2007 Annual Review Division of Pediatric Neurology Department ...


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2007 Annual Review Division of Pediatric Neurology Department ...

  1. 1. 2007 Annual Review Division of Pediatric Neurology Department of Pediatrics Rainbow Babies and Children Hospital University Hospitals Case Medical Center Case Western Reserve University School of Medicine Overview The Pediatric Neurology Division at Rainbow Babies and Children’s Hospital is the most active program in the upper Midwest of the United States, devoted to service, training and research of children with neurological problems. Reorganized in 1997, the Pediatric Neurology Division has grown to include nine full-time pediatric neurologist faculty, and four nurse specialists who provide both outpatient and inpatient consultations for children and their families. Our team provides family-centered care for the full range of neurological challenges to the child and family. We evaluate approximately 15,000 outpatient and 2,000 in-patient consultations every year. Children present with suspected seizures, epilepsy, headaches, developmental delay, movement disorders, learning and behavioral problems including autism and ADHD and neurogenetic diseases. Each pediatric neurology faculty is certified by American Boards of Neurology and Pediatrics, including several with clinical neurophysiology certification. We have a broad range of expertise within the division ranging from epilepsy, metabolic-genetic disorders, sleep medicine, headaches, neuro-oncology, behavior cognitive neurology, including autism and ADHD and the care of multiple-handicapped children including those with cerebral palsy and spina bifida. EDUCATIONAL ACTIVITIES 1. Medical Student Education The Division of Pediatric Neurology is involved in the education of third and fourth year medical students who are assigned to either the neurology rotation at Rainbow Babies and Children Hospital or who choose to take a fourth-year elective in pediatric neurology. In addition, our division members have educational contact with students in other pediatric rotations. We are also involved in with the clinical teaching of M.D.- PhD candidates through the Center of Translational Neuroscience (Dr. Robert Miller, Director of the Neurological Institute of the University Hospitals Case Medical Center). This specific educational contact is either in a clinic setting supplemented by the interdisciplinary education research conference organized by Dr. Miller. 2. Graduate Medical Education: The Division of Pediatric Neurology is involved in the educational activities of multiple programs: a) Pediatric Neurology (one fellow per year for a total of three year); b) Pediatrics Residency; c) Neonatology Fellowship d) Critical care/Pharmacology Fellowship; e) Neurology Residency/Pediatric Neurology Rotation; f) Epilepsy Fellowship; g) Sleep Medicine Fellowship; h) Child Psychiatry Fellowship; i) Family Practice Residency The above-mentioned residencies and fellowships include educational contacts in the inpatient and outpatient settings as well as in the classroom. 3. Continuing Medical Education: The Division of Pediatric Neurology contributes to CME through Pediatrics, Pediatric Neurology and the Neurological Institute. This includes an annual meeting of the Epilepsy Association, epilepsy support groups, the clinical practices of the University Hospitals at their practice sites and organized University Hospital’s continuing education symposia specifically arranged at suburban sites. 4. Other Graduate Student/MSTP Student
  2. 2. Education Activities: The faculty within the Division of Pediatric Neurology is involved in the educational experience of engineering computer science, graduate and post-graduate students throughout the School of Arts and Sciences; nursing students pertaining to specific topics in pediatric neurological health and disease. They are also involved in the MSTP student program as noted above with respect to tutorials in clinical child neurology in an office practice setting with the division chief, Dr. Mark Scher. 