Responsibility Of Pediatrician Research Articles

Comparison of three different nutrition screening tools for pediatric inpatients

Early detection of children at risk of developing malnutrition during hospitalization prevents the development of complications. This study aims to determine the malnutrition risk of pediatric inpatients by using three different nutrition screening tools and to evaluate the reliability/sensitivity of the screening tools. This cross-sectional study included 176 children who were 1-16 years of age and were admitted to the pediatrics service of a second-line hospital. Body weight and height were used to evaluate the nutrition status of children. Age- and sex-specific z-score values for height for age (HFA), weight for age (WFA), and body mass index for age (BFA) were indicators of malnutrition. The Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Yorkhill Malnutrition Score (PYMS), and Pediatric Nutrition Screening Tool (PNST) were used under the responsibility of pediatricians and dietitians to evaluate the risk of malnutrition in children. At admission, according to the HFA, BFA, and WFA SD scores (SDSs), the incidence of malnutrition in children was 8.5%, 14.8%, and 6.3%, respectively. Three screening tools determined that WFA SDSs were significantly higher in children without malnutrition risk than in those at risk of malnutrition (P<0.05). PYMS revealed a relatively higher sensitivity of 90.9% and 84.6% for WFA and BFA, respectively, and PNST revealed a relatively higher sensitivity of 88.9% for HFA. PYMS and PNST are suitable for use in malnutrition risk assessment in pediatric inpatients because of the screening tools' high sensitivity.

‘I'm a doctor, not a teacher’: the roles and responsibilities of paediatricians in relation to education

Medicine and teaching are intrinsically linked. Traditionally, medical education was an apprenticeship model, where practical experience superseded book learning and the student/teacher relationship was paramount.1 2 In recent years there...

Oral Health and Interprofessional Education Experiences in Family Medicine and Pediatric Residency

INTRODUCTION Prevention of dental diseases in children requires interprofessional education (IPE) and care coordination between oral health professionals and primary care providers; however, the extent of preparation of medical residents and its impact on their provision of preventive oral health services in clinical practice requires further investigation. METHODS A two-stage cluster sample of 470 US family medicine and 205 pediatric residency programs was used. A random sample of 30% (N=140) of family medicine and 29% (N=60) of pediatric residency programs were randomly selected. Of these, 42 programs (21%) invited residents to participate. Residents (N=95, 28%) completed an online questionnaire regarding oral health training in residency. Statistical analysis included frequencies and Spearman’s rank correlations. RESULTS Eighty-three percent of family medicine and pediatric residents combined reported receiving oral health education. Clinical experiences involving oral healthcare were frequently reported (77%, n=75); however, IPE with an oral health professional was limited. Both groups indicated they provided anticipatory guidance regarding regular dental visits and toothbrushing “very often” and avoiding bottles at bedtime “often.” Residents reported performing dental caries assessments “often” and applying fluoride varnish “occasionally.” For family medicine residents, moderate correlations (p ≤ 0.01) were found between hours of oral health education and providing anticipatory guidance. For pediatric residents, a moderate correlation (p < 0.01) was found between hours of oral health education and assessing teeth for demineralization. CONCLUSION Increased effort is needed to meet national recommendations for educating family medicine and pediatric residents regarding oral healthcare for children, including increased IPE involving oral health professionals. Received: 05/25/2015 Accepted: 08/28/2015 Published: 10/22/2015 © 2015 Bailey et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Oral Health and Interprofessional Education ORIGINAL RESEARCH 2(3):eP1081 | 2 Introduction Oral health is a vital component of overall health and, therefore, the responsibility of pediatricians. Accordingly, the American Academy of Pediatrics (AAP) recommends pediatricians play an integral role in children’s oral health by providing preventive oral health services including anticipatory guidance, oral health screenings and assessments, and fluoride varnish applications during well-child visits (AAP, 2014). This recommendation applies not only to pediatricians but to other primary care providers (PCP), such as family physicians, nurse practitioners, and physician assistants (PA) (National Interprofessional Initiative on Oral health [NIIOH], 2011). In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended PCP prescribe fluoride supplementation to children beginning at 6 months of age if they reside in areas with suboptimal fluoride concentration in the drinking water and provide fluoride varnish applications to all children beginning at eruption of the first tooth (USPSTF, 2014). In support of these recommendations, medical insurers are requir-ed to reimburse providers under the Affordable Care Act (ACA) for services assigned a grade A or B by the USPSTF. This reimbursement includes fluoride varnish applications for children ages 0-5 years (Kaiser Family Foundation [KFF], 2014). These national children’s oral health initiatives coincide with the recent emphasis on integrating interprofessional education (IPE) opportunities across the healthcare professions to improve the health of the nation and overall quality of care (Institute of Medicine [IOM], 2011). IPE opportunities involving oral health experts such as dental hygienists, dentists, and/or dental professional students are integral to effectively train PCP to de-liver preventive oral health services to children. Little is known about IPE opportunities involving dental professionals in family medicine and pediatric residencies. Patients of all ages experience needless dental diseaserelated pain and expense, in part, because their PCP has not been trained to provide preventive oral health services (NIIOH, 2009). The general health status of children and adolescents can be improved by prevention and early intervention of oral diseases, including dental caries, before they develop into more complicated Implications for Interprofessional Practice

