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Clinical Pediatrics

M Diane McKee, Elizabeth Alderman, Deborah V York, Arthur E Blank, Rahil D Briggs, Kelsey E S Hoidal, Christopher Kus, Claudia Lechuga, Marie Mann, Paul Meissner, Nisha Patel, Andrew D Racine
The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites)...
October 1, 2017: Clinical Pediatrics
Julia Mayne, Shilpa Pai, Lesley Morrow, Daniel Lima, Manuel E Jimenez
Low literacy is associated with poor health. We sought to examine pediatricians' attitudes and practices regarding literacy promotion in early childhood. We distributed a self-administered 23-item survey to a random sample of 500 board certified or eligible New Jersey primary care pediatricians. 134 surveys were returned, 25 of which were excluded. In all, 91% of pediatricians in our sample agreed that literacy promotion was an essential aspect of practice, and two-thirds agreed that they conduct activities to promote literacy...
October 1, 2017: Clinical Pediatrics
Alex M Taylor, Lise E Nigrovic, Meredith L Saillant, Emily K Trudell, Jonathan R Modest, Madeleine Kuhn, Louis Vernacchio
Pediatric primary care providers report limited training and tools to manage concussion. We developed a learning community intervention for a large independent pediatric practice association affiliated with a university hospital to standardize concussion management and improve the use of consensus-based guidelines. The learning community included in-person and online didactics, followed by a web-based reinforcement platform to educate and train clinicians on our treatment algorithm and decision support tools...
October 1, 2017: Clinical Pediatrics
Sophie H Allende-Richter, Sydney T Johnson, Mariam Maloyan, Patricia Glidden, Kerrilynn Rice, Alexandra Epee-Bounya
Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit...
October 1, 2017: Clinical Pediatrics
Susan C Lipsett, Michael C Monuteaux, Richard G Bachur, Mark I Neuman
No abstract text is available yet for this article.
October 1, 2017: Clinical Pediatrics
Anna E Ferguson, Stavra A Xanthakos, Robert M Siegel
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes in children in the United States. Screening for NAFLD in children with obesity is recommended by several published guidelines, but the application of these recommendations in pediatric weight management programs is uncertain. Our study aimed to describe the screening practices for NAFLD in a large pediatric weight management program. During 2014, 1312 patients were seen, with a liver enzyme panel obtained in 847 (64...
October 1, 2017: Clinical Pediatrics
Heide Cygan, Monique Reed, Karen Lui, Mary Mullen
One-third of children in the United States are overweight or obese. Comorbidities continue into adulthood if a healthy weight is not established. While expert guidelines for management of this condition are recognized, provider adherence to guidelines is lacking. The purpose of this quality improvement project was to evaluate the effectiveness of the chronic care model (CCM) on improving primary care provider identification, prevention, and management of childhood overweight and obesity. A pre- and postintervention chart audit was completed to evaluate documentation of 20 assessment measures included in expert guidelines...
October 1, 2017: Clinical Pediatrics
Bryan Anker, Yorghos Tripodis, Webb E Long, Arvin Garg
This study was a secondary data analysis of the 2011-2012 National Survey of Children's Health. Data were available for a nationally representative sample of 81 090 children. Multivariable logistic regression was used to model child health with the medical home while examining the effect modification of household income and controlling for sociodemographic characteristics. Overall, the medical home was significantly associated with "excellent/very good" child health for children regardless of household income...
October 1, 2017: Clinical Pediatrics
Ya-Chao Qi, Xiao-Li Niu, Ya-Ran Gao, He-Bo Wang, Ming Hu, Li-Peng Dong, Ya-Zhou Li
The aims of this study were to investigate the effect of neuromuscular electrical stimulation (NMES) combined with strengthening exercise on movement in children with spastic cerebral palsy (CP). One hundred children with spastic CP were randomly divided into a treatment group (NMES and strengthening exercise, n = 50) and a control group (only NMES, n = 50). We compared the Comprehensive Spasticity Scale (CSS) score, Gross Motor Function Measure (GMFM) score, and walking speed before treatment and 6 weeks and 3 months after treatment between the 2 groups...
