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Article ; Online: Incorporating a Three-Dimensional Printed Airway into a Pediatric Flexible Bronchoscopy Curriculum.

Painter, Natalia / Monovoukas, Demetri / Delecaris, Angela O / Coverstone, Andrea M / Zopf, David A / Saba, Thomas G

ATS scholar

2024 Volume 5, Issue 1, Page(s) 142–153

Abstract: Background: Although hands-on simulation plays a valuable role in procedural training, there are limited tools available to teach pediatric flexible bronchoscopy (PFB). Fellowship programs rely on patient encounters, with inherent risk, or high-cost ... ...

Abstract	Background: Although hands-on simulation plays a valuable role in procedural training, there are limited tools available to teach pediatric flexible bronchoscopy (PFB). Fellowship programs rely on patient encounters, with inherent risk, or high-cost virtual reality simulators that may not be widely available and create education inequalities. Objective: Our objective was to study the educational value and transferability of a novel, low-cost, three-dimensional-printed pediatric airway model (3D-AM) for PFB training. Our central hypothesis was that the 3D-AM would have high educational value and would be easily transferrable to learners at different teaching hospitals. Methods: The 3D-AM was designed to teach technical bronchoscopy skills, airway anatomy, airway pathology, and bronchoalveolar lavage (BAL). The curriculum was offered to incoming fellows in pediatric pulmonology, pediatric surgery, and pediatric critical care across three different teaching institutions. After course completion, each participant assessed the simulation model(s) with a 5-point Likert scale across six domains: physical attributes, realism of experience, ability to perform tasks, value, relevance, and global impression. The expert instructors assessed the learners' competency using a modified version of the Bronchoscopy Skills and Tasks Assessment Tool. Results: A total of 14 incoming fellows participated in the course. The mean scores for the 3D-AM across all six domains and across the three institutions was between 4 and 5, suggesting that learners generally had a favorable impression and a similar experience across different institutions. All learners "agreed" or "strongly agreed" that the course was a valuable use of their time, helped teach technical skills and airway anatomy, and would be useful for extra training during fellowship. Most of the learners correctly identified anatomy, bronchomalacia, and performed a BAL. Wall trauma was observed in 36% of learners. Conclusion: The utility, low cost, and transferability of this model may create opportunities for PFB training across different institutions despite resource limitations in the United States and abroad.
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2023-0078OC
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Case Report: A Relatively Mild Presentation of Unilateral Congenital Pulmonary Lymphangiectasia.

Adair, Dionne / Rabah, Raja / Ladino-Torres, Maria / Saba, Thomas G

Frontiers in pediatrics

2021 Volume 9, Page(s) 657473

Abstract: Pulmonary lymphangiectasia (PL) is a rare congenital disorder of pulmonary lymphatic development. Although it was traditionally a fatal disorder of infancy, some cases in later childhood have been reported, suggesting a spectrum of severity. We present ... ...

Abstract	Pulmonary lymphangiectasia (PL) is a rare congenital disorder of pulmonary lymphatic development. Although it was traditionally a fatal disorder of infancy, some cases in later childhood have been reported, suggesting a spectrum of severity. We present an unusual case of unilateral, congenital pulmonary lymphangiectasia. Our patient presented with neonatal respiratory distress, a chronic wet cough and recurrent episodes of bronchitis. Chest CT revealed thickening of the interlobular septae of the right lung. A lung biopsy confirmed the diagnosis of lymphangiectasia. His clinical course is characterized by chronic coughing and recurrent bronchitis but normal growth and development. This case illustrates a relatively mild presentation of unilateral PL, which, along with other reports, suggests variability in the presentation and severity of this disorder. In the absence of imaging and histological examination, mild presentations may go undiagnosed.
Language	English
Publishing date	2021-04-22
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2021.657473
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Article ; Online: A simulation procedure curriculum to increase pediatric resident exposure to procedures rarely performed in clinical practice.

