Journal articles: 'Ambulatory Pediatric Association'

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STRAIN, JAMES E. "In Reply: `Ivory Tower' Fellowship Statement Challenged." Pediatrics 88, no. 3 (September 1, 1991): 660–61. http://dx.doi.org/10.1542/peds.88.3.660a.

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I would like to respond to Dr Newhart's question about who authored the Statement on Pediatric Fellowship Training. It was written by the Federation of Pediatric Organizations and approved by the Executive Committees/ Boards of each of the organizations represented on the Federation. These include the Ambulatory Pediatric Association, the American Academy of Pediatrics, the American Board of Pediatrics, the American Pediatric Society, the Association of Medical School Pediatric Department Chairmen, the Association of Pediatric Program Directors, and the Society for Pediatric Research.

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Etzel, Ruth A. "Ambulatory Pediatric Association Policy Statement." Ambulatory Pediatrics 5, no. 1 (2005): 3. http://dx.doi.org/10.1367/1539-4409(2005)5<3:apapse>2.0.co;2.

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Best, Dana, Deborah A. Moss, and Jonathan P. Winickoff. "Ambulatory Pediatric Association Policy on Tobacco." Ambulatory Pediatrics 6, no. 6 (November 2006): 332–36. http://dx.doi.org/10.1016/j.ambp.2006.09.002.

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Perrin, James M., Ellen F. Crain, and Kenneth B. Roberts. "From the Presidents of the Ambulatory Pediatric Association and the Editor-in-Chief of Ambulatory Pediatrics." Pediatrics 106, Supplement_1 (July 1, 2000): 167–68. http://dx.doi.org/10.1542/peds.106.s1.167.

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Hamdani, Gilad, Mark M. Mitsnefes, Joseph T. Flynn, Richard C. Becker, Stephen Daniels, Bonita E. Falkner, Michael Ferguson, et al. "Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents." Hypertension 78, no. 1 (July 2021): 30–37. http://dx.doi.org/10.1161/hypertensionaha.120.16896.

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Ambulatory blood pressure (BP) monitoring is the accepted standard to confirm the diagnosis of hypertension. Although adult guidelines use absolute BP cut points to define ambulatory hypertension, current pediatric guidelines define it based on sex- and height-specific 95th percentiles and BP loads. To examine the association of different ambulatory BP parameters with hypertensive target organ injury, we compared adult and pediatric cut points and assessed the utility of BP load as a predictor of left ventricular hypertrophy (LVH) in 327 adolescents who were ≥13 years of age. Logistic regression was used to assess association of different ambulatory BP parameters with LVH. Sensitivity and specificity of different ambulatory BP cut points as predictors of LVH were also calculated. Sixty-eight (20.8%) participants had LVH. In the analysis comparing adult and pediatric criteria for ambulatory hypertension to predict LVH, adult cut points had better sensitivity-specificity balances than the pediatric 95th percentiles. Although the adult cut point for sleep systolic BP (110 mm Hg) was the optimal predictor of LVH, lower cut points for wake systolic BP (125 mm Hg) and 24-hour systolic BP (120 mm Hg) were better predictors of LVH than adult cut points. In a separate analysis, mean systolic BP, but not BP load, was significantly associated with LVH. We conclude that a single static cut point using an absolute ambulatory systolic BP value is comparable to sex-and height-based systolic BP percentiles in predicting LVH and that BP load does not provide any additional (to mean systolic BP) value to predict LVH in adolescents.

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Kuo, Alice A., and Stuart J. Slavin. "Clerkship Curricular Revision Based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics Guidelines: Does It Make a Difference?" Pediatrics 103, Supplement_1 (April 1, 1999): 898–901. http://dx.doi.org/10.1542/peds.103.s1.898.

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Objective. To compare general pediatric knowledge acquisition and clinical problem-solving skills by students pre- and postcurricular reform based on the 1994 Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics (APA–COMSEP) curricular guidelines. Setting. A large, urban academic medical center. Subjects. Third-year medical students on a required clerkship in Pediatrics. Intervention. Pre- and postcurricular revision, the students were given both the National Board of Medical Examiners (NBME) Pediatric Subject Examination and an objective examination, which was developed in-house, based on the APA–COMSEP guidelines (Pediatric Clerkship Examination [PCE]). Baseline data before curricular revision were obtained on 52 students from May 1995 to May 1996. After curricular redesign in May 1996, data were obtained on 42 students from May 1996 to May 1997. Curricular revision focused on the following: defining educational principles, selecting teaching strategies, defining learning objectives, implementing the curriculum, and evaluating the students with an examination. Results. Before curricular revision, the average NBME score was 521 ± 122. The average PCE score was 53.7% ± 10.1%. After curricular revision, the average NBME score was 520 ± 109, and the average PCE score was 67.7% ± 8.4%. Content areas showing the greatest improvement were fluids and electrolytes, issues pertaining to the newborn, and health supervision. Conclusions. Our baseline data indicate that despite spending two thirds of the clerkship in the ambulatory setting, students did not acquire adequate general pediatric knowledge or clinical problem-solving ability. After broad clerkship revision based on the APA–COMSEP Core Curriculum, students' acquisition of general pediatric knowledge and clinical problem-solving improved significantly, as measured by the PCE. The overall NBME Pediatric Subject Examination scores did not reflect this increased acquisition of general pediatric knowledge.

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Landrigan, Philip J., Alan D. Woolf, Ben Gitterman, Bruce Lanphear, Joel Forman, Catherine Karr, Erin L. Moshier, James Godbold, and Ellen Crain. "The Ambulatory Pediatric Association Fellowship in Pediatric Environmental Health: A 5-Year Assessment." Environmental Health Perspectives 115, no. 10 (October 2007): 1383–87. http://dx.doi.org/10.1289/ehp.10015.

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Kittredge, Diane. "2006 Ambulatory Pediatric Association Presidential Address Sustainable, Renewable Educational “Energy”." Ambulatory Pediatrics 6, no. 5 (September 2006): 274–79. http://dx.doi.org/10.1016/j.ambp.2006.07.003.

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Dungy, Claibourne I. "2007 APA Presidential Address Ambulatory Pediatric Association: Past, Present, and Future." Ambulatory Pediatrics 7, no. 6 (November 2007): 407–9. http://dx.doi.org/10.1016/j.ambp.2007.07.005.