5. Goals and Objective for the Next Year The following are six (6) goals and objectives for our educational mission: a. To strengthen and improve our educational tools for residents, students and graduate students consisting of conferences, mentored research projects and teaching programs. Specific on- line electronic HIPPIA protected case studies, literature reviews and didactic teaching sessions are being added to the hospital’s S-Drive for common use. b. To strengthen the cross-disciplinary educational mission of the Neurological Institute of the University Hospitals of Cleveland by the establishment of interdisciplinary clinics at the Bowell facility. At present, we are concentrating on the Epilepsy Center and a neurogenetics clinic that will facilitate medical students, residents and faculty interactions. c. A NIH T-32 application entitled “Cross-Disciplinary Training in Pediatric Neurointensive Care” is currently under review. Funding sources such as this will be sought through federal and non-federal agencies to establish or improve the training environment for both physicians and non-physician students in areas that involve brain health and disease for children requiring intensive care. d. To expand our teaching presence at the MetroHealth Center, particularly within the neonatal and pediatric intensive care units and their Division of Pediatric Neurology. e. To continue and improve our outreach continuing medical education sessions with our colleagues in clinical practice either in their specific office settings or pre-scheduled suburban sites. f. To established an Autism Center at Bellefaire JCB School in Shaker Heights as a specialty clinic to provide students, residents and other post-graduate students an experience in assessing children with suspected autistic spectrum disorders and other related behavior and cognitive challenges. This center will include an interdisciplinary clinic and contact with the Monarch School at Bellefaire where children with autistic spectrum disorders are enrolled. 2
  3. 3. RESEARCH ACTIVITIES The following are the departmental grant and contract funding for the Division of Pediatric Neurology for the past five years: 1. Departmental Grants – Childhood Absence Epilepsy: Rx, PK-PD – Pharmacogenetics Overall study Principal Investigator: Tracey Glauser, MD Study Site: Rainbow Babies and Children’s Hospital Primary Investigator: Mark S. Scher, MD Protocol Number NS 045966/NS 045803 -9/30/03 – 5/31/08 Total Budget $169.265 Budget for Clinical Site $5,642 Neonatal ICU Telemetry System NIH Small Business Innovation Research (SBIR) CleveMed Principal Investigator: Joseph Giuffrida, Ph.D. CWRU Principal Investigator: Mark Scher, M.D. 2R44NS-41118-04 Total Budget $50,000 Kangaroo Care to Blunt Pain in Premature Infants Principal Investigator: Susan M. Ludington, PhD, RN CNM Co-Investigator: Mark S. Scher, MD 1RO3 NR08587-01 September 1, 2003 – September 29, 2005 Total Budget $1,200,000 Preterm Skin Contact Effects on Electrophysiologic Sleep Principal Investigator: Susan M. Ludington CNM, PhD Co-Investigator: Mark S. Scher, MD R01NR04926-01 January 1, 2002 through December 31, 2004 – requesting no cost extension Total Budget $1,218,077 Neonatal ICU Telemetry System – Phase II SBIR project Principal Investigator: Mark S. Scher, MD 5R44NS41118-03 May 1, 2001 - April 31, 2003 (no cost extension) Total Budget $156,473 Neuroimaging and Neurophysiological Correlates of Prenatal Cocaine Exposure Principal Investigator: Lynn Singer, PhD Co-Investigator: Mark S. Scher, MD Feb 1, 2002 - March, 2003 (no cost extension) Total Budget $360,401 A Multi-center Study of Sleep and Outcome in High Risk Infants Principal Investigator: Mark S. Scher, MD RO1 NS34508-01A2, 9/30/97 through 6/30/03 – no cost extension 6/30/04 $1,019,624 Total Direct Costs Assessment of Biological and Social Risk in Preterm Infants Principal Investigator for the multicenter project and Co-Principal Investigator at University of North Carolina site: Diane Holditch-Davis, PhD Principal Investigator at Rainbow Babies and Children’s Hospital site and Co-Principal Investigator for multi-center project: Mark S. Scher, MD 2R01NR01894-06 , June 1, 1998 through May 2003 $1,653,612 Total Budget FEDERAL GRANT GRAND TOTAL $5,833,094 3
  4. 4. 2. Training Grants/Fellowship Support Sleep Medicine Neurobiology and Epidemiology Principal Investigator (Director): Kingman P. Strohl, M.D. Co-Investigator: Mark S. Scher, MD Training grant to mentor individuals interested in research and clinical applications to sleep medicine research $162,000 HL07193 7/01/05 - 6/30/10 / yr. for 5 yrs = Total Budget $810,000 Sleep Medicine Neurobiology and Epidemiology Principal Investigator (Director): Kingman P. Strohl, M.D. Co-Director: Mark S. Scher, MD HL07193 7/1/99-6/30-03 (Competitive renewal sent 6/1/03) Total Budget $840,735 TRAINING GRANTS/FELLOWSHIP SUPPORT GRAND TOTAL $1,270,035 3. Industry Response to Clinical Trials Grant Industry Sponsored Clinical Trials Single Dose Pharmacokinetic