Meerkov, Meera S / Fischer, Jason B / Saba, Thomas G

Medical education online

2019 Volume 24, Issue 1, Page(s) 1611305

Abstract: Background: Pediatrics residents are expected by the Accreditation Council for Graduate Medical Education to competently perform 13 procedures. However, residents are graduating with poor self-perceived competency for these procedures.: Objective: We ...

Abstract	Background: Pediatrics residents are expected by the Accreditation Council for Graduate Medical Education to competently perform 13 procedures. However, residents are graduating with poor self-perceived competency for these procedures. Objective: We developed a curriculum using simulation training at the beginning of internship and 'refresher' workshops throughout the year in order to increase procedure exposure and improve self-perceived competency. Design: Procedural workshops were taught during intern orientation and to all pediatrics residents throughout the academic year. Residents provided a quantitative competency self-assessment before and after each workshop; interns provided an additional self-assessment at the end of the intern year. Results: The curriculum was well-liked and led to more procedural experience. Mean competency self-assessment scores improved immediately after almost every procedure workshop. Mean scores were retained at the end of intern year for most procedures. However, end-of-year mean competency self-assessment and procedural experience on actual patients were similar to interns from a previous year that had not participated in the curriculum. Conclusions: A pre-internship procedure workshop coupled with longitudinal workshops is a feasible way to improve intern exposure to pediatric procedural training. However, it was not sufficient to improve mean competency self-assessments compared to a traditional model of bedside procedural training.
MeSH term(s)	Accreditation ; Attitude of Health Personnel ; Child ; Clinical Competence ; Humans ; Internship and Residency/methods ; Male ; Pediatrics/education ; Self-Assessment ; Simulation Training/methods
Language	English
Publishing date	2019-05-06
Publishing country	United States
Document type	Journal Article
ISSN	1087-2981
ISSN (online)	1087-2981
DOI	10.1080/10872981.2019.1611305
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Article ; Online: Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and Invasive Ventilation in a Pediatric ICU.

Kyle, James M / Sturza, Julie M / Dechert, Ronald E / Custer, Joseph R / Dahmer, Mary K / Saba, Thomas G / Flori, Heidi R

Respiratory care

2022 Volume 67, Issue 8, Page(s) 956–966

Abstract: Background: It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated.: Methods: This was a single-center, ... ...

Abstract	Background: It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated. Methods: This was a single-center, retrospective review of patients admitted with acute respiratory failure to the University of Michigan pediatric intensive care or cardiothoracic ICUs and receiving NIV or invasive mechanical ventilation as first-line therapy. Results: One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV success, 55 NIV failure, and 50 invasive mechanical ventilation alone. Of those failing NIV, median time to intubation was 1.8 (interquartile range [IQR] < 1-7) h. On multivariable regression, ICU-free days were significantly different between groups (NIV success: 22.9 ± 6.9 d; NIV failure: 13.0 Conclusions: We demonstrated that critically ill pediatric subjects unsuccessfully trialed on NIV did not experience increased ICU length of stay or fewer ventilator-free days when compared to those on invasive mechanical ventilation alone, including in the pediatric ARDS subgroup. Our findings are predicated on a median time to intubation of < 2 h in the NIV failure group and the provision of adequate monitoring while on NIV.
MeSH term(s)	Child ; Humans ; Intensive Care Units ; Intensive Care Units, Pediatric ; Noninvasive Ventilation ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy
Language	English
Publishing date	2022-06-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.09348
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Article: Loss of an extensive ciliary connectome induces proteostasis and cell fate switching in a severe motile ciliopathy.

Brody, Steven L / Pan, Jiehong / Huang, Tao / Xu, Jian / Xu, Huihui / Koenitizer, Jeffrey / Brennan, Steven K / Nanjundappa, Rashmi / Saba, Thomas G / Berical, Andrew / Hawkins, Finn J / Wang, Xiangli / Zhang, Rui / Mahjoub, Moe R / Horani, Amjad / Dutcher, Susan K

bioRxiv : the preprint server for biology

2024

Abstract: Motile cilia have essential cellular functions in development, reproduction, and homeostasis. Genetic causes for motile ciliopathies have been identified, but the consequences on cellular functions beyond impaired motility remain unknown. Variants ... ...