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Kemper, Kathi J. "Improving Participation and Interrater Agreement in Scoring Ambulatory Pediatric Association Abstracts." Archives of Pediatrics & Adolescent Medicine 150, no. 4 (April 1, 1996): 380. http://dx.doi.org/10.1001/archpedi.1996.02170290046007.

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Crain, Ellen F. "Environmental Threats to Children's Health: A Challenge for Pediatrics: 2000 Ambulatory Pediatric Association (APA) Presidential Address." Pediatrics 106, Supplement_3 (October 1, 2000): 871–75. http://dx.doi.org/10.1542/peds.106.s3.871.

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Barysauskas, Constance, David G. Bundy, Aditya H. Gaur, Jeffrey D. Hord, Marlene R. Miller, Eric J. Werner, Cindi Winkle, and Amy Billett. "Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 262. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.262.

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262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]

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Bettenhausen, Jessica L., Jeffrey D. Colvin, Jay G. Berry, Henry T. Puls, Jessica L. Markham, Laura M. Plencner, Molly K. Krager, et al. "Association of Income Inequality With Pediatric Hospitalizations for Ambulatory Care–Sensitive Conditions." JAMA Pediatrics 171, no. 6 (June 5, 2017): e170322. http://dx.doi.org/10.1001/jamapediatrics.2017.0322.

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Charney, Evan. "Pediatric Education in Community Settings: Where Do We Go From Here?" Pediatrics 98, no. 6 (December 1, 1996): 1293–95. http://dx.doi.org/10.1542/peds.98.6.1293.

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Pediatric education in community settings is an idea whose time has come. The board of the Johnson & Johnson Pediatric Institute recognized this reality, and they deserve great credit for bringing together this impressive group of people for what I believe to be a watershed event. The conference includes, for the first time in my experience, participants from community practice and academic societies such as the Ambulatory Pediatric Association (APA), the American Board of Pediatrics, the Association of Pediatric Program Directors (APPD), and the American Academy of Pediatrics (AAP), including members of its resident section. At least half of residency program directors are here, as are many chairs of pediatric departments in university and community hospitals. Representatives of funding agencies—the Maternal and Child Health Bureau and the Health Resources and Services Administration—are here as well; one of our speakers heads the Center for the Future of Children of the David and Lucile Packard Foundation. This conference is a pivotal event in medical education. Like those who remember another pivotal event, Woodstock '69, we will look back with nostalgia and pride and say that we were here. I consider a meeting successful if I leave with one good new idea. At this conference, we have heard many creative and provocative ideas about community-based education, and we will be thinking about them on our way home and during the next several months. One of my favorite quotations, however, is from Alfred North Whitehead: "Ideas won't keep. Something must be done about them.

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Gouveia, Kerlane, and Cláudia Silva. "Study of LIF polymorphisms and phenotypes of CAKUT in a Brazilian pediatric population." Conjecturas 22, no. 6 (June 17, 2022): 853–67. http://dx.doi.org/10.53660/conj-1100-r17.

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The congenital anomalies of the urinary tract — CAKUT emerge from the interaction between genetic anomalies and environmental factors present before and during pregnancy. The aim of this study was to evaluate possible associations between pathways of gene polymorphism LIF and CAKUT. The study was done with 538 Brazilian volunteers, the control group being 160 females and 102 males, totaling 262 healthy individuals. The case group contained 115 females and 161 males, totaling 276 pediatric patients originated from the CAKUT ambulatory from Federal University of Minas Gerais, Brazil. The rs 737812, 929271 and 737921 of LIF were investigated. In association analyzes between cases and controls, no correlation was seen between the rs 737812 and 929271 of LIF and CAKUT. There was a positive association between rs 737921 and general CAKUT as well as with the various phenotypes studied except of hydronephrosis and of multicystic renal dysplasia. Force of association of rs LIF to general CAKUT is measured by a p-value of 0.0009 after 1000 permutations.

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Pless, Ivan B. "1988 George Armstrong Award Lecture, Ambulatory Pediatric Association: Prophets, Disciples, and Honorable Schoolboys." Pediatrics 83, no. 6 (June 1, 1989): 1049–54. http://dx.doi.org/10.1542/peds.83.6.1049.

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Few who do research have any illusions that they alone, acting in isolation, are likely to accomplish much that is truly significant. We all build on the work of our prophets and our colleagues. Whatever contributions we may make will, however, almost certainly, pale by comparison with what we can expect our disciples to contribute. From the best and the brightest, those who are fortunate enough to be in the right place at the right time, we truly expect great things. But we can hope as well that all will discover some of the magic ingredients for research training and have the opportunity to transfer these to their successors.

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Herigon, Joshua C., Sarah Mousseau, Amir Kimia, Jonathan Hatoun, and Louis Vernacchio. "1473. Guideline Adherence in Pediatric Ambulatory Visits for Acute Otitis Media." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S738. http://dx.doi.org/10.1093/ofid/ofaa439.1654.

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Abstract Background Acute otitis media (AOM) is the most common pediatric outpatient condition treated with antibiotics in the United States. Over 30% of children receive inappropriate antibiotics for AOM, contributing to increasing antimicrobial resistance and unnecessary adverse events. Strict adherence to diagnostic and treatment guidelines has been proposed by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases as one strategy to combat inappropriate antibiotic use. Our objective was to describe adherence to the 2013 AAP guidelines on AOM. Methods We performed a cross-sectional study on a random sample of visit notes for patients 3 to 59 months old diagnosed with otitis media based on ICD-10-CM codes (H65, H66, H67) and treated with antibiotics between 9/1/2017 and 8/31/2018 in an association of pediatric practices across Massachusetts. Children with tympanostomy tubes or a chronic medical condition increasing their risk for AOM were excluded. Based on the 2013 AAP diagnostic criteria, tympanic membrane exam descriptions were reviewed and classified as describing AOM or not. Antibiotic choices were classified as appropriate or inappropriate. Notes were then labeled as “fully adherent” (exam consistent with AOM and appropriate antibiotic choice), “partially adherent” (exam inconsistent with AOM or inappropriate antibiotic choice), and “non-adherent” (exam inconsistent with AOM and inappropriate antibiotic choice). Results Three hundred and ninety-four visit notes from 39 different practices were analyzed. One hundred and sixty-six notes (42%) were “fully adherent” to the AAP guidelines, 183 (46%) were “partially adherent” and 45 (11%) were “non-adherent” (Figure 1). In the “partially adherent” and “non-adherent” groups combined, exams were inappropriate in 179 notes (45.4%) and antibiotic choice was inappropriate in 94 notes (23.9%). Cefdinir was the most frequent inappropriate antibiotic (44/94, 46.8%) (Table 1). “Watchful waiting” occurred in only 7% (16/229) of eligible cases. Figure 1. Breakdown of encounters by adherence type Table 1. Cross-table of indicated and prescribed antibiotics Conclusion Our analysis of independent pediatric practices showed moderate adherence to the AAP guidelines for AOM. Substantial room exists for improvement in diagnosing and treating AOM in young children, especially regarding the potential for watchful waiting. Disclosures All Authors: No reported disclosures

