patient history, perform “A smooth transition from the physical examination, discuss the findings, and formulate the treat- ment in consultation with the family and patient. pediatric to adult health Adolescent Care Through the Adolescent Care program, hospital physicians educated in care, particularly for pediatrics, adult internal medicine, and adolescent health care offer a full range of services to pre-teens and young adults: preventive health patients with chronic care, treatment of chronic illnesses and disabilities, assessment of growth and development problems, evaluation of school difficulties and Attention Deficit Hyperactivity Disorder (ADHD), care for depression health conditions, is a and other emotional difficulties, and evaluation and management of substance abuse. focus of our program.” These physicians also work with adolescents who are concerned about sexuality, contraception, screening and treatment of sexually trans- mitted infections, and eating disorders. A smooth transition from pediatric to adult health care, particularly for patients with chronic health conditions, is a long-standing focus of our program. 8 9
  6. 6. CLINICAL CARE CLINICAL CARE Congenital Heart Program Neonatal Intensive Care Unit The Michigan Congenital Heart Center is one of the largest and busiest The 40-bed Holden Neonatal Intensive Care Unit (NICU) serves pediatric heart centers in the world. A multidisciplinary team of cardi- newborn babies at risk. Staffed by the Division of Neonatal-Perinatal ologists, cardiac surgeons, intensive care specialists, nurse practitioners, Medicine, it averages 1,200 admissions per year, and is the largest registered nurses, anesthesiologists, radiologists, and other profession- intensive care unit at the University of Michigan Health System. State- als oversee a 15-bed pediatric cardiothoracic intensive care unit. The of-the-art care includes: neonatal surgery, cardiovascular surgery, team performs more than 1000 operations annually, with a 96 percent neonatal neurology, and high frequency and liquid ventilation. success rate. In 2008, more than half of these cases were open heart procedures: closing holes, repairing valves, and heart transplantation. At the University of Michigan, the NICU is located adjacent to the obstetrical ICU, making this the only hospital in the state where a We are also one of the largest hypoplastic left heart syndrome special- mother diagnosed with a prenatal condition can give birth and have ists in the nation. Hypoplastic syndrome occurs when the left side of the her baby treated in the same facility. heart is underdeveloped in the womb. The majority of our patients are born at the University of Michigan Currently more than 20,000 children are being monitored by our team Medical Center. In addition, 30 percent arrive here by ambulance, of experts. More than half are referred here from outside the State of helicopter, or airplane from other facilities around the state and from Michigan. We also staff outreach clinics throughout Michigan and in northern Indiana, northern Ohio, and Ontario, Canada. northwestern Ohio, to help bring subspecialty care to our neighboring communities. Cancer Care Over the past year, the division of Pediatric Cardiology has imple- The Division of Pediatric Hematology/Oncology continues to enjoy a mented three new cutting edge clinical programs. The first of these stellar reputation for clinical care and research in pediatric hematology, is our fetal intervention program. In conjunction with members of the pediatric oncology, and peripheral blood, bone marrow, and cord blood Department of Obstetrics and Gynecology, faculty members from the transplants. Today our multidisciplinary Pediatric Long Term Follow-up Division of Cardiology are engaged in cutting-edge research in fetal Clinic is guiding approximately 1,500 childhood cancer survivors as cardiac interventions designed to prevent or correct defects while the they grow into adulthood. baby is still in the womb. The clinical oncology program offers clinical trials for children suffer- The second new clinical program is our cardiac MRI program. Working ing from childhood leukemia, brain tumors, lymphoma, sarcoma, with members of the Department of Radiology, faculty members from neuroblastoma, and other rare tumors. An international leader in the the Division of Pediatric Cardiology are engaged in advanced imaging treatment of neuroblastoma, patients come here from around the world involving both cardiac MRI and CT scans. Over the past year, more for innovative and experimental therapeutics. than 250 imaging studies have been performed. The pediatric blood and marrow transplant program performs between The third new initiative is the development of an adult congenital heart 45 and 50 pediatric transplants each year, and is an international leader disease program that incorporates physicians from the Division of in developing new therapies for graft versus host disease. Internal Medicine Cardiology, Division of Pediatric Cardiology, Depart- ment of Obstetrics and Gynecology, and the Division of Cardiovascular Multi-disciplinary teams also treat children with non-malignant Surgery. Over the past year, this program has provided innovative care disorders such as bleeding and clotting, and sickle cell disease. Eligible for many adult patients who have repaired or unrepaired congenital patients may choose to participate in research trials in hemophilia, cardiac disease. We also initiated clinical research in order to study new thrombophilia and sickle cell disease. approaches to improving both long-term survival and long-term quality of life for adults with congenital cardiac disease. 10 11
