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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 380, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 238, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 139, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 371, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 338, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 433, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 172, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 177, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover Academic Pediatrics
  [SJR: 1.402]   [H-I: 51]   [26 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1876-2859
   Published by Elsevier Homepage  [3123 journals]
  • In Search of an Answer
    • Authors: Richard Mario Lurshay
      Pages: 1 - 2
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Richard Mario Lurshay

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.09.008
  • Shared Decision-Making with Parents of Acutely Ill Children: A
           Narrative Review
    • Authors: Paul L. Aronson; Eugene D. Shapiro; Linda M. Niccolai; Liana Fraenkel
      Pages: 3 - 7
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Paul L. Aronson, Eugene D. Shapiro, Linda M. Niccolai, Liana Fraenkel
      Background Shared decision-making (SDM) has mostly been used with adults and parents in the primary care setting, and there is limited knowledge on the use of SDM with parents of acutely ill children. The objective of this study was to review the literature on SDM with parents in the management of acutely ill children. Methods We searched MEDLINE, SCOPUS, PsycINFO, the Cochrane Library, and for English language studies published from the time of database inception to February, 2017. Study eligibility criterion was use of SDM with parents for children aged 18 years or younger with an acute medical problem. Results We identified 2 ongoing clinical trials and 10 published studies that met inclusion criteria: 2 using hypothetical SDM scenarios, 1 mixed methods study, and 7 intervention studies. Only 1 study compared an SDM intervention with usual care in a randomized controlled trial. The limited literature shows that parents of acutely ill children have differing preferences for testing and/or treatment, and that they generally want the opportunity to express those preferences through an SDM process. Use of SDM often results in acutely ill children undergoing fewer and/or less intensive testing or treatment, although the effect on outcomes is unclear. Conclusions Parents welcome participation in SDM for management decisions with their acutely ill child. Further investigation is needed to determine how best to implement SDM with parents of acutely ill children and to assess the effect of SDM on outcomes.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.06.009
  • Herbal Medicine in Children With Respiratory Tract Infection: Systematic
           Review and Meta-Analysis
    • Authors: Dennis Anheyer; Holger Cramer; Romy Lauche; Felix Joyonto Saha; Gustav Dobos
      Pages: 8 - 19
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Dennis Anheyer, Holger Cramer, Romy Lauche, Felix Joyonto Saha, Gustav Dobos
      Background Herbal medicines are particularly regarded as an alternative or complement to conventional pharmaceuticals in the treatment and prevention of respiratory tract infections (RTIs). Therefore, the purpose of this review was to identify evidence for herbal therapy in the treatment of RTIs concerning effectiveness and safety. Methods Medline/PubMed, Scopus, and the Cochrane Library were searched through February 12, 2015. Randomized controlled trials that compared herbal therapy with no treatment, placebo, or any pharmaceutical medication in children and adolescents (age 0 to 18 years) with RTI were eligible. Results Eleven trials with 2181 participants were included. No clear evidence for Echinacea (4 trials) or an herbal compound preparation (1 trial) in preventing RTI symptoms was found. Meta-analysis revealed evidence for efficacy (responder rates: risk ratio [RR], 2.56; 95% confidence interval [CI], 1.54–4.26; P < .01; heterogeneity: I 2 = 38%; chi-square = 9.63; P = .14) and safety (patients with adverse events: RR, 1.06; 95% CI, 0.42–2.66; P = .9; heterogeneity: I 2 = 72%; chi-square = 10.64; P = .01) of Pelargonium sidoides in treating RTI symptoms compared with placebo (6 trials). Conclusions Because of conflicting evidence in the included studies no concrete conclusion on effects of Echinacea could be drawn so far. In the case of Pelargonium sidoides, meta-analysis revealed moderate evidence for efficacy and safety in the treatment of RTIs in children.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.06.006
  • Experiences in Care According to Parental Citizenship and Language Use
           Among Latino Children in California
    • Authors: Alexander N. Ortega; Ryan M. McKenna; Brent A. Langellier; Héctor E. Alcalá; Dylan H. Roby
      Pages: 20 - 25
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Alexander N. Ortega, Ryan M. McKenna, Brent A. Langellier, Héctor E. Alcalá, Dylan H. Roby
      Objective To assess differences in health care access, utilization, and experiences among Latino children in California according to parental citizenship status and language use. Methods Data are from the 2011 and 2012 California Health Interview Survey public use child files. A total of 2841 interviews of parents of Latino children younger than the age of 12 years were conducted. Analyses were conducted to determine the associations between access (usual of source of care, delay in receiving needed care, health insurance), utilization (physician visits in past year, emergency department visits), and experiences (doctor listens, doctor explains instructions clearly, communication via telephone or e-mail) according to parental citizenship status and household language use after adjusting for confounders. Results In multivariate analyses, there were no significant differences in access to care according to parental citizenship status. Children with 2 noncitizen parents had fewer doctor visits and were less likely to go to the emergency department in the past year than those with 2 citizen parents. Among children with 1 or 2 noncitizen parents, their parents reported worse experiences in care than those with 2 citizen parents. Similar results were observed for language use. Parents of children in bilingual and Spanish-only households were less likely to report that their children's doctors explained things clearly, and parents in Spanish-only households were less likely to communicate via telephone or e-mail than those in English-only households. Conclusions Health policy should focus on provider-parent communication to ensure health care equity for Latino children whose parents are not citizens or do not speak English.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2016.12.017
  • Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of
           Health Literacy and Experience
    • Authors: Alejandro Torres; Ruth M. Parker; Lee M. Sanders; Michael S. Wolf; Stacy Cooper Bailey; Deesha A. Patel; Jessica J. Jimenez; Kwang-Youn A. Kim; Benard P. Dreyer; Alan L. Mendelsohn; H. Shonna Yin
      Pages: 26 - 34
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Alejandro Torres, Ruth M. Parker, Lee M. Sanders, Michael S. Wolf, Stacy Cooper Bailey, Deesha A. Patel, Jessica J. Jimenez, Kwang-Youn A. Kim, Benard P. Dreyer, Alan L. Mendelsohn, H. Shonna Yin
      Background and Objectives A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience. Methods Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only [“mL”], milliliter/teaspoon [“mL”/“tsp”]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0–1], marginal [2–3], adequate [4–6]). The mediating variable was prior milliliter-dosing experience. Results Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3–6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8–40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5–20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy. Conclusions Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.04.001
  • Insurance Coverage and Well-Child Visits Improved for Youth Under the
           Affordable Care Act, but Latino Youth Still Lag Behind
    • Authors: Alexander N. Ortega; Ryan M. McKenna; Jie Chen; Héctor E. Alcalá; Brent A. Langellier; Dylan H. Roby
      Pages: 35 - 42
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Alexander N. Ortega, Ryan M. McKenna, Jie Chen, Héctor E. Alcalá, Brent A. Langellier, Dylan H. Roby
      Objective To examine whether there have been changes in insurance coverage and health care utilization for youth before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) and to assess whether racial and ethnic inequities have improved. Methods Data are from 64,565 youth (ages 0–17 years) participants in the 2011 to 2015 National Health Interview Survey. We conducted multivariate logistic regression analyses to determine how the period after national implementation of the ACA (years 2011–2013 vs years 2014–2015) was associated with health insurance coverage and utilization of health care services (well-child visits, having visited an emergency department, and having visited a physician, all in the past 12 months), and whether changes over the pre- and post-ACA periods varied according to race and Latino ethnicity. Results The post-ACA period was associated with improvements in insurance coverage and well-child visits for all youth. Latino youth had the largest absolute gain in insurance coverage; however, they continued to have the highest proportion of uninsurance post national ACA implementation. With regard to health care equity, non-Latino black youth were less likely to be uninsured and Latino youth had no significant improvements in insurance coverage relative to non-Latino white youth after national ACA implementation. Inequities in health care utilization for non-Latino black and Latino youth relative to non-Latino white youth did not improve. Conclusions Insurance coverage and well-child visits have significantly improved for all youth since passage of the ACA, but inequities persist, especially for Latino youth.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.07.006
  • Evaluation of an Electronic Clinical Decision Support Tool for Incident
           Elevated BP in Adolescents
    • Authors: Elyse Olshen Kharbanda; Stephen E. Asche; Alan Sinaiko; James D. Nordin; Heidi L. Ekstrom; Patricia Fontaine; Steven P. Dehmer; Nancy E. Sherwood; Patrick J. O'Connor
      Pages: 43 - 50
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Elyse Olshen Kharbanda, Stephen E. Asche, Alan Sinaiko, James D. Nordin, Heidi L. Ekstrom, Patricia Fontaine, Steven P. Dehmer, Nancy E. Sherwood, Patrick J. O'Connor
      Objective To evaluate, among adolescents 10 to 17 years of age with an incident hypertensive blood pressure (BP; ≥95th percentile) at a primary care visit, whether TeenBP, a novel electronic health record-linked clinical decision support tool (CDS), improved recognition of elevated BP, and return for follow-up BP evaluation. Methods We conducted a pragmatic cluster randomized trial in 20 primary care clinics in a large Midwestern medical group. Ten clinics received the TeenBP CDS, including an alert to remeasure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1 to 3 weeks, and patient-specific order sets. In the 10 usual care (UC) clinics, elevated BPs were displayed in red font in the electronic health record. For comparisons between CDS and UC we used generalized linear mixed models. Results The study population included 607 CDS patients and 607 UC patients with an incident hypertensive BP. In adjusted analyses, at the index visit, CDS patients were more likely to have their hypertensive BP on the basis of ≥2 BP measurements (47.1% vs 27.6%; P = .007) and to have elevated BP (International Classification of Diseases, Ninth Revision code 796.2) diagnosed (28.2% vs 4.2%; P < .001). In a multivariate model adjusted for age, sex, systolic BP percentile, and visit type, rates for repeat BP measurement within 30 days were 14.3% at TeenBP CDS clinics versus 10.6% at UC clinics (P = .07). Conclusions The TeenBP CDS intervention significantly increased repeat BP measurement at the index visit and recognition of a hypertensive BP. Rates for follow-up BP measurement at 30 days were low and did not differ between TeenBP and UC subjects.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.07.004
  • Weight Status and Weight Perception in Relation to Mental Distress and
           Psychosocial Protective Factors Among Adolescents
    • Authors: Mary J. Christoph; Elizabeth S. Jarrett; Amy L. Gower; Iris W. Borowsky
      Pages: 51 - 58
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Mary J. Christoph, Elizabeth S. Jarrett, Amy L. Gower, Iris W. Borowsky
      Objective To measure how weight status and weight perception relate to mental distress and psychosocial protective factors in adolescents. Methods Adolescents in 8th, 9th, and 11th grade participating in the 2013 Minnesota Student Survey (N = 122,180) were classified on the basis of weight perception (overweight or not overweight) and weight status (not overweight, overweight, obese). Bivariate tests were used to assess the relationship of weight status and weight perception with internal mental distress, and generalized linear models were used to measure the association between weight status and weight perception with psychosocial protective factors including parent, school, and friend connectedness, social competency, and positive identity. Logistic regressions measured the relationship between psychosocial protective factors and internal mental distress. Results Prevalence of internal mental distress ranged from 14.5% for overweight boys who perceived themselves as not overweight to 55.0% for girls who were not overweight but self-perceived as overweight. Across all weight-status categories, adolescents who perceived themselves as overweight, compared to those who did not, had higher internal mental distress and lower mean levels of psychosocial protective factors. All psychosocial protective factors were related to lower odds of internal mental distress, with significant small differences by weight status and weight perception. Conclusions Weight status and weight perception affected both mental distress and psychosocial protective factors. Those who perceived themselves as overweight, regardless of weight status, had the highest prevalence of mental distress and the lowest levels of psychosocial protective factors. Health care providers should consider screening for weight perception to provide a tailored approach to adolescent care.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.007
  • Adolescent Self-Screening for Mental Health Problems; Demonstration of an
           Internet-Based Approach
    • Authors: J. Michael Murphy; Theresa Nguyen; Cara Lucke; Cindy Chiang; Natalie Plasencia; Michael Jellinek
      Pages: 59 - 65
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): J. Michael Murphy, Theresa Nguyen, Cara Lucke, Cindy Chiang, Natalie Plasencia, Michael Jellinek
      Objective To examine the prevalence of positive screening scores, construct validity, and opportunities for follow-up in a large sample of adolescents who chose to fill out the Pediatric Symptom Checklist–Youth Form (PSC-Y) through the Mental Health America (MHA) Web site. Methods MHA sent researchers a deidentified data set of all PSC-Y data submitted to MHA from May 15, 2015 to May 14, 2016. The analytic data set contained 29,886 PSC-Y forms from youth aged 11 to 17 years who sought out the Web site and chose to fill out the PSC-Y anonymously and independently online. The prevalence of impairment on the PSC-Y was calculated overall and for various subgroups. Next steps reported by at-risk youth were also examined. Results Of all respondents, 77.4% of youth screened positive on the PSC-Y. Significant associations between positive screening and self-ratings of a need for help, previous history of mental health treatment, and low family income provided construct validation for the online PSC-Y. Almost two-thirds of positively screened youth stated that they planned to get some kind of help in the future and 10% indicated that they planned to seek professional treatment. Conclusions The large number of respondents suggested that many adolescents use the Internet to learn about mental health and that a very high percentage of them might be at risk. The availability of brief, free Internet-based psychosocial screens might offer a viable way to identify at-risk youth and provide them with pathways to additional support and/or treatment.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.013
  • Adolescent Health Risk Behaviors: Parental Concern and Concordance Between
           Parent and Adolescent Reports
