Abstract: Publication date: Available online 11 August 2018Source: Academic PediatricsAuthor(s): Jenna E. Reno, Sean T. O'Leary, Jennifer Pyrzanowski, Steven Lockhart, Jacob Thomas, Amanda F. Dempsey ObjectiveTo evaluate the relative use, usefulness, and facilitators and barriers to use, as perceived by providers, of five different components in an HPV vaccine communication intervention—which was found to be effective at improving HPV vaccination rates.MethodsFour serial surveys of 108 providers (MD, NP, or PA) from intervention clinics involved in the study assessed use and usefulness of the 5 communication intervention components over a 12-month period.ResultsResponse rates were 79%-86%. The fact sheet (64%-77%) and motivational interviewing techniques (MI; 86%) were the most used components—use was sustained over the 12-month period. These components were also perceived as somewhat or very useful by most providers, and this perceived usefulness increased over time (very or somewhat useful at end of study, 97% fact sheet, 98% MI, respectively). Although fewer providers reported using the website (15%-42%), or disease images (6%-17%%), when these were used, most providers (67%-87%) felt they were somewhat or very useful. The decision aid was not used frequently (17%-41% of providers) and 43% of providers felt it was not very or not at all useful. Facilitators and barriers were identified for each component. The fact sheet and MI were perceived as the easiest to integrate into the clinic workflow.Conclusion(s)the fact sheet and MI were the most used and most useful intervention components, both were easy to integrate into clinic workflow, and their use was sustained over time. Dissemination of similar interventions in the future should focus on these two specific components.
Abstract: Publication date: Available online 11 August 2018Source: Academic PediatricsAuthor(s): Lindsay Johnston, Taylor Sawyer, Akira Nishisaki, Travis Whtifill, Anne Ades, Heather French, Kristen Glass, Rita Dadiz, Christie Bruno, Orly Levit, Sandeep Gangadharan, Daniel Scherzer, Ahmed Moussa, Marc Auerbach, INSPIRE Research NetworkABSTRACTBackground: Neonatal tracheal intubation (NTI) is an important clinical skill. Suboptimal performance is associated with patient harm. Simulation training can improve NTI performance. Improving performance requires an objective assessment of competency. Competency assessment tools need strong evidence of validity. We hypothesized that a NTI competency assessment tool with multi-source validity evidence could be developed, and could be used for formative and summative assessment during simulation-based training.Methods: A NTI assessment tool was developed based on a literature review. The tool was refined through two rounds of a modified Delphi process involving 12 subject matter experts. The final tool had a 22 item checklist, a global skills assessment (GSA), and an entrustable professional activity (EPA) level. The validity of the checklist was assessed by having four blinded reviewers score 23 videos of healthcare providers intubating a neonatal simulator.Results: The checklist items had good internal consistency (overall α 0.79). Checklist scores were higher for providers at higher training levels and more NTI experience. Checklist scores correlated with GSA (ρ=0.85; P < 0.05), EPA levels (ρ=0.87; P < 0.05), percent glottic exposure (r=0.59; P < 0.05), and Cormack-Lehane scores (ρ=0.95; P < 0.05). Checklist scores reliably predicted EPA levels.Conclusion: We developed a NTI competency assessment tool with multi-source validity evidence. The tool was able to discriminate NTI performance based on experience. The tool can be used during simulation-based NTI training to provide formative and summative assessment and can aid with entrustment decisions.