Acknowledging and researching treatment uncertainties in paediatric practice: an ethical imperative

Illogically, and with no empirical evidence to support it, a mischievous view has been promoted that the interest of the vast number of patients involved in the poorly controlled experiments...

Pediatric approach to early detection of learning disabilities

Learning disabilities (LD) are heterogeneous group of disorders with evidences of genetic or familial trait, intrinsic to the individual and presume to be due to central nervous dysfunction. Learning disabilities and attention deficit hyperactivity dis order (ADHD) are the two of the most common disorders in the population of school-age children. Typically academic achieve ments in children with learning disabilities are significantly lower than expected by their normal or above normal range of IQ. Although academic and cognitive deficits are hallmarks of children with LD, those children are also at risk for a broad range of behavioral and emotional problems. Almost all cases meet criteria for at least one additional diagnosis such as ADHD, developmental coordination disorder, depression, anxiety, obsessive compulsive disorder, tic disorder, among which ADHD is particularly predominant. Because of the response to the therapeutic intervention program is promising and positive when applied early, it is critical to recognize patients as early as possible. Pediatricians often are the first to hear from parents worried about a childs academic progress. It is not the responsibility of pediatrician to make a diagnosis, referring children for a diagnostic evaluation of LD is a reasonable first step. Pediatricians can make early referral of suspicious children by asking some serial short questions about basic and processing skills. With a basic knowledge about the clinical characteristics, diagnostic and therapeutic procedures of LD, pediatricians also can provide primary counseling and education for parents at their outpatient clinical settings. (Korean J Pediatr 2008;51:911-921)

Identifying School Performance Problems in the Pediatric Office

The AAP has underscored the role and responsibility of pediatricians in screening their patients for developmental and learning problems and working with parents, schools, and other professionals to ensure that students with these problems receive appropriate educational and therapeutic interventions. We have proposed a model that is time-efficient and can be tailored to the level of interest and experience of the pediatrician. At a minimum, the primary care physician should elicit any parental concerns about school performance, affirm these, and direct the student and parents to appropriate resources in the community for further evaluation and intervention as necessary. Pediatricians who wish to understand more fully the nature and underpinnings of their patients' learning difficulties can formulate a preliminary diagnosis and develop a plan for treatment using a structured system of information gathering that can be combined with information about the child's medical status and supplemented by brief direct testing in the office setting. By following these approaches, primary care pediatricians can provide comprehensive care for their patients and their families in their medical home and also can derive considerable professional satisfaction.

Diagnosis of sensory impairment in people with intellectual disability in general practice.