and Pharmacodynamic Evaluation of Three Different Zolpidem Doses in Children Ages 6 Months to 18 Years Primary Investigator: Jeffrey Blumer, PhD, MD Sub—Investigator: Mark S. Scher, MD Protocol Number: L8749 January, 2003 – January, 2004 Total Budget $1,729,365 INDUSTRY RESPONSE TO CLINICAL TRIALS GRANT GRAND TOTAL $1,729,365 GRAND TOTAL OF ALL GRANTS $8,832,494 4. Important Collaborations Outside the Department Major research efforts are underway to integrate research activities with specific academic entities across Case Western Reserve University (CWRU) including the Schools of Engineering and Computer Science, Nursing, and Medicine. Ongoing collaborative research continues with Dr. Kenneth Loparo of the EECS at CWRU specifically related to computer analyses of EEG and sleep activity in, preterm neonates and epileptic patients. Drs. Loparo and Scher are also collaborating with Dr. Ludington-Hoe in a study of developmental care of preterm infants using computerized EEG-sleep analyses to assess outcome. These individuals represent two inter-school CWRU contacts as the beginning of a collaborative effort with other individuals across schools at CWRU for cross-disciplinary studies regarding brain health and disease, health disparities and cross-disciplinary training. For example, we are interacting with the Center of Neuroimaging to establish research protocols that will combine magnetic-resonance imaging with computerized EEG studies to assess brain maturation and disease. 1. Departmental Annual Direct Research Expenditures for Federal Awards (Provided by Judy Quinn) 2. Significant Awards and Honors Dr. Mark Scher, President of the Scientific Advisory Council and Trustee of the Epilepsy Association Dr. Mark Scher, Board Member, Hattie Larlham Foundation Drs. Mark Scher, Max Wiznitzer, Carolyn Green, Nancy Bass received the “Top-Docs” Recognition 3. Goals and Objectives for the Next Year For the years 2007-2008, a number of specific research goals and objectives are planned: a) Dr. Loparo and Dr. Scher are resubmitting a R-21 in the winter of 2008 regarding computer analyses of neonatal sleep. 4
  5. 5. b) Drs. Ludington-Hoe, Loparo and Scher are planning a new competitive renewal this spring to the NIH to study developmental care in high-risk neonates with intrauterine growth restriction. c) A proposal to the Gerber Foundation will assess intrauterine growth restriction by using computerized EEG-sleep. Such a proposal will be linked to the presently-funded Gerber proposal through Dr. Walt Chwals, of Pediatric Surgery, who is now studying a population of preterm infants offered an altered nutritional diet regimen. d) We will respond with the critique for resubmission for the T-32 “Application Cross- Disciplinary Training in Pediatric Neurointensive care” to the NIH. This application is a broad effort to unite educational and research efforts across the university among multiple disciplines ranging from medicine, engineering and nursing. PATIENT CARE ACTIVITIES The paragraphs below summarize our multiple programs for outpatient and inpatient pediatric neurology practice, educational and research areas. 1. The Outpatient Neurological Consultation Service Currently our physicians and nurses evaluate and treat children with neurological disorders at seven sites: Landerbrook, Westlake, Mentor, Strongsville, Geauga, Sandusky and Rainbow Babies and Children’s Hospital. Three additional sites are being created: University Hospitals of Cleveland, The Bowell Building at University Hospitals, the UH Hudson facility and the Bellefaire JCB facility in Shaker Heights. At our outpatient facilities evaluate children with a full spectrum of neurological conditions. Selected subspecialty clinics concentrate on children with specific neurological conditions such as spinal bifida, movement abnormalities, epilepsy, autism and pediatric sleep medicine. Medical students and residents’ attendance at all clinics are required. A continuity clinic for our pediatric neurology residents is organized at Rainbow Babies and Children’s Hospital to optimize on their other educational opportunities at University Hospitals. 2. Inpatient Consultation Services We provide an inpatient consultation service which is integrated with service, educational and research missions at Rainbows Babies and Children’s Hospital and the University Hospitals. Primary pediatric neurological service is organized with one of the pediatric resident teams who provide in-hospital support for children in our epilepsy-monitoring unit as well as on the regular medical floors at the hospital. In addition we provide pediatric neurology consultations throughout the hospital independent to the pediatric neurology in-patient service including the neonatal intensive care unit, the pediatric intensive care unit, the emergency room, the MacDonald Hospital for Women and the Child Psychiatry Service. 