scholarly journals The care of the concussed pediatric patient prior to presentation to primary care pediatrician versus concussion specialists: Implications for management

2021 ◽  
Vol 5 ◽  
pp. 205970022199892
Author(s):  
Bruce Taubman ◽  
A Michael Luciani ◽  
David B Gealt ◽  
Thomas P Drake ◽  
Philip Cochetti ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Emergency Department Visits ◽  
Pediatric Care ◽  
Pediatric Practice ◽  
International Consensus ◽  
Consensus Definition ◽  
Specialty Clinic ◽  
Appropriate Treatment ◽  
Management Recommendations

Objective Absent adequate randomized control trials to inform appropriate treatment for concussion in pediatric patients, guidelines have been developed based on expert opinion and observational data that may not apply to all groups. This study examines differences in the previous clinical care between concussed patients who present in pediatric practice and specialty clinics. Differences found might influence treatment recommendations for each setting. Study design Prospective data collected from a pediatric practice in 2011 to 2013 were compared to chart review data from two specialty clinics between 2015 and 2017. In all three groups patients 11–19 years of age with an ICD9 billing code for concussion were included if they met the 4th International Consensus definition of concussion. Patients were excluded if hospitalized or had abnormal CNS imaging. Results The time between injury and presentation was substantially longer in specialty clinic patients versus those seen in the primary pediatric care office. (median 10 vs. 2 days-p < 0.001) Primary care patients presenting had higher rates of immediate rest after injury, 61.4% vs 27.9% (p < 0.001). More specialty clinic patients had been seen in the emergency departments prior to presentation (47.5% vs. 18.8% p < 0.001) regardless of rest status at presentation to the office. Conclusion Several differences in previous clinical care between the groups were found. These included the time of presentation from injury, rates of cognitive rest both immediate and non-immediate, and emergency department visits. These differences may have implications for management recommendations. Accordingly, the appropriate treatment for patients seen by the primary pediatric care physicians may be different from those referred to specialty care. Given these findings randomized controlled trails should be conducted independently in both groups of patients.

Letter re: Reducing emergency department visits utilizing a primary care asthma specialty clinic in a high risk patient population

2017 ◽  
Vol 55 (10) ◽  
pp. 1077-1078
Author(s):  
Simon Braithwaite ◽  
Jonny Coppel ◽  
Lucy Everson ◽  
Jessica Kearney ◽  
Lucy Gibson ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
High Risk ◽  
Patient Population ◽  
High Risk Patient ◽  
Emergency Department Visits ◽  
Risk Patient ◽  
Specialty Clinic

Reducing emergency department visits utilizing a primary care asthma specialty clinic in a high-risk patient population

2017 ◽  
Vol 55 (7) ◽  
pp. 785-794 ◽  
Author(s):  
Dane A. Snyder ◽  
Olivia W. Thomas ◽  
Sean P. Gleeson ◽  
David R. Stukus ◽  
LaQuita M. Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
High Risk ◽  
Patient Population ◽  
High Risk Patient ◽  
Emergency Department Visits ◽  
Risk Patient ◽  
Specialty Clinic

scholarly journals Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm?

2021 ◽  
Vol 10 (9) ◽  
pp. 1818
Author(s):  
Tomohiro Yamazaki ◽  
Mamoru Takenaka ◽  
Shunsuke Omoto ◽  
Tomoe Yoshikawa ◽  
Rei Ishikawa ◽  
...  
Keyword(s):  
Intraductal Papillary Mucinous Neoplasm ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Consensus Guidelines ◽  
International Consensus ◽  
Mucinous Neoplasm ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Diagnostic Values ◽  
International Consensus Guidelines

This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed with IPMN who underwent preoperative CH-EUS between March 2010 and December 2018 were enrolled. We analyzed each malignancy diagnostic value (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) by replacing fundamental B-mode EUS with CH-EUS as the recommended test for patients with worrisome features (WF) (the CH-EUS incorporation ICG) and comparing the results to those obtained using the 2017 ICG. The malignancy diagnostic values as per the 2017 ICG were 78.9%, 42.3%, 60.0%, and 64.7% for Se, Sp, PPV, and NPV, respectively. The CH-EUS incorporation ICG plan improved the malignancy diagnostic values (Se 78.9%/Sp, 53.8%/PPV, 65.2%/NPV 70.0%). CH-EUS may be useful in determining the appropriate treatment strategies for IPMN.