The present authors have participated in the development of a Dutch consensus on the early detection, diagnosis and treatment of hearing and visual impairment in children and adults with intellectual disability. They argue that the early detection of sensory impairment in babies and children with intellectual disability should primarily be a responsibility of paediatricians and youth health physicians. General practitioners should be aware of the necessity of screening and should check whether this has been done when children visit the surgery. It is stressed that the general practitioner should play a more active role in the detection of age-related sensory loss in older adults with intellectual disability, and the assessment of younger adults whose sensory functions have never or incompletely been evaluated. Annual sensory screening is certainly not necessary, but annual otoscopy to detect impacted earwax or unidentified middle ear infection, as well as checks of the proper use of glasses and hearing aids, are suggested. Most adults with mild or moderate intellectual disability can be assessed with methods that are normally used by general practitioners. Uncooperative people should be referred for screening with specialized methods. A low-threshold referral system (e.g. via district expert teams) has been outlined.

General Pediatrician's Role in High-Risk Deliveries

Fortunately, most infants make the transition to extrauterine existence well, even when a number of highrisk factors are present. In those few instances in which the pediatrician and his or her team are called upon to use knowledge, experience, and skill to respond to a delivery room emergency, the need is great. It is the responsibility of pediatricians who attend high-risk deliveries to maintain their skills at the highest level and to promote the education and preparedness of the other team members. The pediatrician must work to assure that every delivery room, regardless of the size of the hospital or the level of care in the nurseries, offers resuscitative and stabilization skills of the highest possible caliber.

General Pediatrician's Role in High-Risk Deliveries

Fortunately, most infants make the transition to extrauterine existence well, even when a number of highrisk factors are present. In those few instances in which the pediatrician and his or her team are called upon to use knowledge, experience, and skill to respond to a delivery room emergency, the need is great. It is the responsibility of pediatricians who attend high-risk deliveries to maintain their skills at the highest level and to promote the education and preparedness of the other team members. The pediatrician must work to assure that every delivery room, regardless of the size of the hospital or the level of care in the nurseries, offers resuscitative and stabilization skills of the highest possible caliber.

The World Health Organization Code of Marketing of Breastmilk Substitutes

At its business meeting in April 1981, the Ambulatory Pediatric Association voted to urge the United States delegation to the World Health Assembly to vote for the adoption of the International Code of Marketing of Breastmilk Substitutes. (The APA resolution, which summarizes salient features of the Code, is shown in the Table.) This action followed two prior resolutions: one at the 1979 meeting expressing concern about "significant risks to child health ... associated with artificial feeding in the developing world," and the second in 1980, supporting the boycott of Nestle's products. In May 1981, the United States was the only nation to vote against the Code. Following the vote, the US House of Representatives condemned the Administration's position by a vote of 301 to 100, and the Senate expressed its concern by a vote of 89 to 2. In view of the current controversy and the crucial role pediatricians play in influencing feeding practices, we think it important to consider (1) the effects of promotion of infant formulas, (2) criticisms of the Code, and (3) the responsibility of pediatricians toward promotion of infant formula. Despite claims to the contrary, marketing of infant formula influences maternal feeding practices. In recent testimony before the House Subcommittee on International Economic Policy and Trade, Carl Taylor, Professor and Head of the Department of International Health at the Johns Hopkins School of Hygiene and Public Health presented some evidence:1 Massive advertising and availability of formula have been associated with a decline in breast-feeding in oil-rich Arab countries so that only 15% of mothers are nursing their babies at 3 months of age.

Primary Care of Previously Institutionalized Retarded Children

Medical care of retarded children is a responsibility of pediatricians that is seldom discussed. Past practices of isolating these children in institutions and caring for them in special multidisciplinary clinics are fading. The medical experience with 48 retarded children, the problems that they present, and the system of care that was developed to meet their special needs are described. Previous medical care was often found to be lacking or inappropriate. The spectrum of morbidity resembles that of a general pediatric population although chronic conditions are much more prevalent. Utilization of primary care and consultative services is much higher than for a nonretarded population. Much time is required for their care; a great deal of time is devoted to advising caretakers and schools and to coordinating health services. A prepaid system of care using a health associate as the primary provider was developed, and has been an effective means of providing health care to these children.