Abstract: Publication date: Available online 10 August 2018Source: Academic PediatricsAuthor(s): Elizabeth A. Gottschlich, Kandyce Larson, BlakeSisk, Mary Pat Frintner ObjectiveTo examine US pediatricians and US adults on three self-reported health measures (sleep, physical activity, and general health status), and to assess factors related to these measures for each group.MethodsPediatrician data were collected through a 2012 AAP Periodic Survey (response rate=64.0%). US population data originated from the 2012 National Health Interview Survey (response rate=61.2%). Analytic samples included those currently working and ≥30 years old; restricted to post-trainees (pediatricians; n=854) and those with at least a Bachelor's degree (US population; n=5,447). Accounting for sample demographic differences, predicted probabilities compared the proportions reporting ≥7 hours of sleep, meeting physical activity recommendations, and reporting very good/excellent health. Multivariable logistic regression examined characteristics associated with health measures for pediatricians and US adults separately.ResultsWhen the US population demographic profile was adjusted to resemble the pediatrician sample, 7 in 10 pediatricians (71.2%, CI=68.0%-74.5%) and US adults (69.9%, CI=67.8%-72.0%) reported ≥7 hours of sleep. Pediatricians were more likely than US adults to meet physical activity recommendations (71.4%, CI=68.0%-74.8% vs. 62.9%, CI=60.6%-65.2%), and less likely to report very good/excellent health (74.3%, CI=71.2%-77.3% vs. 80.2%, CI=78.3%-82.1%). In pediatrician and US population multivariable models, self-identified Asians and those working ≥50 hours were less likely to get ≥7 hours of sleep (p
Abstract: Publication date: Available online 9 August 2018Source: Academic PediatricsAuthor(s): Margie Danchin, Alisha Gulenc, Daryl Efron, Emma Sciberras, Christos Symeonides, Harriet HiscockABSTRACTObjective:Rising anxiety rates and equity of care are ongoing concerns. Through two pediatric practice audits conducted five years apart, we aimed to determine the change in (1) anxiety diagnoses; (2) associated comorbid diagnoses; (3) variance in management by location and (4) child, family and pediatrician predictors of management.Methods:Members of the Australian Paediatric Research Network (APRN) were invited to participate in patient-level prospective national pediatric practice audits in 2008 and 2013. Pediatricians were asked to complete standardized forms for 100 consecutive patients or all patients seen over two weeks, whichever was completed first. Demographic data, diagnoses, medications and referrals were collected. Logistic regressions were conducted, clustered at the pediatrician level.Results:Of eligible APRN pediatricians in 2013 and 2008, 48% and 66% participated and contributed 7102 and 8345 consultations, respectively. Anxiety diagnoses increased over the five-year period (4.4% to 7.6%; p
Abstract: Publication date: Available online 8 August 2018Source: Academic PediatricsAuthor(s): Sydney Hansen, Marlene Melzer-Lange, Melodee Nugent, Ke Yan, Angela Rabbitt
Abstract: Publication date: Available online 8 August 2018Source: Academic PediatricsAuthor(s): Catherine McClure, Maureen Cunningham, Sheana Bull, Stephen Berman, Mandy A. Allison : In this narrative review, we will present a brief overview of known disparities in children's language development based on socioeconomic status (SES) and efforts in the primary care setting to promote children's language development. Next, we will define mobile-health (m-health) and review the limited, published literature regarding the effectiveness of m-health interventions in promoting children's health, in general, and language development, in particular. Finally, we will discuss the potential role of smart phone applications to increase parental behaviors that promote their children's language development as well as challenges that should be addressed as the field of m-health continues to grow.
Abstract: Publication date: Available online 7 August 2018Source: Academic PediatricsAuthor(s): H. Shonna Yin, Carrie Vuong, Ruth M. Parker, Lee M. Sanders, Alan L. Mendelsohn, Benard P. Dreyer, Jessica J. Velazquez, Michael S. WolfWhat's NewThe NIH-funded SAFE Rx for Kids study has identified best practices for the labeling/dosing of pediatric liquid medications. Findings support use of pictographic instructions and optimized provision of dosing tools, along with careful selection of the unit of measurement used.
Abstract: Publication date: Available online 2 August 2018Source: Academic PediatricsAuthor(s): Arti D. Desai, Tamara D. Simon, JoAnna K. Leyenaar, Maria T. Britto, Rita Mangione-Smith
Abstract: Publication date: Available online 2 August 2018Source: Academic PediatricsAuthor(s): David R. Sandweiss, Lauren Allen, Mark Deneau, Janet Harnsberger, Amy Pasmann, Randall Smout, Michael Mundorff, Nanette Dudley Background and ObjectiveConstipation is commonly diagnosed in our pediatric ED. Care has varied significantly, with a heavy reliance on abdominal radiography (AR) for diagnosis and inpatient management for bowel cleanout. We implemented a standardized approach to caring for patients presenting to a pediatric ED with symptoms consistent with constipation, emphasizing clinical history, physical exam, less reliance on AR, and standardized home management.MethodsUsing QI methodology, a multidisciplinary group developed an ED constipation management pathway, encouraging less reliance on AR for diagnosis and promoting home management over inpatient bowel cleanout. The pathway included a home management “gift-basket” containing over-the-counter medications and educational materials to promote successful bowel cleanout. Outcome measures included pathway utilization, AR rate, ED cost and LOS, and ED admission rate for constipation.ResultsWithin 3 months, over 90% of patients discharge home with an ED disposition diagnosis of constipation left with standardized educational materials and home medications. Staff education and feedback, pathway and “gift-basket” changes, and a higher threshold for inpatient management led to significant drops in AR rate (73.3% to 24.6%, p