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Billett, Amy, Aditya H. Gaur, Eric J. Werner, Cindi Winkle, Jeffery D. Hord, Richard Brown, David Bundy, and Marlene R. Miller. "Moving prevention of central line associated bloodstream infection efforts beyond the hospital walls: A multicenter pediatric hematology/oncology collaborative." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 86. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.86.

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86 Background: Elimination of central-line (CL) associated blood stream infections (BSI) (CLABSI) in the inpatient setting has been a focus for many healthcare organizations. Little is known about the rate of CLABSI in the ambulatory setting or the optimal improvement strategies. We systematically expanded CLABSI prevention efforts for children with underlying pediatric hematology/oncology (PHO) disease from inpatient to ambulatory settings and describe the related process (definitions, improvement change packages, compliance assessment) and outcome measures (CLABSI and other BSI rates). Methods: The evidence-based CL care and maintenance bundles developed for the Children’s Hospital Association Quality Transformation Network PHO inpatient multisite collaborative were adapted for the ambulatory setting. Teams self-reported compliance with bundle elements (daily goals, line entry/dressing/ port needle/ tubing change processes) and submitted total CL days for the PHO cohort in their care. National Healthcare Safety Network (NHSN) defined CLABSI, secondary BSI (as per NHSN definitions), and single positive blood cultures (SPBC) (currently not captured by NHSN) were tracked. All process and outcome measures were collected using an online data entry system. Results: Prospective data collection and ambulatory bundle implementation began in Nov. 2011; to date 24 of 36 hospitals participating in the inpatient PHO CLABSI prevention collaborative have successfully implemented the ambulatory component to their program. As of May 2012, accrued data from the ambulatory setting exists for 214 ambulatory CLABSI, 30 secondary BSI, and 72 SPBC in patients with 719,637 CL in situ (not CL accessed) line days. To date self-reported compliance with bundle elements is > 80%. Conclusions: We demonstrate a successful multisite expansion of CLABSI prevention efforts to the ambulatory setting in PHO patients. Given the limitations of the current NHSN CLABSI definitions in the PHO population and the goal to reduce all BSI, not just CLABSI, we also propose tracking of secondary BSI and SPBC and discuss how this contextual information can be helpful.

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Lee, Jason, Charles E. McCulloch, Joseph T. Flynn, Joshua Samuels, Bradley A. Warady, Susan L. Furth, Divya Seth, Barbara A. Grimes, Mark M. Mitsnefes, and Elaine Ku. "Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD." Clinical Journal of the American Society of Nephrology 15, no. 4 (March 11, 2020): 493–500. http://dx.doi.org/10.2215/cjn.10130819.

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Background and objectivesElevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs.Design, setting, participants, & measurementsWe studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters.ResultsOverall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load.ConclusionsBP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3

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Finkelstein, Jonathan A. "Pediatric Residency Training in An Era of Managed Care: An Introduction to Proceedings of a National Conference." Pediatrics 101, Supplement_3 (April 1, 1998): 735–38. http://dx.doi.org/10.1542/peds.101.s3.735.

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On May 4, 1996, a conference sponsored jointly by the Division of Medicine of the Health Resources and Services Administration and the Ambulatory Pediatric Association brought together pediatric educators from academic medical centers and managed care organizations to address the challenges and opportunities for pediatric residency training, given current trends toward increasing managed care for children. This supplement is designed to bring the issues discussed there to a broader audience of pediatricians and educators. The contributions are written by the participants of that conference, with invited commentaries to add additional perspectives on each topic. The papers were reviewed by an editorial board of leaders in pediatric education with experience in relevant areas. This introduction describes the impetus for the conference and highlights a number of critical issues facing pediatric postgraduate training that are presented in greater depth in the contributions that follow. Finally, this paper summarizes the recommendations of the conference for meeting the challenges of training pediatricians in these areas.

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Apfelbaum, Jeffrey L., Carin A. Hagberg, Richard T. Connis, Basem B. Abdelmalak, Madhulika Agarkar, Richard P. Dutton, John E. Fiadjoe, et al. "2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway." Anesthesiology 136, no. 1 (November 11, 2021): 31–81. http://dx.doi.org/10.1097/aln.0000000000004002.

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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Grote, Andrea C., Alexandra M. Lacey, Warren L. Garner, Timothy Justin Gillenwater, Ellen Maniago, and Haig A. Yenikomshian. "Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis." Journal of Burn Care & Research 41, no. 5 (July 11, 2020): 1029–32. http://dx.doi.org/10.1093/jbcr/iraa115.

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Abstract American Burn Association (ABA) guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small burns (<10% TBSA) in pediatric patients in an ambulatory setting with a nondaily dressing. The aim of this study was to determine whether small pediatric burns could be safely managed on an outpatient basis. A retrospective review at a single ABA-verified burn center was conducted, including 742 pediatric patients presenting to the burn evaluation clinic in a 3-year period. Postburn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Overall, the most common burn etiologies were scald (68%), contact (20%), and flame (5%). In this cohort, 14% (101) of patients were admitted on evaluation to the burn center with a mean TBSA of 9%. The remaining 86% (641) of patients were treated outpatient with a mean TBSA of 3%. Of those who were treated outpatient, 96% (613) successfully completed outpatient care and 4% (28) were subsequently admitted. The patients who were successfully managed in an ambulatory setting had a mean TBSA of 3%, whereas the patients who failed outpatient care had a mean TBSA of 4%. The primary reason for the subsequent admission of these patients was nutrition optimization (61%). The vast majority of small pediatric burns can be effectively treated on an outpatient basis with a nondaily dressing.