  7. 7. CLINICAL CARE CLINICAL CARE Nephrology MMGL is a comprehensive clinical laboratory that provides state-of- the art testing for genetic diseases. The mission is to expand advanced The Division of Pediatric Nephrology features one of the only chronic testing for genetic alterations responsible for inborn errors of metabo- kidney disease clinics in the country. This year, in collaboration with lism, birth defects, developmental delay, syndromes, mental retardation, our Pediatric Rheumatology colleagues, we initiated a comprehensive and autism. These tests help referring physicians manage the care of multidisciplinary clinic that focuses on systemic inflammatory diseases complex cases. such as systemic lupus erythematosus and various forms of systemic vasculitis. Infectious Diseases The increase in obesity in children has been associated with a dramatic The Division of Infectious Disease provides care to children with a rise in the number of children with hypertension. To improve our ability variety of infectious and immunological problems. Patients include to diagnose and manage hypertension in children, we now offer 24-hour children who are unable to naturally combat infections because they ambulatory blood pressure monitoring. are born with alterations in their immune systems, and children whose immune systems have been compromised because of treatment for Our pediatric transplant program recently participated in a National cancer or treatment to prevent rejection of a transplanted organ. Institutes of Health steroid-avoidance trial and as a result, we now offer selected kidney transplant recipients regimens that avoid long-term Two questions that U-M pediatric infectious diseases experts – in steroid use. concert with the University of Michigan Health Systems Infection Control Program – are frequently called upon to address are: how do Pediatric Genetics we prevent hospitalized patients from acquiring an infection in the hospital, and how do we protect hospital employees from transmitting The Division of Pediatric Genetics provides service in the diagnosis, an infection from one patient to another? treatment and prevention of birth defects, malformation and mental impairment syndromes, inherited diseases, chromosomal abnormalities Additionally, our team of health care providers is associated with the and mental retardation, and autism. “We recently took part in Derrick Clinic — a special HIV treatment center that provides a number of services to assist HIV infected children, their families, and We also provide services for children with biochemical genetic their communities with managing infection. a N I H steroid-avoidance disorders or inborn errors of metabolism. Genetics outreach clinics are staffed by divisional faculty located in Gaylord, Marquette, Traverse trial and as a result, we City, and Grand Rapids, Michigan. Pediatric Comprehensive Weight now offer selected kidney New clinical services include a biochemical genetics clinic and the Management Center development of the Michigan Medical Genetics Laboratories (MMGL). The University of Michigan Pediatric Comprehensive Weight Manage- transplant recipients a ment Center (PCWMC) was established in 2006, the first center of its kind in Michigan. The PCWMC brings together a team of experts in regimen that avoids long- nutrition, social work, physical fitness, psychology, pediatric medicine, and pediatric surgery to evaluate and treat obese children. term steroid use.” In 2007, the Center launched the Michigan Pediatric Outpatient Weight Evaluation and Reduction Program (MPOWER) for obese adolescents. A year later this was followed by the introduction of MPOWER Jr., a program for seven-to-eleven-year-olds that is offered as part of a collaboration with the Ann Arbor YMCA. These six-month intensive interventions are designed to help family members adopt healthy lifestyle habits and achieve a healthy weight. 12 13