    • Authors: Elon Gersh; Laura P. Richardson; Katherine Katzman; Heather Spielvogle; Adriana Cristina Arghira; Chuan Zhou; Carolyn A. McCarty
      Pages: 66 - 72
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Elon Gersh, Laura P. Richardson, Katherine Katzman, Heather Spielvogle, Adriana Cristina Arghira, Chuan Zhou, Carolyn A. McCarty
      Objective We investigated which adolescent health risk behaviors are of concern to parents generally, according to adolescent age, gender, and in the context of perceived risk. We compared adolescent and parent reports of the presence of health-risk behaviors and factors predicting agreement. Methods Three hundred adolescents aged 13 to 18 years (mean, 14.5 years; 52% female) who presenting for well care completed an electronic screening tool used to assess health-risk behaviors. Parents completed parallel measures of their child's behavior and parental concern. Adolescent and parent reports were compared using McNemar test. Hierarchical linear regression was used to examine predictors of agreement. Results High parental concern was most commonly reported for screen time and diet. When parents identified their adolescent as at-risk, high parental concern was near universal for mental health but less commonly reported for substance use. There were no differences in parental concern according to adolescent gender. Parents of older adolescents expressed more concern regarding physical activity and alcohol. Compared with adolescents, parents were more likely to report risk regarding anxiety, fruit and vegetable consumption, and physical activity, and less likely to report risk regarding screen time, sleep, and marijuana use. Younger adolescent age and higher family relationship quality were predictive of stronger parent-adolescent agreement. Conclusions Parents in well-care visits commonly have concerns about adolescent lifestyle behaviors. Although parents are more likely to report concern when they know about a behavior, parental concern is not always aligned with parental awareness of risk, particularly for substance use. Parent report of higher prevalence of some risk behaviors suggests their input might assist in risk identification.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.012
  • Graduating Pediatric Resident Reports on Procedural Training and
    • Authors: Daniel J. Schumacher; Mary Pat Frintner; William Cull
      Pages: 73 - 78
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Daniel J. Schumacher, Mary Pat Frintner, William Cull
      Objective To determine pediatric resident training and preparation for 14 Accreditation Council for Graduate Medical Education (ACGME)-required procedures. Methods We included a national, random sample of 1000 graduating pediatric residents in 2015. For each of the ACGME-required procedures, residents were asked if they received training, successfully completed the procedure at least once, were comfortable performing the procedure unsupervised, and desired more training. To examine relationships among these 4 measures of training, we conducted logistic regression models and receiver operating characteristics curves. We used chi-square to examine whether desiring more training varied according to program size or career goal. Results Response rate was 55% (550 of 1000). More than half of the residents received training in each procedure (56.4%–99.3% across procedures) and had successfully completed them at least once (59.8%–99.6%). However, 91.3% desired more training in at least 1 procedure, and 30.0% would like more training in more than half of the procedures (≥8). Relationships were found between the 4 training measures, with some relationships stronger than others. Residents with primary care goals were more likely than those with subspecialty or hospital practice goals to desire more training in abscess incision and drainage and temporary splinting of fractures (P < .05). Residents in large programs were more likely than those in smaller programs to desire more training in bladder catheterization, peripheral intravenous catheter placement, and venipuncture (P < .05). Conclusions Although pediatric residents are overall well prepared to perform ACGME-required procedures, exceptions exist. Considering the role of program size and resident career goal might help when optimizing and individualizing resident procedural training and preparation.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.001
  • Children With Medical Complexity: A Web-Based Multimedia Curriculum
           Assessing Pediatric Residents Across North America
    • Authors: Neha H. Shah; Priti Bhansali; Aisha Barber; Keri Toner; Michael Kahn; Meaghan MacLean; Micah Kadden; Jeffrey Sestokas; Dewesh Agrawal
      Pages: 79 - 85
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Neha H. Shah, Priti Bhansali, Aisha Barber, Keri Toner, Michael Kahn, Meaghan MacLean, Micah Kadden, Jeffrey Sestokas, Dewesh Agrawal
      Objective No standardized curricula exist for training residents in the special needs of children with medical complexity. We assessed resident satisfaction, knowledge, and behavior after implementing a novel online curriculum composed of multimedia modules on care of children with medical complexity utilizing virtual simulation. Methods We conducted a randomized controlled trial of residents across North America. A Web-based curriculum of 6 self-paced, interactive, multimedia modules was developed. Readings for each topic served as the control curriculum. Residents were randomized to 1 of 2 groups, each completing 3 modules and 3 sets of readings that were mutually exclusive. Outcomes included resident scores on satisfaction, knowledge-based assessments, and virtual simulation activities. Results Four hundred forty-two residents from 56 training programs enrolled in the curriculum, 229 of whom completed it and were included in the analysis. Subjects were more likely to report comfort with all topics if they reviewed modules compared to readings (P ≤ .01 for all 6 topics). Posttest knowledge scores were significantly higher than pretest scores overall (mean increase in score 17.7%; 95% confidence interval 16.0, 19.4), and the mean pre–post score increase for modules was significantly higher than readings (20.9% vs 15.4%, P < .001). Mean scores on the verbal handoff virtual simulation increased by 1.1 points (95% confidence interval 0.2, 2.0, P = .02). There were no significant differences found in pre–post performance for the device-related emergency virtual simulation. Conclusions There was high satisfaction, significant knowledge acquisition, and specific behavior change after participating in this innovative online curriculum. This is the first multisite, randomized trial assessing satisfaction, knowledge impact, and behavior change in a virtually simulated environment with pediatric trainees.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.008
  • Novel Transfer of Care Sign-out Assessment Tool in a Pediatric Emergency
    • Authors: Ara Festekjian; Ameer P. Mody; Todd P. Chang; Nurit Ziv; Alan L. Nager
      Pages: 86 - 93
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Ara Festekjian, Ameer P. Mody, Todd P. Chang, Nurit Ziv, Alan L. Nager
      Objective Transfer of care sign-outs (TOCS) for admissions from a pediatric emergency department have unique challenges. Standardized and reliable assessment tools for TOCS remain elusive. We describe the development, reliability, and validity of a TOCS assessment tool. Methods Video recordings of resident TOCS were assessed to capture 4 domains: completeness, synopsis, foresight, and professionalism. In phase 1, 56 TOCS were used to modify the tool and improve reliability. In phase 2, 91 TOCS were used to examine validity. Analyses included Cronbach's alpha for internal structure, intraclass correlation and Cohen's kappa for interrater reliability, Pearson's correlation for relationships between variables, and 95% confidence interval of the mean for resident group comparisons. Results Cronbach's alpha was 0.52 for internal structure of the tool's subjective rating scale. Intraclass correlation for the subjective rating scale items ranged from 0.70 to 0.80. Cohen's kappa for most objective checklist items ranged from 0.43 to 1. Content completeness was significantly correlated with synopsis, foresight, and professionalism (Pearson's r ranged from 0.36 to 0.62, P values were <0.001). House staff senior residents scored higher (on average) than interns and rotating senior residents in synopsis and foresight. Also, house staff interns scored higher (on average) than rotating senior residents in professionalism. House staff senior residents scored higher (on average) than rotating senior residents in content completeness. Conclusions We provide validity evidence to support using scores from the TOCS tool to assess higher-level transfer of care comprehension and communication by pediatric emergency department residents and to test interventions to improve TOCS.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.08.009
  • Importance and Feasibility of Transitional Care for Children With Medical
           Complexity: Results of a Multistakeholder Delphi Process
    • Authors: JoAnna K. Leyenaar; Paul A. Rizzo; Dmitry Khodyakov; Laurel K. Leslie; Peter K. Lindenauer; Rita Mangione-Smith
      Pages: 94 - 101
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): JoAnna K. Leyenaar, Paul A. Rizzo, Dmitry Khodyakov, Laurel K. Leslie, Peter K. Lindenauer, Rita Mangione-Smith
      Background Children with medical complexity (CMC) account for disproportionate hospital utilization and adverse outcomes after discharge, and several gaps exist regarding the quality of hospital to home transitional care for this population. We conducted an expert elicitation process to identify important and feasible hospital to home transitional care interventions for CMC from the perspectives of parents and health care professionals. Methods We conducted a 2-round electronic Delphi process to identify important and feasible transitional care interventions. Panelists included parents of CMC and multidisciplinary health care professionals. In the first round, panelists rated the importance and feasibility of 39 transitional care interventions on a 9-point Likert scale; agreement between panelists was defined according to RAND/UCLA Appropriateness Methods. The second round of data collection evaluated 16 interventions that panelists did not agree on in the first round and 8 new or revised interventions, accompanied by quantitative and qualitative data summaries. Results A total of 29 parents of CMC and 37 health care professionals participated in the Delphi process (response rate 75%). Both stakeholder panels endorsed most interventions as important; health care professionals were less likely to rate several interventions as feasible compared with the parent panel. Over 2 rounds of data collection, the 2 stakeholder panels endorsed 25 interventions as important as well as feasible. These interventions related to family engagement during the hospitalization, care coordination and social support assessment, predischarge education, and written materials. Conclusions Parents and health care professionals considered several transitional care interventions important as well as feasible. This research might inform hospitals' transitional care programs and policies.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.07.005
  • Lack of Preparedness for Pediatric to Adult-Oriented Health Care
           Transition in Hospitalized Adolescents and Young Adults
    • Authors: Keely Dwyer-Matzky; Amy Blatt; Barbara L. Asselin; David L. Wood
      Pages: 102 - 110
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Keely Dwyer-Matzky, Amy Blatt, Barbara L. Asselin, David L. Wood
      Objective We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns. Methods From 2013 to 2015, 139 hospitalized patients aged 15 to 21 years completed a 40-item survey on HCT preparation, attitudes, concerns, and perception of knowledge adapted in part from validated questionnaires of the Department of Health and Human Services, Maternal and Child Health Bureau, and SDT Treatment Self-Regulation Study. Results Fewer than 40% of all respondents endorsed previous HCT preparation such as providers discussing taking responsibility for their health, transitioning to adult providers, and only 20% had discussed future health insurance needs. Of our AYA population, 84% had 1 or more special health care needs. Older patients, female patients, and those with increased HCT preparation scores had increased autonomous motivation, positive attitudes toward transition, yet also increased transition concerns. Higher autonomous motivation and perceived competence correlated with increased perception of knowledge (P = .002, < .001 respectively) and more positive attitudes toward transition planning (P < .001, .054 respectively). Multivariate regression analysis revealed those with increased HCT preparation and those with increased perceived competence had increased perception of knowledge (β = .25, P = .005 and β = .35, P < .001). Conclusions Our findings suggest that hospitalized AYA received limited education and preparation regarding key elements of HCT to adult-oriented health care. Moreover, those previously exposed to transition preparation efforts were more likely to have motivation and a sense of competence in HCT skills.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.07.008
  • Care Coordination and Comprehensive Electronic Health Records are
           Associated With Increased Transition Planning Activities
    • Authors: Niraj Sharma; Kitty O'Hare; Karen G. O'Connor; Umbereen Nehal; Megumi J. Okumura
      Pages: 111 - 118
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Niraj Sharma, Kitty O'Hare, Karen G. O'Connor, Umbereen Nehal, Megumi J. Okumura
      Objective Youth with special health care needs (YSHCN) require assistance from their pediatricians to transition to adult care. There are few data on what transition resources pediatricians have. In this article we discuss whether care coordination and/or comprehensive electronic health record (CEHR) implementation are associated with improved transition processes. Methods Using the American Academy of Pediatrics Periodic Survey #79, we report whether practices generated written transition plans, assisted in finding adult providers, and discussed confidentiality issues. Descriptive statistics and a logistic regression model were done to evaluate whether CEHR, care coordination, or practice and physician characteristics were associated with improved transition planning. Results Transition planning support in practices is low. Pediatricians with any care coordinator report more written transition plans for YSHCN (23% vs 6%; P < .001), assistance identifying adult providers (59% vs 39%; P < .001), and discussing confidentiality issues (50% vs 33%; P < .001). Pediatricians with a CEHR compared with those without are more likely to report written transition plans for YSHCN (24% vs 12%; P < .05) and discussing confidentiality issues (51% vs 39%; P < .05). In the logistic regression model, having care coordination (adjusted odds ratio, 11.1; 95% confidence interval, 5.9–21.3) and CEHR (adjusted odds ratio, 2.6; 95% confidence interval, 1.5–5.0) were independently associated with higher odds of having a written transition plan. Conclusions Only 1 in 5 pediatricians have a transition coordinator in their practice and just 15% have a CEHR, even as these resources are associated with improved transition processes for YSHCN. Policy decisions should be made to help practices with supports, such as care coordination and electronic health record implementation, to improve transitions to adulthood.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.04.005
  • Integrated Mental Health Training for Pediatric and Psychology Trainees
           Using Standardized Patient Encounters
    • Authors: Sandra H. Jee; Constance Baldwin; Rita Dadiz; Marybeth Jones; Linda Alpert-Gillis
      Pages: 119 - 121
      Abstract: Publication date: January–February 2018
      Source:Academic Pediatrics, Volume 18, Issue 1
      Author(s): Sandra H. Jee, Constance Baldwin, Rita Dadiz, Marybeth Jones, Linda Alpert-Gillis
      Primary care pediatricians and psychology practitioners who comanage mental health problems can develop interdisciplinary communication and collaborative skills from joint standardized patient encounters and debriefings, combined with brief didactics. Learners showed increased confidence in shared management of behavior health problems.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.06.014
  • Gaining Perspectives on Patient and Family Disease Experiences by
    • Authors: Hamsika Chandrasekar; Seamus Harte; Jules Sherman; K.T. Park; Henry C. Lee
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Pediatrics
      Author(s): Hamsika Chandrasekar, Seamus Harte, Jules Sherman, K.T. Park, Henry C. Lee

