http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Miscellaneous" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/121/5/1050?rss=1 Patriots' Day is a legal holiday in Massachusetts and Maine, celebrating the battle of Concord and Lexington on April 19, 1775. The event of April 19, 1950, was very unusual, because of the origin of a fire at Children's Hospital Boston. At that time, the hospital consisted of 2-story stucco pavilion buildings that housed patients of diverse ages. In addition, on the southwest side of the area, there was a routine laboratory facility adjacent to the clinical neurology unit. The surgical suite was also on the southwest side. In the midst of these buildings was Dr James Gamble's study research laboratory, with his magnificent cherry wood library that contained his personal collection of research journals. This conference room was used for chart reviews for patient and brief seminars. The personnel in the Gamble Division consisted of Dr Gamble ... Schwartz, R. 2008-05-01 doi:10.1542/peds.2008-0239 Patriots' Day Fire on April 19, 1950 at Children's Hospital Boston American Academy of Pediatrics 5 121 1051 1050 2008-05-01 HISTORICAL ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/117/1/205?rss=1 "Careful consideration and planning have been given to the form of Pediatrics. Medical publications follow an almost stereotyped standard from which there is little chance to vary; but every effort has been made to present Pediatrics in an attractive, interesting, and useful way without altering accepted standards." Hugh McCulloch,1 from the inaugural issue of Pediatrics, 1948 From its inception, the design of Pediatrics has been an important consideration for its editors and for the American Academy of Pediatrics (AAP). Readability, usefulness, and ease of navigation have been guiding principles in the journal's evolution from a small "green journal" to a world-renowned publication that reaches beyond the edges of its bindings and into the far corners of cyberspace. Although we have ma ... Clarke, M. T. 2006-01-01 doi:10.1542/peds.2005-2806 The Redesign of Pediatrics American Academy of Pediatrics 1 117 207 205 2006-01-01 COMMENTARIES http://pediatrics.aappublications.org:80/cgi/content/short/116/3/732?rss=1 In 1908, William Sealy Gosset, a chemist in an Irish brewery, published his second article on statistics in Biometrika under the pseudonym "Student." He chose this pseudonym because his company did not allow its scientists to publish confidential data. In the article, Gosset described a procedure to assess population means by using small samples. This was the origin of the "Student's t test." Dr William Silverman (1917-2004), a pioneer neonatologist, also used the pseudonym "Student." He sent thousands of notes, clippings, anecdotes, and quotations to Pediatrics with the signature line "Submitted by Student" that appeared as blurbs at the ends of articles since 1977. Both Gosset and Silverman were rigorous students of science. Silverman chose pseudonyms to seek readers' responses to the message rather than the messenger. He also wished that one would remain a perpetual student, ready to say "I don't know," and strive to understand the human side of medicine. This brief article provides a perspective on these 2 "students" of science. Raju, T. N. K. 2005-09-01 doi:10.1542/peds.2005-1134 William Sealy Gosset and William A. Silverman: Two "Students" of Science American Academy of Pediatrics 3 116 735 732 2005-09-01 SPECIAL ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/115/6/1792-a?rss=1 To the Editor.-- According to the Supreme Court of Japan, there were 1019 newly accepted lawsuits associated with medical malpractice in 2003.1 The numbers of lawsuits among clinical-specialty groups were: internal medicine, 258; pediatrics, 21; psychiatry, 42; dermatology, 20; surgery, 214; orthopedics/plastic surgery, 129; urology, 20; obstetrics/gynecology, 137; ophthalmology, 27; and otorhinolaryngology, 25.1 There were many lawsuits in internal medicine and surgery. Furthermore, the number of lawsuits in each specialty was divided by that of physicians with the specialty.2 Physicians who had such specialties as surgery and obstetrics/gynecology had higher rates of lawsuits (0.62 and 0.91 per 100 physicians per year, respectively), whereas pediatricia ... Ehara, A. 2005-06-01 doi:10.1542/peds.2005-0677 Lawsuits Associated With Medical Malpractice in Japan: Rate of Lawsuits Was Very Low in Pediatrics, Although Many Children Visit Emergency Rooms American Academy of Pediatrics 6 115 1793 1792 2005-06-01 LETTERS TO THE EDITOR http://pediatrics.aappublications.org:80/cgi/content/short/114/3/e361?rss=1 Objectives. Little is known regarding the assessment and treatment of symptoms during end-of-life (EOL) care for children. This study was conducted to describe the circumstances surrounding the deaths of hospitalized terminally ill children, especially pain and symptom management by the multidisciplinary pediatric care team. Design. Patients in the neonatal intensive care unit, pediatric critical care unit, or general pediatric units of Vanderbilt Children's Hospital who were hospitalized at the time of death, between July 1, 2000, and June 30, 2001, were identified. Children eligible for the survey had received inpatient EOL care at the hospital for at least 24 hours before death. A retrospective medical record review was completed to describe documentation of care for these children and their families during the last 72 hours of life. Results. Records of children who had received inpatient EOL care were identified (n = 105). A majority (87%) of children were in an intensive care setting at the time of death. Most deaths occurred in the pediatric critical care unit (56%), followed by the neonatal intensive care unit (31%). Pain medication was received by 90% of the children in the last 72 hours of life, and 55% received additional comfort care measures. The presence of symptoms other than pain was infrequently documented. Conclusions. The duration of hospitalization for most children dying in this inpatient setting was sufficient for provision of interdisciplinary pediatric palliative care. Management of pain and other symptoms was accomplished for many children. The documentation of pain and symptom assessment and management can be improved but requires new tools. Carter, B. S. Howenstein, M. Gilmer, M. J. Throop, P. France, D. Whitlock, J. A. 2004-09-01 doi:10.1542/peds.2003-0654-F Circumstances Surrounding the Deaths of Hospitalized Children: Opportunities for Pediatric Palliative Care American Academy of Pediatrics 3 114 366 361 2004-09-01 ELECTRONIC ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/114/3/898?rss=1 To the Editor.