Abstract	Motile cilia have essential cellular functions in development, reproduction, and homeostasis. Genetic causes for motile ciliopathies have been identified, but the consequences on cellular functions beyond impaired motility remain unknown. Variants in
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.03.20.585965
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Article ; Online: Phenotypic features of ciliary dyskinesia among patients with congenital cardiovascular malformations.

Sherman, Forrest / Wodrich, Mitchel / Zampi, Jeffrey D / Lee, Julie / McCaffery, Harlan / Saba, Thomas G

Pediatric pulmonology

2020 Volume 55, Issue 10, Page(s) 2674–2682

Abstract: Background: Cilia are cell membrane-bound organelles responsible for airway mucus clearance, establishment of left-right organ asymmetry, cardiogenesis, and many other functions in utero. Phenotypic features suggestive of respiratory ciliary dyskinesia ... ...

Abstract	Background: Cilia are cell membrane-bound organelles responsible for airway mucus clearance, establishment of left-right organ asymmetry, cardiogenesis, and many other functions in utero. Phenotypic features suggestive of respiratory ciliary dyskinesia among patients with heterotaxy syndrome, defined as complex cardiovascular malformations (CVM) and situs ambiguus (SA), has not been adequately explored. Objectives: We hypothesized that there is a greater incidence of phenotypic features consistent with ciliary dyskinesia among patients with heterotaxy syndrome compared to patients with other CVM and laterality defects without heterotaxy syndrome. Methods: Thirty six subjects were identified by medical record search and divided into four groups based on situs status and type of CVM as follows: SA and complex CVM (group 1); SA and simple CVM (group 2); situs solitus and complex CVM (group 3); and situs solitus and simple CVM (group 4). Phenotype was assessed with a clinical questionnaire, nasal nitric oxide (NO) level, and pulmonary function testing. Those with complex CVM underwent additional testing for variants in genes involved in ciliary structure and function. Results: The mean nasal NO level was significantly lower among all subjects with complex CVM regardless of situs anomalies (groups 1 and 3). There was no significant difference in respiratory symptoms or lung function among the four groups. No bi-allelic genetic mutations were detected among patients with complex CVM. Conclusions: This study identified a relatively lower mean nasal NO level, suggestive of relative ciliary dyskinesia, among subjects with complex CVM. Pulmonary function and clinical symptoms did not reflect significant pulmonary disease among those with complex CVM.
MeSH term(s)	Adolescent ; Adult ; Cardiovascular Abnormalities/metabolism ; Child ; Ciliary Motility Disorders/metabolism ; Female ; Humans ; Male ; Nasal Cavity ; Nitric Oxide/metabolism ; Phenotype ; Situs Inversus/metabolism ; Young Adult
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2020-07-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.24959
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Article ; Online: A multi-disciplinary, comprehensive approach to management of children with heterotaxy.

Saba, Thomas G / Geddes, Gabrielle C / Ware, Stephanie M / Schidlow, David N / Del Nido, Pedro J / Rubalcava, Nathan S / Gadepalli, Samir K / Stillwell, Terri / Griffiths, Anne / Bennett Murphy, Laura M / Barber, Andrew T / Leigh, Margaret W / Sabin, Necia / Shapiro, Adam J

Orphanet journal of rare diseases

2022 Volume 17, Issue 1, Page(s) 351

Abstract: Heterotaxy (HTX) is a rare condition of abnormal thoraco-abdominal organ arrangement across the left-right axis of the body. The pathogenesis of HTX includes a derangement of the complex signaling at the left-right organizer early in embryogenesis ... ...