scholarly journals The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

2021 ◽  
Author(s):  
Matthijs D. Kruizinga ◽  
Daphne Peeters ◽  
Mirjam van Veen ◽  
Marlies van Houten ◽  
Jantien Wieringa ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hospital Admissions ◽  
Clinical Care ◽  
Pediatric Emergency ◽  
Pediatric Care ◽  
Care Utilization ◽  
Admission Data ◽  
Multicenter Analysis ◽  
Ed Visits ◽  
The Impact

AbstractThe coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

Subspecialization Within Pediatric Practice: A Broader Spectrum

PEDIATRICS ◽  
1992 ◽  
Vol 90 (4) ◽  
pp. 573-581 ◽  
Author(s):  
Brian W. McCrindle ◽  
Barbara Starfield ◽  
Catherine DeAngelis
Keyword(s):  
United States ◽  
Primary Care ◽  
Response Rate ◽  
Fellowship Program ◽  
Pediatric Practice ◽  
Ongoing Controversy ◽  
Manpower Supply ◽  
Final Response ◽  
Pediatric Subspecialty ◽  
Final Response Rate

This study was undertaken to describe subspecialty characteristics and practices of the population of pediatricians given the ongoing controversy regarding a projected manpower oversupply of general pediatricians. A questionnaire was mailed to a national random sample of 1620 United States physicians listed in the American Medical Association's Pysician Masterfile as being in office-based pediatric practice. The final response rate was 63%. Seventy percent of respondents designated their practices as "general pediatrics" versus 17% as "general pediatrics with a specific subspecialty interest" and 13% as "subspecialty practice." The general pediatricians with a specific subspecialty interest were intermediate in the proportion that had some training in a pediatric fellowship program (general pediatricians with a specific subspecialty interest, 63% versus general pediatricians, 14%, P &lt; .0001, and pediatricians with a subspecialty practice, 92%, P &lt; .0001) and that were certified in a pediatric subspecialty by the American Board of Pediatrics (general pediatricians with a specific subspecialty interest 16% versus general pediatricians, 2%, P &lt; .0001, and pediatricians with subspecialty practice, 62%, P &lt; .0001). They were also intermediate in the proportion involved in various academic pursuits. Their practices, however, more closely resembled general pediatricians than pediatricians with a subspeciality practice in their location, setting, associates, and commitment to primary care. They were more likely than general pediatricians to utilize or provide specialized tests or procedures. A large percentage of pediatricians incorporate subspecilaty elements into their general pediatric practices. Models of current and projected pediatric manpower supply need to be reassessed in light of this form of practice.

The Future of Primary Care

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 186-187
Author(s):  
RITAMARIE MOSCOLA
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Social Economic ◽  
Emergency Department Visits ◽  
Missed Appointments ◽  
Cultural Changes ◽  
Pediatric Education ◽  
The Social ◽  
The Future ◽  
Physician Relationship

To the Editor.— In the article "Primary Care: The Future of Pediatric Education"1 Dr Alpert addresses many issues facing pediatrics. I agree with his list of problems. However, I doubt that the social, economic, and cultural changes he describes will ever occur. My informal survey of pediatricians in practice is a song of frustration and boredom. The ringing telephone provides the rhythm. How does a patient-physician relationship develop in an environment of missed appointments, 3 AM emergency department visits, and managed care? Many families change physicians whenever employers change health benefits packages.

Primary Care: The Future for Pediatric Education

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 653-659
Author(s):  
Joel J. Alpert
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Geographic Location ◽  
Pediatric Care ◽  
Past Century ◽  
Inner Cities ◽  
Critical Issues ◽  
Definition Of ◽  
Care Problems

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems. Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines. For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

2021 ◽  
pp. 1-8
Author(s):  
Kim D. Lu ◽  
Dan Cooper ◽  
Raluca Dubrowski ◽  
Melanie Barwick ◽  
Shlomit Radom-Aizik
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Barriers And Facilitators ◽  
Pediatric Care ◽  
Team Approach ◽  
Implementation Barriers ◽  
Primary Care Clinics ◽  
Exercise Medicine ◽  
Practice Variability ◽  
Facilitators And Barriers

Purpose: Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians’ thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. Methods: The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. Results: Despite the pediatricians’ beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. Conclusion: The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

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