  8. 8. RESEARCH The Department of Pediatrics and Communicable Diseases supports wide-ranging research programs directed by more than 50 faculty investigators. Programs focus on laboratory discovery, clinical investigation involving trials of cutting edge therapies, and health services research designed to enhance health care policy and delivery. We are one of the Top Ten pediatric departments in National Institutes of Health (NIH) funding, having received over $17,011,000 through research awards. This year we celebrate 16 years of continued funding of our Child Health Research Center, one of only 20 such NIH- funded centers of excellence nationwide. The Child Health Research Center is dedicated to training young physician- scientists. The Department also boasts five NIH-funded training grants that support postdoctoral fellows pursuing advanced research training. 15
  9. 9. RESEARCH RESEARCH Michigan Congenital Heart Outcomes Child Health Evaluation Research and Discovery & Research Unit The University of Michigan is internationally recognized as a center of Emerging child health issues must be addressed in the context of ever- excellence for patients with complex congenital heart disease. Through changing government policies. The Child Health Evaluation and the Michigan Congenital Heart Center, a partnership has been forged Research (CHEAR) Unit is a center of research activity from which to “A new inter-departmental between the Department of Pediatrics and the Department of Pediatric study the impact of policy and programmatic changes on child health. Cardiovascular Surgery to develop and conduct groundbreaking research Based in the Division of General Pediatrics, the multidisciplinary partnership has been on the long-term outcomes and psycho-social effects of treating both CHEAR unit includes faculty members from the Schools of Medicine, cogenital heart disease and heart transplantation in children. To realize Public Health, Social Work, Dentistry, Pharmacy, Nursing, Business, this goal, the Michigan Congenital Heart Outcomes Research and Dis- Law, and Public Policy. Our mission is to improve the health of children formed to develop covery (MCHORD) program was formed. by evaluating children's policies and programs in our community, in our state, and throughout the nation. ground-breaking research The MCHORD multidisciplinary research team includes pediatric cardiologists, pediatric cardiothoracic surgeons, critical care physicians, CHEAR researchers publish findings in the leading national journals, on children’s congenital epidemiologists, and health services researchers. Current projects and present their work directly to policy makers at the state and national include studying neuropsychological outcomes associated with single level, to allow research data to support policy decisions. Agencies such ventricle repair; testing whether tight blood glucose control during and as the Centers for Disease Control and Prevention, and the State of heart disease and heart immediately after cardiac surgery in infants will improve outcomes; Michigan Medicaid Program, rely on the CHEAR Unit for practical and and trying to reduce the effects of inflammation and injury of the small useful research. transplantation.” intestine that result from inadequate blood supply. Pediatric Genetic Research Child Behavioral Research Division of Genetics faculty members investigate the genetic causes Child Behavioral Health’s research mission is to increase our knowledge of human malformations affecting limbs, craniofacial structures, hear- about the interplay between development, behavior, and health. ing, heart development, the genetics of neuronal development and Researchers are focusing on brain-behavior development, eating/feeding autism, growth of the lower body, growth of the urinary system and behavior, eating disorders, obesity, adherence to chronic illness treat- genital development, modifiers of fetal growth, and altered pregnancy ment, and quality-of-life issues. Studies are also underway to examine outcomes. We also assess long-term outcomes and best practice guide- the relationship between parents’ and children’s behavior during meal- lines for patients with inborn metabolism errors. time, the parents’ psychological state, and the children’s blood glucose “Our research mission at control. We also hope to gain a better understanding of food preferences, We are developing a curriculum for medical residents on disorders so interventions can be developed for preschoolers that may alter their included in the newborn screening panel that will include strategies for long-term risk for obesity. dealing with true and false positive screening results, and knowledge of Child Behavioral Health appropriate state and national resources for education and referral. We This research is funded by the National Institutes of Health (NIH), the are also addressing follow-up issues for children with a chronic illness is to increase knowledge American Heart Association, private foundations, and internally through and an uncertain, long-term prognosis. University of Michigan initiatives. Three areas of research recently about the interplay funded by the NIH are: how early social-environmental factors affect young children’s eating habits; examining mealtime interaction among families with young children suffering diabetes; and development of between development, better tools to assess quality-of-life issues for children born with sex development disorders. behavior, and health.” 16 17