3. Telephone Consultation Service The division of Pediatric Neurology provides prompt consultation service on a 24 hours, 7-days a week basis. During working hours, we receive over a 1000 phone calls a week and triage a wide-range of concerns by families for their children with neurological conditions. Documentation of these telephone contacts are integrated into our charting system to be applied to charges for consultations in our clinic setting as well as appropriate inpatient admissions. 4. Specific Disciplinary Clinics a. Comprehensive Epilepsy Program Dr. Hans Luder, Director Dr. Monisha Goyal, Director, Pediatric Epilepsy b. Motor Assessment Clinic – Pediatric Neurorehabitation Dr. Carolyn Green c. Fetal Neurological Consultations Dr. Mark Scher d. Autism and Behavioral/Cognitive Disorders Service Drs. Wiznitzer, Klein and Holan 5
  6. 6. 5. Total Charges and Collections for the Past 5 Years (Provided by Randy Breininger) 6. Clinical Contracts ($ amount per year, past 5 years) (Provided by Randy Breininger) 7. Departmental Clinical Production (Randy Breininger) 8. Significant Awards and Honors Four physicians within the division of Pediatric Neurology have been recognized as “top-doc” in the northeastern Ohio region, Drs Mark Scher, Max Wiznitzer, Carolyn Green and Dr. Nancy Bass. 9. Goals and Objectives for the Coming Year The following are eight specific goals and objectives to improve patient care activities a) Continue to improve the productivity of our entire faculty as reflected in the RVU statistics. This will be accomplished through perusing new markets for providing neurological consultations. Examples of these new markets include, expanding the epilepsy monitoring unit consultation service through the addition of new faculty such as Dr. Tobias Loddenkemper, who begins in 2008; b) A separate neonatal and pediatric intensive care consult service which includes consulting more specifically the step-down 4th floor NICU for more comprehensive follow-up and intervention; c) To explore opportunities for increased consultations in both neonatal and pediatric intensive care units; d) To increase the volume of consultations for the fetal neurology service through Dr. Scher. e) The Division of Pediatric Neurology in collaboration with the Epilepsy Center of the Neurological Institute, Dr. Hans Luder Director, is consolidating and expanding the neurophysiology monitoring services for both inpatient and outpatient facilities. This will increase the volume of neurophysiology studies within the hospital settings, particularly the intensive care units, as well as, expanding the EEG services at all of our suburban sites. f) To expand the collaboration with the Divisions of Child Psychiatry, and Division of Behavioral Pediatrics and Psychology, to build on the strong contributions by Dr. Jane Holan, a developmental pediatrician who now carries a joint appointment in the Divisions of Pediatric Neurology and Behavioral Pediatrics. We will expand to an Autism clinic at Bellefaire JCB in Shaker Heights, increasing our presence in the school districts of greater Cleveland area, consult with agencies who support children with developmental disabilities and mental retardation and our neonatal follow-up program. g) We are expanding our pediatric neurology outpatient service presence to new sites at Hudson and Mentor and are consolidating our presence at both Firelands Hospital (Sandusky) as well as Geauga Hospital, (Geauga). Interdisciplinary clinics will be established at the Bolwell Building at the University Hospital specifically devoted to neurologic care for epileptic patients and patients with neurogenetics disease. h) To establish and solidify the Rainbow Neurological Center as one of the thirteen centers of the Neurological Institute of University Hospitals of Cleveland. i) To solidify and expand our clinical service partnership with the psychiatry department and particularity the division of child psychiatry with respect to the new inpatient neuropsychiatry unit at Rainbows Babies and Children Hospital as well as our outpatient across consultation. FACULTY DEMOGRAPHICS Below are the list of pediatric neurology faculty including their clinical responsibilities, academic rank and research expertise and experience. Please note that our entire faculty provides general pediatric neurology expertise as well as their subspecialty areas: Mark S. Scher, M.D., Division Chief 6