October 1, 2017: Clinical Pediatrics
Xianhui Zhang, Wei Wang, Yuanjun Li, Hui Wang, Runtao Liu, Lei Zhu
BACKGROUND: Vitamin D can play a vital role in autoimmune diseases. Epidemiologic evidence demonstrates vitamin D deficiency excited in adult patients with vitiligo. OBJECTIVES: To investigate 25-hydroxyvitamin D (25(OH)D) levels in children with vitiligo and explore possible relevant factors. METHODS: A total of 114 patients and 100 controls were included in our case-control study. We analyzed the required data collected by the questionnaire and examination to reveal the correlation with 25(OH)D levels...
October 1, 2017: Clinical Pediatrics
Kristin L Barrett, Deepa Mukundan, Janet L Moore
No abstract text is available yet for this article.
October 1, 2017: Clinical Pediatrics
Rebecca Epstein, Paul M Shaniuk, Ramy Sabe
No abstract text is available yet for this article.
October 1, 2017: Clinical Pediatrics
Courtney E Nelson, Svetlana Ostapenko, Joseph J Zorc, Fran Balamuth
This retrospective cohort study aimed to describe antipyretic use among healthy patients in a pediatric emergency department (ED) with nonurgent fever defined as: triage level 4 or 5, chief complaint fever or temperature 38°C to 39°C, and otherwise normal vital signs, and determine if antipyretic administration is associated with increased ED length of stay (LOS). We compared continuous variables using Kruskal-Wallis and Wilcoxon rank sum testing. We adjusted confounding variables using logistic regression modeling...
October 1, 2017: Clinical Pediatrics
Jeffrey Christopher Lawrence, Robert J Vasquez, Raj Warrier
No abstract text is available yet for this article.
October 1, 2017: Clinical Pediatrics
Christine Thang, Margaret Whitley, Nilufar Izadpanah, Daniel DeUgarte, Wendy Slusser
A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities...
October 1, 2017: Clinical Pediatrics
Nicol Awadalla, Tammy Pham, Ruth Milanaik
The American Academy of Pediatrics (AAP) recommends when to start first finger foods (FFFs) and what types of foods to start with, but it is unclear whether products marketed as FFF comply with these recommendations. We evaluated FFF products for compliance with AAP recommendations and product safety using 41 adult product testers, who were asked to dissolve each product in their mouth. Product characteristics, comments pertaining to product safety, and time to dissolve each product were recorded. Only 2 products met all AAP criteria, and safety concerns were raised for an additional 2 products...
October 1, 2017: Clinical Pediatrics
Michael W Yogman, Susan Betjemann, Anna Sagaser, Liza Brecher
The top 5 reasons for pediatric office visits in the United States today are behavioral health concerns. This article describes a colocated behavioral health and care coordination integration model in a pediatric primary care office to reduce barriers to behavioral health care.
October 1, 2017: Clinical Pediatrics
Michelle McKean, Aaron B Caughey, Melanie A Yuracko McKean, Michael D Cabana, Valerie J Flaherman
Maternal postpartum depression (PPD) has an impact on mothers and infants. The American Academy of Pediatrics recommends screening for PPD at well-child visits during the first 6 months. We conducted a secondary data analysis of depression screening data collected each month during months 1 to 12 postpartum for 152 mothers with an infant participating in a randomized controlled trial. We used descriptive statistics to describe the incidence and the cumulative incidence of a positive PPD screen during months 1 to 12 postpartum...
September 1, 2017: Clinical Pediatrics
Maria Andrews, Carolyn Sawyer, Leah Frerichs, Asheley Cockrell Skinner, Jessica Hoffman, Kiah Gaskin, Sarah Armstrong
BACKGROUND: "Bull City Fit" is a childhood obesity treatment partnership between Duke Children's pediatric weight management clinic and Durham Department of Parks and Recreation. OBJECTIVES: Report on feasibility and implementation, characteristics of participants, and predictors of attendance. METHODS: Mixed methods study consisting of (1) a retrospective cohort analysis (n = 171) reporting demographic, attendance, and clinical data and (2) structured focus groups among stakeholders to identify implementation facilitators and barriers...
September 1, 2017: Clinical Pediatrics
Anna Kobylianskii, Thivia Jegathesan, Elizabeth Young, Kimmy Fung, Joelene Huber, Ripudaman S Minhas
We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity...
September 1, 2017: Clinical Pediatrics
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