Attention-Deficit/Hyperactivity Disorder Knowledge and Practices: A Survey of Pediatricians and Family Practice Physicians

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder often treated by pediatricians or family practice physicians. ADHD knowledge held by treating physicians may be an important predictor in patient outcomes. This study examined ADHD knowledge and common assessment and treatment practices of pediatricians and family practice physicians via a national survey sent to members of the American Academy of Pediatrics and the American Academy of Family Physicians. Mailings included the Knowledge of Attention Deficit Disorders Scale--Revised (KADDS-R) arid a demographic/practice questionnaire. Although both physician types reported utilizing assessment and treatment methods consistent with current ADHD practice guidelines, findings suggested that pediatricians had greater ADHD knowledge than did family physicians. Physicians who had completed a behavioral pediatric rotation or training specific to ADHD had greater knowledge than physicians who had not done so. The number of new ADHD evaluations conducted monthly was also related to ADHD knowledge. Implications for future research examining ADHD knowledge, training, and outcomes are discussed

Public Health Rep

To describe the use of infrared (IR) ear thermometers in pediatric and family practice offices.|The authors mailed a questionnaire to 350 randomly selected members of the American Academy of Pediatrics and to 355 randomly selected members of the American Academy of Family Physicians.|Of respondents in clinical practice, 78% had used IR ear thermometers at least once in the past; 65% of pediatricians and 64% of family practice physicians were current users. Seventeen percent of pediatric offices and 18% of family practice offices that had used IR ear thermometers had discontinued use, most citing inaccuracy or lack of staff trust in the device. Pediatric offices were less likely than family practice offices to use the device in well neonates and sick neonates and more likely to use it in sick children. Advantages cited included rapid readings, ease of use, and accuracy. Seventy-five percent of current users reported at least one problem, including low readings and lack of staff trust.|IR ear thermometers are widely used in pediatric and family practice offices. Some offices limit use of these devices to older children and adults, and most of the offices surveyed report using other devices as a check on the accuracy of IR thermometers. Statements by professional organizations that provide user guidelines and establish appropriate age cut-offs would be helpful.9633875PMCnul

Pediatric Lipid Screening Guidelines: Information for Patients and Families

Universal Pediatric Lipid Screening Guidelines are currently based on expert opinion only. Bright Futures/American Academy of Pediatrics currently recommends screening all patients ages 9-11 and again at ages 17-21. The US Preventive Services Task Force (USPSTF), however, concludes the evidence is insufficient to recommend for or against routine screening. This discordance leaves ambiguity for implementation in Family Medicine practices in Vermont. A survey of providers at Milton Family Practice showed that only 14% of providers at Milton Family Practice regularly perform lipid screening on their pediatric patients.https://scholarworks.uvm.edu/fmclerk/1108/thumbnail.jp

Better together: advancing family-centered care

Family-centered care (FCC) is recommended as “best practice” across a variety of pediatric service settings, as it yields better health and wellness outcomes for clients, and greater work satisfaction for practitioners and administrators (American Academy of Pediatrics, 2012). However, providers in multiple health care fields report challenges with translation of FCC concepts into their practice (Bamm & Rosenbaum, 2008; Graham, Rodger, & Ziviani, 2008; Lawlor & Mattingly, 1998; MacKean, Thurston, & Scott, 2005). Therefore, the aim of this doctoral project was to understand the barriers to FCC implementation, and to propose ways for supporting practitioners to enact FCC in their practice. The resulting solution is Better Together, an on-line professional development course designed to empower health care providers to become ambassadors of FCC and effectively enact the FCC practices in their daily interactions with clients and their families. The Better Together course content and structure are based on findings from a review of the literature specific to identifying core skills and knowledge essential for effective FCC practice, as well as best practices for professional development instruction. Methods for course implementation, funding, and dissemination are described, as well as a research plan for program evaluation

Breastfeeding Success among Infants with Phenylketonuria

Breast milk is the nutrition of choice for human infants (American Academy of Pediatrics, 2005; American Association of Family Physicians, 2008; Association of Women’s Health Obstetric and Neonatal Nurses, 2005; Canadian Paediatric Society, 2005; U.S. Preventive Services Task Force, 2008; World Health Organization, 2009). The literature on the benefits of breast milk and breastfeeding for infants and mothers has established multiple positive outcomes for infants (Hoddinott, Tappin, & Wright, 2008; Horta, Bahl, Martines, & Victora, 2007; Ip et al., 2007). Breast milk has advantages for infants that distinguish it from standard commercial infant formulas. These advantages include growth factors, hormones, immunological factors, and long-chain polyunsaturated fatty acids. For infants with phenylketonuria (PKU), breast milk has additional advantages over any standard commercial infant formula, such as a lower concentration of protein and a lower content of the amino acid, phenylalanine. Despite these benefits, some clinics encourage mothers of infants with PKU to breastfeed whereas others present breastfeeding as an unacceptable option. Although the possible risks and benefits of breastfeeding infants with PKU have been discussed, there is limited research and practice describing breastfeeding infants with PKU. As a result, breastfeeding infants with PKU is based more upon limited clinical experiences rather than upon evidence based practice that aims to apply the best scientific evidence gained from research to clinical decision making

