Effect of Thickened Feeds on Swallow Physiology and Clinical Outcomes in Children with Brief Resolved Unexplained Event (Supplement)

项目摘要 无法解释的短暂事件（BRUE）是以出现以下症状为特征的可怕事件： 危及生命的窒息、发绀和婴儿四肢无力。这些共同活动需要大量资源， 目前的管理不足以解决持续的症状。患有BRUE的婴儿通常 口咽吞咽困难伴误吸，这是持续症状的可改变风险因素，但 没有研究确定这种吞咽功能障碍背后的机制， 发病率系统研究口咽吞咽困难对本研究中疾病负担的贡献， 人群迫切需要，因为这种方法具有巨大的潜力，可以优化临床结果，改善 降低生活质量，降低医疗保健利用率。丹尼尔邓肯，医学博士公共卫生硕士是哈佛医学院的讲师 学校（HMS）和波士顿儿童医院（BCH）呼吸消化中心的一个专科医生。他 在他的医学培训期间获得了大量的临床研究经验，并表现出了对 以病人为导向的研究的学术生涯。他的职业目标是指导一个临床研究项目 重点是确定口咽吞咽困难的循证、最先进的干预措施， 呼吸消化系统疾病改变了对这一脆弱儿童群体的临床护理。 这个职业发展奖将提供额外的指导培训和研究机会， 邓肯博士的高分辨率阻抗测压和决策分析， 研究技能，同时解决目前与吞咽功能障碍机制相关的知识差距， 布鲁。拟议的创新研究将系统地确定增稠饲料 调节吞咽功能，并在更大的队列中证实这些发现，这将允许推导出 BRUE护理的改进算法。他将研究液体粘度的改变对食管上段的影响， 使用咽阻抗-测压法测定运动性，随访前瞻性队列，以确定 反应增厚，并使用决策分析，以确定患者可以接受经验增厚。 这个职业发展奖所提供的指导和科学培训对博士来说至关重要。 邓肯的学术发展。他的主要导师罗森博士是一位呼吸消化专家。他的导师们， Drs. Jadcherla和Omari是新生儿吞咽功能障碍和阻抗测压的专家;他们都是 杰出的临床研究人员，并致力于指导。他将获得奖学金 咨询委员会由Snapper博士，Nurko，Landrigan和Stamoulis组成，他们提供内容区域 专业知识他的正式培训包括在哈佛公共管理学院的决策分析高级课程 健康，食管动力和决策分析的个人指导，以及专业发展 课程他的培训和研究活动将在无与伦比的学术环境中进行， BCH和HMS，这是坚定地致力于邓肯博士的成功过渡到独立。

PROJECT SUMMARY Brief resolved unexplained events (BRUE) are frightening episodes characterized by appearance of life-threatening choking, cyanosis, and limpness in infants. These common events are resource-intensive and current management inadequately addresses persistent symptoms. Infants with BRUE commonly have oropharyngeal dysphagia with aspiration, which is a modifiable risk factor for persistent symptoms, but there are no studies determining the mechanism behind this swallow dysfunction and if swallow interventions reduce morbidity. Systematic investigation of the contribution of oropharyngeal dysphagia to disease burden in this population is urgently needed, as this approach has vast potential to optimize clinical outcomes, improve quality of life and reduce healthcare utilization. Daniel Duncan, MD MPH is an Instructor at Harvard Medical School (HMS) and a subspecialist within the Aerodigestive Center at Boston Children’s Hospital (BCH). He has gained substantial clinical research experience during his medical training and has demonstrated commitment to an academic career in patient oriented research. His career goal is to direct a clinical research program focused on identifying evidenced-based, state of the art interventions for oropharyngeal dysphagia and aerodigestive disorders that transform clinical care for this vulnerable pediatric population. This Career Development Award will provide additional mentored training and research opportunities in high resolution impedance-manometry and decision analysis for Dr. Duncan to advance his quantitative research skills while addressing the current knowledge gap related to mechanisms of swallow dysfunction in BRUE. The proposed innovative studies will systematically determine mechanisms by which thickened feeds modulate swallow function and confirm these findings in a larger cohort, which will allow for derivation of an improved algorithm for BRUE care. He will study effects of alterations in liquid viscosity on upper esophageal motility using pharyngeal impedance-manometry, follow a prospective cohort to determine predictors of response to thickening, and use decision analysis to identify patients that could receive empiric thickening. The mentorship and scientific training afforded by this career development award will be critical for Dr. Duncan’s academic development. His primary mentor, Dr. Rosen, is an aerodigestive expert. His co-mentors, Drs. Jadcherla and Omari, are experts in neonatal swallow dysfunction and impedance-manometry; all are outstanding clinical researchers with deep commitment to mentorship. He will be supported by his Scholarship Advisory Committee consisting of Drs. Snapper, Nurko, Landrigan, and Stamoulis, who lend content-area expertise. His formal training includes advanced coursework in decision analysis at Harvard School of Public Health, personal instruction on esophageal motility and decision analysis, and professional development courses. His training and research activities will be conducted in the unparalleled academic environments of BCH and HMS, which are firmly committed to Dr. Duncan’s successful transition to independence.