C H I L D R E N ’ S M E R C Y H O S P I T A L S & C L I N I C S Physician’s Update December 2004 Child Life Takes Care To Kids’ Level A At 8 years old, Audrey Byerley is all too familiar with the Radiology department at Children's Mercy Hospitals and Clinics. Diagnosed with kidney reflux, Audrey has received numerous fluoroscopic procedures. Her latest visit to the Radiology department required a voiding cystourethrogram (VCUG), a procedure she feared because a catheter is needed to fill the bladder with a liquid contrast material required for X-rays. Fortunately, Audrey had the support of Sara Easley, Child Life specialist, to calm her fears and educate her about the procedure. Child Life specialists are rarely found outside of children’s hospitals and play an instrumental role in the psychosocial care of patients. The Child Life program at Children’s Mercy promotes optimum development of children and their families, and advocates to maintain normal living patterns Sara Easley, Child Life, calms a and minimize psychological trauma. Child Life specialists are integrated into care in 13 radiology patient departments. But being a child life specialists is not child’s play. Child Life specialists are required to have a four-year degree in an area of In Radiology, the presence child studies and complete a 14-week internship within a Child of full-time Child Life special- Life department. The internship consists of workshops, preists has helped reduce the operative and pre-procedural preparation, charting, planning need for sedation from 18 and direct patient-family care contact. percent to 4.2 percent in In Radiology, the presence of Sara Easley and Stephanie the past nine years. Easley, both full-time Child Life specialists, has helped reduce the need for sedation from 18 percent to 4.2 percent in the past nine years. "It is very important to get down on the child's level and prepare him or her step-by-step during the procedure," says Stephanie Easley. “Our job is to create a child-friendly environment and help the child cope with procedures.” Audrey was so comforted to have Sara with her during her VCUG that she has asked if she could have Sara with her for every procedure. "It is hard as a parent to know that your child has to go through this,” says Audrey's mother. “But with the help of the Child Life specialist to explain the procedure and equipment, it takes the pressure off." What’s Inside 2 New Docs 3 Comforting Positions 3 Case of the Quarter News Briefs Kudos and Congrats Congratulations to Gerald Woods, MD, Oncology, and Fred Burry, MD, executive medical director, on being chosen as two of Kansas City’s Top Doctors for 2004 by Ingram’s magazine. Dr. Woods and Dr. Burry were among 10 physicians selected by health care professionals, administrators, insurance and legal professionals. Kudos to Kristin Stegenga and Sharon Blevins for being honored with Heart of Healthcare Nursing Awards from the University of Kansas School of Nursing. More than 400 nurses were nominated, but only 10 were chosen to receive recognition. Congratulations to the Children’s Mercy Contact Center for receiving the McKesson ICARE Award for Excellence. The Contact Center received the award for the hospital’s First Nurse program which assists Children’s Mercy specialty clinics by providing triage of after-hours calls. McKesson provides the Care Enhanced Call Center application for processing calls received for triage by the Contact Center. Congratulations to the Asthma, Allergy, and Immunology section on receiving the ACORN award from the American College of Asthma, Allergy and Immunology (ACAAI). The award is for $100,000 over two years to provide the salary of a fellow-in-training in the field of allergy. Children’s Mercy was one of only five training programs in the United States chosen to receive the award. In addition, Jay Portnoy, MD, section chief, received the prestigious Bela Schick lectureship award from the ACAAI. New Docs Megha Chandramohan, MD James Garner, MD Pediatrician in Neonatology (816) 234-3595 mchandramohan@cmh.edu Children’s Mercy Northland Urgent Care (816) 413-2500 jgarner@cmh.edu Medical Degree: University of Missouri-Kansas City School of Medicine, Kansas City, MO, 2001 Residency: Pediatrics, Children’s Mercy Hospital, Kansas City, MO Medical Degree: University of Kansas School of Medicine, Kansas City, KS, 2000 Residency: Pediatrics, University of Kansas School of Medicine, Kansas City, KS Kathleen Mourning, MD Bonnie Jones, MD Pediatrician in Hematology/Oncology (816) 234-3265 kjmourning@cmh.edu Children’s Mercy Northland Urgent Care (816) 413-2500 bjones@cmh.edu Medical Degree: University of Oklahoma College of Medicine, Oklahoma City, OK, 2000 Residency: Pediatrics, Children’s Mercy Hospital, Kansas City, MO Certification: Pediatrics, 2003 Medical Degree: University of Nebraska College of Medicine-Omaha, Omaha, NE, 2001 Residency: Pediatrics, Children’s Mercy Hospital/University of Missouri-Kansas City, Kansas City, MO Improving Care Through Comforting Positions A A growing body of research and literature has documented the value of comforting approaches to reduce the pain and anxiety of children receiving medical care. While many of these techniques were pioneered in the hospital setting, they