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.01.014
  • Scholarly Activity Training during Residency: are We Hitting the Mark'
           a National Assessment of Pediatric Residents
    • Authors: Erika L. Abramson; Monique M. Naifeh; Michelle D. Stevenson; Elizabeth Mauer; Hoda T. Hammad; Linda M. Gerber; Su-Ting T. Li
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Pediatrics
      Author(s): Erika L. Abramson, Monique M. Naifeh, Michelle D. Stevenson, Elizabeth Mauer, Hoda T. Hammad, Linda M. Gerber, Su-Ting T. Li
      Objective Participation in scholarly activity (SA) is an ACGME requirement. Yet, the authors' previous research with program directors (PDs) suggests pediatric SA training is variable and suboptimal. To help programs better meet requirements, our objective was to understand the resident perspective regarding SA training, including factors associated with satisfaction and productivity. Methods The authors conducted cross-sectional surveys of second and third year pediatric residents and PDs at 22 diverse programs in 2016. Surveys assessed resident demographics, career intentions, program characteristics, beliefs, barriers, satisfaction, and productivity, defined as SA accepted at a regional or national meeting, for publication, or grant funding. Data were analyzed using descriptive statistics and multivariable logistic regression. Results 464 of 771 residents (60.2%) and 22 PDs (100%) responded. Most residents believed that residents should participate in SA (n = 380, 81.9%). However, only 37.9% (n = 175) were extremely or very satisfied with their training. Residents who reported that training to conduct research (Adjusted Odds Ratio (AOR) =1.9, 95% CI 1.1-3.5), availability of a research curriculum (AOR = 1.9, 95% CI 1.2-3.1), and adequate faculty mentorship (AOR = 2.5, 95% CI 1.6-4.1) were not barriers were more satisfied. Protected time was associated with satisfaction (AOR = 1.7, 95% CI = 1.1-2.7). 43.8% of residents (n = 203) were productive. Productivity was associated with future plans to conduct research (AOR = 3.3, 95% CI = 2.1-5.1). Conclusions Residents believe SA training is important. Dedicated program infrastructure, protected time, and adequate mentorship appear key to improving quality perceptions.