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Harvey, Birt. "Introduction." Pediatrics 98, no. 6 (December 1, 1996): v. http://dx.doi.org/10.1542/peds.98.6.v.

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One of the ongoing objectives of the Johnson & Johnson Pediatric Institute is to provide pediatricians with practical information on issues that will improve the health of children. Each year the Board of Trustees selects a topic whose importance is just becoming clear, a topic that is not being addressed adequately in other forums or in the usual pediatric reference sources. Recent topics have included what the pediatrician can contribute toward violence prevention and how the pediatrician can thrive in the changing health care system. The Board of Trustees chose community-based education for the pediatric resident as the 1996 topic. A variety of factors, including the dramatic increase in managed care during the past few years, has led to an increasing proportion of children's care being shifted from inpatient to outpatient settings and has augmented the need for pediatrician involvement in public health and community issues. Some necessary major changes in resident education are reflected in the new Pediatric Residency Review Committee requirements and in the Pediatric Education in Community Settings. A Manual, whose sponsors or supporters included the Ambulatory Pediatric Association, the American Academy of Pediatrics, and the Health Resources and Services Administration. After the Board selected this topic for the 1996 conference, a planning committee—Errol Alden, Carol Berkowitz, Tom DeWitt, Lewis First, Alan Kohrt, and Ken Roberts—determined the structure, content, target audience, and possible faculty. Tom DeWitt and Ken Roberts, chosen as co-chairs, assumed the crucial and laborious tasks of developing the specifics of the program and of identifying the conference faculty and the invitees.

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Macumber, Ian R., Noel S. Weiss, Susan M. Halbach, Coral D. Hanevold, and Joseph T. Flynn. "The Association of Pediatric Obesity With Nocturnal Non-Dipping on 24-Hour Ambulatory Blood Pressure Monitoring." American Journal of Hypertension 29, no. 5 (August 26, 2015): 647–52. http://dx.doi.org/10.1093/ajh/hpv147.

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Yang, Kamie, Anne Baetzel, Wilson T. Chimbira, Yuliya Yermolina, Paul I. Reynolds, and Olubukola O. Nafiu. "Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients." International Journal of Pediatric Otorhinolaryngology 96 (May 2017): 145–51. http://dx.doi.org/10.1016/j.ijporl.2017.03.019.

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Olson, Ardis L., Jerold Woodhead, Roger Berkow, Nancy M. Kaufman, and Susan G. Marshall. "A National General Pediatric Clerkship Curriculum: The Process of Development and Implementation." Pediatrics 106, Supplement_1 (July 1, 2000): 216–22. http://dx.doi.org/10.1542/peds.106.s1.216.

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Objective. To describe a new national general pediatrics clerkship curriculum, the development process that built national support for its use, and current progress in implementing the curriculum in pediatric clerkships at US allopathic medical schools. Curriculum Development. A curriculum project team of pediatric clerkship directors and an advisory committee representing professional organizations invested in pediatric student education developed the format and content in collaboration with pediatric educators from the Council on Medical Student Education in Pediatrics (COMSEP) and the Ambulatory Pediatric Association (APA). An iterative process or review by clerkship directors, pediatric departmental chairs, and students finalized the content and built support for the final product. The national dissemination process resulted in consensus among pediatric educators that this curriculum should be used as the national curricular guideline for clerkships. Monitoring Implementation. Surveys were mailed to all pediatric clerkship directors before dissemination (November 1994), and in the first and third academic years after national dissemination (March 1996 and September 1997). The 3 surveys assessed schools' implementation of specific components of the curriculum. The final survey also assessed ways the curriculum was used and barriers to implementation. Outcomes. The final curriculum provided objectives and competencies for attitudes, skills, and 18 knowledge areas of general pediatrics. A total of 216 short clinical cases were also provided as an alternative learning method. An accompanying resource manual provided suggested strategies for implementation, teaching, and evaluation. A total of 103 schools responded to survey 1; 84 schools to survey 2; and 85 schools responded to survey 3 from the 125 medical schools surveyed. Before dissemination, 16% of schools were already using the clinical cases. In the 1995–1996 academic year, 70% of schools were using some or all of the curricular objectives/competencies, and 45% were using the clinical cases. Two years later, 90% of schools surveyed were using the curricular objectives, 88% were using the competencies, 66% were using the clinical cases. The extent of curriculum use also increased. Schools using 11 or more of the 18 curriculum's knowledge areas increased from 50% (1995–1996) to 73% (1996–1997). Conclusion. This new national general pediatric clerkship curriculum developed broad support during its development and has been implemented very rapidly nationwide. During this period the COMSEP and the APA have strongly supported its implementation with a variety of activities. This development and implementation process can be a model for other national curricula.

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Sharma, Ajay P., Luis Altamirano‐Diaz, Mohamed Mohamed Ali, Katryna Stronks, Amrit Kirpalani, Guido Filler, and Kambiz Norozi. "Diagnosis of hypertension: Ambulatory pediatric American Heart Association/European Society of Hypertension versus blood pressure load thresholds." Journal of Clinical Hypertension 23, no. 11 (October 20, 2021): 1947–56. http://dx.doi.org/10.1111/jch.14368.

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Perrin, James M. "Youth and Disability in the 21st Century: The 2004 George Armstrong Lecture of the Ambulatory Pediatric Association." Ambulatory Pediatrics 4, no. 5 (2004): 402. http://dx.doi.org/10.1367/1539-4409(2004)4<402:yadits>2.0.co;2.

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Dewitt, Thomas G., and Kenneth B. Roberts. "Comments From the Co-Editors." Pediatrics 98, no. 6 (December 1, 1996): iv. http://dx.doi.org/10.1542/peds.98.6.iv.

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"It takes about 6 to 12 months to learn how to practice in an office after completing a residency in pediatrics." This common assertion has been heard so frequently as to have become almost axiomatic. It reflects what has been termed the "residency-practice training mismatch," a problem more extreme in pediatrics than in any other specialty. The effort to combat the mismatch by providing pediatrics residents "real world" experience in community settings is not new, but the movement has taken on new momentum. The Residency Review Committee Program Requirements now mandate "structured educational experiences that prepare residents for the role of advocate for the health of children within the community." Several programs nationally have led the way in developing, implementing, and evaluating models in practices, schools, and various community agencies. The conference, of which this supplement is a summary, provided a "State of the Art" review of basic and applied educational principles for residency education in community settings. The forerunner of the conference was an invitational symposium in Worcester, MA, on June 13 and 14, 1992, supported by the Maternal and Child Health Bureau. The 1992 conference brought together experienced, knowledgeable individuals from programs with education activities in their communities and served as the basis for the development of Pediatric Education in Community Settings. A Manual. The manual was supported by the Maternal and Child Health Bureau, the American Academy of Pediatrics, and the Ambulatory Pediatric Association. The 1996 national conference was designed to take place shortly after the printing of the manual, to reinforce basic elements of education—with special reference to education outside the hospital setting—and to promote active discussion and networking.