  10. 10. RESEARCH RESEARCH Hospitalist Services Findings are also informing new policy initiatives and research ideas on children’s health topics such as insurance coverage, preventive services, Hospitalists participate in quality improvement projects, such as best access to care, obesity, smoking and other substance use, screening pathways for treatment of bronchiolitis, asthma, dehydration, and programs, and special health care needs. life-threatening events of infants. Recently we took part in the American Academy of Pediatrics research on inpatient settings, which involved teams of hospitalists at over 40 children's hospitals around the country. Critical Care In addition, we spearheaded the effort to implement family-centered Members of the Critical Care research team identified differences in rounding, and played a key role in implementing computerized physi- resource utilization and outcomes based upon the source of admission to cian recordkeeping. a Pediatric Intensive Care Unit. We also designed an innovative, multi- institutional trial on therapeutic hypothermia after pediatric cardiac arrest. Kidney Research Recent funding awards will support research on improving the tubing Research by this Division has revolutionized the understanding of cystic used in dialysis and oxygen therapies, and research designed to provide kidney disease, the most common inherited cause of kidney failure to a better understanding of how the body’s immune system responds to require chronic dialysis. We are also a world leader in understanding the these kinds of devices. In the basic sciences, we gained a better under- biology of podocytes — a specialized cell located within the kidney — standing of the gene expression profile that occurs over time in children and recently demonstrated how podocytes may be replaced in disease with severe infections, and the key elements that regulate this process. states associated with kidney damage and scarring. The Division is also investigating the causes of developmental kidney Neonatal/Perinatal Medicine abnormalities, and the impact of dialysis on white blood cell function The Division of Neonatal/Perinatal Medicine has been conducting during acute kidney failure. Faculty members participated in several research to assess the management of respiratory failure in neonatal clinical trials as well, such as an NIH-sponsored study of steroid infants. Advances in our respiratory research include precautions to avoidance in pediatric kidney transplantation. We worked on a number decrease the incidence of infants with lung disease and respiratory of collaborative research projects with faculty from general pediatrics, distress syndrome. child and behavioral health, and transplant surgery. The Division’s B.R.A.I.N. care program focuses on prevention and Gastroenterology Research treatment of newborns with neurological problems at birth, or shortly afterwards. Findings from these studies will improve the care provided Members of the Gastroenterology Research Division are collaborating patients referred to the Holden Neonatal Intensive Care Unit. with the University of Pittsburgh, in order to participate in the Pediatric Intestinal Failure Consortium. Also, we are creating new educational programs to advance the division’s mission, including a pediatric Neurology Research hepatology fellowship training program. Faculty members are in the Research efforts underway in the Division of Neurology include the planning stages of a clinical education program for clinical nutritionists. development of new therapies for congenital muscle diseases, more effective treatment for newborns experiencing seizures, procedures to National Poll on Children’s Health improve childhood sleep apnea, and the evaluation of certain procedures used in treating brain disorders in infants. The Child Health Evaluation and Research (CHEAR) Unit is the home of the new C.S. Mott Children’s Hospital National Poll on Children’s We are also undertaking studies to evaluate the impact of rewarming Health (NPCH). The Poll, launched in 2007, is designed to measure after therapeutic cooling for treatment of brain injury in newborns. This public opinion and perceptions on major health care issues and trends project will make effective use of near-infrared spectroscopy, amplitude- regarding children in the United States. Already, timely findings from integrated EEG, and conventional video-EEG monitoring. In addition, the NPCH have contributed to the national debate on children’s health Division members are part of a national consortium of investigators and health policy issues. working to evaluate more effective treatment for neonatal seizures. 18 19
