Title: Understanding Practice Variations in Treatment of Infants with Suspected UPJ Obstruction
Summary: Ureteropelvic junction (UPJ) obstruction is a common cause of kidney dilation in children that may lead to kidney damage. The goal of surgery is to reduce the risk of kidney damage; however, surgeon variation in the treatment of infants appears to be related to non-clinical patient factors and raises concerns of potential associated surgical risks that may disproportionately affect infants treated with early surgery. This project investigates the role of clinical and non-clinical patient factors on the likelihood of early treatment with surgery and establishes the framework for future studies to improve the identification of children with ureteropelvic junction obstruction who would benefit from initial surgical treatment.
Award Number: 5R03HS024316
Project Period: 09/01/2017-08/31/2021
Title: Developing Individualized Estimates of Patient Prognosis Following Knee Replacement
Summary: The research is relevant to public health because total knee arthroplasty (TKA) is the most common inpatient elective surgery, with almost 700,000 procedures performed each year. TKA surgery is associated with profound functional deficits and substantial healthcare expenditures. We utilize a clinical database to create models that provide patient-specific estimates of prognosis. We believe our research will contribute to AHRQ’s mission by supplying knowledge that will enhance individual clinical decision-making and thereby improve the quality of care surrounding TKA surgery.
Award Number: 5R03HS024316
Project Period: 04/01/2017-03/31/2019
Title: Advancing Treatment for Pediatric Craniopharyngioma (ATPC): Preliminary Assessment of the Cyst Fluid Inflammatory Milieu
Summary: Much of the neuroendocrine injury associated with Adamantinomatous Craniopharyngioma (ACP) derives from cystic components of the tumor, which compress critical structures and respond poorly to current therapies. This project derives from pilot data indicating that a proinflammatory mechanism may underlie cyst growth. We will analyze existing tissue to define the gene expression of specific cell populations with regard to proinflammatory genes, assess whether ACP cyst fluid induces expression of proinflammatory cytokines and if this is inhibited by well-established medications that block the IL-6/IL-6R pathway.
Award Number: 1R03CA212800
Title: Safer Outcomes for Pediatric Spinal Surgery
Summary: In this study, using results from our mixed-methods study, we will first develop a survey for use in screening hospitals for known organizational barriers to spine fusion care. We will then examine the effectiveness of implementing a modified unit-based safety training program in three low‐performing hospitals identified as having dysfunctional elements in their care environment. This modified program will be unique from the traditional CUSP modules in that it will focus on developing a more structured system for integrating families of children undergoing spine surgery into the improvement teams. Finally, we will assess the effectiveness of this systems‐approach to process improvement by longitudinally tracking rates of SSI and other complications, as well as each hospital’s own defined measures of performance improvement. Assessment of the sustainability of unit‐based changes will also be measured by key informant interviews and the unit‐based barriers surveys.
Award Number: 5R00HS022198
Project Period: 06/01/2016-05/31/2018
Title: Effectiveness of ICP Monitoring in Pediatric Traumatic Brain Injury
Summary: This research is relevant to public health because traumatic brain injury is a frequent cause of morbidity and mortality in children. The overall goal of this research is to improve outcomes in children with severe traumatic brain injury by rigorously studying the effectiveness of intracranial pressure monitoring and other interventions recommended by experts but with limited supporting evidence.
Award Number: 7K23HD074620
Project Period: 05/01/2017-04/30/2018