Friday, April 18, 2014

Injury Risk in Children with Epilepsy: New Opportunities for Prevention Strategies

Photo by Amanda Mills via the CDC
Having a seizure disorder is certainly a challenge for our patients, but does having such a disorder further predispose them to accidental fractures, burns, and overdoses of medications?

Prasad et al. (doi: 10.1542/peds. 2013-2554) opted to look into the prevalence of various injuries in
almost 12,000 patients with epilepsy between the ages of 1 to 24 years and compared these patients to a comparison group of more than 46,000 patients without seizures using a large longitudinal data base of primary care records.

Do you counsel your patients with seizures in regard to injury and poison prevention strategies? After reading this study, I suspect you will, based on the results and the discussion of these results by the authors. Check out this early-released study and learn more.

Related Reading:

Thursday, April 17, 2014

Simulation and Pediatrics: Does It Make A Difference?

Photo by LW web2dot0 via Flickr
More and more we are seeing simulation centers springing up in academic medical centers and being
utilized for teaching of students, residents, fellows, and even our peers for enhancement of clinical skills and patient interactions. So when it comes to learning, does the use of simulation for these purposes make a difference compared to teaching the skills without such technology enhancement?

Cheng et al. (doi: 10.1542/peds.2013-2139) share with us a very useful meta-analysis based on 57 studies involving over 3,500 learners to show us what simulation likely can and cannot accomplish—at least as of today. Their research showed that compared with no intervention, simulation training in pediatrics is associated with uniformly favorable results, though some types of simulation training seemed to be more effective than others. How realistic or technology-dependent interventions need to be effective may surprise you.

If you are considering using simulation as a teacher or a learner, center yourself on this review article —the real deal on what we can learn from simulation.

Related Reading:

Wednesday, April 16, 2014

Using Social Media to Recruit Patients with Rare Diseases for Research Studies

When a child has a rare disease and researchers want to study that disease, it is often difficult to recruit enough patients to make the study results valid, reliable, and in turn, generalizable.

Photo by Johan Larsson via Flickr
Schumacher et al. (doi: 10.1542/peds. 2013-2966) reflect on this problem by sharing the results of posting a study for patients with a rare form of protein-losing enteropathy and/or the rare pulmonary disease, plastic bronchitis, and tracking how patients learned of the study –e.g. via the original posting or through social media outlets for families with these rare problems. The results suggest that patient recruitment might be better achieved through social media than through more traditional websites that discuss rare disease research.

There is a lot to think about in reading how parents learned of these rare studies and the power of social media for recruiting subjects for rare disease research. If you have not journeyed into the world of social media—be aware that your patients certainly have—and you can join our world by visiting us on Facebook and Twitter to stay up to date on breaking studies in our journal and others.

Related Reading:

Tuesday, April 15, 2014

The Successful Usage of Pediatric Milestones in Residency Programs: What Will It Take to Happen?

Photo by Stephanie Bryant, via Flickr
The recent requirement of the Accreditation Council for Graduate Medical Education (the ACGME) to implement competency-based
assessment in residency programs is easier said than done. There are a
myriad of issues that one encounters
in trying to use milestones as the assessment currency of the residency realm—and yet as per ACGME—we must.

This week Schumacher et al. (doi:10.1542/peds. 2013-2917) take on this topic in a special article by sharing the components and resources they believe are needed by programs in four critical domains to insure a highly valid and reliable system of assessment using milestone analysis.

Adding clarification to what this article suggests is a commentary (doi: 10.1542/peds. 2013-3827) by Drs. Carol Carracio and David Nichols from the American Board of Pediatrics, who explore the value of changing from the current training and assessment system, the evidence that milestones-based assessment works, and possible ways to increase efficiencies and limit unnecessary costs.

If you are still wondering what milestones are all about—or perhaps need to use these in your office or hospital to assess trainees, then take the time to read these two articles. They will make you far more competent on the topic of milestones than you ever were before.

Monday, April 14, 2014

Two Studies on Media Exposure in Young Children Provide Concerning Results

Photo by normanack via Flickr
The AAP has made media awareness a priority issue for pediatricians and patients and policies to limit media exposure in infants, children and teens have come forth over the past few years in our journal (doi: 10.1542/ peds.2013-2656).

Despite the policies, children seem to be spending more and more time engaged in media usage so this week we are releasing two studies you can share with your patients that might make more of a dent in reducing the amount of television or other media children are often routinely exposed to at home.

The first study by Cespedes et al. (doi: 10.1542/peds.2013-3998) looked at sleep duration differences between infancy and mid-childhood when there was a television in the bedroom as the child got older, as well as whether sleep duration was influenced negatively by the amount of television watched overall. Given the studies we have published on the association of inadequate sleep with general mental and physical health, having sleep duration potentially influenced, or at least associated with, prolonged television exposure and/or television in the bedroom is a message that is well-worth sharing with your patients.

Similarly, a second study by Radesky et al. (doi: 10.1542/peds.2013-2367) looked at parental report of infant behavioral self-regulation and its association with early childhood media exposure. The authors’ study hypothesis was that poor-self regulation would result in parents placing their child in front of television and videos more than those parents who did not perceive their children having self-regulation problems. Again—alerting families that there are better solutions to perceived behavioral issues with their children than simply putting them in front of a television or video screen is also some guidance we might provide to parents in our quest to reduce media exposure in our youngest patients.

Channel your energy into reading these two studies so you can in turn channel your media-reduction messages even more to your patients.

Related Reading:

Wednesday, April 9, 2014

Does Parental Obesity Influence the Risk of a Child Developing an Autism Spectrum Disorder?

Most of us have probably not considered the role of increased parental BMI in being associated with an increased risk of autism spectrum disorder (ASD)—and yet Suren et al. (doi: 10.1542/peds. 2013-3664) certainly did in designing their research hypothesis for a study we are releasing this week.

Photo by Cade Martin, via the CDC
Using a sample of almost 93,000 children from a Norwegian data base used in the Norwegian Mother
and Child (prospective) Cohort Study, the authors looked at maternal pre-pregnancy and paternal BMI and the subsequent risk of a child developing an ASD.

While the study cannot claim any kind of causality, the association is a curious one that the authors speculate upon in their discussion, which makes this study fascinating to read and think about.

Let us know if you agree by responding to this blog in the comments section below, by sharing your thoughts via an eLetter on our journal’s website or through Facebook or Twitter.

Related Reading:

Tuesday, April 8, 2014

What Are the Direct Costs of Childhood Obesity? A New Study Weighs In

The epidemic of childhood obesity warrants an appropriate amount of attention in our journal and others in regard to strategies to reduce the severity of this problem beginning in childhood.

Photo by Debora Caragena via the CDC
While there are many medical reasons to do so, this week Finkelstein et al. (doi: 10.1542/ peds. 2014-0063) offer an economic argument by using a review of studies in PubMed and Web of Science to estimate or impute lifetime direct medical costs of an obese child who stays obese
through adulthood.

The costs are significant and may further energize all of us to pay attention to the myriad of studies that do describe innovative programs involving the individual patient, the family and sometimes an entire community to combat the this problem in our country.

While recently JAMA (doi: 10.1001/jama.2014.732) noted a plateauing of obesity rates in children ages 2 to 5, there is still much to be done, and this article at least puts a price tag on what doing nothing about obesity might mean. If our younger patients can maintain the gains as they get older (which is not yet being seen in older age groups), we find ourselves not only improving health outcomes in these patients but saving on health care costs as well.

Read the study and think about what you are doing to reduce the cost of obesity in your own patient population.