Adolescent Medicine: Attitudes, Training And Experience of Pediatric, Family Medicine and Obstetric-Gynecology Residents

Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive health care services adolescents. We asked residents to identify the following: (1) adolescent health services they considered part of their scope of practice in their respective field; (2) the level of training they had received with regard to select adolescent health services; (3) the experience they had performing select clinical activities with adolescents; and (4) their comfort with aspects of adolescent care. We further asked two questions to test resident knowledge of an adolescents right to consent to contraception or an abortion without parental notification in the state of their residency. A total of 87 residents (31 Obstetric-Gynecology, 29 Family Medicine and 27 Pediatric) were surveyed. Most residents from all three fields felt the full range of adolescent preventive and clinical services represented in the survey fell under the scope of their practice. Most residents also reported high levels of comfort with examined aspects of adolescent care. In regard to some activities, the positive scope and comfort responses were matched by high reported levels of training and experience, including defining confidentiality; counseling about eating, exercise and obesity; counseling about substance abuse; and discussing STDs, sexual partners and contraception. However, for multiple key adolescent services, considerable discrepancies existed between reported levels of training and experience and the positive responses concerning scope and comfort. In particular the results of study suggested all residents need considerably more training and experience with mental health issues, referring teenagers for substance abuse treatment, and addressing physical and sexual abuse. Overall, there were also significant differences between fields. Family Medicine residents reported the greatest potential for providing comprehensive health care. However, they suffered from the overall deficiencies in training and experience noted above. Obstetric-Gynecology residents reported deficiencies in the provision of several preventive counseling and general health services. Pediatric residents reported multiple deficiencies in the provision of sexual health services. Our results indicate, at this time and in the near future, it is unlikely that adolescents will be able to obtain the full range of recommended preventive and clinical services in a single physician visit unless residencies programs actively incorporate increased training in the full range of adolescent preventive and clinical health services

Pediatricians\u27 attitudes, experience and referral patterns regarding complementary/alternative medicine: a national survey

Abstract Background To assess pediatricians\u27 attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies. Methods An anonymous, self-report, 27-item questionnaire was mailed nationally to fellows of the American Academy of Pediatrics in July 2004. 648 of 3500 pediatricians\u27 surveyed responded (18%). Results The median age ranged from 46–59 yrs; 52% female, 81% Caucasian, 71% generalists, & 85% trained in the US. Over 96% of pediatricians\u27 responding believed their patients were using CAM. Discussions of CAM use were initiated by the family (70%) & only 37% of pediatricians asked about CAM use as part of routine medical history. Majority (84%) said more CME courses should be offered on CAM and 71% said they would consider referring patients to CAM practitioners. Medical conditions referred for CAM included; chronic problems (headaches, pain management, asthma, backaches) (86%), diseases with no known cure (55.5%) or failure of conventional therapies (56%), behavioral problems (49%), & psychiatric disorders (47%). American born, US medical school graduates, general pediatricians, & pediatricians who ask/talk about CAM were most likely to believe their patients used CAM (P \u3c 0.01). Conclusion Pediatricians\u27 have a positive attitude towards CAM. Majority believe that their patients are using CAM, that asking about CAM should be part of routine medical history, would consider referring to a CAM practitioner and want more education on CAM

Marie Olivieri Russell and Sarah Sundborg Long

Marie Olivieri Russell Dr. Russell attended Jefferson Medical College where she graduated top of her class in 1970. In addition to being the first woman to receive the Alumni Prize for highest cumulative GPA, in 1971 she became the first student to serve as a full voting member of the Board of Trustees at Jefferson. After graduation she completed both a residency in Pediatrics and a fellowship in Pediatric Hematology Oncology at Children’s Hospital of Philadelphia before continuing on as a part of their academic staff until 1981 and managing the Comprehensive Sickle Cell Program. After leaving Children’s and academic medicine Dr. Russell transitioned into Primary Care, eventually co-founding a pediatric practice for Crozer-Keystone Health System in Media, Pennsylvania. The practice later moved to Springfield, Pennsylvania, grew to include six physicians, and became part of Children’s Hospital of Philadelphia’s Primary Care Network. Over the years she also held faculty appointments at University of Pennsylvania, Hahnemann Medical College, and Drexel University. Dr. Russell retired in 2005 to spend more time with her family. Sarah Sundborg Long Dr. Long graduated from St. Francis College with a Bachelor’s of Science in Biology before entering Jefferson Medical College. Upon her graduation in 1970 she completed an Infectious Disease residency and fellowship at St. Christopher’s Hospital for Children in Philadelphia. She is currently the Chief for the Section of Infectious Diseases at St Christopher’s and a Professor of Pediatrics at Drexel University College of Medicine. Throughout her teaching career she has held more than seventy-five visiting professorships and earned a number of honors and awards, including most recently the Lindback Award. Dr. Long is the founding editor of Principles and Practice of Pediatric Infectious Disease as well as an associate editor of The Journal of Pediatrics and the Red Book Report of the Committee on Infectious Diseases of the American Academy of Pediatrics. Her main research areas are common infectious diseases and vaccine-preventable diseases in children.https://jdc.jefferson.edu/oral_histories/1010/thumbnail.jp

World Health Organization Decision Making Tool for Family Planning- Can We Increase IUD Use?

