Leadership Circle 2009 Grant Finalists

Below are summaries of the proposals from the six finalists for funding from the 2009 Leadership Circle grant awards. These summaries appear in no particular order. Presentations are scheduled for the Leadership Circle Luncheon on April 2, 2009. Join the Leadership Circle today.  

PROPOSAL  #1

Sharad Menon, MD

Department: Critical Care Division

Title: Bedside Echocardiography in the Intensive Care Unit

Amount Requested: $45,000

The purpose of this grant is to purchase a portable Echo machine to be used in the Intensive Care Unit (ICU) and the necessary training for the intensivists to acquire the core skills of bedside echocardiography.  Bedside echocardiography has become an indispensable tool in the management of critical patients providing rapid non-invasive assessment of cardiac function and physiology that complements data available from standard invasive hemodynamic monitoring.  The technological advances leading to miniaturizations of systems and advances in techniques, together with development of more portable and user friendly echo cardiographic systems have led to their increased use in the ICU setting.

This project will empower the intensivists, who by virtue of being available at the bedside will be able to perform echocardiography in the ICU.  Echocardiographic skills will enable the ICU physician to immediately study the changes due to therapeutic interventions and enable focused studies to rule out emergent and life-threatening conditions such as cardiac tamponade.  Better management of fluids and inotropes in the ICU will occur and obviate the need for guess work.  It will thus substantially raise the standard of care with access to instantaneous information about critically ill patients.

Elizabeth Zorn, MD 

Department: Critical Care Division

Title: Electromagnetic Tube Placement Device

Amount Requested: $18,940

The requested grant is for the purchase of an Electromagnetic Tube Placement Device (ETPD) which is a real-time, computer-based system that uses electromagnetic technology to guide clinicians in the placement of feeding tubes through the nose, into the stomach or the small intestine.  The device helps direct feeding tube placement by showing the relative location of the tube as it proceeds down the digestive tract.

Without a guidance system such as the ETPD, feeding tubes are placed "blindly" at the patient's bedside.  This method has several shortcomings involving safety, accuracy, efficiency and cost.  Potential complications from a malpositioned feeding tube include lung injury from the tube itself or from the formula run through the tube.  To avoid complications and confirm final tube position, blind bedside placement of feeding tubes frequently requires subsequent x-ray(s) to determine final position of the feeding tube; this adds cost, increases patient radiation exposure, and reduces the ability to promptly attain the desired nutrition therapy.  Placement of a feeding tube into the small bowel without a guidance system is an exacting process and may not be successful at the bedside; some patients are subjected to more costly and invasive procedures such as endoscopy or fluoroscopy to ensure optimal tube placement.  These alternative placement techniques may also result in radiation exposure and delays in initiating nutritional therapy.

Through its computerized guidance system, the ETPD will improve patient safety and placement accuracy by displaying the path of the tube as it is being placed by the bedside nurse.  Inaccurate insertion will be recognized and corrected immediately, avoiding inadvertent placement into the lungs and multiple x-rays.  The ETPD will improve efficiency in placement of the tube, minimize discomfort for the patient and decrease staff time. The ETPD will also reduce the need for multiple x-rays, fluoroscopy and the use of intravenous nutrition, leading to cost savings. 

Tressia Shaw, MD

Department: General Pediatrics

Title: Improving Palliative Care for Children

Amount Requested: $30,000

We are seeking support to fund an educational program in pediatric palliative care for an interdisciplinary team of health care providers at Phoenix Children's Hospital.  Pediatric palliative care is about optimizing the quality of a child's life while coping with life limiting conditions.  Interdisciplinary pediatric palliative care includes effective communication, psychosocial care, spiritual care, comprehensive pain and symptom control, and grief and bereavement support (Policy Statement on Palliative Care, American Academy of Pediatrics, 2000).  Palliative care is designed to be family centered and provide services over the course of a child's illness.  In order to provide such specialized care, additional education is required for the health care team who will interact with these families. 

This proposal seeks to improve and enhance the care that children are receiving at Phoenix Children's Hospital by training key providers to form a palliative care team.  The type of education needed to achieve this goal requires intense training over a multiple day period.  It is best done by directly learning from a fully operating and functional palliative care team at a children's hospital.  Our proposal will provide this training experience by sending an interdisciplinary team, consisting of physicians, nurses, social workers, chaplains, and child life specialists, to an Initiative for Pediatric Palliative Care (IPPC) conference.  The IPPC conference takes a collaborative approach to education and uses a "train the trainer" format.  The team that attends this program will then return with the knowledge to educate their peers about palliative care for these children.