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Gilani, Sapideh, and Neil Bhattacharyya. "Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times." Annals of Otology, Rhinology & Laryngology 129, no. 2 (September 16, 2019): 110–14. http://dx.doi.org/10.1177/0003489419875758.

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Objective: To determine the association between intraday timing of outpatient pediatric tonsillectomy and revisit outcomes and complications. Study Design: Cross-sectional analysis of New York databases. Setting: Ambulatory surgery, emergency department and inpatient hospital settings. Subjects and Methods: The State Ambulatory Surgery, State Emergency Department and State Inpatient Databases for 2010-2011 were analyzed for revisits. Outcomes assessed were revisits for any reason, bleeding, acute pain or fever, nausea, vomiting and dehydration. The relationships between the hour of admission for surgery, the hour of discharge and the revisit outcomes were analyzed. Results: The study included 33,611 children (mean age, 6.62 years; 45.7% female) and 62.0% were admitted in the early morning. Discharges were most common in the early afternoon (28.3%). Revisit rates were significantly higher for the early evening discharges (6.0%) versus late morning discharges (3.1%) ( P < .001). Revisits for bleeding were 1.8% for discharge in the early evening versus 0.6% in the late morning ( P < .001). Revisits for fever, nausea, vomiting or dehydration were 1.8% for discharge in the early evening versus 0.9% in the late morning ( P = .002). Late afternoon admission was significantly associated with higher revisit rates (10.9%, P < .001). Bleeding revisits were highest for late afternoon admit hour (1.5%, P = .001). Revisits for acute pain were also highest for late afternoon admit hour (2.3%, P = .005). Conclusion: Revisit are significantly higher when the patient is discharged late. Late afternoon surgery is also significantly associated with higher revisit rates. Surgeons may wish to consider these findings when a late tonsillectomy or late discharge is anticipated post-tonsillectomy.

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Lubsch, Lisa, Katelin Kimler, Nicole Passerrello, Mindy Parman, Andrea Dunn, and Rachel Meyers. "Patient Weight Should Be Included on All Medication Prescriptions." Journal of Pediatric Pharmacology and Therapeutics 28, no. 4 (August 1, 2023): 380–81. http://dx.doi.org/10.5863/1551-6776-28.4.380.

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Medication prescriptions for both children and adults often require the patient’s current weight to determine a safe and effective dose. Medication orders in the inpatient setting typically require a patient weight be recorded prior to order verification. However, in the ambulatory setting a very different standard exists; weights are not required on prescriptions and are rarely provided by practitioners. Without this information, the community pharmacist must either ask the caregiver, who may not know an accurate weight, or simply assume that the prescriber used a current and accurate weight and calculated the dose correctly. Standard doses are prescribed for most adult prescriptions, which makes it possible for the pharmacist to identify a dosing error. Without a current patient weight, the pharmacist is not able to provide the same level of patient care to pediatric patients or adults whose prescriptions require weight-based doses. The Pediatric Pharmacy Association recommends that patient weight, recorded in kilograms, be required on all medication prescriptions in both the inpatient and outpatient settings.

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Lucas, Susan R., Mary Sexton, and Patricia Langenberg. "Relationship Between Blood Lead and Nutritional Factors in Preschool Children: A Cross-sectional Study." Pediatrics 97, no. 1 (January 1, 1996): 74–78. http://dx.doi.org/10.1542/peds.97.1.74.

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Objective. The purpose of this study was to assess the relationships between selected nutritional factors and blood lead levels of preschool children. Methodology. Data on 296 children, aged 9 to 72 months, who were cared for at the University of Maryland at Baltimore Pediatric Ambulatory Center were examined in this cross-sectional study. Nutritional status, socioeconomic aspects, medical history, and potential sources of lead exposure were assessed. Blood samples were evaluated for levels of blood lead, serum iron (ferritin), free erythrocyte photoporphyrin, calcium, and hematocrit. Results. The average blood lead level was 11.4 µg/dL. Multicollinearity of nutritional factors was addressed using regression techniques. After adjusting for confounders, significant positive associations with blood lead were found for total caloric intake (P = .01) and dietary fat (P = .05). Conclusions. The findings of this study suggest that even when behavioral and environmental exposures to lead were statistically controlled, total caloric intake and dietary fat each had an independent and significant association with the level of blood lead.

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Rivara, Frederick P. "From the Bedside to the Public Policy Arena: The Role of General Pediatric Research." Pediatrics 91, no. 3 (March 1, 1993): 628–31. http://dx.doi.org/10.1542/peds.91.3.628.

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The Ambulatory Pediatric Association is an organization dedicated to improving teaching, patient care, and research in general pediatrics. This paper addresses the task of conducting successful research in general pediatrics, often a challenging task for fellows and junior faculty beginning their careers. However, I believe general academic pediatrics has almost a unique opportunity to translate what is seen at the bedside into a research question and from there to try to use the results to affect the health of children. There are three steps in this process: finding a good idea, conducting rigorous research, and doing something with the results. PATIENT CARE AS A SOURCE OF RESEARCH IDEAS How does one come up with the "right" research idea? Fellows and graduate students find this a difficult process. I believe the best way to select a research topic is from one's patient care experience. By listening to and learning from our patients, the most important research questions become obvious. Nearly all of us started our careers as pediatricians and most of us remain practicing physicians. This means seeing patients each week, listening to the concerns of their parents, dealing with the thorny issues that arise, and scratching our heads about the unknowns and the uncertainties we face as clinicians. From this constant experience, we learn what is important. We learn which are the problems most in need of prevention, which problems need further study of their etiology and which problems are the most vexing to manage because of our inadequate knowledge.

