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Coria AL, Hassan A, Huang JY, Genadry KC, Kumar RK, Sergios A, Marshall RE, Russ CM. Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement. Hum Resour Health 2023; 21:65. [PMID: 37592365 PMCID: PMC10433606 DOI: 10.1186/s12960-023-00852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement. METHODS We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating "partially present" or "absent", raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark. RESULTS A median of 56% (IQR 43-77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15-39%) were partially present; and 8.3% (IQR 5.5-21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching. CONCLUSIONS Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.
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Affiliation(s)
- Alexandra L Coria
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA.
- Department of Population Health, Maimonides Medical Center and Division of Hospital Medicine, Maimonides Children's Hospital, 4802 10th Ave, Brooklyn, NY, 11219, USA.
| | - Areej Hassan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jui-Yen Huang
- Division of Adolescent Medicine, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan, ROC
| | - Katia C Genadry
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Rashmi K Kumar
- University of Nairobi, P.O Box 30197, GPO, Nairobi, Kenya
- Kenyatta National Hospital, P.O Box 20723-00202, Nairobi, Kenya
| | - Ayten Sergios
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA
| | - Roseda E Marshall
- AM Dogliotti College of Medicine, Capitol Hill, P.O Box 10-9020, 1000, Monrovia 10, West Africa, Liberia
| | - Christiana M Russ
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Intermediate Care Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Genadry KC, Monuteaux MC, Neuman MI, Lowe DA, Lee LK. Disparities and Trends in Migraine Management in Pediatric Emergency Departments, 2009-19. Acad Pediatr 2023; 23:76-84. [PMID: 35609775 DOI: 10.1016/j.acap.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the variation in migraine management over time across US children's hospitals and to identify factors associated with disparities in management. METHODS We conducted a retrospective study of 32 hospitals in the Pediatric Health Information System from 2009 to 2019. We included children 7 to 21 years old with primary ICD-9 or ICD-10 diagnosis codes for migraine headache. We surveyed hospitals to assess for clinical guideline presence. We assessed medication use trends over time. To examine differences in medication and advanced head imaging use by patient characteristics and presence of clinical guideline, we performed multivariable logistic regression analyses reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS We identified 112,077 eligible visits. Opioid use decreased over time, while nonopioid analgesic, dopamine antagonist, and diphenhydramine use increased. Multivariable analysis for opioids revealed increased odds of use for those 14 to 17 (aOR 1.19; 95% CI, 1.06, 1.34) and 18 to 21 years old (aOR 1.69; CI, 1.37, 2.08), and clinical guideline presence had decreased odds (aOR 0.64; CI, 0.48, 0.84). For head computed tomography, increased odds of use were reported for Hispanic ethnicity (aOR 1.15; CI, 1.06, 1.24) and decreased odds for 14 to 17 years (aOR 0.85; CI, 0.80, 0.90), 18 to 21 years (aOR 0.87; CI, 0.77, 0.98), and female sex (aOR 0.74; CI, 0.70, 0.79). CONCLUSIONS Opioid use decreased while other medications increased over time. Medication and imaging differed by demographic characteristics. Opioid use was less likely in hospitals with clinical guidelines. Standardization in management may decrease care disparities and variability.
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Affiliation(s)
- Katia C Genadry
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School (KC Genadry, MC Monuteaux, MI Neuman, and LK Lee), Boston, Mass.
