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The Future of Board Certification Learning Is Competency

from ArchPedi - 01 Sep 14

Although its wording has evolved, the essence of the mission of the American Board of Pediatrics (ABP) has not changed: to certify “pediatricians based on standards of excellence that lead to high-quality health care during infancy, childhood, adolescence, and the transition to adulthood.” The ABP needs assessments embedded in clinical practice and improved patient outcomes as the explicit metric for excellence, which will require a commitment to continuous learning. This Viewpoint proposes ways



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Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors

from ArchPedi - 01 Sep 14

Health care professionals who routinely interact with young people have an important role to play in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. These crimes—which include any sexual activity with someone younger than 18 years in exchange for something of value—occur every day in the United States and have serious, long-term consequences for individuals who have experienced this violence and exploitation. Unfortunately, pediatricians m



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Integrating Curricula on Human Trafficking Into Medical Education and Residency Training

from ArchPedi - 01 Sep 14

Today in the United States, human trafficking occurs in cities, suburbs, and rural areas across all 50 US states. “Severe forms” of human trafficking are defined under the US Trafficking Victims Protection Act of 2000 as the following: (1) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age or (2) the recruitment, harboring, transportation, provision, or obtaining of a person fo



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Distance

from ArchPedi - 01 Sep 14

His face will forever be etched in my memory. The resemblance to my oldest son was striking. He was a slender preteen lying in unfamiliar surroundings and looking distinctly out of place in his hospital gown. Gauze packing disfigured his delicately thin nose. But apart from the gown and the gauze, he looked normal, like he had just wandered off some nearby soccer pitch on a cool autumn morning, hair tousled and dirt in his fingernails.



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Weight Loss Maintenance A Hard Nut to Crack

from ArchPedi - 01 Sep 14

In 1991, a total of 8 people were sealed for 2 years inside a man-made “Biosphere” consisting of a 3-acre ecologically closed habitat. This crew of 4 men and 4 women voluntarily entered the habitat to learn about the interactions between humans and key ecological systems. However, these scientists serendipitously experienced a hardship that has actually taught the world a great deal more about basic human physiology than ever expected. In the first growing season after entering the Biosphere, an



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Substance Misuse Among Adolescents To Screen or Not to Screen?

from ArchPedi - 01 Sep 14

Alcohol, tobacco, and marijuana are the top 3 substances of misuse among teenagers. According to the Monitoring the Future study, marijuana use continues to increase in contrast to tobacco or alcohol use, which has leveled off; currently, more than one-third of 12th graders report having used marijuana in the past year, and 6.5% report using it regularly. Emerging evidence suggests that the adolescent brain is highly vulnerable to exposure to alcohol or cannabis consumption, resulting in proxima



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Effect of Home Visiting by Nurses on Maternal and Child Mortality Results of a 2-Decade Follow-up of a Randomized Clinical Trial

from ArchPedi - 01 Sep 14

ImportanceMothers and children living in adverse contexts are at risk of premature death.ObjectiveTo determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011).Design, Setting, and ParticipantsA randomized clinical trial was designed originally to assess the home visiting program’s effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obs



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Inpatient Treatment of Children and Adolescents With Severe Obesity in the Netherlands A Randomized Clinical Trial

from ArchPedi - 01 Sep 14

ImportanceSevere childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown.ObjectiveTo determine whether an inpatient treatment program is more effective than an ambulatory treatment program at achieving a sustained weight loss in children and adolescents with severe obesity.Design, Setting, and ParticipantsWe conducted a randomized clinical trial with a 2



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Use of a Computerized Decision Aid for Developmental Surveillance and Screening A Randomized Clinical Trial

from ArchPedi - 01 Sep 14

ImportanceDevelopmental delays and disabilities are common in children. Research has indicated that intervention during the early years of a child's life has a positive effect on cognitive development, social skills and behavior, and subsequent school performance.ObjectiveTo determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices.Design, Setting, and Participant



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An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels

from ArchPedi - 01 Sep 14

ImportanceScreening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions.ObjectiveTo describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable c



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Variation and Outcomes Associated With Direct Hospital Admission Among Children With Pneumonia in the United States

from ArchPedi - 01 Sep 14

ImportanceAlthough the majority of children with an unplanned admission to the hospital are admitted through the emergency department (ED), direct admissions constitute a significant proportion of hospital admissions nationally. Despite this, past studies of children have not characterized direct admission practices or outcomes. Pneumonia is the leading cause of pediatric hospitalization in the United States, providing an ideal lens to examine variation and outcomes associated with direct admiss



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Isolated Loss of Consciousness in Children With Minor Blunt Head Trauma

from ArchPedi - 01 Sep 14

ImportanceA history of loss of consciousness (LOC) is frequently a driving factor for computed tomography use in the emergency department evaluation of children with blunt head trauma. Computed tomography carries a nonnegligible risk for lethal radiation-induced malignancy. The Pediatric Emergency Care Applied Research Network (PECARN) derived 2 age-specific prediction rules with 6 variables for clinically important traumatic brain injury (ciTBI), which included LOC as one of the risk factors.Ob