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Nivoche, Yves, Marie-Madeleine Lucas, Souhayl Dahmani, Christopher Brasher, Eric Wodey, and Philippe Courrèges. "French current practice for ambulatory anesthesia in children: a survey among the French-speaking Pediatric Anesthesiologists Association (ADARPEF)." Pediatric Anesthesia 21, no. 4 (January 7, 2011): 379–84. http://dx.doi.org/10.1111/j.1460-9592.2010.03507.x.

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Szilagyi, Peter G. "The Effect of Independent Practice Association Plans on Use of Pediatric Ambulatory Medical Care in One Group Practice." JAMA: The Journal of the American Medical Association 263, no. 16 (April 25, 1990): 2198. http://dx.doi.org/10.1001/jama.1990.03440160060038.

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Szilagyi, P. G. "The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice." JAMA: The Journal of the American Medical Association 263, no. 16 (April 25, 1990): 2198–203. http://dx.doi.org/10.1001/jama.263.16.2198.

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Castillo-García, María, Esther Solano-Pérez, Sofía Romero-Peralta, María Esther Viejo-Ayuso, Laura Silgado-Martínez, Leticia Álvarez-Balado, Rosa Mediano San Andrés, et al. "Prevalence of High Blood Pressure in Pediatric Patients with Sleep-Disordered Breathing, Reversibility after Treatment: The KIDS TRIAL Study Protocol." Children 9, no. 12 (November 28, 2022): 1849. http://dx.doi.org/10.3390/children9121849.

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Current data support an increase in the prevalence of high blood pressure (HBP) in pediatric patients with sleep-disordered breathing (SDB). Adeno-tonsillectomy has been shown to be an effective treatment for most patients. Our objective was to determine the prevalence of HBP in pediatric patients with SDB and the impact of adeno-tonsillectomy with a multicenter, longitudinal, and prospective study that included 286 children referred for suspected SDB. The diagnosis of SDB was established by polysomnography (PSG) and the diagnosis of HBP by 24-h ambulatory blood pressure monitoring (ABPM). In patients without SDB and SDB without treatment indication, these tests were repeated six months after the baseline visit. For patients with medical treatment for SDB, the tests were repeated six months after the treatment initiation. Finally, in patients with surgery indication, ABPM was performed just before surgical treatment and ABPM and PSG six months after the intervention. The study contributes to elucidating the association between SDB and HBP in pediatric patients. Moreover, it contributes to determining if intervention with adeno-tonsillectomy is associated with BP reduction. The results have direct implications for the management of SDB, providing essential information on treatment indications for existing clinical guidelines. NCT03696654.

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Hsu, Chien-Ning, Chih-Yao Hou, Pei-Chen Lu, Guo-Ping Chang-Chien, Sufan Lin, and You-Lin Tain. "Association between Acrylamide Metabolites and Cardiovascular Risk in Children With Early Stages of Chronic Kidney Disease." International Journal of Molecular Sciences 21, no. 16 (August 14, 2020): 5855. http://dx.doi.org/10.3390/ijms21165855.

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Cardiovascular disease (CVD) begins early in children with chronic kidney disease (CKD). Reduced nitric oxide (NO) bioavailability has been associated with increased CVD in CKD patients. Children tend to have more exposure to acrylamide, one of the most common toxins in food. We aimed to determine whether urinary levels of acrylamide metabolites N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) and N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-cysteine (GAMA) are associated with CV risk markers in children with CKD. Data on 112 children and adolescents ages three to 18 years old with CKD stage G1–G4 are reported. We observed that 24 h ambulatory blood pressure monitoring (ABPM) abnormalities were greater, and left ventricular (LV) mass and ambulatory arterial stiffness index (AASI) were higher in children with CKD stage G2–G4 versus G1. Patients with CKD stage G2–G4 had a lower urinary acrylamide level, but a higher AAMA-to-GAMA ratio than those with CKD stage G1. Urinary acrylamide level was negatively associated with high systolic blood pressure (SBP) and diastolic BP (DBP) load on 24 h ABPM. Lower urinary levels of acrylamide, AAMA, and GAMA were correlated with LV mass. Additionally, GAMA are superior to AAMA related to NO-related parameters, namely citrulline and symmetric dimethylarginine (SDMA). This study suggests that determinations of urinary acrylamide level and its metabolites in the early stages of pediatric CKD may identify patients at risk of CVD. Further studies should clarify mechanisms underlying acrylamide exposure to define the treatment for protection against CVD.

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Lin, Chia-Lei, Nila Mistry, Jordana Boneh, Hong Li, and Rina Lazebnik. "Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial." International Journal of Pediatrics 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/8487378.

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Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (p=0.04). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence.

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Chrysaidou, Katerina, Athanasia Chainoglou, Vasiliki Karava, John Dotis, Nikoleta Printza, and Stella Stabouli. "Secondary Hypertension in Children and Adolescents: Novel Insights." Current Hypertension Reviews 16, no. 1 (February 13, 2020): 37–44. http://dx.doi.org/10.2174/1573402115666190416152820.

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Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

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Brummel, Gretchen, and Chad A. Knoderer. "National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey." Journal of Pediatric Pharmacology and Therapeutics 28, no. 3 (May 1, 2023): 192–96. http://dx.doi.org/10.5863/1551-6776-28.3.192.

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OBJECTIVE Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States. METHODS A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019. Responses were screened for multiples within institutions. Repeated organization responses were identified (n = 37) and excluded if the duplicate matched another response from the same organization exactly (n = 0). RESULTS One hundred ninety independent responses were received. Nearly 62% of respondents represented a children's hospital within an acute care hospital; remainder being from stand-alone children's hospitals. Around 55% of respondents indicated prescribers were responsible for choosing the patient-specific formulation for inpatients. Nearly 70% of respondents indicated multiple formulations were available due to clinical need (efficacy, toxicity, measurable volume), whereas over 40% responded that the number of liquid formulations were limited to decrease the potential for error. Variability was demonstrated among institutions using ≥ 2 different formulations for acute otitis media (AOM), sinusitis, lower respiratory tract infection, skin and soft tissue infection, and urinary tract infection (33.6%, 37.3%, 41.5%, 35.8%, and 35.8%, respectively). The 14:1 formulation was the most common, but not exclusive, for AOM, sinusitis, and lower respiratory tract infections with 2.1%, 2.1%, and 2.6% of respondents indicating use of the 2:1 formulation and 10.9%, 15%, and 16.6% of respondents indicating use of the 4:1 formulation. CONCLUSIONS Significant AMC formulation selection variability exists across the United States.