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Caroline R. Paul, Meg G. Keeley, Gregory S. Rebella, John G. Frohna ObjectiveTo evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients.MethodsThirty-three residents in an intervention group from 2 institutions received the curriculum. In the previous year, 21 residents in a nonintervention group did not receive the curriculum. Both groups were evaluated at the beginning and end of their internship years with the use of the same outcome assessments: 1) a written test, 2) an objective standardized clinical examination (OSCE), and 3) direct observation of skills in real patients with the use of a checklist with established validity.ResultsThe intervention group had a significant increase in percentage reaching minimum passing levels between the beginning and end of the internship year for the written test (12% vs 97%; P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Alison L. Miller, Ashley N. Gearhardt, Lauren Retzloff, Julie Sturza, Niko Kaciroti, Julie C. Lumeng ObjectiveTo identify whether psychosocial stress exposure during early childhood predicts subsequent increased eating in the absence of hunger (EAH), emotional overeating, food responsiveness, and enjoyment of food.MethodsThis was an observational longitudinal study. Among 207 low-income children (54.6% non-Hispanic white, 46.9% girls), early childhood stress exposure was measured by parent report and a stress exposure index calculated, with higher scores indicating more stress exposure. Eating behaviors were measured in early (mean, 4.3; standard deviation, 0.5 years) and middle (mean, 7.9; standard deviation, 0.7 years) childhood. Observed EAH was assessed by measuring kilocalories of palatable food the child consumed after a meal. Parents reported on child eating behaviors on the Child Eating Behavior Questionnaire. Child weight and height were measured and body mass index z score (BMIz) calculated. Multivariable linear regression, adjusting for child sex, race/ethnicity, and BMIz, was used to examine the association of stress exposure with rate of change per year in each child eating behavior.ResultsEarly childhood stress exposure predicted yearly increases in EAH (β = 0.14; 95% confidence interval, 0.002, 0.27) and Emotional Overeating (β = 0.14; 95% confidence interval, 0.008, 0.27). Stress exposure was not associated with Food Responsiveness (trend for decreased Enjoyment of Food; β = −0.13; 95% confidence interval, 0.002, −0.26). All child obesogenic eating behaviors increased with age (P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Valerie Flaherman, Eric W. Schaefer, Michael W. Kuzniewicz, Sherian X. Li, Eileen M. Walsh, Ian M. Paul ObjectiveGuidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated with neonatal health care utilization.MethodsA retrospective cohort study conducted at Northern California Kaiser Permanente hospitals in 2009–2013 assessed 143,889 neonates to study the inpatient method of feeding as well as inpatient and outpatient weights. The main outcome measures were inpatient and outpatient health care utilization in the 30 days after birth.ResultsNewborn weight loss and feeding method were both associated with utilization. Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Kimberly C. Arthur, Rita Mangione-Smith, Q Burkhart, Layla Parast, Hangsheng Liu, Marc N. Elliott, Elizabeth A. McGlynn, Eric C. Schneider ObjectiveTo examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination.MethodsWe measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. For a subset of 186 of these CMC a caregiver survey was used to measure care coordination quality (using items adapted from the Consumer Assessment of Healthcare Providers and System Adult Health Plan Survey) and family impact (using items adapted from the National Survey of Children with Special Health Care Needs). Multivariable regression was used to examine the relationship between continuity, entered as a continuous variable ranging from 0 to 1, and the outcomes.ResultsThe median continuity was 0.27 (interquartile range [IQR], 0.12–0.48) in the administrative data cohort and 0.27 (IQR, 0.14–0.43) in the survey cohort. Compared with children with a continuity score of 0, children with a score of 1 had lower odds of having ≥1 ED visit (odds ratio, 0.65; 95% confidence interval [CI], 0.46–0.93; P = .017) and their caregivers reported higher scores for the measure of receipt of care coordination (β = 35.2 on a 0–100 scale; 95% CI, 11.5–58.9; P = .004). There was no association between continuity and family impact.ConclusionsContinuity of care holds promise as a quality measure for CMC because of its association with lower ED utilization and more frequent receipt of care coordination.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Laura J. Chavez, Connor Grannis, Millie Dolce, Deena J. Chisolm BackgroundCaring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care–related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL).MethodsThe study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0–100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation.ResultsAmong 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31–77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92–67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales.ConclusionsTeen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Sanne Verkooijen, Nelleke de Vos, Betty J.W. Bakker-Camu, Susan J.T. Branje, René S. Kahn, Roel A. Ophoff, Carolien M. Plevier, Marco P.M. Boks ObjectiveTo investigate the prevalence of adolescent sleep disturbances and their relation to psychosocial difficulties and health risk behaviors with the use of data from a province-wide health survey (n = 16,781).MethodsPsychosocial difficulties were measured with the Strength and Difficulties Questionnaire. Additional assessments included self-reported sleep disturbances, suicidality, and health risk behaviors including current use of tobacco, alcohol, and drugs, physical inactivity, and compulsive use of multimedia. We used multilevel analyses to investigate the relationhips, including differences, between boys and girls, as well as the mediating role of emotional problems.ResultsJust under 20% of