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.02.002
  • Shared Decision Making for Children with Developmental Disorders: Recent
    • Authors: Susan E. Levy; Alexander G. Fiks
      Abstract: Publication date: Available online 9 February 2018
      Source:Academic Pediatrics
      Author(s): Susan E. Levy, Alexander G. Fiks

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.02.005
  • Educational Text Messages Decreased Emergency Department Utilization among
           Infant Caregivers: a Randomized Trial
    • Authors: Amy Ladley; Amanda Waltos Hieger; Joshua Arthur; Matthew Broom
      Abstract: Publication date: Available online 9 February 2018
      Source:Academic Pediatrics
      Author(s): Amy Ladley, Amanda Waltos Hieger, Joshua Arthur, Matthew Broom
      Objective This study sought to 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. Methods Prospective, randomized experiment conducted in a large, urban, academic pediatric primary care practice enrolled 231 caregivers of infants into 2 groups: 1) enhanced standard of care (ESoC) materials at well-child visits through 6 months (n=99 completing); 2) ESoC and 4 text messages/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. Results Of 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 < $20,000/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 to 1.47; p<.05). Conclusions Sending educational text messages to caregivers is effective in reducing the number of visits to the ED. Given the accessibility and small expense of sending text messages, these findings have direct implications on the cost of healthcare, in addition to improving continuity and quality of care for pediatric patients.

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.02.003
  • The Top Medical Education Studies of 2016: a Narrative Review
    • Authors: H. Barrett Fromme; Michael S. Ryan; Alix Darden; Donna D'Alessandro; Leora Mogilner; Steven Paik; Teri L. Turner
      Abstract: Publication date: Available online 6 February 2018
      Source:Academic Pediatrics
      Author(s): H. Barrett Fromme, Michael S. Ryan, Alix Darden, Donna D'Alessandro, Leora Mogilner, Steven Paik, Teri L. Turner
      Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The seven authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an interative, three-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first two stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This paper presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to OSCEs, self-assessment, professionalism, clinical teaching, competencies/milestones, and Graduate Medical Education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field.