| | - Michael C Monuteaux
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School (KC Genadry, MC Monuteaux, MI Neuman, and LK Lee), Boston, Mass
| | - Mark I Neuman
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School (KC Genadry, MC Monuteaux, MI Neuman, and LK Lee), Boston, Mass
| | - David A Lowe
- Department of Emergency Medicine, Nicklaus Children's Hospital (DA Lowe), Miami, Fla
| | - Lois K Lee
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School (KC Genadry, MC Monuteaux, MI Neuman, and LK Lee), Boston, Mass
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Genadry KC, Shrock C, O'Shea D, Vatsa R, Shah AS, Gise R, Lipsett SC. Traumatic Hyphema. J Emerg Med 2021; 61:740-741. [PMID: 34518051 DOI: 10.1016/j.jemermed.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Katia C Genadry
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Christine Shrock
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Delia O'Shea
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Rajet Vatsa
- Pathways MD Program, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Susan C Lipsett
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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Slemmons KK, Deel MD, Lin YT, Oristian KM, Kuprasertkul N, Genadry KC, Chen PH, Chi JTA, Linardic CM. A method to culture human alveolar rhabdomyosarcoma cell lines as rhabdospheres demonstrates an enrichment in stemness and Notch signaling. Biol Open 2021; 10:bio.050211. [PMID: 33372065 PMCID: PMC7888706 DOI: 10.1242/bio.050211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The development of three-dimensional cell culture techniques has allowed cancer researchers to study the stemness properties of cancer cells in in vitro culture. However, a method to grow PAX3-FOXO1 fusion-positive rhabdomyosarcoma (FP-RMS), an aggressive soft tissue sarcoma of childhood, has to date not been reported, hampering efforts to identify the dysregulated signaling pathways that underlie FP-RMS stemness. Here, we first examine the expression of canonical stem cell markers in human RMS tumors and cell lines. We then describe a method to grow FP-RMS cell lines as rhabdospheres and demonstrate that these spheres are enriched in expression of canonical stemness factors as well as Notch signaling components. Specifically, FP-RMS rhabdospheres have increased expression of SOX2, POU5F1 (OCT4), and NANOG, and several receptors and transcriptional regulators in the Notch signaling pathway. FP-RMS rhabdospheres also exhibit functional stemness characteristics including multipotency, increased tumorigenicity in vivo, and chemoresistance. This method provides a novel practical tool to support research into FP-RMS stemness and chemoresistance signaling mechanisms. Summary: Here we report on a method to culture human PAX3-FOXO1 fusion-positive rhabdomyosarcoma cells in three dimensions, and use these rhabdospheres as a novel tool to study their stemness and chemoresistance signaling mechanisms.
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Affiliation(s)
- Katherine K Slemmons
- Departments of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Michael D Deel
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Yi-Tzu Lin
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Kristianne M Oristian
- Departments of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina.,Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Katia C Genadry
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Po-Han Chen
- Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, North Carolina
| | - Jen-Tsan Ashley Chi
- Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, North Carolina
| | - Corinne M Linardic
- Departments of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina .,Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Genadry KC, Monuteaux MC, Neuman MI, Lipsett SC. Management and Outcomes of Children With Nursemaid's Elbow. Ann Emerg Med 2020; 77:154-162. [PMID: 33127100 DOI: 10.1016/j.annemergmed.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE We identify the incidence and predictors of missed fracture and characterize patterns of radiography performance in children with a diagnosis of radial head subluxation in the emergency department (ED) setting. METHODS We queried the Pediatric Health Information System database for visits by children younger than 10 years and with a diagnosis of radial head subluxation at 1 of 45 pediatric EDs from 2010 to 2018. The frequency of radiography use was assessed overall and between hospitals. Multivariable logistic regression was used to evaluate associations between patient-level characteristics and the outcome of missed fracture (return visit for upper extremity fracture within 7 days of the index visit). RESULTS We identified 88,466 eligible visits; the median patient age was 2.1 years, 59% of visits were by female patients, and in visits in which laterality was noted, 60% of cases occurred in the left arm. Radiography was performed at 28.5% of visits; hospital rates of radiography performance ranged from 19.8% to 41.7%. Missed upper extremity fractures were observed in 247 cases (0.3% of the cohort). The odds of missed fracture were higher in children older than 6 years (adjusted odds ratio 2.32; 95% confidence interval 1.12 to 4.81), children who underwent radiography at the index visit (adjusted odds ratio 2.52; 95% confidence interval 1.84 to 3.43), and children receiving acetaminophen or ibuprofen (adjusted odds ratio 1.54; 95% confidence interval 1.15 to 2.06). CONCLUSION Radiographs were obtained for greater than one quarter of children presenting to a pediatric ED with radial head subluxation, with wide variation between hospitals. Missed fractures were rare. Future efforts should aim to reduce unnecessary radiography in this population.
