doCtoR’s dIgestA MonthlY neWsletter For st. louis Children’s hosPitAl

Attending And reFerring MediCAl stAFFs

may 2012

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In thIs Issue

3 graduating residents Make Plans for the Future

5 Children’s Discovery Institute Awards $3 Million in Pediatric Research grants

7 New Technology at SLCH Limits Radiation Exposure for Patients

[CliniCal foCus] new CLeft PaLate RePaIR teChnIque shows PRomIse foR sIgnIfICantLy betteR outComes

Albert Woo, MD, Washington University physician and director of pediatric plastic surgery at St. Louis Children’s Hospital, has developed a new surgical technique for cleft palate repair that to date has proven significantly more effective than other procedures commonly used to repair this birth defect.

“There are two primary goals for cleft palate repair. The first is to close the hole in the palate. The second is to correctly position the levator muscle so that the palate functions properly; namely, to separate the mouth from the nose when we speak,” he explains.

Currently the most common procedure for first-time cleft palate repair is the Bardach two-flap palatoplasty, in which the skin from the side of the palate is pulled to the middle and the abnormally positioned levator muscle is brought midline. In 15-20 percent of patients undergoing the procedure, however, the levator muscle proves to be improperly positioned or not functioning properly—resulting in children having abnormal, hypernasal speech. In some cases, a second surgery called a Furlow palatoplasty can correct the problem.

“This procedure can only be performed if you know that the muscle is in the wrong position, and sometimes we just don’t know where the muscle is located,” says Dr. Woo. “If you are not absolutely confident about the anatomy before

you begin, there is no other option for repairing or lengthening the palate. Instead, we are left with other, non-anatomic types of operations. One example of this involves creating a wall of skin in the back of the throat to try to close off the air that is leaking, thereby resulting in the abnormal speech. This can prove functional, but it results in a palate that is abnormal in appearance. They also have a much higher risk of sleep apnea and other adverse outcomes.”

Over a two-year period, Dr. Woo worked to solve this problem by combining elements of several surgeries, which resulted in the Woo overlapping intravelar veloplasty and oral z-plasty.

“My surgery involves first dissecting and moving back the muscle to its anatomic location. I then bring the muscle together by overlapping it and tightening it as much as possible,” says Dr. Woo. “The next step is to make a zigzag incision on the roof of the mouth, which lengthens the palate and

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continued on next page

Albert Woo, MD

helps fill the space at the back of the throat that is leaking air.”

To date, Dr. Woo has achieved an 88 percent success rate in operating on children with speech problems, compared to SLCH’s previous experience of a 55-60 percent success rate with the Furlow palatoplasty. In addition, the complication rate with the new technique is 2.5 percent, much lower than the 17 percent typically quoted for the Furlow technique.

Dr. Woo now performs his new surgical approach for both primary and secondary cleft palate repairs. He presented his initial study findings at the American Cleft Palate Association’s national meeting in April.

“Although we will need closer to five or 10 years worth of data to better assess these children’s speech, our early experience with this new technique demonstrates that it is a safe and effective method for reconstruction of both primary and secondary cleft palate deformities,” says Dr. Woo. “Hopefully this will significantly reduce the number of children needing to undergo a second surgery to repair their cleft palates.”

CLeft PaLate and CRanIofaCIaL InstItute Is oLdest In aRea

Established in 1978 as part of the Division of Plastic Surgery, the Cleft Palate and Craniofacial Institute at St. Louis Children’s Hospital is the oldest center in the area dedicated to the needs of this patient group. Its database exceeds 10,000 patients.

“Our goal is to give each child the best chance for a positive self-image,” says Dr. Woo, who serves as the Institute’s director. “To us, that means providing them with an attractive appearance, intact hearing, understandable speech, useful vision and healthy teeth.”

Among the conditions treated are:

• Cleftlipandcleftpalate

• Thefullspectrumofcongenitalfacialand skull problems, including craniosynostosis and hemifacial microsomia; and syndromic conditions

“Among our strengths is the fact that we offer the latest innovations in regard to plastic and reconstructive surgery techniques,” says Dr. Woo. “An example is our ability to correct craniosynostosis endoscopically, which decreases operative time, shortens hospital stay, significantly reduces scars and greatly lessens discomfort and swelling.”

The Institute has the largest comprehensive digital image database of craniofacial deformities, providing opportunities to study the effects of surgery for both clinical and research purposes.

