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There had to be a better way to perform a biopsy for children who have eosinophilic esophagitis, Joel Friedlander, D.O., surmised. Usually, these children must undergo general anesthesia, which is costly and not always safe, and certainly not convenient. He worked with colleagues from the Aero Digestive Program at Children’s Hospital Colorado to develop an innovation that reduces cost, is safer, and makes it much more convenient for patients and their families.
Dr. Friedlander and his colleagues recently published their findings in Gastrointestinal Endoscopy.
Watch this video to learn more.
Challenge: Bill Elder was diagnosed at age 8 with cystic fibrosis (CF), a life-threatening, genetic disease that causes persistent lung infections and progressively limits the ability to breathe. Thanks to now nationwide infant screenings for CF (which started in Colorado), better management and research, the lifespan of those affected is increasing and has gone from the teens to mid- to late-30s. But, that’s not good enough, especially for someone like Bill Elder who has always wanted to be a doctor.
Insight: Bring together the top medical CF researchers, clinicians, patient databases, The CF Foundation, a pharmaceutical company and public/private dollars to maximize and hasten CF research. Dr. Frank Accurso, a lead physician at Children’s Hospital Colorado, was a principal investigator for a major research effort, and his patient Bill was one of the first Colorado patients to try an experimental medicine, now called Kalydeco.
Innovation: After taking Kalydeco, Bill awakened his parents in the middle of the night to tell them that he could breathe through his nose. Bill had never realized that he couldn’t breathe through his nose at night. They sat on his parents’ bed crying and laughing. Today at 28, Bill is a graduate of Stanford University, in his fourth year of medical school and expecting to live a long, full life. He even got to join First Lady Michelle Obama for the 2015 State of the Union.
Kalydeco has revolutionized the care of a small subset of CF patients by targeting the root causes of the disease. Building on this research, a new drug, Orkambi, was just approved by the Food and Drug Administration for a broader section of patients with CF.
Challenge: One in every 1,000 babies is born with spina bifida. In the case of a severe form of spina bifida known as myelomeningocele (MMC), repairing the spinal defect in utero can lessen the devastating consequences, according to a study from the National Institutes of Health. In particular, fetal surgery can decrease the chance of the child needing a cerebral shunt to treat hydrocephalus. Some spinal defect openings are quite large and require a patch to close; yet their actual size is only discovered at the critical surgical time.
Time is of the essence, especially in fetal intervention. Longer surgery times increase the risk to the mother and fetus, including preterm labor, maternal bleeding and exposure of the fetus to anesthetic gases, which can affect brain development.
Insight: Use 3-D MRI imaging to print 3-D patient-specific models that will allow us to predict the need for a patch and help determine the appropriate size and design.
Innovation: Bioengineers and the multidisciplinary team of fetal surgeons, maternal fetal medicine specialists and fetal radiologists at the Colorado Fetal Care Center at Children's Hospital Colorado have joined forces to use 3-D MRI imaging to print 3-D models of fetal defects. Children’s Colorado surgeons were the first to use 3-D printing to repair spina bifida, in utero. The surgeons used a 3-D replica of the unborn baby’s spine to assist in fetal surgery to correct the MMC.
The 3-D models offer better pre-operative planning and tailor-made patches, which decreases operative times and improves outcome success. These 3-D models have become regular tools in our efforts to lessen the debilitating effects of spina bifida, and once born, give these children a better quality of life.
Challenge: Childhood obesity has become a significant public health problem in the United States and rates continue to rise. Current dosing recommendations for medications in critically ill children, based on weight, are inadequate for children who are obese, but are often used anyway, often increasing those children’s length of stay and leading to complications.
Insight: Children’s Hospital Colorado formed a multidisciplinary obesity task force to develop clinical care guidelines to improve clinical outcomes and safety in obese patients. Clinical Pharmacists conducted a literature review and developed a scoring system to help address the knowledge gap of medication dosing for obese children.
Innovation: The Children’s Colorado team developed pediatric obesity medication dosing recommendations for 113 of Children’s Colorado’s most commonly prescribed medications in critically ill patients. The American Journal of Health-System Pharmacy published their findings in this first-ever comprehensive recommendation published for medication dosing in obese pediatric patients within the medical literature.
The pharmacy team believes that with more appropriate dosing we will decrease length of stay and time in the intensive care unit by getting patients to appropriate therapeutic levels and keeping them there. They also believe that we will decrease adverse drug events and improve patient safety in this population, by not overdosing the individuals.