Quality of Preventive Health Care for Young Children: Strategies for Improvement

Looks at early childhood developmental services, including assessment, education, intervention, and coordination of care. Recommendations include national standards for preventive care, and improvements in health provider training

Psychotropic medication use among children in the child welfare system

Prior research demonstrates that children in the child welfare system are given psychotropic medication at rates approximately three times higher than children and adolescents in the general population. Using data from the second National Survey of Child and Adolescent Well-Being, authors Wendy Walsh and Marybeth Mattingly report that among children age 4 and older with a report of maltreatment, rates of psychotropic medication use are significantly higher in rural (20 percent) than urban areas (13 percent). Children age 4 and older with a maltreatment report in rural areas were significantly more likely to take more than one medication than children in urban areas. The significantly higher rates of psychotropic medication use among children in rural areas and the significantly higher rates of taking multiple medications point to the need among child welfare professionals in rural areas to closely monitor use. The results of the current analysis indicate that more information is needed about the complex decision-making process regarding medication use. This includes a need to better understand how pediatric clinicians make decisions, and the impact of community norms on medication use

Increasing Knowledge of Community Autism Resources Among Pediatric Clinicians Using an Educational Intervention: A Quality Improvement Project

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits of social communication, social interaction, and restrictive and/or repetitive behaviors and interests, and currently affects 1 in 54 children in the United States (Centers of Disease Control and Prevention, 2020). Presently, no cure exists for ASD; however, therapies and local resources have been utilized to aid patients with ASD and avoid delays in treatment. Early intervention has been shown to be most effective when providers have referred their patients with ASD to the appropriate resources. There are ample studies on clinician awareness of ASD diagnosis and treatment, but few studies have investigated clinicians’ knowledge of treatment and community resources for ASD treatment. The purpose of this quality improvement study was to increase knowledge of community ASD resources among pediatric clinicians in Coral Gables, Florida. A quasi-experimental research design utilizing a pre- and posttest was conducted for this project. A total of N = 43 subjects from a large pediatric hospital in Coral Gables, Florida participated in the study. The study was conducted remotely through a virtual educational presentation, and participants were asked to complete a pre- and post-questionnaire on Qualtrics that assessed their level of knowledge of local ASD resources in Miami-Dade County as well as their demographics, clinical and educational background, and their self-efficacy level. The study’s results revealed a significant increase between the pre- and posttest on knowledge on ASD resources among all provider types increasing over time, t(54) = -3.03, p = .004, (p \u3c 0.05). Pediatric clinicians should receive continuing education on local ASD resources to improve clinical practice and self-efficacy levels, and to improve overall patient outcomes

Social Media as a Healthcare Tool: Case Study Analysis of Factors Influencing Pediatric Clinicians\u27 Behavioral Intent to Adopt Social Media for Patient Communication and Engagement

Social media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians\u27 behavioral intent to adopt social media for patient engagement and communication. A new framework, the Healthcare Social Media Adoption Framework (HSMA), guided this mixed-method approach to assess 7 factors identified by theory and literature as adoption influencers. A custom, web-based survey collected data from 60 full-time, pediatric clinicians (47 quantitative) at the case institution (a pediatric hospital). Additionally, individual interviews of 6 participants provided their prospective on using social media for patient communications and engagement. Results: Privacy concerns were the only statically significant factor; with an inverse relationship to positive adoption intent, indicating higher privacy concerns influence lower behavioral intent to adopt social media for patient engagement and communication. The qualitative analysis revealed privacy concerns encompass two themes, personal privacy for patient and providers (boundaries), and cybersecurity. The qualitative inputs also uncovered perceived unprofessionalism as a new factor influencing clinician adoption. The implications for these findings indicate a need for both healthcare organizations and healthcare regulators to establish cyber-security defenses for security and use protocols for privacy to aid the diffusion and adoption acceptance of social media use by pediatric healthcare professionals. This research has contributed in four areas: 1) fill a knowledge gap by identifying new factors that influence the behavioral intent of pediatric clinicians to adopt social media; 2) confirm/reject behavioral intent influences found in the literature; 3) formulated a new HSMA framework that measures functional, cognitive, and social aspects of social media adoption; and 4) prioritizes policies and global standard focus

