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Scholars Day

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Add to Calendar Scholars Day 4/10/2019 12:00:00 AM 4/9/2020 12:00:00 AM America/New_York false MM/DD/YYYY


Date & Location
Wednesday, April 10, 2019, 12:00 AM - Thursday, April 9, 2020, 12:00 AM

Target Audience
Emergency Medicine, Hematology, Internal Medicine, Neurology, Psychiatry, Surgery General, Rheumatology

Overview

Pediatric Grand Rounds


Objectives

At the conclusion of this activity, participants should be able to:

  1. Recognize the critical role of the emergency room physician in acute management of VOC in children with SCD;
  2. Describe key components of a standardized pain protocol;
  3. Recall the nuances and correlation between pain scores, frequency of assessment and analgesia selection;
  4. Identity the effects of a patent ductus arteriosus on the premature infant;
  5. Review the risks and benefits of surgical PDA ligation vs percutaneous PDA closure;
  6. Introduce the phenomenon of post-PDA ligation syndrome and understand its physiologic basis;
  7. Recall the role of the proposed BTK-BCAP-PI3K interaction in Ras signaling as it pertains to pathophysiology of JMML;
  8. Recognize the potential efficacy of combined inhibition of BTK and PI3Kp110d in ameliorating JMML phenotypes in an in vivo mouse model;
  9. Recognize the role of combined inhibition of BTK and PI3Kp110d in promoting megakaryopoeisis and depressing monocytopoeisis towards correction of JMML phenotypes;
  10. Identitify how a mutation in the DNA repair mechanism can cause increased sensitivity to chemotherapy;
  11. Recognize how colony forming assays and Western blots can help determine cell survival and protein expression after ionizing radiation; and
  12. Appreciate how a laboratory experiment can be translated to the bedside to help answer a clinical question.

Accreditation

Accreditation Statement

In support of improving patient care, Indiana University School of Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians

Indiana University School of Medicine designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

References for this presentation: 

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 Simon E, Long B, Koyfman A. Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update. J Emerg Med. 2016;51(4):370-381.

 Glassberg JA. Improving Emergency Department-Based Care of Sickle Cell Pain. Hematology Am Soc Hematol Educ Program. 2017;2017(1):412-417.

 Kayle M, Brennan-Cook J, Carter BM, Derouin AL, Silva SG, Tanabe P. Evaluation of a Sickle Cell Disease Educational Website for Emergency Providers. Adv Emerg Nurs J. 2016;38(2):123-132.

 Padmanabhan P, Oragwu C, Das B, Myers JA, Raj A. Utility of Non-Invasive Monitoring of Cardiac Output and Cerebral Oximetry during Pain Management of Children with Sickle Cell Disease in the Pediatric Emergency Department. Children (Basel). 2018;5(2).

 Ballas SK. The sickle cell painful crisis in adults: phases and objective signs. Hemoglobin. 1995;19(6):323-333.

 National Heart Lung and Blood Institute. Division of Blood Diseases and Resources. The management of sickle cell disease. 4th ed. Bethesda, MD: The Institute; 2002.

 Kavanagh PL, Sprinz PG, Wolfgang TL, et al. Improving the Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department. Pediatrics. 2015;136(4):e1016-1025.

 Kowalczyk RS. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Choice: Current Reviews for Academic Libraries. 2012;49(11):2098-2098.

 Glassberg JA, Tanabe P, Chow A, et al. Emergency provider analgesic practices and attitudes toward patients with sickle cell disease. Ann Emerg Med. 2013;62(4):293-302 e210.

 Brousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010;303(13):1288-1294.

 

Kelly GS, Stewart RW, Strouse JJ, Anders JF. Intranasal fentanyl improves time to analgesic delivery in sickle cell pain crises. Am J Emerg Med. 2018;36(7):1305-1307.

Wang CJ, Kavanagh PL, Little AA, Holliman JB, Sprinz PG. Quality-of-care indicators for children with sickle cell disease. Pediatrics. 2011;128(3):484-493.

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Zempsky WT. Treatment of sickle cell pain: fostering trust and justice. JAMA. 2009;302(22):2479-2480.

Givens M, Rutherford C, Joshi G, Delaney K. Impact of an emergency department pain management protocol on the pattern of visits by patients with sickle cell disease. J Emerg Med. 2007;32(3):239-243.

Silbergleit R, Jancis MO, McNamara RM. Management of sickle cell pain crisis in the emergency department at teaching hospitals. J Emerg Med. 1999;17(4):625-630.