  11. 11. RESEARCH RESEARCH Through the work of the University of Michigan Pediatric Compre- Pulmonary Research hensive Weight Management Center (PCWMC), researchers studied the The Division of Pediatric Pulmonology conducts basic and clinical effects of behavioral interventions on weight loss and the reduction of research on asthma, cystic fibrosis and bronchopulmonary dysplasia – risk factors for heart disease and diabetes among children and adoles- a complication in prematurity. The Cystic Fibrosis Foundation recently cents. The research focused on finding innovative ways to use state-of- granted the division a Clinical Research Facilitation Award, to acknowl- the-art computer and communications technology to help improve the edge the Center’s long-standing contribution to clinical research. The health of obese children. University of Michigan CF Center currently conducts 17 distinct multi- center and investigator-initiated clinical research studies. Endocrinology Research Until recently, most children born with thoracic insufficiency syndrome Members of the Endocrinology Division are involved in clinical and died of respiratory failure in infancy or early childhood. Members of basic science research on growth, puberty, adolescent health, develop- the pediatric pulmonology, pediatric surgery, and pediatric orthopedic mental programming, childhood obesity, Type-2 diabetes, prevention surgery departments partnered to develop the Vertical Expandable strategies of Type-1 diabetes, and health care delivery. Prosthetic Titanium Rib (VEPTR), an implantable metal rod designed to mechanically expand the chest, to allow normal lung development. A National Institutes of Health project award is allowing our researchers C.S. Mott Children’s Hospital is currently the only hospital in Michigan to examine the basic molecular and cellular mechanisms of fetal pro- to offer the VEPTR device. gramming. The focus of this work is to investigate the impact of early exposure to excess steroids on feedback systems in the brain that regulate the release of various hormones. Cardiology Research The Division of Pediatric Cardiology has a research portfolio that spans We are also involved in collaborative studies to analyze the body mass a wide range of initiatives — from understanding the molecular and index of large populations, and to evaluate the impact of state-level genetic basis of congenital heart disease, to clinical investigations that policy changes on specific populations of children. A collaborative “Until recently, children with project with the U-M Dental School is examining the effect of childhood evaluate new treatments, to new ways to improve long-term quality of life. Members of the division are also investigating the molecular and obesity on African-Americans living in inner-city Detroit. thoracic insufficiency died genetic basis of congenital heart disease. This research is funded through the NIH and other foundations, such as the American Heart Association. of respiratory failure in Infectious Disease Research In partnership with the Division of Pediatric Cardiovascular surgery, we Why do bacteria living normally in children’s respiratory tract suddenly are conducting a multi-centered randomized trial to study the surgical cause ear infections, pneumonia, or sinusitis? Why do children with early childhood. Now we management of infants with hypoplastic left heart syndrome (HLHS). cystic fibrosis get such unusual and serious infections in their lungs and As a result of this trial, our knowledge regarding how to treat children airways? How do respiratory viruses act in concert with a child’s im- can offer an implantable with HLHS will be improved and outcomes — including the neuro- mune system to cause infection? Researchers in the Division of Pediatric developmental outcome — will be enhanced. Infectious Diseases are searching for answers to these questions through metal rod to mechanically grants funded by the National Institutes of Health and the Cystic Fibro- sis Foundation. expand their chest for Obesity Research To improve the health of children and adolescents affected by obesity, The Division is also conducting research to prevent infection in IV lines, faculty are studying unanswered questions that exist regarding its treatment of antibiotic-resistant bacteria, the association of H. influenzae normal lung development.” causes, complications, and treatment. Researchers are exploring early genes with acute middle ear infections, and genes associated with childhood eating patterns that might affect the development of obesity, severe bacteria that may spread among patients with cystic fibrosis. and are examining the effect of obesity on conditions such as diabetes, lung disease, polycystic ovarian syndrome, and sleep apnea. 20 21
