LE BONHEUR CHILDREN’S

PEDIATRIC
New medical Cystic Fibrosis Center participates in
notes
directors named national QI collaborative
Melody The University of Tennessee Cystic importance of collecting accurate weight and
Cunningham, MD, has Fibrosis (CF) Care and Research Center at height measurements and developed a
been named director Le Bonheur Children’s recently participated in system for the registered dietician to
of Le Bonheur’s
Palliative Care service. a nationwide collaborative to build quality prioritize time spent with the patient based
She comes to improvement skills useful in the care of on the patient’s risk of growth problems. The
Memphis from patients with cystic fibrosis. center has also developed a Starting
Boston, where she As one of 16 centers chosen to be part of Transition to Adult Responsibility (STAR)
served on Children’s Melody Cunningham, MD the Cystic Fibrosis Foundation’s Learning and Clinic to help and encourage teenage
Hospital Boston’s Leadership Collaborative VI, Le Bonheur used patients to accept more responsibility for
Hematology service data that was compiled into a national their care as they transition into adulthood.
and as an assistant
professor at Harvard registry of cystic fibrosis patients to compare Lung function and body weight of
Medical School. Prior outcomes in lung function and nutrition at pediatric patients begin to deteriorate once
to her service in more than 100 CF care centers across the they are responsible for taking care of
Boston, she was an country. This information is being used to themselves and taking medicines and
attending physician help cystic fibrosis centers standardize their therapies without parental supervision,
on the Hematology care to help ensure the best outcomes for all Stokes said. In the STAR clinic, patients ages
service at St. Jude Kip Frizzell, MD
cystic fibrosis patients. 13 and older are seen without their parents,
Children’s Research Hospital.
Cunningham will also serve as an “The Learning Collaboratives were and are expected to know their medications
associate professor of pediatrics at the initiated after the Cystic Fibrosis Foundation and treatment. Patients typically transition to
University of Tennessee Health Science noticed variability in treatment and the adult care program between ages 18 and
Center. outcomes for various centers across the 21, and having those skills are critical to
In addition, Kip Frizzell, MD, has country,” said Dennis Stokes, MD MPH, chief successful transition.
been named Le Bonheur’s medical of pulmonary medicine at Le Bonheur The team continues to meet weekly to
director of Care Coordination – a new
Children’s. “The collaborative has given new focus on quality improvement and raise the
position developed to coordinate the
care of children with chronic conditions training and skills in quality improvement to bar in delivering care to patients with cystic
and complex conditions. A well- participating centers to enable them to work fibrosis. The center has also been named a
respected Memphis pediatrician, more transparently and achieve better 2009 Therapeutic Development Center by the
Frizzell also serves as a clinical assistant outcomes.” Cystic Fibrosis Foundation, recognized as a
professor at the University of Le Bonheur’s center has focused on center committed to delivering the best
Tennessee Health Science Center. optimizing nutritional outcomes in therapies and finding ways to improve
adolescents as a way to improve the treatment of cystic fibrosis patients.
transition into adult cystic fibrosis care.
Memphis’ CF patient population sits
9

Pediatric Notes is a quarterly below the national average in nutritional

publication for the medical staff of outcomes, making Le Bonheur an ideal
2 0 0

Le Bonheur Children's Medical Center, candidate to study. With about 130 adult and
spring

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Nellann Mettee, Editor
Jennilyn Utkov, Adviser
pediatric patients on its roster, the UT cystic
fibrosis center at Methodist Le Bonheur
Healthcare sees patients from Tennessee,
Missouri, Mississippi and Arkansas.
To attain its goal of optimizing
nutritional outcomes, the Memphis team
developed a pulmonary and nutrition care
plan that is discussed with each patient and a
pre-clinic screen to ensure patients receive Cystic fibrosis patient Max Betts, 14, tests in
the correct therapies. It also stressed the Le Bonheur's pulmonary function testing lab.

