Pediatrics Research Today is a free monthly online journal that collates and summarizes the latest research about Pediatrics, including details on child development, perinatal medicine, child health care.

Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: a mailed survey of pediatric oncologists.

Henderson TO, Hlubocky FJ, Wroblewski KE, Diller L, Daugherty CK

University of Chicago, Section of Pediatric Hematology, Oncology and Stem Cell Transplantation, 5841 S Maryland Ave, MC 4060, Chicago, IL 60637, USA. thenderson@uchicago.edu

PURPOSE Little is known about physicians' attitudes and knowledge regarding the health care needs of childhood cancer survivors (CCS). We sought to obtain pediatric cancer physicians' self-reported attitudes and knowledge regarding this population. METHODS A mailed survey was sent to 1,159 pediatric oncologists in the United States. Results A total of 655 surveys were returned (ie, 57% response rate). Median age of respondents was 47 years (range, 31 to 82 years); 57% were men. Respondents practiced for a median 14 years (range, 1 to 50 years) and reported seeing a median of 21 patients per week (range, 0 to 250 patients per week). When comfort levels in caring for CCS were described (ie, 1 = very uncomfortable; 7 = very comfortable), respondents were most comfortable with survivors < or = 21 years (mean +/- standard deviation, 6.2 +/- 1.3 level), were less comfortable (5.0 +/- 1.5 level) with those older than 21 years but less than 30 years old, and were uncomfortable with CCS > or = 30 years (2.9 +/- 1.7 level). In response to a clinical vignette of a 29-year-old woman treated with mantle radiation for Hodgkin's lymphoma at 16 years of age, and on the basis of available guidelines, 34% of respondents did not appropriately recommend yearly breast cancer surveillance; 43% of respondents did not appropriately recommend cardiac surveillance; and 24% of respondents did not appropriately recommend yearly thyroid surveillance. Those with greater self-reported familiarity with available long-term follow-up (LTFU) guidelines (odds ratio [OR], 1.33; 95% CI, 1.15 to 1.54) and with receipt of training in the care of CCS (OR, 1.73; 95% CI, 1.18 to 2.52) were more likely to have answered all three questions correctly. CONCLUSION Pediatric oncologists express a range of preferences with regard to LTFU of CCS. Many appear unfamiliar with LTFU surveillance guidelines.

Published 9 February 2010 in J Clin Oncol, 28(5): 878-83.
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Articles on Pediatrics published 4 February 2010:

Current approaches to the diagnosis and management of paediatric migraine.   Lancet Neurol, 9(2): 190-204.

Headache is a common complaint in childhood with up to 75% of children reporting a notable headache by the age of 15 years. Paediatric migraine is the most frequent recurrent headache, occurring in up to 28% of older teenagers. Migraine can have a substantial effect on the life of the child, as well as their family, leading to lost school days and withdrawal from social interactions. Early recognition can lead to successful treatment, improved outcome, and reduced disability. The treatment ... [Abstract] [Full-text]

Articles on Pediatrics published 3 February 2010:

COMSEP: an overview of its history, mission, and relationship to pediatrics.   Pediatrics, 125(2): 203-5.

The reader may wonder, "What is COMSEP, and how does an article from COMSEP affect me?" COMSEP, the Council on Medical Student Education in Pediatrics, is a community of pediatric clerkship directors and other educators whose mission is to improve the health of children and their families by advancing the art and science of medical student education in pediatrics.(1) This is the first in what is envisioned to be a quarterly report from the COMSEP to the readership of Pediatrics. In ... [Abstract] [Full-text]

Implementing developmental screening and referrals: lessons learned from a national project.   Pediatrics, 125(2): 350-60.

OBJECTIVES: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts. BACKGROUND: In 2006, the AAP released a policy statement on developmental surveillance and screening that included an algorithm to aid practices in implementation. Simultaneously, the AAP launched a 9-month ... [Abstract] [Full-text]

Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.   Pediatrics, 125(2): 214-20.

OBJECTIVES: Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline. PATIENTS AND ... [Abstract] [Full-text]

Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.   Pediatrics, 125(2): 361-7.

DESCRIPTION: Update of the 2005 US Preventive Services Task Force (USPSTF) statement about screening for overweight in children and adolescents. METHODS: The USPSTF examined the evidence for the effectiveness of interventions that are primary care feasible or referable. It also examined the evidence for the magnitude of potential harms of treatment in children and adolescents. RECOMMENDATION. The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them ... [Abstract] [Full-text]

Articles on Pediatrics published 1 February 2010:

Pediatric surgery: a career resource.   Am J Surg, 199(2): 275-7.

Pediatric surgeons provide care to neonates and children with a unique range of congenital, oncologic, infectious, and traumatic disorders. This unique surgical subspecialty continues to recruit outstanding trainees, despite the additional training required. This career resource guides the interested medical student and physician through the pathway to a practice in pediatric surgery. It includes a discussion of training requirements, research opportunities, board certification, and continuing ... [Abstract] [Full-text]

Defining the correctness of a diagnosis: differential judgments and expert knowledge.   Adv Health Sci Educ Theory Pract, 15(1): 65-79.

Approaches that use a simulated patient case to study and assess diagnostic reasoning usually use the correct diagnosis of the case as a measure of success and as an anchor for other measures. Commonly, the correctness of a diagnosis is determined by the judgment of one or more experts. In this study, the consistency of experts' judgments of the correctness of a diagnosis, and the structure of knowledge supporting their judgments, were explored using a card sorting task. Seven expert ... [Abstract] [Full-text]

Articles on Pediatrics published 28 January 2010:

The applicability and efficacy of guidelines for the management of acute gastroenteritis in outpatient children: a field-randomized trial on primary care pediatricians.   J Pediatr, 156(2): 226-30.

OBJECTIVE: To evaluate the applicability and efficacy of guidelines for the management of acute gastroenteritis (AGE) as used by pediatricians. STUDY DESIGN: This was a national, open, randomized, controlled intervention trial. The intervention consisted of a 2-hour course based on the guidelines for management of AGE. Seventy-five randomly selected primary care pediatricians underwent training in AGE management (group A), and 75 pediatricians who were not specifically trained served as ... [Abstract] [Full-text]

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