  12. 12. RESEARCH RESEARCH Cancer Research Pediatric Research Symposium The Division of Hematology/Oncology is a leader in cutting edge basic For over a decade, one of the research highlights of each year has been science, and translational and clinical research to develop therapies and the Department of Pediatric’s Annual Research Symposium. During this to improve the care of pediatric patients suffering from non-malignant event, pediatric faculty members, fellows, residents, and student trainees and malignant blood disorders and childhood cancers. present exciting new research, in oral or poster format. Faculty members hold leadership roles in national consortiums that In 2007, 83 abstracts were presented and in 2008, 96 were presented. conceptualize, design, and conduct clinical trials for newly diagnosed Competitive awards were given to junior investigators for basic science and relapsed patients. Our faculty serve as lead investigators in the research, clinical investigation, and health services research. Awards also Children’s Oncology Group, the Blood and Marrow Transplant Clinical were given for resident, graduate student, and medical student research. Trials Network, and New Approaches in Neuroblastoma Therapy. A highlight of the annual symposium is the keynote presentations by nationally recognized physician-scientists who provide their unique We are internationally recognized for our studies to prevent, diagnose perspectives on topics of current interest. and treat graft vs. host disease, which is the most common complication of bone marrow transplant. We are also recognized for our research into new therapies for treating neuroblastoma. The University of Michigan is one of 20 institutions participating in the COG Phase-1 Consortium, and the Therapeutic Advances in Childhood Leukemia Consortium, which focus on new drug studies in children with refractory solid tumors and leukemia. We are also active members of the Childhood Cancer Survivor Study (a federally funded multi- institutional consortium researching survivorship issues), and a six- institution consortium conducting interventional trials to reduce the side effects of cancer therapy. Rheumatology Research “We’re conducting research Juvenile arthritis is the most common cause of childhood disability. Our research team is conducting studies to determine what triggers the abnormal immune response in arthritis that can lead to serious damage to determine what triggers in joints, eyes, and other vital organs. the abnormal immune A current research project investigates the ability of a protein called DEK to act as a measure of disease activity in juvenile diabetes. The response in juvenile arthritis research may help us choose the best therapy for childhood arthritis, and test the effectiveness of new therapies. that can lead to serious damage in a child’s joints, eyes, and other organs.” 22 23
  13. 13. EDUCATION Training the next generation of pediatric leaders is at the core of our mission. We provide clinical bedside teaching, and a comprehensive curriculum of innovative programs using the latest technologies. More than 100 physicians are trained each year, in one of six programs nationally recognized for the quality of their educational experiences. We are proud to have four National Institutes of Health fellowship training programs. Each one uses simulation, asynchronous web-based learning modules, and case studies to prepare students for the 21st century. Regardless of your career path or global destination, a Department of Pediatrics and Communicable Diseases education is the precursor to success in primary care, academic medicine, subspecialty care, and research. 25
  14. 14. E D U C AT I O N E D U C AT I O N Medical Students Our resident complement has grown to include 18 categorical Clinical Simulation Center pediatric residents, eight medicine-pediatrics residents, and The Pediatric Medical Student Education Program has in- The Clinical Simulation Center provides a flexible approach one or two combined pediatrics-child neurology residents. creased pediatric exposure during the first and second years to education in a field where the technology is constantly Graduates have entered all types of sub-specialty fellowships, of medical school, and has improved our third-year core changing. We are one of few programs in the country to offer health services research fellowships, and private or academic clerkship. We have instituted an email assessment exercise for pediatric simulations. general practices at this hospital and across the country. students in our third-year core curriculum, and completely revised our evidence-based medicine curriculum. In addition, a mock code gives residents, nurses and other The mission of the pediatrics residency training programs is to graduate leaders in primary care, subspecialty, and general code team members a chance to practice pediatric resuscita- In 2008, we offered our first elective – Pediatricians Just tions. We use videotaped mocks codes to evaluate how resi- academic pediatrics who will make a difference in the lives of Want to Have Fun! – a popular course that we teach in part- dents respond, work together, and utilize equipment prior to children and in their communities. Our residents truly fulfill nership with the Child