adolescents reported sleep disturbances in the previous month. These sleep disturbances were associated with psychosocial problems (odds ratio [OR], 6.42; P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Megan L. Ranney, Julie Bromberg, Alyssa Hozey, T. Charles Casper, Michael J. Mello, Anthony Spirito, Thomas H. Chun, James G. Linakis, Pediatric Emergency Care Applied Research Network BackgroundProblem behaviors, such as substance use and peer aggression, frequently coexist and are common among youth seen in emergency departments (EDs). EDs are increasingly urged to screen for both psychological distress and problem behaviors.ObjectiveTo inform screening and intervention efforts, we aimed to identify classes of problematic substance use and peer aggression in a sample of adolescents from 16 pediatric EDs, and to examine the relative prevalence of psychological distress in identified classes.MethodsWe completed a cross-sectional survey of youth (n = 5001) presenting for any reason to 16 pediatric EDs across the United States, with the use of validated measures of demographics, alcohol and substance use, and peer aggression. We used standard latent class analysis techniques to create behavioral risk classes of adolescents based on violence and substance use variables; then we conducted logistic regression to examine the relationship between psychological distress and the latent classes.ResultsThree classes of problem behaviors were identified: low-risk (few problem behaviors, 91.2% of sample), medium risk (high cigarette smoking; moderate violence, alcohol/substance use; 5.2%), and high risk (high levels of all problem behaviors, 3.5%). A significant directional association (P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Kai A. Jones, Stephanie Do, Lorena Porras-Javier, Sandra Contreras, Paul J. Chung, Tumaini R. Coker BackgroundIn a community-academic partnership, we implemented a group-based model for well-child care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC).MethodsThe FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age < 31 days) and again at a 6-month follow-up survey. Main outcomes were feasibility and acceptability of CenteringParenting; we also collected exploratory measures (parent experiences of care, utilization, self-efficacy, and social support).ResultsOf the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or “other” race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants’ mean scores on exploratory measures demonstrated positive experiences of care, overall satisfaction of care, confidence in parenting, and parental social support.ConclusionsA community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Amy Ladley, Amanda Waltos Hieger, Joshua Arthur, Matthew Broom ObjectiveTo determine the feasibility and effectiveness of text messages as an educational tool to reduce the prevalence of nonurgent emergency department (ED) visits among a population with high levels of low health literacy.MethodsThis prospective, randomized experiment conducted in a large, urban, academic pediatric primary care practice enrolled 231 caregivers of infants into 2 groups: enhanced standard of care materials at well-child visits through 6 months (n = 99 completing), and enhanced standard of care and 4 text messages a week through 6 months (n = 108 completing). Use of the ED and visit urgency were compared between groups via chart review at 1 year of age.ResultsOf the 230 included in the analysis, 84.2% (n = 194 of 230) were racial or ethnic minorities, 69.7% (n = 142 of 204) reported yearly incomes of less than $20,000 per year, and 70.4% (n = 142 of 204) were identified as having likely or probable limited health literacy. Participants who received text messages had fewer visits to the ED in their first year (2.14 visits in the control group to 1.47 visits in the intervention group who received text messages; P
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Maya I. Ragavan, Wendy Li, A. Rani Elwy, John D. Cowden, Megan Bair-Merritt ObjectivesWell-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience.MethodsQualitative interviews were conducted with Chinese, Vietnamese, and Asian Indian immigrant parents. Participants were recruited from community-based organizations in the Boston area. Interviews focused on parents' perceptions about well-child visits, including individual attitudes, social and cultural factors affecting their opinions, perceived behavioral control, and improving visits for Asian immigrant families. Data were coded and analyzed using thematic analysis.ResultsFifty-one parents participated. Although participants reported attending well-child visits, they thought language barriers and unfamiliarity with US preventive health care may limit attendance for other Asian immigrant families. Some reported high-quality visits, while others described them as “too simple,” recollecting health care experiences from their countries of origin where more tests were completed. Participants described seeking advice about their children's preventive care from elder family members. Many expressed the importance of culturally concordant health care providers and culturally sensitive care, while others thought that culture was less relevant. Differences emerged among the 3 subgroups around culturally concordant care and traditional medicine.ConclusionsQuerying parents about their past health care experiences and providing information about well-child visits may be useful when caring for immigrant families. Social influences on children's health outside of the parent–provider–child triad may also be important. Further work should explore how to deliver culturally sensitive care that considers not only a family's language preferences but also their unique cultural identity.