Tanabe P, Reddin C, Thornton VL, Todd KH, Wun T, Lyons JS. Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), a focus group and decision support tool development project. Acad Emerg Med. 2010;17(8):848-858.

Tanabe P, Hafner JW, Martinovich Z, Artz N. Adult emergency department patients with sickle cell pain crisis: results from a quality improvement learning collaborative model to improve analgesic management. Acad Emerg Med. 2012;19(4):430-438.

Powers RD. Management protocol for sickle-cell disease patients with acute pain: impact on emergency department and narcotic use. Am J Emerg Med. 1986;4(3):267-268.

Crosby LE, Simmons K, Kaiser P, et al. Using Quality Improvement Methods to Implement an Electronic Medical Record (EMR) Supported Individualized Home Pain Management Plan for Children with Sickle Cell Disease. J Clin Outcomes Manag. 2014;21(5):210-217.

Chiruvolu A, Punjwani P, Ramaciotti C. Clinical and echocardiographic diagnosis of patent ductus arteriosus in premature neonates. Early Hum Dev 2009;85(3): 147-149

Dollberg  S,  Lusky  A,  Reichman  B.  Patent  ductus  arteriosus,  indomethacin  and  necrotizing enterocolitis in  very  low  birth  weight infants:  a  population-based  study.  J  Pediatr  Gastroenterol  Nutr. 2005;40(2):184-188

Evans N, Kluckow M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed.  1996;75(3):F183-F186

Garland  J,  Buck  R,  Weinberg  M.  Pulmonary  hemorrhage  risk  in  infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study. Pediatrics. 1994;94(5):719-72

Cunha GS, Mezzacappa-Filho F, Ribeiro JD. Risk factors for bronchopulmonary dysplasia in very low birth weight newborns treated with mechanical  ventilation  in  the  first  week  of  life. J  Trop  Pediatr 2005. 51(6):334-340. doi:10.1093

Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis? J Perinatol 2010;30:241–52

Noori S. Pros and cons of patent ductus arteriosus ligation: hemodynamic changes and other morbidities after patent ductus arteriosus ligation. Sem Perintaol 2012; 139-145

Noori S, Friedlich P, Seri I et al. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol 2010; 30: S31-S37

Noori S, Friedlich P, Seri I, Wong P. Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants. J  Pediatr 2007;150:597-602

McNamara PJ, Stewart L, Shivananda SP, Stephens D, Sehgal A. Patent ductus arteriosus ligation is associated with impaired left ventricular systolic performance in premature infants weighing less than 1000 g. J Thorac Cardiovasc Surg. 2010;140:150-7. Erratum in:J Thorac Cardiovasc Surg. 2010;140:944

Noori S, McNamara P, Jain A, Lavoie PM, Wickremasinghe A, Merritt TA, et al. PDA Ligation/Hypotension Trial Investigators. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation. J Perinatol 2015;35:123-7.

Ogando AR, Asensio IP, Sanchez de la blanca AR, Tejerizo FB, Luna MS, Jaurena JM, et al. Surgical ligation versus percutaneous closure of patent ductus arteriosus in very low-weight preterm infants: which are the real benefits of the percutaneous approach? Pediatr Cardiol 2018; 39: 398-410

Wang-Giuffre EW and Breinholt J. Novel use of the Medtronic micro vascular plug for PDA closure in preterm infants. Catheterization and Cardiovascular Interventions 2017; 89: 1059-1065.

Sathanandam S, Justino H, Warrer BR 3rd, Radtke W, Qureshi AM. Initial clinical experience with the Medtronic Micro Vascular Plug in transcatehter occlusion of PDAs in extremely premature infants. Catheter Cardiovasc Interv 2017; 89: 1051-1058

Pamukcu O, Tuncay A, Narin N, Baykan A, Korkmaz L, Argun M, et al. Patent ductus arteriosus closure in preterms less than 2 kg: surgery versus transcatheter. International journal of cardiology 2018; 250: 110-115

Zahn EM, Peck D, Phillips A, nevin P, Basaker K, Simmons C, et al. Transcatheter closure of patent ductus arteriosus in extremely premature newborns early results and midterm-follow up. J Am Coll Cardiol Intv 2016; 9: 2429-37

 Chan RJ, Cooper T, Kratz CP, Weiss B, Loh ML. Juvenile myelomonocytic leukemia: A report from the 2nd International JMML Symposium. Leukemia Research. 2009;33(3):355-362. doi:10.1016/j.leukres.2008.08.022.

