Abstract:
OBJECTIVE:Almost one-half of all pediatric gastrostomy tube insertions are accompanied by a fundoplication, yet little is understood about the surgical decision-making for these procedures. The objective of this study was to examine the decision-making process of surgeons about whether to perform a fundoplication in children already scheduled to have a gastrostomy tube placed. METHODS:A written questionnaire of all pediatric surgeons at a major children's hospital was completed for each planned gastrostomy procedure over the course of 1 year; the questionnaire asked about various influences on the fundoplication decision: primary care and subspecialty physicians' opinions, patient characteristics, and parent opinions. Patient demographics and clinical characteristics from the medical record, as well as questionnaire responses, were summarized for each gastrostomy occurrence. We modeled the association of questionnaire responses and patient characteristics with the outcome of having a fundoplication. RESULTS:We received questionnaires on 161 of 169 eligible patients (95%). A total of 52% of patients had fundoplication. Primary care physicians were involved in 44% of decisions, and when involved had "a lot" of influence on the fundoplication decision only 28% of time, compared with neonatologists (61%), hospitalists (44%), pediatric pulmonologists (42%), and pediatric gastroenterologists (40%). A total of 86% of patients had a subspecialist involved, and 28% had >1 subspecialist. A pH probe was performed in 7.5% of cases, and failed pharmacotherapy was noted by the surgeons in only 26.5% of the fundoplications performed. CONCLUSIONS:The decision to do a fundoplication was rarely based on definitive testing or failed medical treatment. From the surgeon's perspective, subspecialists were more influential than primary care physicians, which is at odds with current concepts of the medical home.
journal_name
Acad Pediatrjournal_title
Academic pediatricsauthors
Fox D,Barnard J,Campagna EJ,Dickinson LM,Bruny J,Kempe Adoi
10.1016/j.acap.2012.07.006subject
Has Abstractpub_date
2012-11-01 00:00:00pages
558-66issue
6eissn
1876-2859issn
1876-2867pii
S1876-2859(12)00198-2journal_volume
12pub_type
杂志文章abstract:OBJECTIVE:Dermatologic complaints are common in outpatient pediatrics. However, pediatric dermatology specialty care can be difficult to access. We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the m...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.10.005
更新日期:2020-10-15 00:00:00
abstract:OBJECTIVES:The cognitive expertise of Pediatric Hospitalists (PH) lies not in standard knowledge but in making decisions under conditions of uncertainty. To maintain expertise, PH should engage in deliberate practice via self-assessments that promote higher-level cognitive processes necessary to address problems with m...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.10.003
更新日期:2020-10-14 00:00:00
abstract:OBJECTIVE:Depression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collabo...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2019.02.014
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:The Core Entrustable Professional Activities for Entering Residency (Core EPAs) were developed to address the gap between medical school and residency. There is a lack of instruments to measure performance of the Core EPAs in clerkships. We describe the operationalization and outcomes of a workplace-based ass...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.09.016
更新日期:2020-10-07 00:00:00
abstract:OBJECTIVE:Previous research suggests that cognitive functioning is associated with the risk of several adult psychiatric disorders. In this study we investigated whether adolescents who perform worse than expected at secondary school are at a higher risk for general mental health problems. METHODS:In a cross-sectional...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.04.016
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents. OBJECTIVE:1) To evaluate the impact of participation in a virtual home visit cur...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.05.001
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To determine the proportion of abstracts submitted to the 2010 Pediatric Academic Societies (PAS) meeting that were exclusively qualitative, and to examine whether these abstracts were more or less likely than all others to be designated as platform, poster, or publish only. METHODS:The database of abstracts...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2013.01.007
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To compare the prevalence of a medical home for children with public versus private insurance and identify components of the medical home that contribute to any differences. METHODS:We performed a secondary data analysis of the 2007 National Survey of Children's Health. A medical home was defined as meeting ...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2011.03.006
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this stud...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.08.005
更新日期:2018-03-01 00:00:00
abstract::Neonatal intensive care unit networks that encompass regions, states, and even entire countries offer the perfect platform for implementing continuous quality improvement initiatives to advance the health care provided to vulnerable neonates. Through cycles of identification and implementation of best available eviden...