-- It has been 5 years since the 50th anniversary of military pediatrics. Members of the American Academy of Pediatrics have reason to be proud of the role of their colleagues in uniform in the ongoing conflict in Southwest Asia. Nearly 100 active-duty and reserve military pediatricians from the Army, Air Force, and Navy have deployed to support Coalition Forces since the fall of 2002. In particular, 72 active-duty Army pediatricians have deployed for up to 1 year each, which represents 35% of all active-duty Army pediatricians (72 of 207). In fact, the first uniformed physicians who entered Iraq, and the furthest forward during the offensive phase of the conflict, were 2 Army pediatricians. The deployed pediatricians have provided direct, primary, and acute emergency trauma care for the adolescents who make up ... Callahan, C. W. Doyle, A. E. Schobitz, E. P. 2004-09-01 doi:10.1542/peds.2004-1254 Military Pediatricians in Southwest Asia American Academy of Pediatrics 3 114 898 2004-09-01 LETTERS TO THE EDITOR http://pediatrics.aappublications.org:80/cgi/content/short/114/1/328?rss=1 To the Editor. -- With interest I read the article "Missed Opportunities for Perinatal HIV Prevention Among HIV-Exposed Infants Born 1996-2000, Pediatric Spectrum of HIV Disease Cohort" by Peters et al.1 It is a remarkable achievement that the rate of transmission has dropped so dramatically in the United States. Comparing the social and health systems in the United States to those in sub-Saharan Africa, where the magnitude of the problem is exponentially larger (2.6 million children aged 0-14 years vs 10 000 children2 [it is assumed that a large proportion of these children are perinatally infected]) and the resources are exponentially lower, one wonders if the same results can be achieved there. I would like to highlight some key differences in prenatal ca ... Hyslop, A. E. 2004-07-01 doi:10.1542/peds.114.1.328 Missed Opportunities for Perinatal HIV Prevention Among HIV-Exposed Infants Born 1996-2000, Pediatric Spectrum of HIV Disease Cohort American Academy of Pediatrics 1 114 329 328 2004-07-01 LETTERS TO THE EDITOR http://pediatrics.aappublications.org:80/cgi/content/short/113/1/S1/185?rss=1 Objective. To assess the availability and use of quality measures for children's health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally. Study Design. Two-day invitational expert meeting, informed by 3 commissioned articles. Results. Quality of care for children is far less than optimal. A number of measures are available for measuring children's health care quality on a regular basis, although measures are scarce at least in many areas (eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children's health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children's health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children's health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement. Conclusions. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children's health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children's health and health care but also activities to build a broad base of support among the public and key health care decision-makers. Dougherty, D. Simpson, L. A. 2004-01-01 doi:10.1542/peds.113.1.S1.185 Measuring the Quality of Children's Health Care: A Prerequisite to Action American Academy of Pediatrics 1 113 198 185 2004-01-01 ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/113/1/S1/199?rss=1 Background. The ability to measure and improve the quality of children's health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children's health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children (aged 0-18 years). We categorized the individual measures into the Institute of Medicine's framework for the National Health Care Quality Report. The framework includes health care quality domains (patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains (staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures (how well they assess care for all children versus children with special health care needs) and their comprehensiveness (how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children's health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% (measures were multidimensional if they applied to >1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority ([≥]79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey (Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children. Beal, A. C. Co, J. P. T. Dougherty, D. Jorsling, T. Kam, J. Perrin, J. Palmer, R. H. 2004-01-01 doi:10.1542/peds.113.1.S1.199 Quality Measures for Children's Health Care American Academy of Pediatrics 1 113 209 199 2004-01-01 ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/113/1/S1/210?rss=1 The movement to measure medical care quality has been accelerating, spurred on by evidence of poor quality of care and trials of interventions to improve care. Appropriate measurement of quality of care is an essential aspect of improving the quality of care, yet some quality measures may be influenced by patients' attributes unrelated to quality of care. Risk adjustment is the term commonly applied to those methods that account for patient-related attributes, making measurement of health care quality as comparable as possible across providers or organizations seeing different mixes of patients. The measurement of quality of care for children poses specific challenges. In addition to these measurement challenges, analysts must ensure that quality comparisons among doctors, groups of doctors, hospitals, or health plans are not adversely affected by the likelihood that different types of patients seek care in different places. Although some techniques designed to adjust performance measures for case mix were developed for both adults and children, other systems are specific to childhood circumstances. The theoretical issues involved in risk-adjusting childhood outcomes measures for newborns in the neonatal intensive care unit were reviewed recently. Here, we go beyond the neonatal intensive care unit setting to consider risk adjustment for pediatric quality measures more broadly. In particular, we 1) review the conceptual background for risk-adjusting quality measures, 2) present policy issues related to adjusting pediatric quality measures, and 3) catalog existing risk-adjustment methodologies for pediatric quality measures. We conclude with an overall assessment of the status of risk adjustment for pediatric quality measures and recommendations for additional research and application. Kuhlthau, K. Ferris, T. G. G. Iezzoni, L. I. 2004-01-01 doi:10.1542/peds.113.1.S1.210 Risk Adjustment for Pediatric Quality Indicators American Academy of Pediatrics 1 113 216 210 2004-01-01 ARTICLE