Racial Bias, HPV Vaccination, Patient Perspective

Looking at ways to improve children’s health from different perspectives is what pediatric research at The Children’s Hospital of Philadelphia is all about. Take a look at three examples in this week’s In the News:

Stress in the ED and Unconscious Racial Bias

As the nation celebrated Emergency Medical Services Week, PolicyLab’s Tiffani Johnson, MD, MS, posted a new blog that poses an important question: How can we reduce racial disparities in pediatric emergency departments (ED)?

Dr. Johnson’s research team began to explore this in a 2013 study that examined how stress impacts implicit racial bias among resident physicians working in a large urban pediatric ED in western Pennsylvania. She defined implicit racial bias as unconscious attitudes toward a person or group of people that lie below the surface but may still influence behaviors such as perceptions about patients or decisions about patient care.

The study’s findings suggest that increased stress, such as when residents worked in the ED when it was extremely busy to severely overcrowded, is associated with greater implicit racial bias. Dr. Johnson called for future research to investigate how implicit bias affects patient care in the ED.

“Most healthcare professionals strive to achieve the best outcome for all of their patients, but that doesn’t make us immune from biases,” Dr. Johnson wrote. “All clinicians should be aware of their implicit biases. Residents and the providers who train and educate them in the ED should also be aware of how stress, including ED overcrowding and a high number of patients per provider, may exacerbate their biases and ultimately lead to racial disparities in care.”

Dr. Johnson is a faculty member at PolicyLab and assistant professor of Pediatrics in the division of Emergency Medicine at CHOP and the Perelman School of Medicine at the University of Pennsylvania. She is also a member of CHOP’s Center for Perinatal and Pediatric Health Disparities Research.

Read the entire blog here.

Gender and Receipt of HPV Vaccine

Providers of human papilloma virus (HPV) vaccine, which prevents a sexually transmitted infection, are more likely to recommend the vaccine to girls than to boys, previous studies have shown; however, this research did not examine clinician gender in relation to HPV vaccination behavior, nor did it consider the gender of the accompanying guardian.

In a new study in the Journal of Adolescent Health, Alex Fiks, MD, MSCE, who is an urban primary care pediatrician at CHOP, faculty member at PolicyLab, and an associate professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and colleagues examined this issue. They analyzed electronic health record data from visits by adolescents (11 to 18 years old) to 27 primary care practices from 2009 to 2014.

The study team found that clinician gender was associated with vaccination at acute, but not preventive, visits. In the context of efforts to increase acute visit vaccination, the study authors concluded, “differences between female and male clinicians' rates might reflect alternate practice styles by gender that deserve future study.” Guardian gender was not associated with vaccination.

The study’s first author is Laura Johnson Faherty, MD, MPH, a Robert Wood Johnson Foundation Clinical Scholar, working with PolicyLab and the Center for Pediatric and Perinatal Disparities, both at CHOP. See Dr. Faherty’s work on neonatal abstinence syndrome featured in Cornerstone earlier this month.

Read the article here.

Patient Perspective on Participating in Clinical Research

“Many clinical trials in general fail because of lack of participation,” wrote Kyle Bryant, who has Friedreich’s ataxia (FA), in a blog post about why he devotes so much of his time to take part in clinical research trials at CHOP’s Friedreich’s Ataxia Center of Excellence. FA is a genetic, progressive, debilitating disease that occurs in approximately 1 in 50,000 people. “So with numbers like in FA, each person has a big responsibility to do their part.”

While relatively rare, FA is the most common form of inherited ataxia, a condition characterized by progressive lack of coordinated movement and loss of balance. FA also involves degeneration of heart muscle and nerve cells. Currently there are no approved drugs to treat FA.

The FA Center of Excellence launched in 2014 as the result of a longtime collaboration including CHOP, Penn Medicine, and the Friedreich’s Ataxia Research Alliance (FARA), a nonprofit organization dedicated to curing FA. But the key players in the Center’s success are truly study participants like Bryant who are willing to undergo series of blood tests, heart exams, neurological exams, and exercise tests that aim to provide valuable evidence so that clinicians can evaluate potential FA treatments. Even when the tests are exhausting, annoying, or frustrating to complete, Bryant perseveres.

“Participating in clinical trials makes me feel extremely hopeful,” he wrote.

Read more about Bryant’s experiences as a clinical trial participant in his blog post that originally appeared on the FARA Ambassador Blog and was published this week by the The Huffington Post.

ICYMI

In case you missed it, this week on Cornerstone we highlighted all the interactive fun and excitement generated by CHOP researchers and clinicians who participated in the Philadelphia Science Festival.

Last week’s “In the News” summary featured a potential treatment for rare blood diseases, a mother who transformed grief over her daughter’s terminal disease into a foundation helping other families, and research that will help distinguish a serious knee condition from Lyme disease.

Keep up with our news, stories, and updates in real time by following us on Twitter, Facebook, or LinkedIn.

Or join our email list to get a summary of Cornerstone blog posts sent every other Friday by signing up here, or via the box on the upper right of this page.