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Hill-Horowitz, Taylor A., Penina Feldman, Rachel Frank, Laura J. Castellanos, Pamela Singer, Christine B. Sethna, and Abby M. Basalely. "Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines." Journal of the American Society of Nephrology 34, no. 11S (November 2023): 228. http://dx.doi.org/10.1681/asn.20233411s1228a.

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Carlson, Lucas, Kori Zachrison, Brian Yun, Gia Ciccolo, Benjamin White, Carlos Camargo Jr, and Margaret Samuels-Kalow. "The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization." Western Journal of Emergency Medicine 22, no. 6 (October 27, 2021): 1283–90. http://dx.doi.org/10.5811/westjem.2021.5.50233.

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Introduction: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presentations. In this study the authors sought to identify opportunities to potentially prevent emergency conditions and to strengthen systems of ambulatory care by analyzing patterns of ED utilization for PQI conditions. Methods: Using multivariable logistic regression, the authors analyzed the relationship of patient demographics and neighborhood-level socioeconomic indicators with ED utilization for PQI conditions based on ED visits at an urban, academic medical center in 2017. We also used multilevel modeling to assess the contribution of these variables to neighborhood-level variation in the likelihood of an ED visit for a PQI condition. Results: Of the included 98,522 visits, 17.5% were categorized as potentially preventable based on the ED PQI definition. On multivariate analysis, age < 18 years, Black race, and Medicare insurance had the strongest positive associations with PQI visits, with adjusted odds ratios (aOR) of 1.41 (95% confidence interval [CI], 1.29, 1.56), 1.40 (95% CI, 1.22, 1.61), and 1.40 (95% CI, 1.28, 1.54), respectively. All included neighborhood-level socioeconomic variables were significantly associated with PQI visit likelihood on univariable analysis; however; only level of education attainment and private car ownership remained significantly associated in the multivariable model, with aOR of 1.13 (95% CI, 1.10, 1.17) and 0.96 (95% CI, 0.93, 0.99) per quartile increase, respectively. This multilevel model demonstrated significant variation in PQI visit likelihood attributable to neighborhood, with interclass correlation decreasing from 5.92% (95% CI, 5.20, 6.73) in our unadjusted model to 4.12% (95% CI, 3.47, 4.87) in our fully adjusted model and median OR similarly decreasing from 1.54 to 1.43. Conclusion: Demographic and local socioeconomic factors were significantly associated with ED utilization for PQI conditions. Future public health efforts can bolster efforts to target underlying social drivers of health and support access to primary care for patients who are Black, Latino, pediatric, or Medicare-dependent to potentially prevent emergency conditions (and the need for emergency care). Further research is needed to explore other factors beyond demographics and socioeconomic characteristics driving spatial variation in ED PQI visit likelihood.

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Seeman, Tomas, Jiri Gilik, Karel Vondrak, and Janusz Feber. "STRICTER AMBULATORY BLOOD PRESSURE CONTROL IS POSSIBLE IN PATIENTS AFTER KIDNEY TRANSPLANTATION AND IS ASSOCIATED WITH REGRESSION OF LEFT VENTRICULAR HYPERTROPHY: POST HOC ANALYSIS." Journal of Hypertension 42, Suppl 1 (May 2024): e99. http://dx.doi.org/10.1097/01.hjh.0001020268.58686.08.

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Objective: The recently published analysis of the 4C-T study demonstrated an association of stricter cumulative office blood pressure (BP) control with lower left ventricular mass (LVM) in children after kidney transplantation. The aim of our study was to investigate whether stricter control of ambulatory BP is also associated with improved LVMI and regression of left ventricular hypertrophy (LVH) in pediatric kidney transplant recipients. Design and method: A post-hoc analysis of nineteen patients (median age at baseline 9.7 years, range 3.3–15.1, median time after transplantation 4.3 years, range 1.0-13.1) from our previous ESCORT trial who had echocardiography performed at baseline (T0), 1 (T1), 2 (T2) and 3 (T3) years was performed. Cumulative 24-hour mean arterial pressure (MAP) Z-scores (CMAPz) were calculated according to 4C-T study (Sugianto et al. 2023). Left ventricular hypertrophy (LVH) was defined as LVMi>40 g/m^2.7 in girls >9 yrs of age and LVMi>45 g/m^2.7 in boys >9 yrs of age; in children <=9 yrs the LVH was defined as LVMi >95th percentile (Khoury et al 2009). Results: The median CMAPz decreased from a median +0.27 (IQR=-0.09 to +0.38) in the 1st year down to -0.06 (IQR=-0.26 to +0.32) in the 2nd year (p=0.02) and to +0.05 (IQR=-0.32 to 0.27) in the 3rd year (p=0.04) of follow-up. The prevalence (number) of children with LVH was 26% (5/19) at T0, 16% (3/19) at T1, 23% (3/13) at T2 and 0% (0/11) at T3 (trend in proportions p=0.06). All 5 children with elevated LVMi>0.9 at T0 decreased / normalized their LVMi at T3 (p=0.07), on contrary children without LVH at baseline did not significantly change their LVMi during follow-up. Conclusions: This first prospective interventional study demonstrated an association between stricter cumulative ambulatory MAP and regression of LVH in patients after kidney transplantation. Our data suggest that aiming stricter ambulatory BP can improve the often unfavourable cardiac phenotype in these patients. However, randomized control trial is required to confirm our findings.

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Amirah, Putri, Henny Adriani Puspitasari, and Cut Nurul Hafifah. "Analysis of the Impact of Continuous Ambulatory Peritoneal Dialysis on Nutritional Status in Pediatric Chronic Kidney Disease." Archives of Pediatric Gastroenterology, Hepatology, and Nutrition 2, no. 4 (November 30, 2023): 1–10. http://dx.doi.org/10.58427/apghn.2.4.2023.1-10.