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.01.015
  • Promoting Resident Professional Development Using Scholarly Academies
    • Authors: Ariel S. Winn; S. Jean Emans; Lori R. Newman; Thomas J. Sandora
      Abstract: Publication date: Available online 6 February 2018
      Source:Academic Pediatrics
      Author(s): Ariel S. Winn, S. Jean Emans, Lori R. Newman, Thomas J. Sandora

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.01.017
  • Prenatal Material Hardship and the Internal Locus of Control Over the
           Prevention of Child Obesity: a Progress Report
    • Authors: Rachel S. Gross; Alan L. Mendelsohn; Mary Jo Messito
      Abstract: Publication date: Available online 5 February 2018
      Source:Academic Pediatrics
      Author(s): Rachel S. Gross, Alan L. Mendelsohn, Mary Jo Messito

      PubDate: 2018-02-14T11:18:29Z
      DOI: 10.1016/j.acap.2018.01.016
  • Tools for Learning About the Referral and Consultation Process for
           Pediatric Residents
    • Authors: Ellen K. Hamburger; Sarah Muradian; Alicia Widge; J. Lindsey Lane; Dewesh Agrawal; Claire Boogaard; Janice L. Hanson; Mary Ottolini
      Abstract: Publication date: Available online 2 February 2018
      Source:Academic Pediatrics
      Author(s): Ellen K. Hamburger, Sarah Muradian, Alicia Widge, J. Lindsey Lane, Dewesh Agrawal, Claire Boogaard, Janice L. Hanson, Mary Ottolini

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.010
  • Screening for Behavioral Risk Factors is Not Enough to Improve Preventive
           Services Delivery
    • Authors: Olivier Drouin; Jonathan P. Winickoff
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Olivier Drouin, Jonathan P. Winickoff
      Background/Objective Unhealthy behaviors are a major cause of chronic disease. Pre-appointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians. Methods We used a pre-/post-design in one practice with a control practice to evaluate the effects of pre-appointment screening for three behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them. Results We recruited 264 parents in the pre- phase and 242 in the post- phase. Among 215 parents whose child had one or more risk factors, parents in the post- phase were as likely to report receiving counseling than parents in the pre- phase for each risk factors: Smoking Odds Ratio (OR): 6.75 (95% CI: 0.51, 88.90), dental health OR: 1.44 (95% CI: 0.47, 4.41) and sugar-sweetened beverages (SSBs) consumption OR: 0.34 (95% CI: 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases. Conclusions Counseling rates for tobacco, dental health, or SSBs consumption were low in pediatric primary care, and pre-appointment screening did not significantly impact clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.008
  • Can You See the Gorilla'
    • Authors: Jessica Tsai
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Jessica W. Tsai

      PubDate: 2018-02-03T09:39:26Z
  • Quality Improvement to Immunization Coverage in Primary Care Measured in
           Medical Record and Population-Based Registry Data
    • Authors: Valerie S. Harder; Sara E. Barry; Bridget Ahrens; Wendy S. Davis; Judith S. Shaw
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Valerie S. Harder, Sara E. Barry, Bridget Ahrens, Wendy S. Davis, Judith S. Shaw
      Objectives Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measures the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups. Methods In 2013, 20 primary care practices completed a seven month QI project aimed to increase immunization coverage among early childhood (29-33 months), school-age (6 years), and adolescent (13 years) age groups. For this study, we examined random cross-sectional medical record reviews from 12 of the 20 practices within each age group in 2012, 2013, and 2014 to measure improvement in immunization coverage over time, using Chi-squared tests. We repeated these analyses on population-level data from Vermont's immunization registry (IMR) for the 12 practices in each age group each year. We used difference-in-differences regressions in the IMR data to compare improvements over time between the 12 practices and those not participating in QI. Results Immunization coverage increased over three years for all ages and all immunization series (Ps≤0.009) except one, as measured by medical record review. Registry results aligned partially with medical record review with increases in early childhood and adolescent series over time (Ps≤0.012). Notably, the adolescent immunization series completion, including human papilloma virus, increased more than in the comparison practices (P=0.037). Conclusions Medical record review indicated that QI efforts led to increases in immunization coverage in pediatric primary care. Results were partially validated in the IMR particularly among early childhood and adolescent groups, with a population-level impact of the intervention among adolescents.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.012
  • Early Childhood Stress and Child Age Predict Longitudinal Increases in
           Obesogenic Eating among Low-Income Children
    • Authors: Alison L. Miller; Ashley N. Gearhardt; Lauren Retzloff; Julie Sturza; Niko Kaciroti; Julie C. Lumeng
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Alison L. Miller, Ashley N. Gearhardt, Lauren Retzloff, Julie Sturza, Niko Kaciroti, Julie C. Lumeng
      Objective To 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. Methods This was an observational longitudinal study. Among 207 low-income children (54.6% non-Hispanic white, 46.9% females) early childhood stress exposure was measured by parent report and a stress exposure index was calculated (higher scores indicating more stress exposure). Eating behaviors were measured in early (M: 4.3 (SD 0.5) years) and middle (M: 7.9 (SD 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. Results Early childhood stress exposure predicted yearly increases in EAH (β=0.14, 95% confidence interval (CI) 0.002, 0.27) and Emotional Overeating (β=0.14, 95% CI 0.008, 0.27). Stress exposure was not associated with Food Responsiveness (trend for decreased Enjoyment of Food; β=-0.13, 95% CI 0.002, -0.26). All child obesogenic eating behaviors increased with age (p's<.05). Conclusions Early stress exposure predicted increases in child eating behaviors known to associate with overweight/obesity. Psychosocial stress may confer overweight/obesity risk through eating behavior pathways. Targeting eating behaviors may be an important prevention strategy for children exposed to stress.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.007
  • Knowledge of Inhaled Therapy and Responsibility for Asthma Management
           among Young Teens with Uncontrolled Persistent Asthma
    • Authors: Sean M. Frey; Marybeth R. Jones; Nicolas Goldstein; Kristin Riekert; Maria Fagnano; Jill S. Halterman
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Sean M. Frey, Marybeth R. Jones, Nicolas Goldstein, Kristin Riekert, Maria Fagnano, Jill S. Halterman
      Objectives To compare the abilities of teens with uncontrolled persistent asthma and their caregivers to identify inhaled medications and state correct indications for use; examine medication responsibility within dyads; and determine whether responsibility is associated with knowledge about inhaled therapies. Design/Methods In the baseline survey for the School-Based Asthma Care for Teens (SB-ACT) trial, we separately asked caregivers and teens to: 1) identify the teen's inhaled asthma therapies by name and from a picture chart (complete matches considered “concordant”); 2) describe indications of use for each medication; 3) describe the allocation of responsibility for medication use within dyads. We limited analyses to dyads in which either member reported at least one rescue and one inhaled controller medication; we used McNemar and Pearson chi-square tests. Results 136 dyads were analyzed. More caregivers than teens concordantly identified medications (63% vs 31%, p<0.001). There was no difference between caregivers and teens in the ability to state correct indications for use (56% vs 54%, p=0.79). More teens than caregivers endorsed “full teen responsibility” for rescue medication (65% vs 27%, P<0.001) and controller medication use (50% vs 15%, P<0.001). Neither concordant identification nor knowing indications for use were associated with reported medication responsibility. Conclusion(s) Medication responsibility within dyads of caregivers and teens with persistent asthma is not associated with knowledge about inhaled therapies. Targeting both members of the dyad with education and self-management strategies before responsibility transitions start may allow providers to avoid a missed opportunity to support these emerging stakeholders to adherence.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.006
  • Unexplained Practice Variation in Primary Care Providers' Concern for
           Pediatric Obstructive Sleep Apnea
    • Authors: Sarah Honaker; Tamara Dugan; Ameet Daftary; Stephanie Davis; Chandan Saha; Fitsum Baye; Emily Freeman; Stephen Downs
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Sarah Honaker, Tamara Dugan, Ameet Daftary, Stephanie Davis, Chandan Saha, Fitsum Baye, Emily Freeman, Stephen Downs
      Objective To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography (PSG) completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA. Methods A computer decision support system that automated screening for snoring was implemented in five urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children between 1 and 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site. Results PCPs suspected OSA in 20% of snoring children. Factors predicting PCP concern for OSA included clinic site (p < .01; OR=0.13), Spanish language (p < .01; OR=0.53), provider training (p=.01; OR=10.19), number of training years (p=.01; OR=4.26) and child age (p<.01), with the youngest children least likely to elicit PCP concern for OSA (OR=0.20). No patient health factors (e.g., obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range 6% to 28%) and between specific providers (range 0% to 63%). Of children referred for PSG (n=100), 61% completed the study. Of these, 67% had OSA. Conclusions Results suggest unexplained small area practice variation in PCP concern for OSA amongst snoring children. It is likely that many children at-risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.011
  • Qualitative Evaluation of Individual and Group Well-Child Care
    • Authors: Cynthia DeLago; Brittany Dickens; Etienne Phipps; Andrew Paoletti; Magdelena Kazmierczak; Matilde Irigoyen
      Abstract: Publication date: Available online 31 January 2018
      Source:Academic Pediatrics
      Author(s): Cynthia DeLago, Brittany Dickens, Etienne Phipps, Andrew Paoletti, Magdelena Kazmierczak, Matilde Irigoyen
      Objective Individual primary care (IWC) is the standard delivery model for well-child care in the U.S. Alternative models, such as group care (GWC), may create opportunities to enhance care for babies. The purpose of this study is to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. Methods Since 2014, we have provided both IWC and GWC at an urban, academic practice serving a low-income, minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n=32 parents; 7 GWC groups, n=33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t-tests; focus groups were digitally recorded, transcribed and analyzed to identify themes. Results Both groups had similar demographics: parents were mostly female (91%); Black (>80%); and about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment or stress. IWC parents' themes highlighted ways to improve care delivery while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits such as garnering social support and learning from other parents. Conclusions Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.