Abstract	Heterotaxy (HTX) is a rare condition of abnormal thoraco-abdominal organ arrangement across the left-right axis of the body. The pathogenesis of HTX includes a derangement of the complex signaling at the left-right organizer early in embryogenesis involving motile and non-motile cilia. It can be inherited as a single-gene disorder, a phenotypic feature of a known genetic syndrome or without any clear genetic etiology. Most patients with HTX have complex cardiovascular malformations requiring surgical intervention. Surgical risks are relatively high due to several serious comorbidities often seen in patients with HTX. Asplenia or functional hyposplenism significantly increase the risk for sepsis and therefore require antimicrobial prophylaxis and immediate medical attention with fever. Intestinal rotation abnormalities are common among patients with HTX, although volvulus is rare and surgical correction carries substantial risk. While routine screening for intestinal malrotation is not recommended, providers and families should promptly address symptoms concerning for volvulus and biliary atresia, another serious morbidity more common among patients with HTX. Many patients with HTX have chronic lung disease and should be screened for primary ciliary dyskinesia, a condition of respiratory cilia impairment leading to bronchiectasis. Mental health and neurodevelopmental conditions need to be carefully considered among this population of patients living with a substantial medical burden. Optimal care of children with HTX requires a cohesive team of primary care providers and experienced subspecialists collaborating to provide compassionate, standardized and evidence-based care. In this statement, subspecialty experts experienced in HTX care and research collaborated to provide expert- and evidence-based suggestions addressing the numerous medical issues affecting children living with HTX.
MeSH term(s)	Anti-Bacterial Agents ; Bronchiectasis ; Child ; Humans ; Intestinal Volvulus
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-09-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2225857-7
ISSN	1750-1172 ; 1750-1172
ISSN (online)	1750-1172
ISSN	1750-1172
DOI	10.1186/s13023-022-02515-2
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Article ; Online: A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children

Laforte Diane / Houghton Fiona / Fairbairn James / Saba Thomas G / Foster Bethany J

BMC Pediatrics, Vol 11, Iss 1, p

2011 Volume 82

Abstract: Abstract Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV) maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in ... ...

Abstract	Abstract Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV) maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV fluids for maintenance needs. Methods This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional fluids were left to their discretion. Results Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours) and rate of study fluid infusion, and the volume of additional isotonic fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02) and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07). The rate of change and absolute change in serum [Na] did not differ significantly between groups. Conclusions When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended. Clinical Trial Registration Number NCT00457873 ( http://www.clinicaltrials.gov/ )
Keywords	hyponatremia ; sodium ; intravenous fluids ; isotonic fluid ; Pediatrics ; RJ1-570 ; Medicine ; R ; DOAJ:Pediatrics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2011-09-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pre-clinical medical student experience in a pediatric pulmonary clinic.

Saba, Thomas G / Hershenson, Marc B / Arteta, Manuel / Ramirez, Ixsy A / Mullan, Patricia B / Owens, Sonal T

Medical education online

2015 Volume 20, Issue 1, Page(s) 28654

Abstract: Objective Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods First- and second-year medical students at the University of ... ...

Abstract	Objective Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article
ISSN	1087-2981
ISSN (online)	1087-2981
DOI	10.3402/meo.v20.28654
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Article ; Online: Pre-clinical medical student experience in a pediatric pulmonary clinic.

Saba, Thomas G / Hershenson, Marc B / Arteta, Manuel / Ramirez, Ixsy A / Mullan, Patricia B / Owens, Sonal T

Medical education online

2015 Volume 20, Page(s) 28654

Abstract: Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting.: Methods: First- and second-year medical students at the University ...

Abstract	Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.
MeSH term(s)	Ambulatory Care Facilities/organization & administration ; Child ; Clinical Competence ; Communication ; Education, Medical, Undergraduate/organization & administration ; Empathy ; Female ; Humans ; Male ; Motivation ; Pediatrics/education ; Pulmonary Medicine/economics ; Self Concept ; Students, Medical/psychology ; Young Adult
Language	English
Publishing date	2015
Publishing country	United States
Document type	Journal Article
ISSN	1087-2981
ISSN (online)	1087-2981
DOI	10.3402/meo.v20.28654
Database	MEDical Literature Analysis and Retrieval System OnLINE

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