Dr. Woo adds, “Our partnership with pediatric neurosurgery when performing this procedure is an example of the depth of expertise we have available to us as part of a pediatric hospital consistently ranked among the top facilities in the nation.”

“Our highly individualized treatment plans enhance our coordination of care and minimize the number of surgical procedures our patients need. This is extremely important to parents dealing with serious issues involving their children,” says Dr. Woo.

The Institute is an affiliated member of the American Cleft Palate and Craniofacial Association and has been certified by the association as meeting its criteria for care provided to patients by cleft palate and craniofacial teams.

To learn more or to speak with Dr. Woo, call 800.678.HELP (4357).

new CLeft PaLate RePaIR teChnIque shows PRomIse continuedshaRe youR Ideas Should you have ideas or suggestions you would like brought before the Children’s Medical Executive Committee (CMEC), contact one of your CMEC private physician representatives:

Joseph K. goldenberg, md 314.576.1616

david hartenbach, md 314.567.7337

Catherine Remus, md 314.842.5239

Christina m. Ruby-Ziegler, md 314.535.7855

Robert strashun, md 314.991.1217

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Let us heaR fRom you If you have comments or suggestions regarding Doctor’s Digest, or if you would like to share information about your activities as a physician, contact:

amy Connelly Marketing and Communications St. Louis Children’s Hospital 4901 Forest Park Avenue Suite 1022 St. Louis, MO 63108 Mailstop 90.75.560

314.286.0324 fax: 314.747.8644 atc7538@bjc.org

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doCtoR’s dIgestPublished for the attending and referring medical staffs of St. Louis Children’s Hospital.

Lee f. fetter President

Perry L. schoenecker, md Medical Staff President

Joseph K. goldenberg, md Medical Staff President-Elect

[2] Children’s direCt line 800.678.4357 • stlouisChildrens.org

[slCH news] LICensed beds InCRease at hosPItaL

In early April, the state of Missouri approved St. Louis Children’s Hospital’s request to increase its licensed bed count by a total of 8 beds—from 250 to 258. The increase means that three beds were added to the Newborn Intensive Care Unit (NICU), and five beds to the Pediatric Intensive Care Unit (PICU).

“We requested a license for additional beds due to our higher Intensive Care Unit volumes over the last year,” said Rick Majzun, vice president of strategic operations and planning at SLCH. “There were a number of periods in 2011 when these units were operating at or over capacity, so the bed increase more accurately reflects our critical care needs.” No construction or renovation was required to implement the bed increase.

In 2011, the hospital’s PICU patient days were up 15 percent.

Children’s direCt line 800.678.4357 • stlouisChildrens.org [3][2] Children’s direCt line 800.678.4357 • stlouisChildrens.org

[slCH news] gRaduatIng ResIdents maKe PLans foR the futuRe

On June 30, 2012, the 35 pediatric residents at St. Louis Children’s Hospital will move into the next phase of their career—as community pediatricians, hospitalists, or by continuing subspecialty training.

“St. Louis Children’s Hospital has been a training ground for hundreds of general pediatricians, pediatric specialists, clinician-investigators, division directors, chairs and even deans for more than a century,” says Andrew J. White, MD, director of the pediatric residency program at Washington University School of Medicine and St. Louis Children’s Hospital. “We truly appreciate our residents’ hard work and hope they’ve gained invaluable clinical experience that will serve them well in the future.”

graduating Residents

Attarian, Stephanie J. (Grissom)

Fellowship, Neonatology, WUSM

Bu, FangGeneral Pediatrics, Seashore Pediatrics, Myrtle Beach, SC

Cargill Jr, Algernon M., Jr. Fellowship, Emergency Medicine, Linda Loma Hospital, CA