  7. 7. Center Director, Rainbow Neurological Center, Neurologic Institute University Hospital Case Medical Center Professor of Pediatric Neurology, Case Western Reserve University Fetal Neonatal Neurology, Pediatric Epilepsy/Sleep, Pediatric Neurocritical Care, General Pediatric Neurology Max Wiznitzer, M.D. Director, Pediatric Neurology Outpatient Clinics, Behavioral/Cognitive Neurology and Autism Centers, Pediatric Stroke Consortium Associate Professor of Pediatric Neurology, Case Western Reserve University Behavioral/Cognitive Neurology, Psychopharmacology, General Pediatric Neurology Carolyn Green, M.D. Director, Medical Home Program, Motor Assessment Clinic for Children with Chronic Neurological Disease Medical liaison to the Hattie Larhlam Center, Mentor, Ohio Associate Professor of Pediatric Neurology, Case Western Reserve University Neurorehabilitation, Neurological Conditions of the Complex Pediatric Patient and General Pediatric Neurology Nancy Bass, M.D. Director, Pediatric Neurology Residency Program Neurogenetics Consultant Pediatric Neurology Education Coordinator Associate Professor of Pediatric Neurology, Case Western Reserve University Medical Education, Neurogenetics, General Pediatric Neurology Monisha Goyal, M.D. Director, Pediatric Epilepsy Program, Comprehensive Epilepsy Center within the Neurological Institute of University Hospital Case Medical Center Assistant Professor of Pediatric Neurology, Case Western Reserve University Pediatric Epilepsy, Neuropharmacology of Anti-epileptic Medications, General Pediatric Neurology Deborah Gold, M.D. Pediatric Neuro-oncology, Consultant to the Ireland Cancer Center, Pediatric Stroke Consortium Assistant Professor of Pediatric Neurology, Case Western Reserve University Pediatric Neuro-oncology, Pediatric Stroke, General Pediatric Neurology Jane Holan, M.D. Development and Behavioral Pediatrics Joint Appointment with the Division of Behavioral Pediatrics and Psychology, Autism Center, Multiple Handicapped Children, Downs Syndrome Center Assistant Professor of Pediatric Neurology, Case Western Reserve University Down’s syndrome, Multi-handicapped Children, Expertise in Developmental Care Susan Klein, M.D., PhD. Co-Director of the Behavioral and Cognitive Neurology and the Autism Center Assistant Professor of Pediatric Neurology, Case Western Reserve University Behavioral Neurology, Psychopharmacology, General Pediatric Neurology Tobias Loddenkemper M.D.(start date of July, 2008) Pediatric Epilepsy Program, Comprehensive Epilepsy Program in the Neurology Institute of University Hospitals Pediatric Epilepsy, Language Focalization in Children 7
  8. 8. Faculty Demographics • Eight (one starting in July, 2008) total full-time faculty members - ranging from assistant to associate and full professor. • One part-time (80%) assistant professor. • 75% women • 12% minority Continued efforts are now underway to expand our division with diversity candidates in Pediatric Neurology with service, educational and research interests in Pediatric neurocritical care, neuromuscular disease, neurogenetics, neuropharmacology and neuroepidemiology. FISCAL PERFORMANCE (Randy Breininger will provide) 1. Clinical Operation Revenue Expense Income 2. Research Operation Revenue Expense 3. Salary Support from External Sources 4. Gift and Endowment Income 5. Overall Margin KEY INITIATIVE 2007-2008 As detailed above, the Division of Pediatric Neurology will contribute to the department of Pediatrics within the University Hospitals of Cleveland to solidify and expand clinical programs, research activities and educational programs and collaborations for the next academic year. SUMMARY Over the preceding ten years, the Pediatric Neurology Division has grown from two individuals to our present size and we are operating as the busiest clinical service in the Department of Pediatrics, providing the most diversified Pediatric Neurology Program serving the surrounding communities throughout northeastern Ohio. Areas of improvement and expansion include educational and research and selected clinical areas. Our divisional mission is integrated into the Departmental and Hospital missions for service, education, research and will best be served by unifying as many activities into the Neurological Institute at the University Hospitals while maintaining our identify within Rainbows Babies and Children Hospital. 8