 Caywood et al. Juvenile myelomonocytic leukemia, UpToDate, 2018

 Chang TY, Dvorak CC, Loh ML. Bedside to bench in juvenile myelomonocytic leukemia: insights into leukemogenesis from a rare pediatric leukemia. Blood. 2014;124(16):2487-2497. doi:10.1182/blood-2014-03-300319.

 Xu D, Liu X, Yu W-M, et al. Non–lineage/stage-restricted effects of a gain-of-function mutation in tyrosine phosphatasePtpn11(Shp2) on malignant transformation of hematopoietic cells. The Journal of Experimental Medicine. 2011;208(10):1977-1988. doi:10.1084/jem.20110450.

 Deng L. The role of Bruton's tyrosine kinase and PI3K p110δ in mutant SHP2-induced juvenile myelomonocytic leukemia . IU Scholarworks. January 2018.

 Goodwin CB, Li XJ, Mali RS, et al. PI3K p110  uniquely promotes gain-of-function Shp2-induced GM-CSF hypersensitivity in a model of JMML. Blood. 2014;123(18):2838-2842. doi:10.1182/blood-2013-10-535104.

 Deng L, Virts EL, Kapur R, Chan RJ. Pharmacologic inhibition of PI3K p110δ in mutant Shp2E76K-expressing mice. Oncotarget. 2017;8(49). doi:10.18632/oncotarget.21455.

 Futatani T. Deficient Expression of Bruton's Tyrosine Kinase in Monocytes From X-Linked Agammaglobulinemia as Evaluated by a Flow Cytometric Analysis and Its Clinical Application to Carrier Detection. Blood. 1998;91(2):595-602.

 Castello A, Gaya M, Tucholski J, Oellerich T, Lu KH, Tafuri A, Pawson T, Wienands J, Engelke M, and Batista FD. Nck-mediated recruitment of BCAP to the BCR regulates the PI(3)K-Akt pathway in B cells. Nat Immunol. 2013; 14: 966-75.

 Qin S and Chock PB. Implication of phosphatidylinositol 3-kinase membrane recruitment in hydrogen peroxide-induced activation of PI3K and Akt. Biochemistry. 2003; 42: 2995-3003

 Oguro H, Ding L, Morrison SJ. SLAM Family Markers Resolve Functionally Distinct Subpopulations of Hematopoietic Stem Cells and Multipotent Progenitors. Cell Stem Cell. 2013;13(1):102-116. doi:10.1016/j.stem.2013.05.014.

 Buschman, M.D., J. Rahajeng, and S.J. Field, GOLPH3 links the Golgi, DNA damage, and cancer. Cancer Res, 2015. 75(4): p. 624-7.Buschman, M.D., M. Xing, and S.J. Field, The GOLPH3 pathway regulates Golgi shape and function and is activated by DNA damage. Front Neurosci, 2015. 9: p. 362.

 Farber-Katz, S.E., et al., DNA damage triggers Golgi dispersal via DNA-PK and GOLPH3. Cell, 2014. 156(3): p. 413-27.

 

Dippold, H.C., et al., GOLPH3 bridges phosphatidylinositol-4- phosphate and actomyosin to stretch and shape the Golgi to promote budding. Cell, 2009. 139(2): p. 337-51.

Abraham, R.T., GOLPH3 links the Golgi network to mTOR signaling and human cancer. Pigment Cell Melanoma Res, 2009. 22(4): p. 378-9.

Ng, M.M., et al., GOLPH3L antagonizes GOLPH3 to determine Golgi morphology. Mol Biol Cell, 2013. 24(6): p. 796-808.

Scott, K.L., et al., GOLPH3 modulates mTOR signalling and rapamycin sensitivity in cancer. Nature, 2009. 459(7250): p. 1085-90.

Burman, J.L., J.N. Hamlin, and P.S. McPherson, Scyl1 regulates Golgi morphology. PLoS One, 2010. 5(3): p. e9537.

For questions about accessibility or to request accommodations please contact the CME office at 317-274-0104 or cme@iu.edu. One week advance notice will allow us to provide seamless access. Please ensure to specify the accommodations you need in order to participate.

The registration form for this activity Is currently unavailable.

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, educational programs sponsored by the Indiana University School of Medicine (IUSM) must demonstrate balance, independence, objectivity, and scientific rigor. All faculty, authors, editors, and planning committee members participating in an IUSM-sponsored activity are required to disclose any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an educational activity.

Olufunke Y Martin, MD
Resident Physician
IU Health
Indianapolis, IN
Roshni Patel, Other
IUPUI
April Rahrig, DO
Dr.
IU Health
Indianapolis, IN
Ryan Serrano, MD
Pediatric Cardiology Fellow
IU Health
Indianapolis, IN

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