The primary pediatric affiliate of The University of Tennessee Health Science Center/School of Medicine
 Physicians,
pharmacists
author new
textbooks
A handful of Le Bonheur
Children’s physicians recently
have authored textbooks on
pediatric topics ranging from
epilepsy to nephrology.
The books include:
Pediatric Nephrology for
Primary Care, co-authored by
Pediatric Nephrologist Dr. Russell
Chesney, who also serves as
chairman of the Department of
Pediatric for University of
Tennessee Health Science Center.
This book was developed to
provide primary care physicians
with a resource to diagnose and
treat children with uncomplicat-
ed kidney problems – and advise
them on when to refer to a
specialist. The book is published
by the American Academy of
Pediatrics.
Advanced Therapy in
Epilepsy, co-authored by
Le Bonheur Neuroscience
Institute Director James Wheless,
MD, looks at the diagnosis and
treatment of epilepsy in
children, adolescents and adults.
The textbook incorporates
modern diagnostic evaluation
and all aspects of epilepsy treat-
ment, from medicine to dietary
and surgical options. It also
covers associated co-morbid
conditions and their treatment.
The publisher is People’s Medical
Publishing House.
Pediatric Injectable Drugs,
Eighth Edition, also known as
The Teddy Bear Book, is
co-authored by University of
Tennessee Health Science Center
pharmacy faculty Cathy Crill,
Stephanie Phelps and Emily Hak,
with contributions from
pharmacist Kelley Lee.
This book is the definitive
textbook on the use of
intravenous drugs in children.
It describes side effects and
drug-drug interactions.
2
Le Bonheur partners with community
to tackle drowning tragedies
Group offers swim lessons, hosts diversity meet
“
The tragic deaths of two Memphis
teens in city swimming pools last summer
spurred a group of concerned citizens and
”
Le Bonheur Children’s to work together to
make a difference.
This summer, the newly formed Make
a Splash Mid-South hopes to prevent
tragedy from striking again by providing
free swimming lessons, hosting a diversity
swim meet and offering lifeguard training
to improve water safety and generating
excitement about participating in the
sport.
We knew there was a need
to teach children how to be safe
around water, but couldn't
do it alone.
- Susan Helms, director of injury prevention
and Safe Kids Mid-South at Le Bonheur Children's
Recent findings from a University of
Memphis research study commissioned by
USA Swimming found that 60 percent of
African American and Hispanic/Latino
children don’t know how to swim and are
three times more likely to drown than
white children.
Make a Splash Mid-South, formed in
June 2008, is a group of concerned
community organizations with special
interest in swimming, children’s health and
safety issues. Susan Helms, director of
injury prevention and Safe Kids Mid-South
More than 300 children recently participated in the
“I Have a Dream ... Diversity in Swimming Weekend”
swim meet. The weekend was part of a community-
wide campaign to prevent drownings and teach
children to be safe in and around the water. Part of
the weekend included a developmental clinic taught
by experienced swimmers.
Above, a Memphis Parks Services swimming instructor
teaches a new student how to float and kick.
The swim lessons are part of Make a Splash
Mid-South, a community group formed to prevent
drownings by, among other things, providing free
swim lessons to children.
at Le Bonheur Children’s Medical Center,
has been overwhelmed with the response.
“We, at Le Bonheur, too often see
these tragedies when it’s too late to help,”
Helms said. “We knew there was a need to
teach children how to be safe around
water, but couldn’t do it alone. Partnering
with these organizations will allow us to
have a comprehensive program that can
make a big difference for our community’s
children.
Le Bonheur will partner with local city
parks services, community centers and local
swim groups as part of Make a Splash
Mid-South. This spring, the group piloted a
learn-to-swim program at a Memphis
aquatics center. More than 200 children
participated in the “I Have a Dream…
Diversity in Swimming Weekend” in
March. The event included a competitive
meet and a development clinic and meet
for new swimmers.
“Swimming has taught my children
so many things – a practical lifelong skill,
discipline, and allowed them to build
relationships that bridge cultural divides,”
said Anthony Norris, a parent of two
young swimmers who has been
instrumental in organizing the group’s
efforts. “If we can offer free
comprehensive lessons, we’ll make children
safer in and around water. We’re also
providing an opportunity to participate in
an enjoyable sport that teaches lifelong
lessons.”
Make a Splash Mid-South also has
plans to expand a learn-to-swim pilot
program to help other children around the
city learn for free.