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Blood Culture Time to Positivity in Febrile Infants With Bacteremia

from ArchPedi - 01 Sep 14

ImportanceBlood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known.ObjectiveTo determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit.Design, Setting, and ParticipantsMulticenter, retrospective, cross-sectional evaluation of blood



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Effect of Gestational Age and Birth Weight on the Risk of Strabismus Among Premature Infants

from ArchPedi - 01 Sep 14

ImportanceStrabismus causes irreversible vision loss if not detected and treated early. It is unclear whether birth weight (BW) and gestational age (GA) are risk factors for strabismus.ObjectiveTo estimate the effect of BW and GA on the likelihood of premature infants developing strabismus.Design, Setting, and ParticipantsIn this longitudinal cohort analysis, we monitored a group of premature children from birth to determine the proportion that developed strabismus and the timing of the first st



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Ethics and Etiquette in Neonatal Intensive Care

from ArchPedi - 01 Sep 14

When parents voice their dissatisfaction with the neonatal intensive care unit (NICU), it is often not because they think their baby has not received good medical care. Instead, it is often because their needs have not been addressed. Policy statements and pedagogy alike urge professionals to be empathetic, compassionate, honest, and caring. However, these theoretical concepts are generally endorsed without practical suggestions on how to achieve these goals. Negative encounters for parents are




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It Is Too Early to Declare Early or Late Rescue High-Frequency Oscillatory Ventilation Dead

from ArchPedi - 01 Sep 14

To the Editor High-frequency oscillatory ventilation (HFOV) has been on shaky ground since the publication of 2 trials in adults. Especially worrisome were the findings of the OSCILLATE (Oscillation for Acute Respiratory Distress Syndrome Treated Early) trial. This trial was stopped prematurely, as there was an increased mortality in patients randomized to HFOV. Both trials questioned the role of HFOV in the management of acute respiratory failure and have left pediatric critical care physicians



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It Is Too Early to Declare Early or Late Rescue High-Frequency Oscillatory Ventilation Dead

from ArchPedi - 01 Sep 14

To the Editor We read with interest the study by Gupta et alin the recent issue of JAMA Pediatrics. The value of high-frequency oscillatory ventilation (HFOV) in the management of severe acute respiratory failure is a recurrent question for pediatric intensivists.



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It Is Too Early to Declare Early or Late Rescue High-Frequency Oscillatory Ventilation Dead

from ArchPedi - 01 Sep 14

To the Editor The recent study in JAMA Pediatrics by Gupta et al, “Comparison of High-Frequency Oscillatory Ventilation and Conventional Mechanical Ventilation in Pediatric Respiratory Failure” concluded that the application of high-frequency oscillatory ventilation (HFOV) results in increased mortality. To reach this conclusion, the authors drew data from a large database of experiences at 98 US pediatic intensive care units; however, we do not believe their conclusion is supported by their ana



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It Is Too Early to Declare Early or Late Rescue High-Frequency Oscillatory Ventilation Dead—Reply

from ArchPedi - 01 Sep 14

In Reply We appreciate the insightful comments by Kneyber et al, Essouri et al, and Rimensberger et al concerning our article in JAMA Pediatrics comparing the outcomes associated with the use of high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation in children with acute respiratory failure. We agree with the limitations of database studies. Owing to the nature of the database used for this study, we lacked important parameters such as peak inspiratory pressure,



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Multiple Nutrient Intake Recommendations Guide Dietary Supplement Formulations

from ArchPedi - 01 Sep 14

To the Editor We read the study in JAMA Pediatrics by Madden et al with great interest. However, it is apparent that the authors were either unaware of federal regulations regarding dietary supplement labeling or chose to ignore them.



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Multiple Nutrient Intake Recommendations Guide Dietary Supplement Formulations—Reply

from ArchPedi - 01 Sep 14

In Reply We appreciate the letter written by Ciappio and McBurney as it brings the concept of varying nutrient intake recommendations between the Institute of Medicine (IOM) and the Food and Drug Administration (FDA) to the forefront. We contend that there are a few points that should be thought about when considering guidance from the FDA or IOM.



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Characteristics of Acetaminophen Users Compared With Nonusers During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders

from ArchPedi - 01 Sep 14

To the Editor The study by Liew et al in JAMA Pediatrics on the association between gestational acetaminophen use with attention-deficit/hyperactivity disorder in childhood may bear practical implications for antipyretic use in pregnancy. Because gestational hyperpyrexia has potential adverse effects, including congenital malformations, the role of antipyretic medication in pregnancy is crucial. Numerous studies have shown associations between maternal hyperthermia and increased risk for neural-



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Characteristics of Acetaminophen Users Compared With Nonusers During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders—Reply

from ArchPedi - 01 Sep 14

In Reply We appreciate the opportunity to provide the following response to the letter by Amitai in JAMA Pediatrics. Among the 64?322 mothers in the cohort for hyperkinetic disorder diagnosis and attention-deficit/hyperactivity disorder (ADHD) medication end points, 36?187 women reported having used acetaminophen during pregnancy and 28?135 did not. The proportions of several important indications for acetaminophen use (for acetaminophen users vs nonusers, respectively) include maternal fever (3


 

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