Academic Pediatrics最新文献

{"title":"Monitoring Infant Vaccination Timeliness and Patterns: Progress and Future Directions","authors":"Sophia R. Newcomer PhD, MPH , Alexandria N. Albers PhD, MPH, MS , Sarah Y. Michels MPH , Jason M. Glanz PhD , Matthew F. Daley MD","doi":"10.1016/j.acap.2025.102854","DOIUrl":"10.1016/j.acap.2025.102854","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102854"},"PeriodicalIF":3.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in Pediatric Resident Self-Efficacy and Documentation of Childhood Obesity Care With an Educational Intervention","authors":"Christiana J. Stark MD ,&nbsp;Jeffrey Zhang MD ,&nbsp;Jessica Walters MD ,&nbsp;Dominick DeBlasio MD, MEd ,&nbsp;JangDong Seo PhD ,&nbsp;Robert Siegel MD ,&nbsp;Kristin Stackpole MD, FAAP ,&nbsp;Melissa Klein MD, MEd","doi":"10.1016/j.acap.2025.102846","DOIUrl":"10.1016/j.acap.2025.102846","url":null,"abstract":"<div><h3>Objective</h3><div>Childhood obesity is a public health crisis with increasing rates and long-term complications. Primary care providers are essential to address this concern; however, clinicians report inadequate training and self-efficacy.</div></div><div><h3>Methods</h3><div>This educational study evaluated the impact of an obesity management curriculum on residents’ self-efficacy and documentation. Three interactive educational sessions were presented. Residents rated their self-efficacy on caring for patients with obesity using a retrospective pre-post anchored–response scale survey. Practice change was evaluated via chart review. Documentation of key history and treatment items was collected utilizing a standardized rubric over a 2-month period, both before and after the education.</div></div><div><h3>Results</h3><div>Posteducation, self-efficacy ratings were higher compared to pre-education scores (<em>P</em> &lt; .0001). Chart review for 63 residents showed improvement in documentation of history and treatment items (<em>P</em> = .026). Nutrition, activity, and sleep history elements improved in postgraduate level (PGY) 1 residents' documentation compared to PGY2 (<em>P</em> &lt; .0001) and PGY3 residents (<em>P</em> = .004). Documentation of treatment components—including healthy habits counseling, specific, measurable, achievable, relevant, and time-bound goals, lab testing, referrals, and follow-up—increased among all PGY levels (<em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>A primary care–based curriculum improved resident self-efficacy in caring for patients with obesity. Documentation of history and treatment items increased for all residents, with greatest improvement by PGY1 residents.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102846"},"PeriodicalIF":3.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Metamorphosis","authors":"Anthony Milki MD","doi":"10.1016/j.acap.2025.102848","DOIUrl":"10.1016/j.acap.2025.102848","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102848"},"PeriodicalIF":3.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Educational Debt of Board-Certified Pediatricians by Gender, Race, and Ethnicity Across the Age Spectrum","authors":"Amarilis A. Martin MD ,&nbsp;Jeremy W. Jacobs MD, MHS ,&nbsp;Garrett S. Booth MD, MS ,&nbsp;Jessica M. Allan MD ,&nbsp;Adaira I. Landry MA ,&nbsp;Nancy D. Spector MD ,&nbsp;Julie K. Silver MD","doi":"10.1016/j.acap.2025.102847","DOIUrl":"10.1016/j.acap.2025.102847","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the characteristics of pediatricians’ educational debt.</div></div><div><h3>Methods</h3><div>Using publicly available results from the American Board of Pediatrics Maintenance of Certification surveys (2019–2023), this cross-sectional study assessed the proportion of 1) female to male pediatricians and 2) pediatricians of various races and ethnicities to White pediatricians with educational debt by age, debt amount, and subspecialty.</div></div><div><h3>Results</h3><div>Overall, 31.9% (12,286/38,499) of pediatricians had educational debt. Of pediatricians aged ≤40 years, 58.8% (5120/8713) had debt. Debt decreased with age, but of the pediatricians who had debt, 46.1% (111/241) of those aged 61 to 70 years and 64.3% (9/14) of pediatricians older than 70 years owed ≥$100,000. A greater proportion of female than male pediatricians had debt overall (34.6%, 8588/24,846 vs 27.1%, 3696/13,644; relative risk 1.28; 95% confidence intervals 1.24–1.32; <em>P</em> &lt; .0001) and for every bracket above $25,000. However, male pediatricians carried the highest debt amounts when stratified by age. Subspecialty pediatricians and Black or African American pediatricians had the most debt at all ages up to 70 years. The proportion of Asian, Middle Eastern or North African, and Hispanic, Latino, or Spanish Origin pediatricians with debt was lower than that of White pediatricians.