Life faculty. Also, our pediatric student their functioning in a real code environment. this commitment. interest group continues to grow and sponsor events on nearly a monthly basis. The newest addition to our family is a baby simulator that Currently we offer six studies, most of them collaborative Fellowship Programs breathes, has a heart beat, a pulse, and even blinks. The computerized baby allows residents to practice unlimited with other pediatric divisions, as well as with other offices The Department offers fellowship programs in 13 accredited patient scenarios without patient risk. Students gain hands-on and programs throughout the medical school. divisions and health services research for men and women experience in critical care, trauma management, and proce- who have completed their residency training in pediatrics. dural skills such as intubation and ventilator management. We offer diverse training with both clinical and research “The newest member of our The Pediatric Medical Student Education Program continues components, thanks to the second largest number of National to be highly ranked by students. Faculty and residents win family is a baby simulator that prestigious teaching awards on an annual basis, while our Institutes of Health funded fellowship training grants in the nation. Recently we added a fellowship in developmental and Standardized Patient Program students are recruited by outstanding pediatric residency The U-M Standardized Patient Program is one of the largest programs across the country. Also, because we believe staff, behavioral pediatrics. and oldest in the country. We train future pediatricians to breathes, has a heart beat, has faculty, and house officers should be well-acquainted with the communicate effectively and respectfully with patients and student program, we have launched a quarterly newsletter to Many fellows receive extramural funding for independent research projects, and they present their results at national and families from diverse populations. a pulse, and even blinks. Using improve awareness and communication. international meetings. Publication in major journals is also expected, because it offers an excellent opportunity to set the Individuals trained as standardized patient instructors role- play the characteristics of real patients, so students can this high-tech teaching aid Residency Programs tone for a successful academic career. In addition, fellows participate in a departmentally sponsored course in clinical experience scenarios they may not encounter during their We continue to offer nationally renowned residency programs and epidemiologic research, to set the stage for further studies, but must know how to handle in real life. Medical gives our students the hands-on that recruit individuals with diverse backgrounds and career situations are simulated for use in teaching, evaluating academic work. interests. These programs offer superb training opportunities clinical skills, and providing feedback on performance. experience they need in critical delivered by a world-class faculty, with a strong emphasis on Most of our Fellows pursue academic appointments following Students are taught to be sensitive to cultural differences and teaching, advocacy, health services, evidence-based medicine, completion of training. We were pleased to retain 33 percent to behaviors that may influence the care provided. care and trauma scenarios.” cultural competence, and ethics. Recently we received a of our recent graduating class as junior faculty members. Residency Review Committee Accreditation for five years — the maximum length possible. Residents share management of patients with a supportive multi-disciplinary team focusing on patient and family- centered care. New initiatives within the residency program include: a graduate medical education innovations grant on Enhancing Quality Through Resident Initiatives in Collabora- tive Patient-Centered Care; our expanded clinical simulation program; and our expanding global health initiative. 26 27
  15. 15. Recent T. Grace Brown Estate Dr. T. Grace Brown, who received five degrees from U-M, expressed her lifelong passion for medicine by leaving part of her estate to the Depart- Vrishin Chandra Charity Golf Outing The 4th Annual Vrishin Chandra Charity Golf Outing, held in June 2007, raised over $10,000 to benefit research efforts in pediatric nephrology. Annual Donor ment of Pediatrics to support its educational and research programs. David & Joan Evans Child Behavioral Health and Autism Unit Over the past four years, the Vrishin Chandra Research Foundation has donated over $39,000 to the Division of Pediatric Nephrology. The Foundation was created to memorialize Vrishin Chandra who lost his life Community Highlights A sizable donation from Joan and David Evans helped establish the University of Michigan's Autism and Communication Disorders Center. to Nephrotic Syndrome, a condition that affects kidney function. Team Braylon