Impact of a Quality Improvement Initiative on Increasing Height Measurement Among Children with Medical Complexity.

BACKGROUND: This quality improvement project aimed to increase the rate of height measurement among children with medical complexity (CMC) seen for well-child visits. METHODS: Three interventions were implemented over 17 months. Retrospective chart review of well-child visits for patients 35 months through 18.5 years was conducted for children with medical complexity. Height measurement rates were analyzed across intervention phases. RESULTS: Overall rate of height measurement was 81.1% for children with medical complexity. From start to finish, rate of height measurement for CMC increased - 63.6% to 100.0% (P=0.006). CONCLUSION: Quality improvement methodology increased height measurement rates at well-child visits amongst children with medical complexity. This approach can be utilized to address health care inequities among individuals with medical complexity.

Advocating for Automatic Eligibility for Early Intervention Services for Children Exposed to Lead.

Lead poisoning remains one of the most prevalent and preventable environmental health hazards affecting children. Low-level lead exposure has been shown to significantly increase the risk of learning disabilities, behavioral problems, and developmental delay. It also has substantial social implications as lead toxicity disproportionately affects children from low-income, ethnic minority households. Early Intervention (EI) is a state-based federal program (Part C of the Federal Individuals with Disabilities Education Act) created to support the development of children from birth to age 3 years who are experiencing or who are at risk for developmental delay. In 2016, an Illinois EI and Lead Workgroup was established to address the best practice of offering EI services to children who have been exposed to lead. This work serves as a template for advocates and health providers in other states to establish automatic eligibility for EI services at low levels of lead exposure, while also demonstrating the capacity to serve these children without overwhelming the state's EI system. [Pediatr Ann. 2018;47(10):e413-e418.].

Identification of HDAC6-Selective Inhibitors of Low Cancer Cell Cytotoxicity.

The histone deacetylases (HDACs) occur in 11 different isoforms, and these enzymes regulate the activity of a large number of proteins involved in cancer initiation and progression. The discovery of isoform-selective HDAC inhibitors (HDACIs) is desirable, as it is likely that such compounds would avoid some of the undesirable side effects found with the first-generation inhibitors. A series of HDACIs previously reported by us were found to display some selectivity for HDAC6 and to induce cell-cycle arrest and apoptosis in pancreatic cancer cells. In the present work, we show that structural modification of these isoxazole-based inhibitors leads to high potency and selectivity for HDAC6 over HDAC1-3 and HDAC10, while unexpectedly abolishing their ability to block cell growth. Three inhibitors with lower HDAC6 selectivity inhibit the growth of cell lines BxPC3 and L3.6pl, and they only induce apoptosis in L3.6pl cells. We conclude that HDAC6 inhibition alone is insufficient for disruption of cell growth, and that some degree of class 1 HDAC inhibition is required. Moreover, the highly selective HDAC6Is reported herein that are weakly cytotoxic may find use in cancer immune system reactivation.