Background and Purpose: Worldwide unintended pregnancy rates are reported at 40% of all pregnancies. The United States has an unintended pregnancy rate of 45%. Contraception is safe and available for most women. Many providers lack evidence-based tools and current information in assisting clients to choose a highly effective contraceptive method. Intrauterine devices (IUD) and implants are highly effective contraception. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend IUDs and implants as first tier contraception for most sexually active females. Methods: Implementation of the World Health Organization Decision-Making Tool (WHO DMT) for contraceptive counseling guidance for clients and providers. The tool consists of a training manual for providers, exam room posters, flipcharts, and printed patient education materials. Pre and post intervention surveys were collected and analysis conducted. Hypothesis 1: The WHO DMT will increase client selection of intrauterine devices as the preferred contraceptive method. Hypothesis 2: There will be an increased IUD selection by clients seen by providers using the WHO DMT for counseling. Hypothesis 3: Patients counseled with WHO DMT will be more satisfied with contraceptive method chosen. Implications for practice: Use of WHO DMT can impact unintended pregnancy rate by educating women on the highly effective contraceptive methods, focusing on IUDs, to all populations, especially the underserved and vulnerable. Keywords: Contraception, family planning, WHO DMT, intrauterine devices, shared decision- making, provider trainin

Evaluation of an Evidence-Based Breastfeeding Education Program for Pediatric and Women\u27s Health Care Providers, Family Practice Residents, Medical Students, and Physician Assistant Students

Background.;Every year approximately {dollar}13 billion are spent and an estimated 900 infant lives are lost in the United States as a result of infants not exclusively receiving breast milk for the first six months of life. Many health care providers lack knowledge and supportive skills regarding basic breastfeeding management. However, the results of several research studies indicate that health care providers who provide support and who are knowledgeable in breastfeeding management can improve the breastfeeding rates of the maternal-infant dyads that they serve. An evidence-based breastfeeding educational program can significantly increase the breastfeeding knowledge and attitudes of health care providers.;Objectives.;The goal of this project was to significantly increase the breastfeeding knowledge and attitudes of family practice residents, medical students and Physician Assistant students and the pediatric and women\u27s health clinical faculty practicing within the outpatient clinics of a rural hospital located in eastern Kentucky.;Design.;This study used a quasi-experimental pre-test and post-test design. Clinical faculty working in the pediatric and women\u27s health clinics attended a 1-hour evidence-based breastfeeding education program. Family practice residents, medical students, and Physician Assistant students attended 12 1-hour breastfeeding education seminars which occurred twice weekly for six weeks during hospital Grand Rounds. Pre- and post- measurements included knowledge and attitude scores. Clinical faculty completed the modified Physicians Breastfeeding Assessment Survey pre- and post-intervention. Residents, medical students, and Physician Assistance students completed the American Academy of Pediatrics Breastfeeding Residency Curriculum Tests, the modified Physicians Breastfeeding Assessment Survey, and the modified Nursing Support for Breastfeeding Questionnaire pre- and post- intervention.;Subjects.;Thirty clinical faculty members were eligible to attend the program and the program was completed by 27 clinical faculty. All 14 eligible students attended and completed the Grand Rounds program.;Results.;Clinical faculty members had a statistically significant improvement in knowledge scores on the modified Physicians Breastfeeding Assessment Survey after attending the 1-hour program (p \u3c 0.001). Clinical faculty did not display a statistically significant improvement in attitude scores (p = 0.19). Residents and students had statistically significant improvement in knowledge scores on the modified Physicians Breastfeeding Assessment Survey and the American Academy of Pediatrics Breastfeeding Residency Curriculum Tests (p \u3c 0.001; p \u3c 0.001, respectively). Residents and students also experienced statistically significant improvement in breastfeeding attitudes on the modified Physicians Breastfeeding Assessment Survey and the modified Nursing Support for Breastfeeding Questionnaire (p = 0.054; p \u3c 0.001, respectively).;Conclusion.;The implementation of an evidence-based breastfeeding education program for students and faculty improved breastfeeding knowledge and attitudes of students and breastfeeding knowledge of faculty. Evidence-based breastfeeding programs are a cost-effective strategy to improve knowledge of heath care providers