Thursday, August 28, 2014

Are There Benchmarks to Strive For in Caring for Children with Asthma, Bronchiolitis & Pneumonia?

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

Photo by Hey Paul Studios via Flickr
Pediatrics, along with other journals, has published studies on the variability of tests ordered, treatments used, and length of stay for a number of common pediatric illnesses. In fact, hospitalists use variability studies to help them identify care pathways to improve quality and reduce costs of care. But is there an ideal set of benchmarks we should strive for in creating our care pathways?

Parikh et al. (doi: 10.1542/peds.2014-1052) believe there are, as a result of their performing a cross-sectional study of data obtained from the Pediatric Health Information System (PHIS) to identify common benchmarks used at the top 10 percent of performing hospitals to note how often images, lab and viral studies, types of antibiotics and frequency of usage could be or should be utilized for inpatient care of asthma, bronchiolitis, and pneumonia.

And speaking of benchmarks, Ralston et al. (doi: 10.1542/peds.2014-1036) add to the discussion with release of their systematic review article of quality improvement studies on ways to reduce unnecessary tests and treatments for children hospitalized with bronchiolitis and provide some additional benchmarks for you to consider.

After reading these studies, you will want to reflect on your own patients or those cared for by your local hospitalists to see whether the benchmarks recommended in these two studies are being adhered to or not when children present with asthma, bronchiolitis, or pneumonia. Benchmark this article for further reference – you’ll likely need it as we move away from volume-based to value-based quality care.

Wednesday, August 27, 2014

Effect of a Pertussis Epidemic on Vaccination Status: Coughing Up Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by  Sandy Chase via Flickr

From late 2011 throughout 2012, a pertussis epidemic occurred in Washington State. One would think that an epidemic would result in an uptick in infants being up-to-date on their pertussis vaccinations, but think again—at least after you read the study by Wolf et al. (doi: 10.1542/peds.2013-3637) we are early releasing this week.

If an epidemic doesn't prompt parents to insure their infants are vaccinated, just what will? Drs. Jessica Atwell and Daniel Salmon (doi: 10.1542/peds.2014-1883) reflect on the implications of this study in a topical commentary that accompanies this study.

We welcome your thoughts on this study and commentary and on what you are doing to improve your own vaccination rates in your practice, since an epidemic does not appear to be a significant change agent. Share your comments with us via a response to this blog, an eLetter or on Facebook or Twitter.

Related Reading: 

Tuesday, August 26, 2014

Asthma, Eczema & Allergic Rhinitis from Pre-, Postnatal Second Hand Smoke Exposure?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Javier Ignacio Acuna Ditzel

We certainly suspect an association exists between second-hand smoke exposure and allergic disease, but has it ever been confirmed in peer-reviewed scientific literature? Not as well as Thacher et al. (doi: 10.1542/peds.2014-0427) have done in an early release article we are sharing this week.

Their study involved more than 4,000 children followed for 16 years prospectively, while information was gathered on parental smoking habits, and symptoms of asthma, eczema and allergic rhinitis.

The results are fascinating and itching for your perusal. For example, second-hand smoke exposure in infancy seems to result in increased risk for asthma and allergic rhinitis, while exposure later in life seems to increase the risk of eczema.

These findings just scratch the surface of what awaits your own review of this study—so read on and learn more!

Related Reading:

Monday, August 25, 2014

Parental Perceptions of Overweight 20 Years Ago and Today: The Times (and BMIs) They Are a Changin’!

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

Photo by via Flickr
Part of the problem of trying to get a family to help their overweight child lose weight is getting parental buy-in—and that begins when parents agree that their child is medically perceived to be overweight. One would think that parents would view their child as being overweight quite easily—and while that may have been true 20 years ago—it is not as easily perceived today—at least according to a study we are sharing this week by Hansen et al. (doi: 10.1542/peds.2014-0012).

The authors looked at survey data from parents on close to 3,000 children (ages 6-11 years) enrolled in the National Health and Nutrition Examination Survey in 1988 through 1994 and another cohort enrolled in 2005 to 2010 and found some substantive differences. Parents today are less likely to perceive their child as overweight: They did not view weight gain above the 85th percentile but below the 91st percentile as concerning, whereas 20 years ago it was.

What does this shift in social norms mean for the health of children who are showing increased body weight and crossing high percentiles on a growth curve? Weigh in on the information contained in this study and then perhaps share it with parents of overweight patients and see if it can’t help them realize that their child’s increasing BMI over time really is a problem.