CCP tapped to lead effort against child maltreatment
Le Bonheur’s Center for Children and
Parents (CCP) is leading more than 30
local and state agencies in an effort to
prevent child maltreatment.
The project – Shelby County Coalition
for Effective Early Home Visitation – will
build and develop an evidence-based
home visitation program for 100 first-
time mothers. The program will receive
about $2.4 million from the United States
Department of Health and Human
Services throughout five years.
The CCP was selected by the State of
Tennessee Department of Health to
implement the Nurse Family Partnership
(NFP) in Shelby County, but requires
broad community involvement. NFP is a
nationally recognized program that uses
nurses to provide home visitation services
to low-income, first-time mothers. It has
the highest rating of evidence-based
practice and the strongest evidence of
SHORTSCRIPTS
Nurse practitioner wins
national award
Lai Brooks, an
inpatient nurse
practitioner in
Le Bonheur’s
Neuroscience Institute,
was recently awarded
a national Rising Star
Award of Clinical
Practice from the
American Association
of Neuroscience Nurses. Lai Brooks
The award is given
to individuals with one-three years of
clinical practice in the neurosciences who
contribute to the fulfillment of the
organization’s mission and vision. Brooks
recently received her award at the
association’s national conference, where
she also presented a lecture entitled “Seize
the Moment, Empowering Nurses in the
Care of the Pediatric Patient with Epilepsy.”
Study looks to involve families
in their child’s care
Le Bonheur’s neuroscience unit has
launched a second phase of research aimed
“
”
any current home visitation model.
“In other communities served by NFP,
children in home visitation programs
have better health outcomes, are more
ready for preschool, and have decreased
Our goal is to stop abuse and
neglect before it can happen.
- Ruth Hamblen,
CCP prevention services manager
rates of child abuse and neglect. Mothers
have a decreased use of alcohol and
drugs and show progress toward
sufficiency and employment,” said Ruth
Hamblen, prevention services manager
at CCP.
at providing families with additional ways
to be involved in their child’s care. The
study, called Operation Collaboration, calls
on nursing, rehabilitation therapy, Child
Life, social work, nutrition and pharmacy
staffs to encourage parents to help set their
child’s schedule while in the hospital.
“If a child takes his nap every day at 2
p.m., it’s important that we work around
that schedule. The child isn’t going to get
the maximum out of his rehab therapy if
he’s sleepy,” said Brain Tumor Coordinator
Tracy Tidwell.
The research team will evaluate the
results of the change in scheduling on
patient satisfaction scores and compare the
results to the previous six months.
Emergency Physicians Study
Non-Invasive Method of
Detecting Elevated
Intracranial Pressure
Audrey Le, MD, a pediatric emergency
medicine fellow at Le Bonheur Children’s,
recently investigated the test performance
of bedside sonographic measurement of
optic nerve sheath diameter in identifying
Hamblen uses an illustration to
explain how the program will work.
“You’re standing on the bank of a river
and you see babies floating down stream.
Do you start rescuing the babies one by
one out of the water? Or do you go
upstream and build a dam to stop the
flow? Our goal is to stop abuse and
neglect before it can happen,” Hamblen
said.
The CCP pulled together leaders from
30 agencies in February to form the
Steering Committee for the Coalition.
From that meeting, several work groups
have been developed to address specific
issues such as continuum of care,
monitoring the effectiveness of the NFP
program, securing funding for future
efforts and creating public awareness of
the issues. The program’s staff will
include a nurse supervisor and four
nurses.
elevated intracranial pressure (EICP).
This prospective cohort study, published
in Annals of Emergency Medicine, was a
result of collaboration between pediatric
ophthalmologist Mary Ellen Hoehn, MD,
and pediatric intensivist Tom Spentzas, MD.
The results showed limited accuracy
(sensitivity of 83 percent, 38 percent
specificity) in predicting EICP relative to a
criterion standard of cranial imaging or
intracranial pressure monitoring. There was
good interobserver agreement between the
emergency physician and pediatric
ophtalmologist (k=0.64)
“I am extremely proud of Audrey and
the other fellows for continuing to advance
point-of-care emergency ultrasonography in
our ED,” said research mentor and
fellowship program director Jay Pershad,
MD. “Bedside optic nerve sheath diameter
measurement is a promising technique for
the non-invasive estimation of EICP but the
test characteristics may not aid decision
making.”
The article can be viewed by visiting
www.annemergmed.com and clicking on
“Articles in Press.”
3

Permit No. 3093
Memphis, TN
PAID
U S POSTAGE
Non-Profit Org.
Researcher studies new asthma
therapy potential
A Le Bonheur Children’s researcher
is developing a carbohydrate-based
Le Bonheur Children’s Medical treatment that could meet unmet needs for
Center Physician Advisory Council millions of asthma sufferers worldwide.
Pediatric Allergist Betty Lew, MD, is
Stephen Bauch, MD conducting pre-clinical Phase I of a National
Institutes of Health-funded study on the use
Martin Blakely, MD of mannan to treat inflammation and
Mark Bugnitz, MD remodeling in both children and adult
James Carter, MD asthma patients. Remodeling occurs when
scarring from chronic inflammation causes
Russell Chesney, MD smooth muscle in the lung to thicken.
Thomas Chin, MD “As a pediatric allergist, I see children in
Barry Gilmore, MD the Intensive Care Unit with respiratory
failure who don’t respond well to current
Jay Hayes, MD
therapies,” Lew said. “We are very excited
John Hill, MD and optimistic about mannan’s potential in
Michael Lacy, MD meeting the needs of hundreds of millions of
people suffering from asthma worldwide.”
Linda Lazar, MD
In fact, about 30 percent of asthma
Bill May, MD patients don’t respond to current asthma
Deborah Nelson, MD therapies – which can include toxic doses of
Stephanie Storgion, MD adrenergic bronchodilators and steroids.
Mannan is a carbohydrate cell wall
Jerome Thompson, MD component of baker’s yeast and is a mannose
receptor blocker.
Memphis, Tennessee 38103
50 North Dunlap
Airway smooth
muscle cells express
mannose receptors, and
activation of these
receptors by lysosomal
hydrolases causes Betty Lew, MD
hypertrophy and hyper-
plasia of smooth
muscle. Lysosomal hydrolases, mannose-rich
inflammatory mediators, are released from
the mast cells, macrophages and other
inflammatory cells in response to allergic and
non-allergic stimuli.
Lew hopes to begin Phase II, which will
include pre-clinical work that studies
mannan’s toxicity, by next spring.
Lew, who also serves as a professor and
director of the Allergy and Immunology
training program at the University of
Tennessee Health Science Center, is working
with the UT Research Foundation and
Cumberland Emerging Technologies to
develop further trials. The UTRF and CET
have completed a licensing agreement to
further development the product for
clinical trials.