do have applications in the primary care office. This is particularly true of the use of comforting positions–techniques developed by Mary Barkey, a child life specialist at Rainbow Babies and Children’s Hospital. Through the involvement of parents and the use of seated positions, children can become more comfortable, parents can be more relaxed, and the relationship with the health care provider can become more supportive and interactive. The benefits of comforting positions are numerous: • Child is made more comfortable and has greater sense of control by sitting up, rather than laying down in an uncomfortable position • Parent involvement holding the child in a secure, hugging hold adds to comfort • Parent is positioned to be supportive of the child, not negatively restraining the child • Mobility of the child is limited • Less staff is required to complete a procedure Comforting positions are particularly appropriate to the primary care provider office when taking blood samples, providing immunizations, performing nasal aspirations or conducting other examinations or procedures which require limited mobility of the patient. The Child Life department at Children’s Mercy Hospitals and Clinics has implemented the use of comforting positions, along with developmentally appropriate play and educational preparation for medical experiences, to improve the patient experience at the hospital. More information and photos of comforting positions are available on the Children’s Mercy Internet site at www.childrensmercy.org. Child Life Department Children’s Mercy Hospitals and Clinics Comforting positions can reduce pain and anxiety and improve the patient experience. Case ofQuarter the A 13-year-old presented with a five-week history of uncontrollable right arm and leg movements. The symptoms started initially with right arm weakness and clumsiness. She then started having writhing movements of her arms and legs. There was no history of sore throat or other symptoms. She has no history of any rashes. Parents did note some emotional liability and fatigue. There was slight slurring of speech on exam as well as uncontrollable writhing movements of her right-sided extremities. She had difficulty walking due to these movements. She occasionally had spontaneous facial grimacing as well. The rest of the exam was normal. Laboratory studies revealed a normal CBC, BMP, CRP, and ESR. Her ASO titer was elevated. Her CSF studies, including arboviral studies, were normal. Her lupus panel was also negative. An ECHO revealed mitral insufficiency. This patient was diagnosed with Sydenham chorea due to acute rheumatic fever (ARF). She received benzathine penicillin as treatment for the streptococcal infection. She was also sent home with monthly IM penicillin injections as prophylaxis. She was started on haloperidol for her movement disorders. Sydenham chorea follows an infection with group A beta-hemolytic streptococcal infection and can be the sole manifestation of ARF. It can also be a late manifestation of the disease often occurring six months or longer after the initial infection. The peak incidence is in children 5-15 years old. It is usually bilateral although 20 percent of cases may demonstrate hemichorea. Emotional liability, clumsiness, hypotonia and irritability are also common. Usually the motor symptoms last five weeks to 15 weeks but recurrence within two years may occur. The emotional liability and cardiac disease may become chronic problems. Treatment consists of supportive care such as minimizing stress. In severe cases, trials of diazepam, valproic acid or haloperidol may be warranted. Appropriate antibiotic treatment of the underlying rheumatic fever is also vital. J. Bryan Wohlwend, MD and Megan Loeb, MD Co-Chief Residents, Pediatrics Purchase Your 2005 Calendar The new Children’ s Mercy Calendar, “A Window Into Their World,” is now on sale for $10. Calendars may be purchased at Crossroads Arts District merchants, Children’s Mercy Gift Shops, or on the Children’s Mercy Internet site at www.childrensmercy.org. All proceeds from calendar sales will benefit the Michael Meers Nursing Scholarships at Children’s Mercy. The calendar is a pictorial celebration of 12 children who have been touched by Children’s Mercy Hospitals and Clinics. Photography was donated by Mark Braswell of Strauss Peyton photography. Production costs were underwritten by Meers Marketing. Physician’s Update is produced monthly by Community Relations and Physician Services. For more information, contact Shawn Arni, (816) 346-1371 or e-mail to sarni@cmh.edu. Pre-Op Tours The Child Life department at Children’s Mercy offers pre-operative tours for patients scheduled to have surgery. Call Children’s Mercy Hospital at (816) 983-6870 or Children’s Mercy South at (913) 6968101 to schedule a tour, or visit our Internet site at www.childrensmercy.org for a virtual “storybook tour” led by Mercy Bear. Visit the Children’s Mercy Web site: www.childrens-mercy.org December 2004 Children’s Mercy is an equal opportunity/affirmative action employer and a United Way Agency. Return Service Requested PHYSICIAN SERVICES 2401 Gillham Road Kansas City, Missouri 64108-4698 www.childrens-mercy.org Non-Profit Org. U.S. Postage PAID Kansas City, MO Permit 4301