</div></div><div><h3>Conclusion</h3><div>Educational debt is unequally distributed among board-certified pediatricians concerning gender, race, ethnicity, and subspecialty. Even though most pediatricians pay off their educational debt, some still owe ≥$100,000 late in their career or retirement age. Further investigation and targeted interventions are needed to address financial inequities and reduce educational debt within the pediatric workforce.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102847"},"PeriodicalIF":3.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Resident Perspectives on How to Teach About Neonatal Health Inequities: A Multisite Exploratory Study","authors":"Shamita Punjabi MD ,&nbsp;Christina Konecny MD ,&nbsp;Evangelina Molina MD, MBA ,&nbsp;Rebecca Webb MD ,&nbsp;Kayla L. Karvonen MD, MAS ,&nbsp;Stephanie Fong Gomez MD, MS ,&nbsp;Heather Briscoe MD ,&nbsp;Rebecca Blankenburg MD, MPH ,&nbsp;Elizabeth Blecharczyk MD ,&nbsp;the CINC Study Team","doi":"10.1016/j.acap.2025.102841","DOIUrl":"10.1016/j.acap.2025.102841","url":null,"abstract":"<div><h3>Objective</h3><div>To examine pediatric residents’ perspectives and education on neonatal health inequities, thereby identifying training needs and opportunities to improve health inequities for newborns.</div></div><div><h3>Methods</h3><div>We performed an Institutional Review Board (IRB)-approved multi-institutional, qualitative study. Over 18 months, we conducted 10 focus groups across Bay Area institutions. We developed focus group guides using literature review, expert consensus, and feedback from health equity experts. Focus groups were audio-recorded and transcribed verbatim. We used thematic analysis to code transcripts and develop themes until reaching thematic sufficiency, employing reflexivity and member checking.</div></div><div><h3>Results</h3><div>Five key themes emerged across 44 pediatric resident focus group participants. 1) Residents spotlight how neonatal inequities influence patient outcomes, finding difficulties in addressing them in real-time due to systems-level barriers and limited action-oriented knowledge. 2) Residents express a high level of moral distress and cognitive dissonance over the perceived inability to fully address inequities in the clinical setting, seeking a safe space to communicate these emotions. 3) Residents desire protected time for longitudinal reflection and action-oriented education about inequities throughout residency. 4) Residents emphasize the importance of faculty role modeling their knowledge and approach to addressing inequities, highlighting a need for ongoing faculty development. 5) Collaboration with multidisciplinary care team members, families, and community partners is central to a well-rounded curriculum.</div></div><div><h3>Conclusions</h3><div>These findings underscore the need to enhance action-based health equity education in pediatric training. Addressing these identified themes can improve resident preparedness to mitigate health disparities in neonatal care, fostering equitable outcomes for newborns.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102841"},"PeriodicalIF":3.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuts and Bolts","authors":"Molly Broder MD ,&nbsp;Zac Gohsman MD ,&nbsp;Kendall Steadmon MD ,&nbsp;Melissa Grageda MD ,&nbsp;On Behalf of the Association of Pediatric Program Directors Faculty and Professional Development Task Force","doi":"10.1016/j.acap.2025.102831","DOIUrl":"10.1016/j.acap.2025.102831","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102831"},"PeriodicalIF":3.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Clinical Decision Supports to Improve Adolescent Depression Screening and Management in Pediatric Primary Care","authors":"Nathaniel J. Glasser MD, MPP ,&nbsp;Camron Shirkhodaie MD ,&nbsp;Zachary C. Newman BS ,&nbsp;Joanne Wang BA ,&nbsp;Mengqi Zhu MS ,&nbsp;James W. Mitchell MD, FAAP ,&nbsp;Erin Staab MPH ,&nbsp;Stephanie Lichtor MD ,&nbsp;Neda Laiteerapong MD, MS","doi":"10.1016/j.acap.2025.102839","DOIUrl":"10.1016/j.acap.2025.102839","url":null,"abstract":"<div><h3>Objective</h3><div>To examine how depression screening rates changed after implementation of electronic health record (EHR) clinical decision support tools and medical assistant (MA)-led depression screening at an outpatient pediatric practice.