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Keeley J. Pratt, Joseph A. Skelton Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Brandi K. Freeman, Tumaini R. CokerAbstractIn the United States, well-child care has the goal of providing comprehensive care to children by addressing developmental, behavioral, psychosocial, and health issues through visits at recommended intervals. The preventive care needs of families can outpace the capacity of clinics and practices to provide it, necessitating a redesign of our well-child care system that aligns the structure of preventive care delivery with the needs of families. Here we focus on 6 questions (the what, when, who, why, how, and where) for well-child care redesign for infants and young children. By addressing these key questions and providing recommendations for advancing well-child care redesign in the clinical and research arenas, we hope to accelerate the process of well-child care redesign. In the current political and socioeconomic environment, continuing with well-child care “as usual” will mean that many families will find that their well-child care visits do not fully address the most pressing needs impacting children's health and well-being. It is time to implement and sustain real change in our system for preventive care.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Jennifer Benjamin, Judith Groner, Jennifer Walton, Garey Noritz, Gregg M. Gascon, John D. MahanWhat's NewDespite increasing numbers of patients with neurodisability, residents lack training to develop physical examination skills. Following a blended educational intervention combining online and bedside teaching, residents demonstrated desired patient-care behaviors on standardized clinical exam assessment.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Cara Lichtenstein, Desiree de la Torre, Olanrewaju Falusi, Alexandra Sims, Yael Smiley, Melissa BaiyewuWhat's NewA community bus tour with a focus on social determinants of health created through a partnership between the pediatric residency program and the hospital's Child Health Advocacy Institute was shown to increase knowledge of health disparities among pediatric interns.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Margot A. Lazow, Francis J. Real, Nicholas J. Ollberding, David Davis, Bradley Cruse, Melissa D. KleinWhat's New'Using innovative technology to teach about social determinants of health might address current training barriers related to standardization, sustainability, and scalability. A virtual tour of an impoverished neighborhood that used 360° videos was noninferior to the previous in-person experience.
Abstract: Publication date: August 2018Source: Academic Pediatrics, Volume 18, Issue 6Author(s): Jennifer Watts, Christiana Russ, Nicole E. St Clair, Omolara Thomas Uwemedimo ObjectiveThe number of pediatric Global Health (GH) tracks has more than doubled in less than 10 years. The goal of this study was to describe the characteristics of the pediatric GH tracks to identify commonalities and differences in track structure, funding, and education. In addition, we also identified demographic, institutional, and residency-related factors that were significantly associated with educational offerings and logistical challenges.MethodsA cross-sectional survey was electronically administered to pediatric residency programs with GH tracks. Statistical analyses included frequencies to describe GH track characteristics. Fisher's exact tests were used to identify bivariate associations between track structure and funding with educational offerings and logistical challenges.ResultsLeaders of 32 pediatric GH tracks (67%) completed the survey. The majority of GH tracks were completed within the 3 years of residency (94%) and identified a GH track director (100%); however, tracks varied in size, enrollment methods, domestic and international partnerships, funding, and evaluations. Dedicated faculty time and GH track budget amounts were associated with more robust infrastructure pertaining to resident international electives, including funding and mentorship. Many tracks did not meet American Academy of Pediatrics recommended standards for clinical international rotations.ConclusionsDespite the presence of multiple similarities among pediatric GH tracks, there are large variations in track structure, education, and funding. The results from this study support the proposal of a formal definition and minimum standards for a GH track, which may provide a framework for quality, consistency, and comparison of GH tracks.
Abstract: Publication date: Available online 26 July 2018Source: Academic PediatricsAuthor(s): Sara L. Toomey, Marc N. Elliott, Alan M. Zaslavsky, Jessica Quinn, David J. Klein, Stephanie Wagner, Cassandra Thomson, Melody Wu, Sarah Onorato, Mark A. SchusterABSTRACTBackgroundMost US hospitals conduct patient experience surveys by mail or telephone after discharge to assess patient/family-centeredness of care. Pediatric response rates are usually very low, especially for black, Latino, and low-income respondents. We investigated whether day of discharge surveying using tablets improves response rates and respondent representativeness.MethodsQuasi-experimental study of parents of patients discharged from four units of a children's hospital. Parents were assigned to receive Child HCAHPS via an audio-enabled tablet before discharge or via mail ∼1 week post-discharge. Intervention and control conditions alternated by week. We compared response rates, child/respondent characteristics, and mean top-box scores between Tablet and Mail Only arms.ResultsAdministering Child HCAHPS on a tablet was administratively feasible and did not interfere with the discharge process (median completion time 12.4 minutes). Tablet response rate was 71.1% (424/596), vs. 16.3% (96/588) for Mail Only. Although Tablet response rates were higher in every subgroup, Tablet respondents were more likely to be fathers (20.4% vs. 6.4%, p=.006) and have ≤high school education (17.5% vs. 8.4%, p=.002); patients were were less likely to be white (56.8% vs. 71.9%, p=.006) and more likely to be publicly-insured (31.4% vs. 19.8%, p=.02). Tablet scores were significantly higher than Mail Only scores for 3 of 17 measures.ConclusionsThe response rate for day-of-discharge tablet survey administration was>four times higher than with single-wave mail-only administration, with greater participation of hard-to-reach groups. These findings suggest tablet administration before discharge shows great promise for real-time feedback and QI and may transform the field of inpatient survey administration.