Combs, Bridget C. General Pediatrics, Cleveland, OH

Criscola, Jennifer A.Fellowship, Critical Care Medicine, Johns Hopkins

Cyriac, RoseAnn L.Fellowship, Emergency Medicine, Cincinnati Children's

felsch, Kora n. Chief Resident, sLCh

Fleener, Barbara X.General Pediatrics, Sarasota Children's Clinic, Florida

Gaschler, Christa D.Hospitalist, Legacy Hospitals, Portland, OR

Gomez, Tamara L.Fellowship, Neonatology, Columbia University, NY

Hainline, Margaret L.Hospitalist, Childrens Mercy, Kansas City, MO

Heeley, Jennifer M. Fellowship, Genetics, WUSM

Hickey, Christina K. (Ahn) Fellowship, Gastroenterology, WUSM

Jacobs, Janie L. (Hemphill) General Pediatrics, Southern Pines, NC

Knipstein, Brittany L. Fellowship, Neonatology, WUSM

Lorbert, Josie v. (vitale) Chief Resident, sLCh

Maguire, Courtney R.Fellowship, Critical Care Medicine, WUSM

McKee, Ryan S.Fellowship, Emergency Medicine, WUSM

Mills, Kimberly I.Fellowship, Cardiology, Boston Childrens, MA

Nguyen, Hoang H. Fellowship, Cardiology, WUSM

Rockefeller, Toby A. Fellowship, Cardiology, WUSM

Scott, Angela A.Fellowship, Hem-Onc, Seattle Children's, WA

Sisti, Kelsey A. Hospitalist, WUSM/SLCH

Strutt, Jonathan R. Hospitalist, WUSM/SLCH

svarczkopf, Kali L. Chief Resident, sLCh

Wu, Katherine A. General Pediatrics, Boston , MA

Completing Chief year

Schulz, Kyle S.Hospitalist, Good Samaritan, Corvallis, OR

Steed, Ashley L., PhDFellowship, Critical Care Medicine, WUSM

Walker, Jacqueline M. Hospitalist, Childrens Mercy, Kansas City, MO

Residents fast tracking to fellowship

Rosen, David A., PhDFellow, Pediatric Infectious Disease WUSM

Said, Ahmed S. M., PhD Fellow, Pediatric Critical Care Disease WUSM

Residents moving to neurologyAnderson, Jacqueline L. Child Neurology, SLCH/WUSM

Fay, Alexander J., PhD Child Neurology, SLCH/WUSM

Riordan, Heather M. Child Neurology, SLCH/WUSM

Williams, Ryan P. Child Neurology, Children's Hospital of Philadelphia, PA

Mark your calendars for the Washington University Orthopedics sports medicine event, “Focusing on the School-aged to College Athlete,” July 20-21 at the Drury Plaza Hotel at the Arch. Learn about the latest in sports medicine care from Washington University physicians at St. Louis Children’s Hospital and Barnes-Jewish Hospital. Topics include:

Visit http://cme.wustl.edu to learn more and to register or visit StLouisChildrens.org/DD to download a brochure.

[save tHe date] 7th annuaL sPoRts medICIne uPdate

• Skin,BugsandDrugsinSports• CommonOrthopedicConditionsoftheShoulderandHip• PhysicalExamHandsOnSessions:KneeandHipExams•HotTopic:ConcussionsinSports

• StressFracturesintheAthlete•HowtoInterpretAnkleX-rays• Problem-basedLearningSession

The same year that Dr. Alison Nash, general pediatrician, was born in 1955, her father, Dr. Homer Nash, opened his medical practice in North St. Louis.

Alison, a third-generation physician, joined her father’s office on 3737N.KingshighwayBlvd.in1989,afterservingasaphysician in the U.S. Navy. She is now treating fourth-generation patients.

“It’s a family business, and that’s really the important word,” Alison said. “We are a family who are about families. It makes it fun to talk to the parents, and they remember when my father gave them a shot. All these families have trust in what we provide, and I definitely don’t take that lightly. That’s very important to me.”

Complementing her private practice, Alison has also held a number of leadership roles at St. Louis Children’s Hospital and throughout the medical community.

On Saturday, May 5, Dr. Alison Nash received the 2012 Stellar Performer in Health Care at the St. Louis American Foundation’s Salute to Excellence in Health Care Awards Luncheon at the Frontenac Hilton.

On a given day, her office sees about 60 patients a day—during flu season it’s more. By working with three nurse practitioners, Alison has been able to expand the family’s practice and serve more children, said Dr. Homer Nash, who received the St. Louis American Foundation’s 2009 Lifetime Achiever award.

WhenHomermovedhisofficetoKingshighwayfromGrandBoulevard in 1965, he said it was “upper class for black doctors.” As time passed, many of the other doctors in that office moved to St. Louis County.

“When my daughter came, I was wondering if she wanted to join the flight to the suburbs,” Homer said. “But she was interested in staying with folks who needed good medical care.”