      PubDate: 2018-02-03T09:39:26Z
      DOI: 10.1016/j.acap.2018.01.005
  • Characteristics Associated With Parent–Teacher Concordance on Child
           Behavior Problem Ratings in Low-Income Preschoolers
    • Authors: Tiffany G. Munzer; Alison L. Miller; Holly E. Brophy-Herb; Karen E. Peterson; Mildred A. Horodynski; Dawn Contreras; Julie Sturza; Niko Kaciroti; Julie C. Lumeng
      Abstract: Publication date: Available online 19 January 2018
      Source:Academic Pediatrics
      Author(s): Tiffany G. Munzer, Alison L. Miller, Holly E. Brophy-Herb, Karen E. Peterson, Mildred A. Horodynski, Dawn Contreras, Julie Sturza, Niko Kaciroti, Julie C. Lumeng
      Objective Assessment of pediatric behavior problems often requires rating scales from multiple reporters in different settings (eg, home and school); however, concordance between reporters may be low. Pediatricians must reconcile differences to inform treatment. We sought to examine characteristics predicting parent–teacher concordance on ratings of preschoolers' behavior problems. Methods Data from 562 preschoolers were used from the Growing Healthy study, an obesity prevention trial in Head Start programs (2011–2015). Parents and teachers completed the Eyberg Child Behavior Inventory (ECBI)/Student Behavior Inventory (SBI) and the Social Competence and Behavior–Evaluation (SCBE). Outcome variables were: parent–teacher concordance (teacher minus parent score on each subscale of ECBI/SBI and SCBE); teacher reports problem behavior, parent does not (children rated in the top quintile of challenging behavior by teacher but not parent); and parent reports problem behavior, teacher does not (children rated in the top quintile of challenging behavior by parent but not teacher). Multiple linear and logistic regression models were created for each subscale outcome, including the following covariates: child sex, child race/ethnicity, parent age, parent education, family structure, parent depressive symptoms, and parenting self-efficacy, and time of school year. Results Lower concordance was associated with child female sex, and child black or Hispanic race/ethnicity; parent older age, lower education, more depressive symptoms, and greater self-efficacy; and beginning of school year. Conclusions Low parent–teacher concordance may reflect different perceptions of child behavior. Pediatricians could consider parent depressive symptoms, culture, and implicit bias when interpreting differences in behavior ratings by parents and teachers.

      PubDate: 2018-01-23T11:48:16Z
      DOI: 10.1016/j.acap.2017.10.006
  • Predicting Low Resource Intensity Emergency Department Visits in Children
    • Authors: Margaret Samuels-Kalow; Alon Peltz; Jonathan Rodean; Matthew Hall; Elizabeth R. Alpern; Paul L. Aronson; Jay G. Berry; Kathy N. Shaw; Rustin B. Morse; Stephen B. Freedman; Eyal Cohen; Harold K. Simon; Samir S. Shah; Yiannis Katsogridakis; Mark I. Neuman
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Pediatrics
      Author(s): Margaret Samuels-Kalow, Alon Peltz, Jonathan Rodean, Matthew Hall, Elizabeth R. Alpern, Paul L. Aronson, Jay G. Berry, Kathy N. Shaw, Rustin B. Morse, Stephen B. Freedman, Eyal Cohen, Harold K. Simon, Samir S. Shah, Yiannis Katsogridakis, Mark I. Neuman
      Background and Objectives Interventions to reduce frequent emergency department (ED) use in children are often limited by the inability to predict future risk. We sought to develop a population-based model for predicting Medicaid-insured children at risk for high frequency of low-resource intensity (LRI) ED visits. Methods. Retrospective cohort analysis of Medicaid-insured children (age 1-18 years) included in the MarketScan® Medicaid database with ≥1 ED visit(s) in 2013. LRI visits were defined as ED encounters with no laboratory testing, imaging, procedures or hospitalization; and high frequency as ≥3 LRI ED visits within 365-days of the initial encounter. A generalized linear regression model was derived and validated using a split-sample approach. Validity testing was conducted examining model performance using 3 alternative definitions of LRI. Results Among 743,016 children with ≥1 ED visit in 2013, 5% experienced high frequency LRI ED use, accounting for 21% of all LRI visits. History of prior LRI ED use [2 visits: aOR=3.5 (95% CI:3.3, 3.7), and ≥3 visits aOR=7.7 (95% CI:7.3, 8.1)] and presence of 3 or more chronic conditions [aOR=1.7 (95% CI:1.6, 1.8)] were strongly associated with future high frequency LRI ED use. A model incorporating patient characteristics and prior ED use predicted future high frequency LRI ED utilization with an area under the curve of 0.74. Conclusion Demographic characteristics and patterns of prior ED use can predict future risk of high frequency LRI ED use in the following year. Interventions for reducing low-value ED use in these high-risk children should be considered.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.12.012
  • Feels Not Right Stabbing a Child
    • Authors: Erwin Jiayuan Khoo; Zhong Ning L. Goh
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Pediatrics
      Author(s): Erwin Jiayuan Khoo, Zhong Ning L. Goh