Abstract: Publication date: Available online 26 July 2018Source: Academic PediatricsAuthor(s): Andres Jimenez-Gomez, Michael R. FitzGerald, Carmen Leon-Astudillo, Javier Gonzalez-del-Rey, Charles J. Schubert PurposeInternational Medical Graduates (IMGs) constitute around 25% of the US pediatric workforce. Their recruitment into US residency training yields concerns regarding their competence, though this has not been formally studied. Cincinnati Children's Hospital has systematically recruited IMGs over 16 years. This study evaluates perceptions of IMG performance by faculty and US-graduate (USG) peers.Methods Authors surveyed IMG, USG and faculty groups including current and former trainees, assessing perceived IMG performance compared to USGs in clinical knowledge/skills, resource utilization, communication, public health knowledge and efficiency, and overall impact on the program.ResultsOverall perceived performance was within one standard deviation of expected USG performance. IMGs outperformed USGs in clinical knowledge/skills and resource utilization, underperforming in communication, public health knowledge and efficiency. Significant differences were noted in communication with patients and public health knowledge (IMGs ranked their performance significantly lower than USGs/Faculty ranked their performance). Overall impact was perceived positively, including an increased interest in global health in among USGs.ConclusionCarefully recruited IMGs are perceived to perform near equally to USG peers and their presence is perceived as positive to a major pediatric residency program. Specific domains for educational interventions are identified for programs wishing to expand IMG recruitment.
Abstract: Publication date: Available online 24 July 2018Source: Academic PediatricsAuthor(s): Ann M Neumeyer, Julia Anixt, James Chan, James Perrin, Donna Murray, Daniel L Coury, Amanda Bennett, Justin Farmer, Robert A Parker BackgroundChildren with autism spectrum disorders (ASD) have high prevalence of co-occurring medical conditions including speech, sleep, and gastrointestinal disorders (constipation and feeding difficulties), developmental delay, attention deficit/hyperactivity disorder, hypotonia, epilepsy, anxiety, disruptive behavior, pica, and eczema. Less is known about whether these commonly co-exist in the same children. We sought to determine clinically meaningful, statistically significant associations among co-occurring medical conditions in children with ASD that could lead to better identification, treatment or understanding of the disease process.MethodsWe studied 2114 children with ASD ages 17 months to 5 years and 1221 children 6-17 years at 15 Autism Speaks-Autism Treatment Network Registry sites. Clinician-reported diagnoses and problems were grouped into 12 core conditions. We determined observed prevalence (O) of co-occurring conditions and estimated expected prevalence (E) across the network, adjusting for site variability in the prevalence of individual conditions. P-values were calculated using a Cochran-Mantel-Haenszel test stratified by site. We identified pairs of conditions co-occurring more frequently than expected (O/E> 1) and less frequently than expected (O/E < 1) and highlighted statistically significant differences.ResultsAmong the 66 condition pairs for each age group, we confirmed previously identified associations such as sleep disorders and anxiety symptoms in older children. We found associations not previously described: feeding with sleep disorders (younger children only), constipation with sleep disorders, feeding with speech disorders, and constipation with speech disorders.ConclusionsWe identified new associations among co-occurring medical conditions in children with ASD, offering the potential to examine common pathways.
Abstract: Publication date: Available online 23 July 2018Source: Academic PediatricsAuthor(s): Colleen K. Gutman, Liliana Cousins, Jesse Gritton, Eileen J. Klein, Julie C. Brown, Jack Scannell, K. Casey Lion ObjectiveFamilies with limited English proficiency (LEP) experience communication barriers and are at risk for adverse events after discharge from the pediatric emergency department (ED). We sought to describe the characteristics of ED discharge communication for LEP families and to assess whether professional interpreter use was associated with provider communication quality during ED discharge.MethodsTranscripts of video-recorded ED visits for Spanish-speaking LEP families were obtained from a larger study comparing professional interpretation modalities in a freestanding children's hospital. Caregiver-provider communication interactions that included discharge education were analyzed for content and for the techniques providers used to assess caregiver comprehension. Regression analysis was used to assess for an association between professional interpreter use and discharge education content or assessment of caregiver comprehension.ResultsWe analyzed 101 discharge communication interactions from 47 LEP patient visits; 31% of communications did not use professional interpretation. Although most patients (70%) received complete discharge education content, only 65% received instructions on medication dosing and only 55% were given return precautions. Thirteen percent of patient visits included an open-ended question to assess caregiver comprehension and none included teach-back. Professional interpreter use was associated with greater odds of complete discharge education content (OR 7.1, 95% CI 1.4-37.0) and high-quality provider assessment of caregiver comprehension (OR 6.1, 95% CI 2.3-15.9).ConclusionsProfessional interpreter use is associated with superior provider discharge communication behaviors. This study identifies clear areas for improving discharge communication, which may improve safety and outcomes for LEP children discharged from the ED.