The office sees primarily children who receive their health insurance from the state’s Medicaid program.

Alison is also deeply involved with Children’s Hospital because she said that’s where she refers her patients.

“It’s important that I know what’s going on there, so I can feel confident that I am making the best choice for my patients if they need specialty care,” she said.

Alison just finished her two-year term as president of Children’s Hospital medical staff, and prior to that she was the president-elect for two years.

Dr. Perry Schoenecker, acting orthopedic surgeon-in-chief at Children’s Hospital, works with Alison when he treats her patients.

“She is a plus to any medical staff because of her busy practice, and a lot of patients that come to Children’s Hospital are Alison’s patients,” said Schoenecker, who is also a professor of orthopedic surgery at Washington University and is chief of staff at St. Louis Shriners Hospital for Children. “She is highly respected by all, in all regards.”

When Schoenecker was the previous president-elect for the medical staff, he supported Alison in her leadership role. He is now the president of the medical staff. He said Alison was effective in implementing new ways of re-credentialing the hundreds of doctors at Children’s. She was also highly concerned about diversity in the hospital, he said.

“Her overall steady hand was very much appreciated at meetings,” he said. “She is very much somebody who could compromise and get us moving in the right direction and move on.”

For the past 21 years, Alison has been mentoring pediatric residents through Children’s COPE program (Community Outpatient Practice Experience), which is a pediatric residency-training program. Alison agreed to supervise and teach residents primary care in her outpatient office. Most pediatric residents complete a three-year residency, so committing to this program means committing to three years of working with a resident.

“The feedback from the residents has all been enthusiastic of her officeandherteaching,”saidKarenWickline,associateprofessorof pediatrics and director of the COPE program. “She is a great mentor.”

Wickline said Alison particularly excels at working with adolescent patients. “She has a great reputation for being wonderful with teenagers,” Wickline said. “She seems to understand and care for them extra well.”

When working with teenage mothers, this understanding is particularly important, she said.

“As a community colleague, I admire her greatly,” she said. “She has been so involved in everything at Children’s Hospital. She deserves this award and we applaud her and thank her for her participation in our program.”

In Alison’s practice, one of the main challenges she sees among her patients is asthma. To stay abreast with the best care, she stays active in research, particularly with the Asthma and Allergy Foundation and the Washington University Pediatric and Adolescent Ambulatory Research Consortium.

Alison has four children of her own and a wonderful husband, Clarence Dula, who without him, “all these things I’m doing I couldn’t have done,” she said.

“We are making a positive impact on the children in this community,” Alison said. “And we do our part to partner with the parents so we have wonderfully, healthy children.”

This article appeared in the April 26, 2012 issue of the St. Louis American. Reprinted with permission by the St. Louis American.

[4] Children’s direCt line 800.678.4357 • stlouisChildrens.org

Alison Nash, MD

[pHysiCian profile] | nash ReCeIves steLLaR PeRfoRmeR awaRd at st. LouIs ameRICan foundatIon’s saLute to exCeLLenCe

Life-threatening bacterial infections and brain tumors are just some of the serious health issues affecting children. Now, 12 Washington University School of Medicine research teams are preparing to ask – and answer – critical questions about these and other pediatric health problems with help from $3 million in new grants from the Children’s Discovery Institute.

“These projects represent the broad range of important pediatric diseases that the Institute tackles each year,” says Mary Dinauer, MD, PhD, scientific director of the Children’s Discovery Institute, the Fred M. Saigh Distinguished Chair of Pediatric Research at St. Louis Children’s Hospital and professor of pathology and immunology at the School of Medicine. “Collectively, this research could ultimately benefit millions of children in the United States.”

The Children’s Discovery Institute is a multi-disciplinary, innovation-based research partnership between St. Louis Children’s Hospital and the School of Medicine that has awarded nearly $29 million in scientific grants since its launch. The Institute encourages unique, productive collaborations among scientists at the School of Medicine, the university’s Danforth Campus and Children’s Hospital. Institute-funded projects constitute “discovery research”— preliminary studies that could yield new treatments in the future.

To date, Institute awards have resulted in significant progress in children’s health research. Awardees have leveraged their initial “seed funding” to gain $69 million in additional funding resources from the National Institutes of Health (NIH) and other national organizations.