Daphne E. deMello, MD

Department: Hematology/Laboratory

Title: Blood Cells by Cella Vision

Amount Requested: $50,000

This is a request for the purchase of Sysmex Cella Vision DM96 and the training of 10 medical technologists in its use. The main purpose of this grant application is to enhance the diagnostic support that the hospital laboratory provides to the Hematology/Oncology division for the recognition and classification of childhood blood disorders. 

A child presenting to PCH with a suspected blood disorder has a complete blood count (CBC) done.  A blood smear on a glass slide is stained and examined under a microscope by a medical technologist who identifies and counts the different cell types to obtain a differential count. Abnormal numbers of blood cells or abnormal (immature) cells seen in the smear enable a diagnosis of a blood disorder.  Because cell identification is subjective, diagnostic accuracy varies with the experience and expertise of the technologist.  Suspected abnormal cells such as leukemic blasts require review and confirmation by a pathologist.  This necessitates another search by the pathologist for the abnormal cell(s) on the glass slide.  When cell numbers are low, considerable time consumption is involved in such a search.  

Automated Digital Cell Morphology eliminates the time lost in manually examining a slide and searching for a suspected abnormal cell, because with the CellaVision DM96, the cells are automatically located on a stained blood smear, pre-classified, stored and transmitted for confirmation by a technologist.  Thus, the CellaVision automatically performs the manual differential count, dramatically increasing its efficiency and proficiency by analyzing in each cell, over 250 specific characteristics that are used for cell classification.  Digitized images of each cell are stored creating a photo journal. 

Cristina Carballo, MD

Department: Neonatology

Title: Research Nurse Coordinator/Development of a Neuro NICU 

Amount Requested: $50,000

An integral part of the development of a Neuro NICU at PCH includes the ability to collaborate and initiate research projects, concerning the neurologic well being of the neonate.  These research projects depend on a research nurse coordinator that will be able to organize, collect and analyze data.  Without this person, it would be impossible to succeed with any research projects.

Phoenix Children's Hospital is in the process of developing the second Neuro NICU (NNICU) in the country.  The concept of the program is to standardize care, to establish protocols, and to introduce new therapies and conduct research for the neurological care of newborns in the intensive care setting.  The development of protocols and the opportunity to do research will result in a systematic approach to the care of various neurological results/disease in our most vulnerable patients. 

The Neuro NICU at Phoenix Children's would bring state of the art expertise in the field of Neonatal Neurology which would drastically improve the neurodevelopmental outcome of this patient population.  The acquisition of a research nurse would hasten the completion of this new program and place PCH at the forefront in the care of neonatal neurological patients.

P. David Adelson, MD

Department: Neuroscience Institute

Title: Phoenix CNI Data Center

Amount Requested: $50,000

This proposal requests a start-up grant to establish a data management group for the hospital's newly developed Phoenix Children's Neuroscience Institute (CNI).  The CNI Data Center (CNI DC) for pediatric neurosciences will be a unique data center that integrates multiple databases and sources of information aimed at the health goal of better treatments and outcomes for children with neurological disease. The CNI DC will expedite and enrich all of the neuroscience research and quality assessment going on at Phoenix Children's Hospital (PCH) in the neurosciences and amongst our collaborators. 

Our overall goal is to facilitate the development of more effective methods to diagnose and treat neurological diseases in children and facilitate outcomes assessments (better understanding of impact of disease and treatment on the function and quality of life of these children)  including such potential and immediate areas as: 1) improved neurocognitive function in children following traumatic brain injury; 2) the effect of intensive social interactive therapy in children with autism and autistic spectrum disorders; 3) limiting the negative impact of adjunctive therapy (i.e.) chemotherapy and radiation therapy, on the developing brain following diagnosis of pediatric brain tumors. 

We propose to establish a CNI DC that would serve as a central data management database and the central data repository for the projects for all the basic science and clinical research programs at CNI and serve to integrate data, demographics, information systems, program development and communications within the growing institute.  Funding for the CNI DC would support initially the partial funding of a master's level information specialist, and the hardware and software needed to develop, integrate and centralize data across projects and facilitate the mission of the CNI.