Abstract: Publication date: Available online 21 July 2018Source: Academic PediatricsAuthor(s): Michelle J. White, H. Shonna Yin, Russell L. Rothman, Lee M. Sanders, Alan Delamater, Kori Flower, Eliana M. Perrin ObjectivesTime spent commuting is associated with obesity. The objective of this study was to assess the relationship between neighborhood-level commute to work (CTW) times and self-reported health behaviors and food access.MethodsWe conducted a cross-sectional analysis of caregivers with infants as part of the Greenlight study, a multisite obesity trial in Chapel Hill, NC; New York, New York; Nashville, TN and Miami, FL. Zip-code based commute estimates were determined using the U.S. Census’ American Community Survey. Self-reported health behavior and food access data were collected via directed interview. Logistic and linear regression models determined associations between neighborhood CTW times and health behaviors and food access.ResultsThe average neighborhood CTW time for all zip codes was 29 mins (N=846). Caregivers in longer CTW time neighborhoods were more likely to endorse fewer food choices (AOR=1.39; 95% CI 1.15,1.69; p=0.001) and difficulty accessing markets with fresh produce (AOR=1.51; 95% CI 1.02, 2.25; p=0.04). Neighborhood CTW time>30 mins were associated with less caregiver physical activity (AOR=0.58; 95% CI 0.34, 0.98; p=0.044). Neighborhood CTW time was inversely related to infant television time (adjusted mean 399 min/day for ≤30min; 256min/day for>30 minutes; p=0.025). New York families in longer CTW neighborhoods were more likely to report difficulty accessing markets with fresh produce (AOR= 1.80, 95% CI 1.03, 3.14; p=0.039).ConclusionsNeighborhood CTW times are associated with several self-reported health behaviors and perceived food access among caregivers with children. Neighborhood CTW times may represent city-specific features including transportation infrastructure which may impact the health of families.
Abstract: Publication date: Available online 11 July 2018Source: Academic PediatricsAuthor(s): Cristina R. Fernández, Maiko Yomogida, Yumiko Aratani, Diana HernándezABSTRACTObjectiveTo examine dual food and energy hardship and internalizing and externalizing behavior problems in 9 year-old children.MethodsWe conducted a cross-sectional analysis of the Fragile Families and Child Wellbeing Study, a prospective national urban birth cohort, when the children were 9 years-old. Maternal reported “food hardship” (ever hungry and/or ever received free food) and “energy hardship” (ever unable to pay utility bill and/or utility shut-off) within the past year, and child behavior using the Child Behavior Checklist/6-18 years were assessed. Multiple logistic regression analyses estimated associations between individual and dual food and energy hardship and child behavior problems, adjusting for a priori covariates (child sex, health insurance, maternal sociodemographic characteristics, poverty, reported health, attention deficit hyperactivity disorder, depressive symptoms, smoking, and substance and alcohol abuse).ResultsApproximately 10% of households reported dual food and energy hardship. Children experiencing dual food and energy hardship had 3 times greater odds of withdrawn/depressed behaviors (adjusted odds ratio [AOR]=2.8, 95% CI:1.4-5.5), 3 times greater odds of somatic complaints (AOR=3.2, 95% CI:1.5-6.9), and 4 times greater odds of rule breaking behavior (AOR=3.7, 95% CI:1.5-9.2) in the borderline/clinical range compared to children with no hardship, and had 4 times greater odds of borderline/clinical range somatic complaints (AOR=4.2, 95% CI: 1.7-10.3) compared to children with only energy hardship.ConclusionsChildren experiencing dual food and energy hardship have greater odds of coexisting internalizing and externalizing behaviors after controlling for possible confounders. Providers can consider screening and resource referrals for these addressable hardships alongside behavior assessments in the clinical setting.