</div></div><div><h3>Methods</h3><div>We assessed changes in depression screening rates at an urban academic pediatric clinic between September 2016 and December 2020 using interrupted time series analysis. During this time, we implemented 1) EHR clinical decision support tools for depression screening and management (November 2017) and 2) training of MAs to screen for depression (July 2019).</div></div><div><h3>Results</h3><div>Over the study period, 3963 patients received care in the pediatric clinic. Their mean age was 14.9 years (standard deviation, 2.6) and about half were female (n = 2011, 51%). The majority were Black/African American (n = 2852, 72%) and had private insurance (n = 2860, 72%). Depression screening rates increased from 3% to &gt;80%. Preintervention, depression screening rates were not increasing (0.9% per month, 95% confidence interval [CI]: −0.3% to 2.1%; <em>P</em> = .15). After implementing EHR clinical decision support tools, there was a 15.6% (95% CI: 2.5%–28.6%, <em>P</em> = .02) increase in the screening rate. Also, MA-led screening was associated with a 24.6% (95% CI: 9.9%–39.2%, <em>P</em> = .002) screening rate increase.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that EHR clinical decision support tools and MA-led screening are likely to increase adolescent depression screening and management in pediatric clinics.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102839"},"PeriodicalIF":3.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Delivery of Firearm Safety Resources for Behavioral Health Patients in the Pediatric Emergency Department: A Quality Improvement Initiative","authors":"Katherine Donches MD ,&nbsp;Ashlee Murray MD, MPH ,&nbsp;Maggy Carka ,&nbsp;Mushyra Wright LCSW ,&nbsp;Joel Fein MD, MPH","doi":"10.1016/j.acap.2025.102843","DOIUrl":"10.1016/j.acap.2025.102843","url":null,"abstract":"<div><h3>Objective</h3><div>Addressing unsafe firearm storage is essential to preventing suicide and unintentional firearm injury. For patients presenting to our pediatric emergency department (ED) with behavioral health (BH) needs, we implemented a standardized approach to screening for exposure to unsafely stored firearms and offering firearm storage devices and educational resources to the families of patients presenting with BH concerns.</div></div><div><h3>Methods</h3><div>Using quality improvement methodology, we identified electronic medical record (EMR) documentation and availability of firearm safety resources (gun locks and firearm safety handouts) as areas for improvement. Plan-Do-Study-Act (PDSA) cycles were 1) integrating standardized, templated firearm safety questions within an existing social work BH assessment template in the EMR; and 2) improving access to/restocking of firearm safety resources. We tracked screening documentation rates and safety resource offering rates as process and outcome measures.</div></div><div><h3>Results</h3><div>Screening documentation rates increased from 0% preintervention to an initial 89% postintroduction of standardized EMR firearm safety questions. Firearm safety screening documentation rates increased to and were sustained at &gt;90% without special cause variation following our 2 PDSA cycles. Two sporadic and expected fluctuations occurred, both attributed to changes in screening documentation formatting in EMR. Over the course of the study, our offering rate increased from 0% prestudy to 85% for patients with unsafely stored guns following chart review.</div></div><div><h3>Conclusions</h3><div>Incorporating firearm safety questions into the EMR and maintaining a supply of firearm safety resources in the ED is an effective and sustainable approach to enhancing firearm safety for high-risk BH patients.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102843"},"PeriodicalIF":3.