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Affiliation(s)
- Katia C Genadry
- Department of Pediatrics, Boston Children's Hospital, Boston, MA.
| | - Michael C Monuteaux
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Mark I Neuman
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Susan C Lipsett
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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Abstract
Soft tissue sarcomas (STSs) are an uncommon group of solid tumors that can arise throughout the human lifespan. Despite their commonality as non-bony cancers that develop from mesenchymal cell precursors, they are heterogeneous in their genetic profiles, histology, and clinical features. This has made it difficult to identify a single target or therapy specific to STSs. And while there is no one cell of origin ascribed to all STSs, the cancer stem cell (CSC) principle—that a subpopulation of tumor cells possesses stem cell-like properties underlying tumor initiation, therapeutic resistance, disease recurrence, and metastasis—predicts that ultimately it should be possible to identify a feature common to all STSs that could function as a therapeutic Achilles' heel. Here we review the published evidence for CSCs in each of the most common STSs, then focus on the methods used to study CSCs, the developmental signaling pathways usurped by CSCs, and the epigenetic alterations critical for CSC identity that may be useful for further study of STS biology. We conclude with discussion of some challenges to the field and future directions.
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Affiliation(s)
- Katia C Genadry
- Division of Hematology-Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Silvia Pietrobono
- Department of Hematology-Oncology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Rossella Rota
- Department of Hematology-Oncology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Corinne M Linardic
- Division of Hematology-Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.,Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, NC, United States
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Deel MD, Slemmons KK, Hinson AR, Genadry KC, Burgess BA, Crose LES, Kuprasertkul N, Oristian KM, Bentley RC, Linardic CM. The Transcriptional Coactivator TAZ Is a Potent Mediator of Alveolar Rhabdomyosarcoma Tumorigenesis. Clin Cancer Res 2018. [PMID: 29514840 DOI: 10.1158/1078-0432.ccr-17-1207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Alveolar rhabdomyosarcoma (aRMS) is a childhood soft tissue sarcoma driven by the signature PAX3-FOXO1 (P3F) fusion gene. Five-year survival for aRMS is <50%, with no improvement in over 4 decades. Although the transcriptional coactivator TAZ is oncogenic in carcinomas, the role of TAZ in sarcomas is poorly understood. The aim of this study was to investigate the role of TAZ in P3F-aRMS tumorigenesis.Experimental Design: After determining from publicly available datasets that TAZ is upregulated in human aRMS transcriptomes, we evaluated whether TAZ is also upregulated in our myoblast-based model of P3F-initiated tumorigenesis, and performed IHC staining of 63 human aRMS samples from tissue microarrays. Using constitutive and inducible RNAi, we examined the impact of TAZ loss of function on aRMS oncogenic phenotypes in vitro and tumorigenesis in vivo Finally, we performed pharmacologic studies in aRMS cell lines using porphyrin compounds, which interfere with TAZ-TEAD transcriptional activity.Results: TAZ is upregulated in our P3F-initiated aRMS model, and aRMS cells and tumors have high nuclear TAZ expression. In vitro, TAZ suppression inhibits aRMS cell proliferation, induces apoptosis, supports myogenic differentiation, and reduces aRMS cell stemness. TAZ-deficient aRMS cells are enriched in G2-M phase of the cell cycle. In vivo, TAZ suppression attenuates aRMS xenograft tumor growth. Preclinical studies show decreased aRMS xenograft tumor growth with porphyrin compounds alone and in combination with vincristine.Conclusions: TAZ is oncogenic in aRMS sarcomagenesis. While P3F is currently not therapeutically tractable, targeting TAZ could be a promising novel approach in aRMS. Clin Cancer Res; 24(11); 2616-30. ©2018 AACR.
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Affiliation(s)
- Michael D Deel
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Katherine K Slemmons
- Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, North Carolina
| | - Ashley R Hinson
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Katia C Genadry
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Breanne A Burgess
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Lisa E S Crose
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | | | - Kristianne M Oristian
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Rex C Bentley
- Department of Pathology, School of Medicine, Duke University, Durham, North Carolina
| | - Corinne M Linardic
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina. .,Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, North Carolina
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