“Through a unique and extensive set of collaborations, Institute researchers have already made tremendous progress in advancing research on pediatric diseases,” Dinauer says. “There is still a long way to go, and the newest round of funding will help these investigators provide important insights that have the potential to lead to new treatments.”

ChILdRen’s dIsCoveRy InstItute awaRds – febRuaRy 2012

•Carlos bernal-MizraCHi, Md, will investigate the contribution of fetal vitamin D deficiency to the development of metabolic syndrome and identify genes that predict the onset of metabolic syndrome and cardiovascular disease.

•MartHa bHattaCHarya, pHd, will receive a fellowship to develop molecular strategies to prevent the chemotherapy drug vincristine from causing peripheral nerve damage, which results in pain and loss of nerve function.

•Megan Cooper, Md, pHd, will use next-generation gene sequencing to determine whether genetic defects in abnormal immune cells lead to the development of a range of pediatric autoimmune diseases associated with serious long-term health problems.

• siMon fisHer, Md, pHd, will study the mechanisms by which high insulin doses in children with type 1 diabetes can cause sudden death, and test novel therapeutic approaches to prevent this potential deadly side effect.

• stepHanie fritz, Md, will receive a Faculty Scholar Award to track pediatric patients and their households to identify genetic and environmental factors that influence the spread of MRSA.

•MattHew goldsMitH, Md, and CHristina gurnett, Md, pHd, will examine the genetic basis of adolescent idiopathic scoliosis, the most common pediatric spinal deformity, to gain biological insights that could lead to the development of non- surgical therapeutic strategies.

•paul Hruz, Md, pHd, and KatHerine Henzler- wildMan, pHd, will study the structure and movements of glucose transport proteins, which carry the blood sugar glucose into cells, to provide a basis for designing drugs that improve the function of these proteins in type 2 diabetes.

•CyntHia ortinau, Md, will use advanced neuroimaging techniques to test whether changes in blood flow to the brain associated with congenital heart disease impair brain development and neurologic outcome in infants, and assess the impact of neonatal heart surgery on brain development.

•anand patel, Md, will identify genes and molecular pathways responsible for excessive airway narrowing in response to allergen exposure or viral infection to offer insights that could lead to the discovery of novel treatments for asthma, the most common chronic childhood disease.

• JosHua rubin, Md, pHd, and david gutMann, Md, pHd, will examine genetic variations that increase the risk for brain tumors in children with the genetic disease neurofibromatosis 1, and investigate why these tumors are more common in boys than in girls, in order to improve diagnostic and therapeutic strategies for children with brain cancer.

•gang Xu, dsC, will receive a fellowship to measure the mechanical properties of important structural components found in cilia to understand abnormalities in the movements of cilia that are associated with pulmonary diseases.

•zHongsHeng you, pHd, and david piwniCa-worMs, Md, pHd, will investigate the role of nonsense-mediated messenger ribonucleic acid decay (NMD), a cellular surveillance system that blocks the production of defective proteins, in pediatric brain cancer.

[Cdi news] ChILdRen’s dIsCoveRy InstItute awaRds $3 mILLIon In PedIatRIC ReseaRCh gRants Funding will support studies on cancer, heart, pulmonary and other diseases

Children’s direCt line 800.678.4357 • stlouisChildrens.org [5]

Whether as a means of providing hope to less fortunate children, or as a direct investment in the future of pediatric medicine, this year’s Advocacy Awards honor individuals who recognize the link between education and healthcare.

St. Louis Children’s Hospital presented its 2012 Advocacy Awards to United States Senator Roy Blunt and Judge Jimmie Edwards. Established in 1994, the awards recognize local and state leaders who leverage their positions, resources, and influence to do what’s right for kids.

unIted states senatoR Roy bLunt: state advoCate of the yeaR

Senator Blunt’s history with St. Louis Children’s Hospital stretches back to his first days as a member of the House of Representatives. However, his dedication to issues involving children spans all 30 years of his political career.

“As a father of four and grandfather of six, I know young people are the future of this country. We must provide better access to good quality, affordable care for Americans of all ages.”

During his years in the House, Senator Blunt was on the Appropriations Committee and the Energy and Commerce Committee, both of which exercise jurisdiction over the Children’s Hospital Graduate Medical Education (CHGME) program. He co-sponsored the CHGME reauthorization legislation and has always supported full funding for the program. He also was the Co-Chair of the House Education Caucus, sponsored legislation to require healthcare plans to continue to include dependent children through age 25, and supported legislation establishing a nationwide AMBER alert system for missing children.