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEADS-ED as a Predictor of Hospitalization in Children Seeking Emergency Department Care With Mental Health Concerns","authors":"Hannah Byles MD ,&nbsp;Amanda S. Newton PhD ,&nbsp;Jianling Xie MD, MPH ,&nbsp;Kathleen Winston MSc ,&nbsp;Mario Cappelli PhD ,&nbsp;Jennifer Thull-Freedman MD, MSc ,&nbsp;Stephen B. Freedman MDCM, MSc ,&nbsp;on behalf of Pediatric Emergency Research Canada (PERC)","doi":"10.1016/j.acap.2025.102845","DOIUrl":"10.1016/j.acap.2025.102845","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between the Home, Education/Employment, Activities, Drugs, Suicidality, Emotions, Discharge (HEADS-ED) tool and hospitalization among children presenting with mental health concerns for emergency department (ED) care.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of data from a prospective quasi-experimental study evaluating an acute mental health care bundle in 2 pediatric EDs in Alberta, Canada. Participants were &lt;18 years and presented with a mental health concern. A high-risk HEADS-ED score was defined by a total score ≥8 (range: 0–14) and/or suicide score of 2 (range: 0–2). Primary outcome was index ED visit hospitalization.</div></div><div><h3>Results</h3><div>Seven hundred and fourteen eligible participants had complete data available for analysis. Median participant age was 14.0 (interquartile range [IQR]: 12.0, 15.0) years, 12.0% (86/714) of whom were hospitalized at the index ED visit. The HEADS-ED score was ≥8 for 16.9% (121/714) of participants and 28.6% (204/714) had a suicide risk score of 2; 35.7% (255/714) met one or both high-risk criteria. Exactly 79.1% (95%confidence interval [CI]: 69.0, 87.1) of hospitalizations were among children who had high-risk scores, whereas 70.2% (95%CI: 66.5, 73.8) of children who were discharged had low-risk scores. Similarly, including follow-up through 30 days after the index visit, 77.7% (95%CI: 67.9, 85.6) of hospitalizations were among children who had high-risk scores, while 70.7% (95%CI: 66.9, 74.2) of children who were not hospitalized had low-risk scores. Among children ≥14 years, HEADS-ED scores were inversely correlated with well-being scores.</div></div><div><h3>Conclusion</h3><div>In our study population, high-risk HEADS-ED scores are moderately associated with hospitalization. Adolescents with higher HEADS-ED scores reported lower well-being.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102845"},"PeriodicalIF":3.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Interviews Residency Applicants? A National Study of Pediatric Programs’ Practices","authors":"Arishna Patel MD,&nbsp;Lahia Yemane MD,&nbsp;Caroline E. Rassbach MD, MAEd","doi":"10.1016/j.acap.2025.102842","DOIUrl":"10.1016/j.acap.2025.102842","url":null,"abstract":"<div><h3>Objective</h3><div>Interviews play a critical role in assessing applicants for residency. Historically, these interviews have been conducted primarily by faculty; however, in recent years, more programs have begun using nonfaculty interviewers. We aimed to characterize the identity, prevalence, motivations behind, and perceived benefits and challenges of utilizing nonfaculty interviewers during pediatric residency recruitment.</div></div><div><h3>Methods</h3><div>We developed and distributed a survey to program leaders of all US categorical pediatric residencies from September to December 2022 to inquire about their interview methods. We analyzed the data using descriptive statistics and inductive content analysis for free-text responses.</div></div><div><h3>Results</h3><div>The response rate was 65% (125/193 programs). Overall, 71% of programs used nonfaculty interviewers, with the most common groups being chief residents (if not considered clinical faculty) (58%), residents (31%), and fellows (14%). Perceived benefits of nonfaculty interviewers included providing diverse perspectives in evaluating applicants and increasing the number of interviewers. Noted challenges were scheduling difficulties, assuring adequate training and preparation, and the uncertainty of applicant perceptions of interviewing with nonfaculty members. Many programs felt that each nonfaculty interviewer group positively or very positively impacted residency interviews (71%, 87/123).</div></div><div><h3>Conclusions</h3><div>Many programs utilize nonfaculty interviewers during pediatric residency recruitment. Respondents described several perceived benefits and challenges related to these interviewers and overall felt their inclusion positively impacted recruitment. These study findings can serve as a resource for program leaders seeking to evaluate and evolve their current interview practices.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102842"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}