Curr Dev Disord Rep

Early identification of fetal alcohol spectrum disorders (FASDs) is important for providing services and preventing secondary disabilities. Recent studies indicate that many FASDs are undiagnosed, partly because there is a need to improve detection of prenatal alcohol exposure (PAE). The aims of this review are to characterize existing practices for assessing PAE in pediatric care, identify the most efficient, promising methods of detecting PAE, and recognize the knowledge and practice gaps. This review indicates that maternal self-reports remain the most common method utilized in routine clinical practice and highlights promising methods of PAE identification, including a single binge drinking question. The review yields few studies describing existing strategies to assess PAE in pediatric practice and identifies knowledge gaps that need to be addressed for improving recognition of FASDs in pediatric practice.R01 AA016234/AA/NIAAA NIH HHS/United StatesU84 DD000884/DD/NCBDD CDC HHS/United States2016-09-01T00:00:00Z26317063PMC454736

Stability of extemporaneously prepared cinacalcet oral suspensions

Purpose The stability of extemporaneously prepared cinacalcet suspensions over 90 days was evaluated. Methods Cinacalcet 5-mg/mL suspension was prepared by triturating 30-mg cinacalcet tablets. Twelve 30-mL batches were prepared with a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF (sugar free). Three suspensions of each kind were stored at both room temperature and refrigerated conditions. A 1-mL sample was taken from each bottle at 0, 7, 18, 32, 64, and 90 days. Each sample was assayed using high-performance liquid chromatography (HPLC). A new HPLC method for evaluating drug peaks of pure cinacalcet was developed. Stability was defined as retention of at least 90% of the initial drug concentration. Results The HPLC method established in this study serves as a novel assay for evaluating cinacalcet oral suspensions. For all suspensions tested at individual conditions, the concentration remained above 90% of the initial concentration for 90 days of storage with the exception of Ora-Plus and Ora-Sweet SF suspensions stored under refrigeration, which were stable for 64 days. Usual sedimentation of the suspensions occurred over time but resolved with agitation; there was no other change in visual appearance of the suspensions over the course of the 90-day study. The color and odor of the suspensions throughout the study remained unchanged with respect to the initial time point. Conclusion Extemporaneously compounded cinacalcet 5-mg/mL oral suspensions prepared with a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF and stored in 2-oz amber polypropylene plastic bottles were stable for at least 64 days at room temperature and under refrigeration

An unusual cause of duodenal perforation due to a lollipop stick

Children have a natural tendency to explore objects with their mouths; this can result in the swallowing of foreign objects. Most ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, some foreign bodies cause obstruction or perforation of the gastrointestinal tract, requiring surgical intervention. Perforation of the gastrointestinal tract may be associated with considerable morbidity and mortality. The most common sites of intestinal foreign body perforation are the ileocecal and rectosigmoid regions. Foreign body perforation of the duodenum is relatively uncommon. We report the first Korean case of duodenal perforation by an ingested 8-cm lollipop stick. Lollipops are popular with the children and fairly accessible to them, as most parents are not aware of their potential harm. Pediatric clinicians should be aware of the risks associated with lollipop stick ingestion. Our report also describes the feasibility and safety of laparoscopic diagnosis and management of pediatric patients with peritonitis induced by the ingestion of foreign bodies

Building brains, forging futures: the pediatrician's role

AbstractRecent leaps in the understanding of early brain growth and child development provide us with scientific underpinnings for strategies to improve child health outcomes. Genetic, environmental, and behavioral factors impact the growing child and have a profound impact on lifelong health and function. Recent advances in knowledge concerning the biologic underpinnings of brain development provide a better understanding upon which to base interventions. All growing children experience stress. However, if children are stressed in a manner that exceeds their coping capability, the stress is considered toxic. Toxic stress can impede the cognitive and social emotional growth of the developing brain. Pediatricians have the opportunity to intervene through screening for families at risk, supporting optimal parenting, and linking in a team fashion with other providers of care for young children to support development

Survival, virological and immunological outcomes of HIV-infected children accessing ART at South African primary health care clinics

Includes bibliographical references.South Africa faces the world’s largest pediatric HIV epidemic. Combination antiretroviral therapy (ART) is the only effective treatment for HIV virus suppression. Pediatric HIV care has traditionally been provided in academic research and tertiary care facilities, however efforts to improve ART availability for children are ongoing through decentralization. Tygerberg Hospital physicians with training in pediatric HIV management are providing care in seven community-based primary health care (PHC) clinics in the greater Cape Town region. ART initiation and ongoing ART management for those down-referred from tertiary and district level facilities are provided. The HIV-related outcomes of this cohort have yet to be reported