Related Reading:

Friday, August 22, 2014

Two Studies on HPV Vaccines Inject Some New Information Worth Sharing with Patients

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

Photo by James Gathany for the US CDC
Recently, Assistant Surgeon General Anne Schuchat, MD, who is also Director of the National Center for Immunization and Respiratory Diseases for the Centers for Disease Control and Prevention spoke at our children’s hospital, the Vermont Children’s Hospital, on the successes and challenges of our national immunization program.

Up front as a national challenge was the inability to get more teens vaccinated against human papilloma virus (HPV) despite the important role this vaccine plays in reducing cervical and genital cancers. To help overcome this challenge, we are publishing two studies this week on the HPV vaccine.

The first is a long-term safety, immunogenicity, and effectiveness study of a quadrivalent HPV vaccine by Ferris et al. (doi: 10.1542/peds.2013-4144). Teens and pre-teens ages 9-15 received a series of HPV4 vaccines or placebo (with the placebo group getting the vaccine after 30 months into the study) with both cohorts followed for eight years to determine the persistence of high serologic levels of the strains of HPV in the vaccine as well as the effectiveness in preventing HPV infection.

The good news is persistence of protection for at least eight years with no adverse events—suggesting the safety and immunogenicity of this vaccine as well as its ongoing effectiveness is well-worth sharing with parents who worry about the risks more than the benefits of having their teens get this vaccine.

The second study by Perkins et al. (doi: 10.1542/peds.2014-0442) chose to focus on those families who do worry about giving this vaccine to their adolescents or at least delay the administration of the vaccine for later than the recommended age (prior to onset of sexual activity). The authors performed qualitative interviews and found that some of the leading reasons why families had the vaccine delayed was not because they did not believe in its importance, but because their physician did not recommend it or agreed to wait until a teen became sexually active before giving it.

Hopefully, if you are reading this blog, you are not in the group of providers hampering the appropriate administration of this vaccine (at ages 11 to 12), but if you have been delaying its administration or forgetting to mention it, take a shot at reading this study and reducing your HPV missed opportunities to vaccinate at the appropriate 11 or 12 year visit.

Related Reading: 

Thursday, August 21, 2014

Think Teen Tobacco Use, Quitting Advice Are Discussed at Health Maintenance Visits? Think Again!

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

Photo by Debora Cartagena
for the US Centers for Disease Control and Prevention
Do you pride yourself in counseling your adolescent patients who smoke on the need to quit?

Count yourself in the minority according to data shared this week by Schaeuer et al. (doi: 10.1542/ peds.2014-0458) who analyzed data from more than 18,000 teens in grades 6 to 12 via the National Youth Tobacco Survey.

The good news is that the overall prevalence of teen smokers is less than 20 percent, although the bad news is that less than a third of teens are even asked by their health care professional if they smoked, let alone wanted to quit. So why is this happening and what can we do to improve our adolescent anti-tobacco counseling efforts?

American Academy of Pediatrics Associate Executive Director Dr. Jonathan Klein (doi: 10.1542/peds.2014-1925) clears the air on this issue with a commentary on this important study that is also well worth your consideration.

So how good is your practice at inquiring about smoking and offering quit options for teens who want to stop? Have you discovered any “tricks” or methods to get an honest disclosure, and how successful have you been with getting teens to quit?

We welcome your feedback on this study by sharing your thoughts with us via this blog, Facebook, Twitter or by sending an eLetter to us about the study we urge you to read—and we’re not just blowing smoke about its importance!

Related Reading:

Tuesday, August 19, 2014

The Changing Trends of Childhood Disability

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our September issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Photo by US  Naval Surface Forces via Flickr
If you’re practicing pediatrics, it’s likely that about eight percent of your pediatric patients have some kind of disability. The nature of childhood disability is changing and so are the affected populations, according to research published in the September issue of Pediatrics.

Dr. Amy J. Houtrow and her colleagues (doi: 10.1542/peds.2014-0594) used datasets from four cycles of the National Health Interview Survey (NHIS), conducted by the US Centers for Disease Control and Prevention, to collect their data and perform a secondary analysis.

The prevalence of any childhood disability increased 15.6 percent during the decade ending in 2011, but more of the children had neurodevelopment and mental health conditions than physical health conditions. The highest rates of parent-reported disability were among children living in poverty (102.6/1,000), but children from high-income households were reported to have the largest increase (28.4 percent).

The researchers also found the prevalence of reported disability increased among children whose parents had a college education and among those living in two-parent households. Reported disabilities did not increase among children whose parents had a high-school education or less schooling or among single-parent households.

The changes reported in the Pediatrics paper mean that practicing pediatricians will need to be ready to manage the care of more children with neurodevelopment and mental health conditions.

Related Reading: