Wednesday, August 26, 2015

Are We “Choosing Wisely” to Reduce the Frequency of CT Scans in Children? New Study Tells All!

By: Lewis First, MD, MS; Editor-in-Chief 

          Our journal along with many other peer-reviewed pediatric journals have certainly published our share of studies suggesting the potential radiation risks of computed tomography (CT)  scans—especially multiple CT scan exposures in the same child.  This has led to lower dosages of radiation when children need to use this imaging modality as well as a national campaign to “Image Gently” or to avoid overuse of this readily accessible technology unless it’s medically or surgically indicated relative to other radiologic options.  
       So are trends in CT scanning improving?  Parker et al. (doi: 10.1542/peds.2015-0995) opted to assess these trends in a study being released this week in Pediatrics.  The authors performed a cross-sectional study of 33 tertiary care children’s hospitals using data from the Pediatric Health Information System between 2004 and 2012 looking at trends in not just CT but also ultrasound (US) and magnetic resonance imaging (MRI) for ten leading pediatric diagnoses recorded in this extensive dataset.   
      The results show that CT utilization is decreasing for most of the leading diagnoses and US and MRI trends and that alternative radiologic modalities are increasing.  Just what do the trends show more specifically for what disease?  The answers can be found by carefully scanning through the extensive data shared in this interesting study and then reassuring families that just because a CT scanner is available, doesn’t mean that the benefit of using it outweighs some radiation risks when less risky modalities may exist.

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Monday, August 24, 2015

Infection-Related Hospitalizations in Childhood and Adult Cardiometabolic Disease: An Association You May Not Know About


By: Lewis First, MD, MS; Editor-in-Chief 
         
     We are always looking for early determinants of adult disease processes so we might be able to intervene sooner and abate serious morbidity up the road—but sometimes we discover a determinant that we had not suspected to be a contributor.  Take childhood infections for example and their influence, or at least their association with adult cardiometabolic disease.   
     Burgner et al. (doi:10.1542/peds.2015-0825) report this week on their study of a longitudinal cohort of children in Finland who were followed from ages 3- to 9-years onward until they were 30 to 45 years of age with data being accessible in terms of infection-related hospitalizations since birth as well as their degree of adiposity, body mass index and metabolic syndrome in adulthood.   
      The authors controlled for various confounders and discovered that early childhood infectious disease-related hospitalizations correlated significantly with increased BMI and metabolic syndrome even when age, sex, birthweight, childhood BMI, family income and other factors were controlled for.  In fact, the more infection-related hospitalizations, the higher the increase in adult BMI.  If this seems puzzling to you, it did to us initially as well until we read this study and learned from the discussion as to what role these infection-related inpatient stays might have with adult cardiometabolic outcomes.   
      You’ll want to weigh in to the results of this study—and then think about your patients from years back with recurrent hospitalizations for infections and whether or not they are tackling cardiac-related metabolic complications as adults as this study certainly suggests.

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Thursday, August 20, 2015

Heads Up on a Study of Eye Protection and Eye Injuries in Field Hockey

By: Lewis First, MD, MS; Editor-in-Chief       

          Mandatory protective eyewear for field hockey was only recently implemented nationally but has it made a difference in decreasing eye injuries since then?  Kriz et al. (doi: 10.1542/peds.2015-0216) achieved their goal of answering this question by reviewing injury rates in states before and after implementation of a national mandate for protective eye wear.
       Even before the mandate, states that required protective eye wear were already demonstrating lower injury rates and after the mandate, the reductions are dramatic—not just for eye injuries but for overall face and head injuries as well. 
     Sadly concussion remains a problem, raising the question of whether mandatory helmets are the next step in injury reduction in this sport.  To learn more about the types of injuries that still occur with protective eyewear and those that are dramatically reduced, put your best face forward and eyeball this study to learn more.

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Tuesday, August 18, 2015

Global Health Rotations for Residents: Just How Good Are They?