Abstract: Publication date: Available online 6 July 2018Source: Academic PediatricsAuthor(s): Jane M. Garbutt, Katharine Kulka, Sherry Dodd, Randall Sterkel, Kathryn PlaxABSTRACTObjectiveThe most common source for misused opioids is pain relievers prescribed for family and friends. Our objective was to assess knowledge, attitudes and behaviors of adolescents’ caregivers regarding prescribed opioids in the home.MethodsThe self-administered survey was completed by caregivers in the waiting rooms of 12 pediatric practices in the mid-west. Eligibility required living in a home where youth ≥10 years old were frequently present. 700 of 793 (88.3%) eligible caregivers completed the survey, and 76.8% were the parent.ResultsOf 700 caregivers, 34.6% reported opioids in their home (13.6% active prescription, 12.7% leftover medications, 8.3% both). Of those with an active prescription, 66.0% intended to keep any leftover medications for future need (for the patient 60.1%, someone else 5.9 %). Of those with leftover medications, 60.5% retained them for the same reason (for the patient 51.0%, someone else, 9.5%). Others kept medications unintentionally: they never got around to disposing of them (30.6%), did not know how (15.7%), or it never occurred to them (7.5%). Many caregivers were unaware that adolescents commonly misuse opioids (30.0%), use them to attempt suicide (52.3%), and that opioid use can lead to heroin addiction (38.6%). 7.1% would give leftover opioid medications to an adolescent to manage pain and 5.9% may do so.ConclusionOpioids are prevalent in homes in our community and many parents are unaware of the risks they pose. Study findings can inform strategies to educate parents about opioid risk and encourage and facilitate timely, safe disposal of unused medications.
Abstract: Publication date: Available online 5 July 2018Source: Academic PediatricsAuthor(s): Dominick DeBlasio, Francis J. Real, Nicholas J. Ollberding, Melissa D. Klein ObjectiveTo determine the impact of a curriculum which included parent feedback on resident communication skills.MethodsIn a prospective, controlled study, categorical pediatric residents in continuity clinic were divided into control and intervention groups based on clinic day. Parent feedback was obtained for all residents at the beginning and end of the year using the Communication Assessment Tool (CAT), a validated survey to assess physician communication. Intervention residents participated in learning conferences which reviewed communication best practices and received parental feedback via individual and group CAT scores. Scores were dichotomized as 5 (excellent) versus 1-4 (less than excellent) and reported as percentage of items rated excellent. Curriculum impact was assessed by comparing score changes between groups. Residents’ scores in both arms were combined to assess changes from year beginning to end. Statistical testing was performed using generalized linear mixed effects models.ResultsAll residents (n=68) participated. Intervention (n=38) and control (n=30) residents received at least 10 CATs at the beginning and end of the year. The percentage of parents rating all items as excellent increased by similar percentages in intervention and control groups (60.9% to 73.8% vs. 61.1% to 69.8; p=0.38). When scores of residents in both arms were combined, improvement was found from the beginning to end of the year for all CAT items (p
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Rebecca Wallihan, John Mahan, Suzanne Reed, Claire Stewart, Mary Kay Kuzma, Alex Rakowsky
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Lorraine E. Canham, Molly H. Silber, Leah S. Millstein, Jason W. Custer, Susan Feigelman, Ronald San Juan, Erin L. Giudice
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Markita L. Suttle, Margaret Chase, Melissa Moore-Clingenpeel, Tensing Maa, Donald Boyer, William Sasser, Jason Werner, Karen Marcdante, Meredith Bone, Katherine Mason, Megan McCabe, Felice Su, Richard Mink, David Turner
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Lisa E. Herrmann, Michael Tchou, Allison Parsons, Naveen Muthu, Rebecca Tenney-Sorreo, Evan Fieldston, Brad Lindell, Adam Dziorny, Maya Dewan
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Katherine A. Jordan, Laura Cannon, Mark W. Chandler, Kenya McNeal-Trice
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Elizabeth S. Sandberg, Steven Weinberg, Zachary Smith, Emily Vander Schaaf, Sue Tolleson-Rinehart
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Audrea M. Burns, Satid Thammasitboon, Teri L. Turner, Mark A. Ward, Jordan S. Orange
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Michael B. Spewak, Carolynn L. Price, Laura K. Eder, Sharon M. Unti
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Ross E. Myers, Keith Ponitz, Meghan Treitz, Katherine Mason
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Lauren E. Veit, Janice L. Liebhart, Jennifer C. Kesselheim
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Erika L. Abramson, Michelle D. Stevenson, Monique Naifeh, Elizabeth Mauer, Linda Gerber, Su-Ting Li
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Joshua T. Williams, Laura Zastoupil, Melisa Tanverdi, Leonard B. Seltz
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Kimberly A. Gifford, Daniel J. Schumacher, Suzanne Reed, Ann Burke, Laura Zastoupil, Lynn Thoreson, John Mahan, Tai Lockspeiser
Abstract: Publication date: July 2018Source: Academic Pediatrics, Volume 18, Issue 5Author(s): Lindsay F. Schwartz, Clarence Braddock, Roy L. Kao, Myung-Shin Sim, Jacqueline N. Casillas
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