Support Lydia S. Foley Estate In 2007, Team Braylon raised over $12,000 in the 34th annual Dexter- The Lydia Foley estate generously awarded part of her estate to create Ann Arbor Run. Monies are used for research efforts within the Division the Finlan RenzoGorgEffen Fund to benefit B.R.A.I.N. Research and of Pediatric Cardiology. In addition to supporting the Dexter-Ann Arbor Innovative Neurological Care for Newborns. Run, Team Braylon raises funds for the The Big House Big Heart Run and the Champions for Children s Hearts celebrity golf tournament Carroll J. Haas Foundation and Cystic Fibrosis Research hosted by Brian Griese and Steve Hutchinson. John LiPuma, M.D., Department of Pediatrics, and James Baker, M.D., Ruth Down Doan Professor of Biologic Nanotechnology, are working Annual Endlein Invitational together to test a novel nano-emulsion for its activity against Burkholderia In 2007, the 20th Annual Endlein Golf Invitational raised $7,400 to and other multi-drug-resistant bacterial pathogens that infect cystic fibro- support the University of Michigan s Children s Cancer Fund in the sis patients. Their cutting edge research would not be possible without Department of Pediatrics. Since 2000, the annual golf invitational has the support of the Carroll J. Haas Foundation. raised over $55,000. Dr. Amnon Rosenthal and Mrs. Prudence Rosenthal Dr. Rosenthal, Professor Emeritus of Pediatrics and Communicable Diseases, and his wife Prue have made a gift that will be used to acquire works of art for use in the new C. S. Mott Hospital. Long recognized as an important part of the healing process at Mott, art can make a huge difference in the lives of those who experience it. The Sorini Family Children's Emergency Medicine Center Ernest Sorini, M.D., and Kelly Sorini will provide a gift to establish the urgent care facility in the new C. S. Mott Children's Hospital. This magnificent new space will become a model for pediatric emergency medicine and a source of hope for families both near and far. Victor J. Strecher and Jeri Rosenberg Victor Strecher and Jeri Rosenberg established an endowed fund in appreciation of the pediatric cardiologists at C. S. Mott Hospital who took such good care of their daughter Julia. Named the Strecher Family "For (S)he's a Jolly Good Fellow" Research Grant Fund, it will be used to fund research grants for Fellows in pediatric cardiology. (left to right) Allison Finch, Paul Finch, Teresa Thomas, Dr. Linda McAllister-Lucas, Bill Zirinsky and Ruth Schekter Denis Endlein, and Dr. Valerie Castle holding a representative check of In memory of their two children, Sam and Juliana, Bill and Ruth have monies raised at the Endlein Golf Invitational. given a generous gift to name the palliative care suite in the new C. S. Mott Children's Hospital. 28 29
  16. 16. Executive Officers University of Michigan of the University of Michigan Health System Department of Pediatrics and Ora Hirsch Pescovitz, Executive Vice President for Medical Affairs, Uni- Communicable Diseases versity of Michigan, and CEO, U-M Health System; James O. Woolliscroft, Dean, U-M Medical School; Douglas Strong, Chief Executive Officer, U-M Hospitals and Health Centers; Kathleen Potempa, Dean, School of Nursing. Chair Valerie P. Castle, M.D. Regents of the University of Michigan Associate Chair for Finance & Billing Operations Julia Donovan Darlow, Laurence B. Deitch, Denise Ilitch,Olivia P. Maynard, Margie C. Andreae, M.D. Andrea Fischer Newman, , Andrew C. Richner, S. Martin Taylor, Katherine Associate Chair for Faculty Affairs E. White, Mary Sue Coleman, ex officio Laurence A. Boxer, M.D. The University of Michigan, as an equal opportunity/affirmative action em- C.S. Mott Children’s Hospital Associate Director, Clinical Affairs ployer, complies with all applicable federal and state laws regarding nondis- Chris J. Dickinson, M.D. crimination and affirmative action, including Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973. The Associate Chair, External Affairs University of Michigan is committed to a policy of nondiscrimination and Gary L. Freed, M.D., M.P.H. equal opportunity for all persons regardless of race, sex, color, religion, creed, Associate Chair for Education national origin or ancestry, age, marital status, sexual orientation, gender Hilary M. Haftel, M.D., M.H.P.E. identity, gender expression, disability, or Vietnam-era veteran status in em- ployment, educational programs and activities, and admissions. Inquiries or Associate Chair for Research complaints may be addressed to the Senior Director for Institutional Equity John J. LiPuma, M.D. and Title IX/Section 504 Coordinator, Office of Institutional Equity, 2072 Associate Chair for Clinical Affairs Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734-763- Albert P. Rocchini, M.D. 0235, TTY 734-647-1388. For other University of Michigan information call 734-764-1817 Chief Department Administrator Jamie Dimond, M.B.A. © 2009, The Regents of the University of Michigan.