By: Lewis First, MD, MS; Editor-in-Chief       

      The rising interest in global health rotations for trainees seems to be spreading across residency training programs as resident applicants ask more and more about what training programs are doing to train future pediatricians to recognize the importance of helping and advocating for children worldwide.  Yet how similar are the various global health programs that are ongoing in residency?  Are they similar to each other or better yet, are they based on any valid and reliable curriculum for training in global health education?   
     Butteris et al. (doi: 10.1542/peds.2015-0792) collected data from US residency programs in 2013-14 and compared and contrasted training programs that did and did not have a global health track while also looking at variations in these tracks by size of program.  The fact that 99.5% of all programs responded to this survey is impressive and speaks to the rising import of this topic in training future pediatricians. The authors noted those programs that had a track and if not, a faculty leader, and/or field experiences both internationally and domestically.   
     Just how consistent or inconsistent these various global health education offerings are makes for interesting reading and learning from this article. If you want even more perspective on where global health training for residents is going, travel over to the commentary by Dr. Gordon Schutze (doi: 10.1542/peds.2015-1820), who is an expert on global health issues in children to learn even more. 
     Hopefully this study and accompanying commentary will serve as the nidus for collaboration across programs to find the best practices for global health education and in turn lead to more reliable and valid criteria for what a global health curriculum and training experience should consist of.

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Monday, August 17, 2015

Getting the Right Beat: How Do Children with Congenital Heart Disease Do in School?

By: Joann Schulte  DO, MPH; Editorial Board Member   

         You want to get to the heart of the matter when a neonate has a  murmur or cyanosis.   About 1% of US infants are born with congenital heart disease (CHD) and their lives after discharge can be complicated with follow-up care.  But what happens when such children start school?  How do they  compare to other children?
            A new study published this month in Pediatrics from Riehle-Colarusso et al. (doi: 10.1542/peds.2015-0259) explores that issue with an innovative linkage of three databases to provide a picture about how such children do when school starts.  (This last sentence is the punch line and you state it below—so would not state it here.)
            The authors, epidemiologists from the Centers for Diseases Control and a cardiologist from Emory University, used data from Georgia birth certificates, the Atlanta Congenital Defects Program (population-based surveillance of birth defects) and the Special Education Database of Metropolitan Atlanta to study 3,744 children with CHD.  They tracked a cohort of children born during a 22-year period (1982 to 2004) and compared them to a group of children without major birth defects.
            Only children with isolated CHD, not including children whose conditions was complicated by other genetic diseases or birth defects were included in the study..  The comparison group of 860,715 children was identified through Georgia birth certificates. 
            The authors followed the entire group of 864,459 children to determine if they required special education between 1992 and 2012, using the database that tracked receipt of such services.  The special education database covers nine public school districts in the five counties that make up the metro Atlanta area.  
            The results of this study indicate that 15% of the children with CHD had received special education service compared to 9% of those without birth defects. Compared to the children without birth defects, those with CHD had a higher prevalence of intellectual disability, sensory impairment, and significant developmental delay among other neurodevelopmental impairments..
              This study has implications for what kind of care and follow-up attention might be needed for children with CHD.   Since 2011, screening for congenital heart disease has been recommended through pulse oximetry screening after 24 hours of age and before discharge.  This study suggests that pediatricians taking care of children with congenital heart disease might do well to track the developmental progress of those children.  Early identification of children with special education needs can help their success in school.  Examining twenty-two years’ worth of data for a group of Atlanta children with and without CHD provides important information on neurodevelopmental outcomes that can benefit the entire pediatric population with congenital heart disease..

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Friday, August 14, 2015

A Study of Rudeness and Its Effect on Medical Team Performance: How Rude Is That?


By: Lewis First, MD, MS; Editor-in-Chief       

COD Newsroom
          Ever wonder if clinical performance in the ability to diagnose or perform a procedure can be hampered when someone on the team or watching your team is rude to you?  Riskin et al. (doi: 10.1542/peds.2015-1385) decided to answer that question using an innovative methodology involving a training simulation in which one group of neonatal intensive care unit (NICU) teams were observed by someone offering rude comments and the other control teams received neutral comments.   
      While it would be rude for me to give away the results, it would not be rude for me to say that rudeness had adverse consequences on NICU team performance in terms of diagnostic and procedural performance. So have you found the rudeness of others affecting your ability to do what you need to do clinically?   
     If so, what have you done to overcome the problem?  Share with us your anti-rudeness strategies via a response to this blog, an e-letter or by posting your thoughts on our Facebook site or Twitter.

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