Since the citizens of Missouri elected Roy Blunt to the United States Senate in 2010, he has continued his commitment to healthcare and issues important to St. Louis Children’s Hospital and Missouri’s Medicaid program. He co-sponsored the CHGME reauthorization legislation, and as a member of the Senate Appropriations Committee, prioritized funding for CHGME, helping to prevent further cuts. Senators Blunt and McCaskill also coordinated Missouri’s congressional delegation’s efforts to protect Missouri’s provider tax from proposed cuts and secured the signatures of the entire delegation in support of the program.

Judge JImmIe edwaRds: CommunIty advoCate of the yeaR

Judge Jimmie Edwards has served as juvenile court judge in St. Louis since 1992. For more than 18 years, Judge Edwards watched as a stream of “broken” children entered his courtroom. They were in limbo between adulthood and a structured school environment because they were considered “incorrigible”: they’d broken laws, disrupted classrooms or violated public school safety codes. Some serious infraction had removed these children from their public

school and funneled them into a complex system where education was unlikely and graduation seemed completely out of reach. These were the children Judge Edwards heard from daily, and it was only a matter of time before they ended up back in Edwards’ courtroom on more serious charges, and with less hope.

In 2009, with the help of myriad community partners, Edwards created Innovative Concept Academy (ICA) in the abandoned Blewett Middle School on Cass Avenue as an alternative school for juvenile offenders. Innovative Concept Academy is the country’s first school run by the court system, and Judge Edwards’ idea is working. While mandatory extra-curricular programs keep kids off the street and out of trouble, 45 community partners offer ICA students the option of a variety of enriching activities Including golf lessons, chess instruction, classical music, creative writing and ballroom dance.

“Most youth just need structure and someone to care about them,” he said. “If you give young people a sense of worth and value than they will have the motivation to succeed because they feel like they belong in society.”

The school enrolls up to 375 students and also provides resources such as medical and psychological care to juveniles between the ages of 10 and 18. Since opening, 18 students have earned a high school diploma or G.E.D, and two have gone to college. “Disadvantaged youth want to be successful as much as any other children,” Edwards explains.

Judge Edwards has received national recognition for his work. As recently as December 21, The Today Show featured Innovative Concept Academy as part of a three day series called “Getting to the Heart of Christmas.” Judge Edwards was also named a “Hero of the Year” by People Magazine.

[slCH news] | st. LouIs ChILdRen’s hosPItaL announCes 2012 advoCaCy awaRd wInneRs Senator Roy Blunt and Judge Jimmie Edwards honored for work to improve children’s lives

[6] Children’s direCt line 800.678.4357 • stlouisChildrens.org

Left to right: Lee Fetter, Senator Roy Blunt, Judge Jimmie Edwards, St. Louis Children’s Hospital Board Chair Kelvin Westbrook

[slCH news] new teChnoLogy at sLCh LImIts RadIatIon exPosuRe foR PatIentsNew FLASH CT scanner reduces radiation exposure by up to 75 percent

St. Louis Children’s Hospital is the first pediatric hospital in Missouri to acquire new FLASH CT scanner technology that will make scans safer for even the smallest of patients.

The number of CT scans performed on children has increased five-fold over the last 15 years. Ninety percent of those scans were performed at non-pediatric hospitals, often exposing children to unnecessary radiation.

“Children’s hospitals are well aware of the dangers inherent tomedicalradiation,”saysDr.RobertMcKinstry,WashingtonUniversity physician and Chief of Radiology at St. Louis Children’s Hospital. “With that in mind, we make ultrasound and MRI more available, and follow guidelines to limit the number of CT scans that are performed when they wouldn’t be otherwise indicated.”

While nationwide the statistics show an upward trend in the volume of CT scans performed on pediatric patients, the number of CT scans ordered at Children’s has decreased by half since 2005.

The FLASH CT, expected to be available to patients by mid-summer, helps ensure the hospital’s radiology team acquires high-quality images while minimizing the amount of radiation exposure for the child. Children, whose cells, organs and tissues are still developing, are more susceptible to the dangers of radiation. St. Louis Children’s Hospital has long manually customized the dosage of CT scans for patients, cutting dosage by about half and thereby minimizing a child’s risk.

