Research Methods, Statistics, Patient Safety, and Quality Improvement

The chapter on research methods, statistics, patient safety, and quality improvement (QI) uses a question-and-answer format to make concepts in these areas relevant and accessible to general pediatricians. Research topics covered include study design and study types, validity, sources of bias, types of errors, sensitivity and specificity, positive and negative predictive values, likelihood ratios, incidence and prevalence, p values and confidence intervals. The patient safety questions focus on medical errors and adverse events, including their categorization, detection, prevention, and disclosure. Finally, the QI questions address key QI principles and methods, including tools to understand systems (e.g. fishbone diagrams and Pareto charts), analysis of variation, and the Langley Model for Improvement.

Ethics

The practice of medicine is an intrinsically ethical endeavor because its fundamental goal is health, a good necessary for and integral to human flourishing. This goal also helps define and identify what counts as ethical behavior in the practice of medicine. Fundamentally, actions that promote the possibility of health are generally to be accounted as ethically good actions. Conversely, those that tend to frustrate or destroy the possibility of health are to be accounted as ethically bad. In addition to having an identity-defining goal, clinical medicine also has a nature or structure proper to it. That structure is relational. The authentic and effective practice of medicine requires a relationship of deep mutual trust between the physician and the physician’s patient and the patient’s family. Therefore, a commitment to and an ability to create and sustain such a relationship is a legitimate moral expectation of a physician and is the source of many of the physician’s ethical responsibilities. In the eleven case studies that follow, common ethical challenges that pediatricians might reasonably expect to encounter in their practice are explored. In each case, it is recommended that the pediatrician adopt the course of action that is most consistent with the nature and goal of medicine understood as a healing profession rooted in and requiring a relationship of mutual trust.

Dermatology

This chapter on dermatologic disorders presents patient scenarios in a series of vignettes. Each vignette is followed by a question-and-answer format to provide active learning that emphasizes key points regarding clinically relevant topics. These topics are also covered in the American Board of Pediatrics Content Outline for certification exams. The topics addressed in this chapter range from common dermatologic conditions encountered by pediatricians to important more rare conditions that may be part of pediatric practice. Specific topics include skin problems in neonates, atopic dermatitis, infections and infestations, hair loss, neurocutaneous syndromes, pigmented lesions, acne, inflammatory skin conditions, and inherited rare skin conditions.

Nephrology and Urology

This chapter on pediatric nephrology and urology examines normal renal physiology and urological anatomy along with common manifestations of renal and urological dysfunction in children. It reviews the clinical presentation, diagnosis, and management of fluid, electrolyte, and acid-base disorders. It describes the presentation and management of glomerular diseases associated with proteinuria, hematuria, and chronic kidney disease. Inherited diseases and syndromes affecting the kidney, bladder, and urinary tract are described. In addition, age-related changes in glomerular filtration, common pathogens associated with urinary tract infection, the diagnosis and management of inguinal masses and vaginal discharge, and the management of acute kidney injury are discussed. This chapter is written for pediatric residents in training.

Allergy and Immunology

The chapter on allergy and immunology reviews the risk factors, clinical presentation, diagnostic evaluation, and management of atopic diseases and immunodeficiency diseases. The material is presented in an engaging clinical vignette and question-and-answer format. The key medical conditions covered in the chapter include allergic and atopic diseases such as asthma, food allergy, anaphylaxis, urticaria/angioedema, drug allergy, and stinging insect allergy; it also touches on rarer primary immunodeficiency diseases. It highlights key clinical features to enable differentiation of allergic disorders from their mimickers; it provides a diagnostic approach to evaluate primary immunodeficiency diseases, and it covers both acute/urgent and long-term disease management.

Pulmonology

This chapter presents vignettes on commonly encountered pulmonary issues in a general pediatric practice. It details the clinical presentation, evaluation, and management of upper and lower airway disorders, parenchymal lung diseases, respiratory control disorders, and ventilatory muscle disorders. Clinical pearls in the recognition of rare pulmonary diseases are discussed. Illustrative cases highlight the appropriate use of procedures and laboratory and radiographic tests such as chest radiographs, computerized tomography scans, pulmonary function tests, blood gases, polysomnography, and bronchoscopy to aid diagnosis. Also reviewed are clinical guidelines and current data that impact the management approach.

Cardiology

This chapter reviews important concepts in pediatric cardiology through board-relevant questions. Emphasis is placed on the diagnosis of common cardiac conditions, evaluation of murmurs, understanding electrocardiograms, appropriate ordering and use of diagnostic tests, appropriate emergency management of common cardiac conditions, and the recognition of important genetic cardiac conditions. The chapter provides answers to each question with explanations of the correct and incorrect answers.

Endocrinology

Disruptions of growth and puberty are typically the first signs of an endocrine disorder. Using vignettes and a question-and-answer format, this chapter discusses common and uncommon cases of hormone dysfunction presenting from infancy through adolescence. Topics in the chapter include short stature, delayed puberty, obesity, diabetes, hypoglycemia, conditions of endocrine hormone deficiencies and excess and associated genetic syndromes. Challenges in distinguishing normal versus abnormal growth are also reviewed.

Hematology

Pediatric hematology focuses on the diagnosis and management of disorders of the blood and blood-forming organs in infants, children, and adolescents. These include disorders in the number or function of platelets, erythrocytes (red blood cells), leukocytes (white blood cells), and coagulation factors, among others, that lead to abnormal bleeding, clotting, oxygen delivery, infectious predisposition, and other complications. Using pediatric board review questions and answers, this chapter reviews key concepts in nonmalignant hematology of interest to both general pediatricians and pediatric specialists. Specific topics include the evaluation and management of iron and other nutritional deficiency anemias, hemolytic anemias, hemoglobinopathies, bleeding disorders, immune-mediated cytopenias, bone marrow failure syndromes, platelet disorders, neutropenia and other leukocyte disorders, and transfusion reactions, among others.

Oncology

Pediatric oncology focuses on the diagnosis and management of cancer in infants, children, and adolescents. Leukemias, lymphomas, and other hematological malignancies are the most common group of pediatric cancers, followed by brain tumors. Other important pediatric cancers include Wilms tumor, neuroblastoma, sarcomas, histiocytosis, and germ cell tumors. Certain cancers can present with oncologic emergencies, such as tumor lysis syndrome or spinal cord compression, or as part of a cancer predisposition syndrome. With increased survival rates, short- and long-term complications of chemotherapy, radiation, surgery, and hematopoietic cell transplantation are also prevalent and important to recognize. This chapter reviews these key concepts in pediatric oncology using board review–style questions and answers.