journal_title:Academic pediatrics
pub_type: 杂志文章,评审
doi:10.1016/j.acap.2013.04.014
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:The Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11 or 12 years for girls since 2006 and for boys since 2011. We sought to describe adolescent HPV vaccination coverage, doses administered from 2009 to 2012, and age at first vaccinati...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2014.03.005
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determi...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2016.03.003
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability ...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2014.08.006
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:Underreporting of adverse events by physicians is a barrier to improving patient safety. In an effort to increase resident and medical student (hereafter "trainee") reporting of adverse events, trainees developed and led a monthly conference during which they reviewed adverse event reports (AERs), identified ...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.01.004
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:An innovative low-cost parenting intervention, implemented through health services in Jamaica showed benefits to children's cognitive development at 18 months and parent's attitudes concerning childcare. We assessed the impact of the intervention on child and parent outcomes at 6 years of age. METHODS:A clus...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2021.01.003
更新日期:2021-01-09 00:00:00
abstract:BACKGROUND:Adults tend to underestimate their personal risk of disease, but little is known about parents' perceptions of children's risk. METHODS:In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 y...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2018.09.008
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS). METHODS:The LISAM is a tool used by educators to self-assess their performances after giving a lecture. The tool is lo...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.02.019
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Use of complementary and alternative medical (CAM) therapies is common among adults with mental health concerns, but little is known about CAM use among adolescents with mental health concerns. METHODS:Data from the 2007 National Health Interview Survey were analyzed for youth from 7 to 17 years old. The st...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2013.05.001
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:In October 2016, the American Board of Medical Specialties approved the petition for pediatric hospital medicine (PHM) to become the newest pediatric subspecialty. Knowledge about residents entering the PHM workforce is needed to inform certification and fellowship accreditation. This study describes the char...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.05.001
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:Children with special health care needs (CSHCN) are at risk for decreased participation in educational and social activities, which can negatively impact their lives. The objectives of this study were to document the presence of participation restrictions for CSHCN compared with other children and to determin...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2012.03.004
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of a traditional didactic session (TDS) as compared to a self-paced, interactive, multimedia module (SPM) on the application of evidence-based medicine (EBM) skills among medical students during their inpatient pediatric rotation. METHODS:We conducted a randomized controlled tri...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.09.012
更新日期:2020-09-30 00:00:00
abstract:OBJECTIVE:To determine the initial effectiveness of a novel, pediatric office-based intervention in motivating mothers to seek further assessment of positive depression screens. METHODS:In this pilot randomized controlled trial, English-speaking mothers (n = 104) with positive 2-question depression screens and present...
journal_title:Academic pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.acap.2014.11.008
更新日期:2015-05-01 00:00:00
abstract:OBJECTIVE:Pediatricians have regular opportunities to perform screening dental examinations on young children and to educate families on preventive oral health. We sought to assess pediatricians' current attitudes and practices related to oral health of children 0-3 years old. METHODS:A Periodic Survey of Fellows, foc...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2009.09.016
更新日期:2009-11-01 00:00:00
abstract:OBJECTIVE:To examine the association between chronic school absenteeism and adverse childhood experiences (ACEs) among school-age children. METHODS:We conducted a secondary analysis of data from the 2011-2012 National Survey of Children's Health including children 6 to 17 years old. The primary outcome variable was ch...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.09.013
更新日期:2017-01-01 00:00:00
abstract::Population health is associated with the socioeconomic characteristics of neighborhoods. There is considerable scientific and policy interest in community-level interventions to alleviate child poverty. Intergenerational poverty is associated with inequitable access to opportunities. Improving opportunity structures w...
journal_title:Academic pediatrics
pub_type: 杂志文章,评审
doi:10.1016/j.acap.2016.01.013
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:A parent-child relational framework was used as a method to train pediatric residents in basic knowledge and observation skills for the assessment of child development. Components of the training framework and its preliminary validation as an alternative to milestone-based approaches are described. METHODS:P...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2016.09.005
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:To determine pediatric resident training and preparation for 14 Accreditation Council for Graduate Medical Education (ACGME)-required procedures. METHODS:We included a national, random sample of 1000 graduating pediatric residents in 2015. For each of the ACGME-required procedures, residents were asked if th...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2017.08.001
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:Despite recommendations to consume iron-, calcium-, and vitamin C-rich foods for managing blood lead levels (BLLs), limited evidence exists on how specific foods affect children's BLLs. Using data from 12- to 36-month olds (n = 992) from the 2009 to 2014 National Health and Nutrition Examination Survey, we as...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2020.06.009
更新日期:2020-06-17 00:00:00
abstract::The goal of designing innovative curricula and programs in medical education is to create interventions that will change the attitudes, knowledge, skills, and behaviors of learners in order to prepare them to contribute to the health of patients and communities they serve. Systematic evaluation allows curriculum/progr...
journal_title:Academic pediatrics
pub_type: 杂志文章,评审
doi:10.1016/j.acap.2020.07.005
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To identify whether psychosocial stress exposure during early childhood predicts subsequent increased eating in the absence of hunger (EAH), emotional overeating, food responsiveness, and enjoyment of food. METHODS:This was an observational longitudinal study. Among 207 low-income children (54.6% non-Hispani...
journal_title:Academic pediatrics
pub_type: 杂志文章
doi:10.1016/j.acap.2018.01.007
更新日期:2018-08-01 00:00:00