FLASH will require far fewer manual dosing steps and further improve patient care by automatically adjusting the dosage to fit the size and needs of each individual patient. Studies show the technology cuts the amount of radiation emitted by a standard CT scanner by 75 percent. Additionally, it will virtually eliminate the need to sedate a child because of the speed at which it captures images. Faster scans mean that children need to remain still for

far less time, reducing prep time and anxiety, and improving their experience.

AccordingtoDr.McKinstry,“Thedosingprotocolforapediatricpatient is much different than that of an adult patient. A child should never be exposed to the amount of radiation we would consider appropriate for an adult patient. This is another important step for us to ensure all of our patients receive the lowest possible dose in the safest environment of care.”

Children’s direCt line 800.678.4357 • stlouisChildrens.org [7]

[slCH news] town haLL meetIngs addResses soCIaL medIa, faCebooK and buLLyIng

Social media. Drug addiction. Bullying. Homelessness. These are the topics that consumed a candid and provocative town hall meeting in St. Louis, Missouri that united parents, teens and more than 20 local health and behavioral health agencies to discuss the scariest issues facing the adolescent population today.

Among those agencies was the SPOT, a youth drop-in-center supported by Washington University and St. Louis Children’s Hospital, as well as Washington University School of Medicine.

“A lot of the discussion centered on social media, Facebook and bullying,” said Dr. Neha Navsaria, a child psychologist with Washington University School of Medicine, who attended the Town Hall, entitled Youth at Risk-Finding Solutions Together. “I would

recommend parents watch this with their kids as it opens up some thoughtful discussions and offeres insightful perspectives from parents, teens and the community behavioral health professionals who work with teens.”

Watch the town hall meeting in its entirety by visiting http://youthatriskstl.org.

dosIng faCts on Ct sCans:

• A typical adult chest Ct emits approximately 175-times-greater the dose of radiation as a routine chest X-ray.

• using FLASH CT technology, a pediatric CT scan performed at St. Louis Children’s Hospital is comparable to only 44 X-rays (75 percent less than a standard adult CT).

• no other center in the region offers pediatric scans at such a significantly reduced dose.

• the number of Ct scans performed on children has increased five-fold over the last 15 years.

• 90 percent of Ct scans are performed at non- pediatric hospitals.

• since 2005, the number of Ct scans performed at St. Louis Children’s Hospital has decreased by half.

In thIs Issue___________________________________________________________________________________________________________

1 New Cleft Palate Repair Technique Shows Promise for Signicantly Better Outcomes

6 SLCH Announces 2012 Advocacy Awards

7 New Technology at SLCH Limits Radiation Exposure for Patients

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[8] Children’s direCt line 800.678.4357 • stlouisChildrens.org SLC12308 5/12

The Division of Pediatric Laboratory Medicine has an updated policy for requesting clinical laboratory services for research protocols. In addition to the laboratory billing and compliance officer, the appropriate laboratory technical supervisor and a laboratory medical director will now review requests for clinical laboratory services by principal investigators (PIs).

Review by the laboratory technical supervisors ensures that the laboratory has the capability and capacity to perform the testing requested on the proposed sample type within the research time frame. “Medical director review provides an additional check that the target analyte and mode of analysis is appropriate to answer the research question,” says Gregory Storch, MD, Washington University physician and medical director of clinical laboratories at St. Louis Children’s Hospital. “This additional review of research protocols will benefit the PI by improving the efficiency by which research specimens are handled and ensure the delivery of accurate, meaningful data.”

The appropriate laboratory medical director may contact the investigator with concerns or questions prior to study initiation.

An updated form has been modified to include the title of the research project and the proposal abstract.

For more information, contact Jim Burns, laboratory billing and compliance officer, at 314.454.2157.

[laboratory news] Changes to ReseaRCh Request RevIew

[laboratory news] LaboRatoRy InfoRmatIon avaILabLe onLIne

weekly virus and microbiology testing data, as well as other important laboratory information, is located in the Clinical Laboratories section of our website. to bookmark the sLCh Clinical Laboratories web page, type the uRL—stLouisChildrens.org/clinicallabs—into your web browser and add it to your “favorites” section. In addition to up-to-date virus and microbiology updates, this page links to the lab test guidebook and other valuable information about the clinical laboratories.