Monday, October 26, 2015

Taking Our Best Shot at Vaccinating Teen Males against HPV: How Are We Doing?

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

3483848619_db4edf31ef_o.jpg
    It’s been four years since human papilloma virus (HPV) vaccine was recommended routinely for all adolescent makes.  Just because something is recommended doesn’t mean it is happening—and Lu et al. (doi/10.1542/peds.2015-1631) decided to look at prevalence rates of vaccine administration as well as factors predictive of male vaccination in a new study being released this week in our journal.  
      The authors used data from the 2013 National Immunization Survey of Teens to determine the number of HPV vaccines received teen males and then used multivariable logistic regression analysis to determine key predictors.  The results two years into standard-of-care recommendation for HPV vaccine administration is disappointing to say the least with only a third of makes nationally getting at least one dose of the vaccine and less than 14% getting all three doses.  
       So what factors are associated with an increased risk of being vaccinated and what factors are associated with a reduced risk? The authors make some sharp points in providing plenty of information that awaits your perusal and perhaps your awareness when these factors are identified in your teen male patients to even more insure the vaccine is given.  While the data are two years old, do you think HPV vaccine uptake rates in adolescent makes is as bad as the rates were in 2013?  
       If you practice general primary care pediatrics, share with us how you are faring with getting teen males vaccinated to HPV? Any strategies you find working better than others?  Share your thoughts with us by responding to this blog, sending us an e-letter or posting your comments on our Facebook or Twitter pages.  

Related Links

Wednesday, October 21, 2015

Cardiopulmonary Resuscitation and a Metronome: A Study That Puts the Two Together to Improve Chest Compression Administration


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

          When one thinks of a metronome, it’s usually to help a child or adult practice keeping the tempo in a piece of music they are trying to play.  Yet Zimmerman et al. (doi: 10.1542/peds.2015-1858) decided to try a metronome in a prospective simulation-based crossover randomized controlled trial of residents, fellows, nurses, and medical students randomly assigned to do chest compressions on a manikin with or without a metronome to keep the tempo of those compressions. 
        The authors looked at rate and depth of compressions as the participants did rounds of compressions with and without the metronome going.  Rather than compress the findings of this study in this blog, we will encourage you to read the study for yourselves and see if your resuscitation room warrants buying a metronome as a valuable addition to the equipment you already have available in your office, emergency or inpatient setting.   Beat a path to reading this article to learn more.

Related Links

Monday, October 19, 2015

Who Is Seeing the Children and Teens with Mental Health Issues—and Who Is Doing the Prescribing of Psychotropic Medications?


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

          We know that there is a critical shortage of mental health services for children and teens in this country, such that primary care providers (PCPs) are called upon to often diagnose and in turn treat and follow these patients because of lack of access to psychiatrists and even psychologists and social workers.  
         So just how often are these children being managed by a PCP?  Anderson et al. (doi: 10.1542/peds.2015-0807), in a study being released this week, used a nationally representative data set to determine if children and teens from 2 to 21 years are seen in the outpatient setting for their mental health issues by PCPs, psychiatrists or psychologists and social workers and who is prescribing psychotropic medications for these patients.  More than a third of children in this database were being seen by PCPs only which may or may not surprise you.  What won’t surprise you is that more than 40% of children with attention-deficit hyperactivity disorder (ADHD) were only seen by a PCP.  These numbers may be increasing rather than decreasing as the mental health issues we uncover in our patients rise, and the mental health work force stays about the same or even decreases in the years ahead. 
How does your practice compare to the results shared in this provocative study?  What do you suggest the AAP might do to help remedy the situation? Should pediatricians be trained to prescribe psychotropic medications that go beyond an ADHD regimen more than they are currently learning how to do?  We want to know how you are dealing with the mental health problems in your practice through your response to this blog, sending us an e-letter or posting your comments on our Facebook or Twitter pages.

Related Links

Friday, October 16, 2015

Familiar with Early-Onset Neutropenia in a Small for Gestational Age Infant? After Reading a New Study You Will Be!

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


        Small for gestational age (SGA) infants are known to have early neutropenia when compared to normal size infants at a gestational age—but just what do we know about this neutropenia?  How common is it? How long does it last?  What might be causing it and what makes it better?  
       These questions and more are answered in an informative study by Christensen et al. (doi: 10.1542/peds.2015-1638) being released this month in our journal who looked at ten years of neutropenia in the first week of life in more than 200 SGA infants out of 3600 studied compared to less than 50 out of 3650 non-SGA infants.  The authors looked at a variety of factors associated or not-associated with this neutropenia ranging from necrotizing enterocolitis to thrombocytopenia and give us a much clearer picture of what the “neutropenia of SGA” is all about.  
        If you want to know more about a common finding in your SGA newborns and what to follow and worry about (or not) in this neutropenic population, then reading this study should be an easy “cell.”

Related Links