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2018.01.001
  • 14th of July Terror Attack in Nice, France
    • Authors: Federico Solla; Joseph Carboni; Jean Bréaud; Philippe Babe; Gilles Brézac; Nathalie Chivoret; Audrey Dupont; Arnaud Fernandez
      Abstract: Publication date: Available online 10 January 2018
      Source:Academic Pediatrics
      Author(s): Federico Solla, Joseph Carboni, Jean Bréaud, Philippe Babe, Gilles Brézac, Nathalie Chivoret, Audrey Dupont, Arnaud Fernandez
      On July 14th, 2016, a terrorist attack by truck occurred in Nice (France), during the traditional fireworks for Bastille Day. The authors present the point of view of the doctors from Lenval University Children's Hospital, which is located near the attack place and had to manage 47 casualties including 12 adults.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2018.01.004
  • Efficacy of a Web-Based Oral Case Presentation Instruction Module: a
           Multi-Center Randomized Controlled Trial
    • Authors: Colin M. Sox; Rebecca Tenney-Soeiro; Linda O. Lewin; Jeanine Ronan; Mary Brown; Marta King; Rachel Thompson; Michelle Noelck; Jamie S. Sutherell; Michael Silverstein; Howard J. Cabral; Michael Dell
      Abstract: Publication date: Available online 8 January 2018
      Source:Academic Pediatrics
      Author(s): Colin M. Sox, Rebecca Tenney-Soeiro, Linda O. Lewin, Jeanine Ronan, Mary Brown, Marta King, Rachel Thompson, Michelle Noelck, Jamie S. Sutherell, Michael Silverstein, Howard J. Cabral, Michael Dell
      Objective Effective self-directed educational tools are invaluable. Our objective was to determine whether a self-directed, web-based oral case presentation module would 1) improve medical students' oral case presentations compared to usual curriculum 2) with similar efficacy as structured oral presentation faculty feedback sessions. Methods We conducted a pragmatic multi-center cluster randomized controlled trial among medical students rotating in pediatric clerkships at seven U.S. medical schools. In the clerkship's first 14 days, subjects were instructed to complete either (1) an on-line “CLIPP” oral case presentation module, (2) an in-person faculty-led case presentation “Feedback” session, or (3) neither (“Control”). At clerkship end, evaluators blinded to intervention status rated the quality of students' oral case presentations on a 10-point scale. We conducted intention-to-treat multivariable analyses clustered on clerkship block. Results Study participants included 274 CLIPP (33.8%), 266 Feedback (32.9%), and 270 Control (33.3%) subjects. Only 51.1% of CLIPP subjects completed the assigned presentation module, while 98.5% of Feedback subjects participated in presentation feedback sessions. Compared to Controls, oral presentation quality was significantly higher in the Feedback group (adjusted difference in mean quality: 0.28, 95% CI 0.08, 0.49) and trended towards being significantly higher in the CLIPP group (0.19, 95% CI -0.006, 0.38). The quality of presentations in the CLIPP and Feedback groups was not significantly different (-0.10, 95% CI -0.31, 0.11). Conclusions The quality of oral case presentations delivered by students randomized to complete the CLIPP module did not differ from faculty-led presentation feedback sessions and was not statistically superior to neither (Control).

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.12.010
  • Visits to Primary Care and Emergency Department Reliance for Foster Youth:
           Impact of Medicaid Managed Care
    • Authors: Melissa A. Bright; Lawrence Kleinman; Bruce Vogel; Elizabeth Shenkman
      Abstract: Publication date: Available online 8 January 2018
      Source:Academic Pediatrics
      Author(s): Melissa A. Bright, Lawrence Kleinman, Bruce Vogel, Elizabeth Shenkman
      Objective To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access. Methods Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida). Eligible participants were foster youth (aged 0–18 years) enrolled in these states between 2006 and 2010 (n = 126,714). A Puhani approach to difference-in-difference was used to identify the effect of transition after adjusting for race/ethnicity, gender, and health status. Data were used to calculate access to primary and preventive care as well as ED reliance. ED reliance was operationalized as the number of ED visits relative to the number of total ambulatory visits; high ED reliance was defined as ≥33%. Results The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change. Conclusions Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.10.005
  • Impact of the Childhood Vaccine Discussion Format Over Time on
           Immunization Status
    • Authors: Douglas J. Opel; Chuan Zhou; Jeffrey D. Robinson; Nora Henrikson; Katherine Lepere; Rita Mangione-Smith; James A. Taylor
      Abstract: Publication date: Available online 8 January 2018
      Source:Academic Pediatrics
      Author(s): Douglas J. Opel, Chuan Zhou, Jeffrey D. Robinson, Nora Henrikson, Katherine Lepere, Rita Mangione-Smith, James A. Taylor
      Objective Presumptive formats to initiate childhood vaccine discussions (e.g. “Well we have to do some shots.”) have been associated with increased vaccine acceptance after one visit compared to participatory formats (e.g. “How do you feel about vaccines'”). We characterize discussion format patterns over time and the impact of their repeated use on vaccine acceptance. Methods We conducted a longitudinal prospective cohort study of children of vaccine-hesitant parents enrolled in a Seattle-based integrated health system. After the child's 2, 4, and 6 month visits, parents reported the format their child's provider used to begin the vaccine discussion (presumptive, participatory, or other). Our outcome was the percentage of days under-immunized of the child at 8 months old for 6 recommended vaccines. We used linear regression and generalized estimating equations to test the association of discussion format and immunization status. Results We enrolled 73 parent/child dyads and obtained data from 82%, 73%, and 53% after the 2, 4, and 6 month visits, respectively. Overall, 65% of parents received presumptive formats at ≥1 visit and 42% received participatory formats at ≥1 visit. Parental receipt of presumptive formats at 1 and ≥2 visits (vs. no receipt) was associated with significantly less under-immunization of the child, while receipt of participatory formats at ≥2 visits was associated with significantly more under-immunization. Visit-specific use of participatory (vs. presumptive) formats was associated with a child being 10.1% (95% CI: 0.3, 19.8; P=.04) more days under-immunized (amounting to, on average, 98 more days under-immunized for all 6 vaccines combined). Conclusions Presumptive (vs. participatory) discussion formats are associated with increased immunization.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.12.009
  • Barriers to Physical Activity in Urban School Children with Asthma:
           Parental Perspective
    • Authors: Amy Kornblit; Agnieszka Cain; Laurie J. Bauman; Nicole Brown; Marina Reznik
      Abstract: Publication date: Available online 5 January 2018
      Source:Academic Pediatrics
      Author(s): Amy Kornblit, Agnieszka Cain, Laurie J. Bauman, Nicole Brown, Marina Reznik
      Objective Physical activity (PA) levels are low in today's youth and may even be lower in those with asthma. Barriers to PA have not been well studied in inner-city, minority children with asthma. We conducted a qualitative study to characterize parental perceptions of barriers to PA and ways to improve PA levels in children with asthma. Methods We used the socio-ecological model (SEM) to inform development of our interview guide. Questions fell into two SEM domains: 1) interpersonal (parent, family) barriers and 2) community (neighborhood, school) barriers. Qualitative semi-structured interviews were conducted with 23 parents (21 mothers, 2 fathers) of inner-city children with asthma (ages 8-10 years) from 10 Bronx, New York (NY) elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. Emerging themes were discussed and agreed upon by investigators. Results Three themes surrounding interpersonal barriers to PA emerged: 1) parental fear of exercise-induced asthma due to lack of child symptom awareness; 2) non-adherence and refusal to take medications; and 3) challenges with asthma management. Four themes around community barriers to PA emerged: 1) lack of trust in school management of asthma; 2) lack of school PA facilities; 3) unsafe neighborhoods, and 4) financial burden of PA. Conclusions Our results indicate a complex multi-level set of barriers to PA in children with asthma. Addressing these barriers by involving stakeholders at the family, school and community levels may improve PA levels in children with asthma.

      PubDate: 2018-01-13T22:11:41Z
      DOI: 10.1016/j.acap.2017.12.011
  • Impact of Implementation of Electronically-Transmitted Referrals on
           Pediatric Subspecialty Visit Attendance
    • Authors: Kristin N. Ray; Michael Drnach; Ateev Mehrotra; Srinivasan Suresh; Steven G. Docimo
      Abstract: Publication date: Available online 23 December 2017
      Source:Academic Pediatrics
      Author(s): Kristin N. Ray, Michael Drnach, Ateev Mehrotra, Srinivasan Suresh, Steven G. Docimo
      Objective One barrier to timely access to outpatient pediatric subspecialty care is the complexity of scheduling processes. We evaluated the impact of implementing electronically-transmitted referrals on subspecialty visit attendance. Methods Through collaboration with stakeholders, an electronically-transmitted referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment non-attendance, and referral volume. Electronically-transmitted referrals then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after implementation. Results From April 2015 through September 2016 there were 33,485 referral orders across all practices (7,770 pre-pilot, 11,776 during the pilot; 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9% to 20.0% (p<0.001)). Relative to control practices, pilot practices experienced an 8.6% improvement (p=0.001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8% to 14.7% (p<0.001). In survey responses, referring pediatricians noted improved scheduling processes, but continued concerns with appointment availability and referral tracking. Conclusions While electronically-transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizeable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.

      PubDate: 2018-01-02T23:06:52Z
      DOI: 10.1016/j.acap.2017.12.008
  • Primary Care Provider Perceptions and Practices Regarding Dosing Units for
           Oral Liquid Medications
    • Authors: Maribeth C. Lovegrove; Mathew R.P. Sapiano; Ian M. Paul; H. Shonna Yin; Tricia Lee Wilkins; Daniel S. Budnitz
      Abstract: Publication date: Available online 18 December 2017
      Source:Academic Pediatrics
      Author(s): Maribeth C. Lovegrove, Mathew R.P. Sapiano, Ian M. Paul, H. Shonna Yin, Tricia Lee Wilkins, Daniel S. Budnitz
      Introduction To prevent errors, healthcare professional and safety organizations recommend using milliliters (mL) alone for oral liquid medication dosing instructions and devices. In 2018, for federal incentives under the Quality Payment Program, one requirement is for Electronic Health Records (EHRs) to automatically use mL alone whenever oral liquid medications are prescribed. Current perceptions and practices of primary care providers (PCPs) regarding dosing units for oral liquid medications were assessed. Methods Pediatricians, family practitioners, nurse practitioners, and internists participating in the 2015 DocStyles web-based survey were asked about their perceptions and practices regarding dosing units for oral liquid medications. Results Three-fifths of PCPs (59.0%) reported that using mL alone is safest for dosing oral liquid medications; however, nearly three-quarters (72.0%) thought that patients/caregivers prefer instructions that include spoon-based units. Within each specialty, fewer PCPs reported they would prescribe using mL alone than reported that using mL alone is safest (P<.0001 for all). Among PCPs who think mL-only dosing is safest, those who perceived patients/caregivers prefer spoon-based units were less likely to prescribe using mL alone (odds ratio: 0.45, 95% CI: 0.34-0.59). Pediatricians were more likely than other PCPs to report that it is safest to use mL alone (80.8% vs 54.7%) and that they would use mL alone when prescribing (56.8% vs 30.9%) (P<.0001 for both). Conclusions Because fewer than two-thirds of pediatricians and one-third of other PCPs would use mL alone in dosing instructions, additional education to encourage prescribing and communicating with patients/caregivers using mL alone may be needed.

      PubDate: 2018-01-02T23:06:52Z
      DOI: 10.1016/j.acap.2017.12.002
  • A Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk
    • Authors: Elizabeth Reifsnider; David P. McCormick; Karen W. Cullen; Michael Todd; Michael W. Moramarco; Martina R. Gallagher; Lucia Reyna
      Abstract: Publication date: Available online 23 December 2017
      Source:Academic Pediatrics
      Author(s): Elizabeth Reifsnider, David P. McCormick, Karen W. Cullen, Michael Todd, Michael W. Moramarco, Martina R. Gallagher, Lucia Reyna
      Introduction Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. Objectives We hypothesized that parent education, initiated prenatally, and provided in the home, would reduce the incidence of infant overweight at age 12 months. Methods Pregnant obese Latina women were recruited at WIC and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects. Results Compared with controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age six months. Infants overweight at six months were likely to be overweight at age 12 months (r=0.60, P<0.0001). Overweight was more common in formula fed infants at ages six months (P<0.06) and 12 months (P=0.005). Breastfeeding was less common in families with employed mothers (P=0.02) and unemployed fathers (P<0.01), but father living with mother at the time of the prenatal visit predicted successful breastfeeding at infant age two months (P<0.003). Compared with formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed ≥ two months (P = 0.01). Conclusion The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.

      PubDate: 2017-12-26T22:34:26Z
      DOI: 10.1016/j.acap.2017.12.007
  • The Inherent Fallibility of Validated Screening Tools for Social
           Determinants of Health
    • Authors: Arvin Garg; Radley Christopher Sheldrick; Paul H. Dworkin
      Abstract: Publication date: Available online 20 December 2017
      Source:Academic Pediatrics
      Author(s): Arvin Garg, Radley Christopher Sheldrick, Paul H. Dworkin

      PubDate: 2017-12-26T22:34:26Z
      DOI: 10.1016/j.acap.2017.12.006
  • When Residents Let Conscience be Their Guide: Professional Development and
           Educational Opportunity
    • Authors: Catherine D. Shubkin; Jeremy R. Garrett; John D. Lantos
      Abstract: Publication date: Available online 18 December 2017
      Source:Academic Pediatrics
      Author(s): Catherine D. Shubkin, Jeremy R. Garrett, John D. Lantos

      PubDate: 2017-12-20T08:04:19Z
      DOI: 10.1016/j.acap.2017.12.003
  • Saving Ourselves, Our Patients, and Our Profession: Making the Case for
           Narrative Competence in Pediatrics
    • Authors: Casey N. Hester; Jessica W. Tsai
      Abstract: Publication date: Available online 18 December 2017
      Source:Academic Pediatrics
      Author(s): Casey N. Hester, Jessica W. Tsai

      PubDate: 2017-12-20T08:04:19Z
      DOI: 10.1016/j.acap.2017.12.004
  • Enhancing Resident Education and Optimizing Care for Children with Special
           Health Care Needs in Resident Continuity Clinic
    • Authors: Julie M. Linton; Elizabeth Reichard; Abby Peters; Laurie Wong Albertini; Anna Miller-Fitzwater; Katherine Poehling
      Abstract: Publication date: Available online 18 December 2017
      Source:Academic Pediatrics
      Author(s): Julie M. Linton, Elizabeth Reichard, Abby Peters, Laurie Wong Albertini, Anna Miller-Fitzwater, Katherine Poehling

      PubDate: 2017-12-20T08:04:19Z
      DOI: 10.1016/j.acap.2017.12.005
  • Cross Talk: Evaluation of a Curriculum to Teach Medical Students How to
           Use Telephone Interpreter Services
    • Authors: Emma A. Omoruyi; Jesse Dunkle; Colby Dendy; Erin McHugh; Michelle S. Barratt
      Abstract: Publication date: Available online 14 December 2017
      Source:Academic Pediatrics
      Author(s): Emma A. Omoruyi, Jesse Dunkle, Colby Dendy, Erin McHugh, Michelle S. Barratt
      Purpose Telephone interpretation and recent technology advances assist patients with more timely access to rare languages, but no one has examined the role of this technology in the medical setting and how medical students can be prepared for their use. We sought to determine if structured curriculum on interpretation would promote learners self-reported competency in these encounters and if proficiency would be demonstrated in actual patient encounters. Methods Training on the principles of interpreter use with a focus on communication technology was added to medical student education. The students later voluntarily completed a retrospective pre/post-training competency self-assessment. A cohort of students rotating at a clinical site had a blinded review of their telephone interpretation encounters scored on a modified validated scale and compared to scored encounters with pre-intervention learners. Nested ANOVA models were used for audio file analysis. Results 176 students who completed the training reported a statistically significant improvement in all 4 interpretation competency domains. 83 audio files were analyzed from pre- and post-intervention students. These scored encounters showed no statistical difference between the scores of the two groups. However, plotting the mean scores over time from each encounter suggests that those who received the curriculum started their rotation with higher scores and maintained those scores. Conclusions Our study is the only one to date that evaluates learners' ability to use interpreters in actual patient encounters. The focused education led to earlier proficiency of using interpreters compared to peers who received no training.

      PubDate: 2017-12-20T08:04:19Z
      DOI: 10.1016/j.acap.2017.11.010
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