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Background: Chronic kidney disease (CKD) is a serious problem for all age groups, particularly in children. Several studies have shown that patients with CKD who underwent dialysis, including Continuous Ambulatory Peritoneal Dialysis (CAPD), experienced malnutrition, short stature and growth retardation. This study aimed to evaluate the correlation between the indicators of CAPD regiments with the nutritional status of pediatric patients with CKD and factors that influence it. Method: We conducted a cross-sectional study by collecting secondary data from medical records such as disease stage and duration, the most recent CAPD regimen, etiology, and comorbidities. Data on nutritional status was then obtained by measuring body weight, height, and upper arm circumference. The measurement was then plotted using the WHO anthropometry application or the CDC growth chart. Demographic data such as the education level of father and mother, family economic status, age, and gender were obtained by filling out the Case Report Form (CRF). Result: A total of fifteen respondents were included in this study. Children with CKD who underwent CAPD primarily had normal nutritional status with very short stature. Furthermore, no significant association was found between the CAPD regiments with the nutritional status of children with chronic kidney disease who are undergoing CAPD (p>0.05). Conclusion: Children with CKD who underwent CAPD primarily had normal nutritional status with very short stature. There was no correlation between the parameters of CAPD regiments with the nutritional status of CKD patients who underwent CAPD. This indicates that the regiment used in this study is already quite satisfactory as it does not impact the nutritional status of those patients.

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Skrzypczyk, Piotr, Anna Ofiara, Michał Szyszka, Anna Stelmaszczyk-Emmel, Elżbieta Górska, and Małgorzata Pańczyk-Tomaszewska. "Serum Sclerostin Is Associated with Peripheral and Central Systolic Blood Pressure in Pediatric Patients with Primary Hypertension." Journal of Clinical Medicine 10, no. 16 (August 13, 2021): 3574. http://dx.doi.org/10.3390/jcm10163574.

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Recent studies showed the significance of the canonical Wnt/beta-catenin pathway and its inhibitor—sclerostin, in the formation of arterial damage, cardiovascular morbidity, and mortality. The study aimed to assess serum sclerostin concentration and its relationship with blood pressure, arterial damage, and calcium-phosphate metabolism in children and adolescents with primary hypertension (PH). Serum sclerostin concentration (pmol/L) was evaluated in 60 pediatric patients with PH and 20 healthy children. In the study group, we also assessed calcium-phosphate metabolism, office peripheral and central blood pressure, 24 h ambulatory blood pressure, and parameters of arterial damage. Serum sclerostin did not differ significantly between patients with PH and the control group (36.6 ± 10.6 vs. 41.0 ± 11.9 (pmol/L), p = 0.119). In the whole study group, sclerostin concentration correlated positively with height Z-score, phosphate, and alkaline phosphatase, and negatively with age, peripheral systolic and mean blood pressure, and central systolic and mean blood pressure. In multivariate analysis, systolic blood pressure (SBP) and height expressed as Z-scores were the significant determinants of serum sclerostin in the studied children: height Z-score (β = 0.224, (95%CI, 0.017–0.430)), SBP Z-score (β = −0.216, (95%CI, −0.417 to −0.016)). In conclusion, our results suggest a significant association between sclerostin and blood pressure in the pediatric population.

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Hsu, Lu, Lo, Lin, and Tain. "The Association between Nitric Oxide Pathway, Blood Pressure Abnormalities, and Cardiovascular Risk Profile in Pediatric Chronic Kidney Disease." International Journal of Molecular Sciences 20, no. 21 (October 24, 2019): 5301. http://dx.doi.org/10.3390/ijms20215301.

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Cardiovascular disease (CVD) is common in chronic kidney disease (CKD), while major CV events are rare in young CKD patients. In addition to nitric oxide (NO)-related biomarkers, several surrogate markers have been assessed to stratify CV risk in youth with CKD, including 24-h ambulatory blood pressure monitoring (ABPM), carotid artery intima-media thickness (cIMT), pulse wave velocity (PWV), ABPM-derived arterial stiffness index (AASI), flow-mediated dilatation (FMD), and left ventricular mass index (LVMI). The aim of this study was to identify subclinical CVD through the analysis of indices of CV risk in children and adolescents with CKD. Between 2016 and 2018, the prospective observational study enrolled 125 patients aged 3 to 18 years with G1–G4 CKD stages. Close to two-thirds of young patients with CKD exhibited blood pressure (BP) abnormalities on ABPM. CKD children with abnormal office BP showed lower plasma arginine levels and arginine-to-asymmetric dimethylarginine (ADMA) ratio, but higher ratios of ADMA-to-symmetric dimethylarginine (SDMA) and citrulline-to-arginine. High PWV and AASI, indices of arterial stiffness, both strongly correlated with high BP load. Additionally, LV mass and LVMI exhibited strong correlations with high BP load. Using an adjusted regression model, we observed the citrulline-to-arginine ratio was associated with 24-h systolic and diastolic BP, systolic blood pressure (SBP) load, and diastolic blood pressure (DBP) load. Early assessments of NO-related parameters, BP load abnormalities, arterial stiffness indices, and LV mass will aid in early preventative care toward decreasing CV risk later in life for children and adolescents with CKD.

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Saulsberry, Anjelica C., Marita Partanen, Jerlym S. Porter, Pradeep S. B. Podila, Jason R. Hodges, Allison A. King, Winfred Wang, et al. "Neurocognitive Impairment Predicts Poor Transition Outcomes Among Patients with Sickle Cell Disease." Blood 134, Supplement_1 (November 13, 2019): 519. http://dx.doi.org/10.1182/blood-2019-121617.

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Introduction: In the United States, most children with sickle cell disease (SCD) survive into adulthood and transfer from pediatric to adult-centered care. Cognitive deficits begin during childhood and are highly prevalent among individuals with SCD, potentially affecting their functional ability to establish adult care and navigate the new adult care environment. Lack of engagement in adult care can place youth with SCD at higher risk for care discontinuity and higher disease morbidity and mortality. The relationship between cognition and transition to adult care has not been examined. We hypothesized that better performance on measures of neurocognition were associated with decreased latency in initiating adult care, greater retention in adult care, and increased utilization of adult ambulatory services. As a secondary objective, we examined the relationship of environmental outcomes to transition outcomes. Methods: We included participants enrolled in the Sickle Cell Research and Intervention Program (SCCRIP; Hankins J. et al, Pediatric Blood and Cancer 2018), a longitudinal lifetime cohort study of individuals with SCD that monitors neurocognition. Participants were included if they underwent neurocognitive screening assessment in adolescence, prior to their transfer to adult care and if they satisfied their first appointment in adult care. The neurocognitive screening battery included measures of estimated global intelligence (Wechsler Abbreviated Scales of Intelligence, 2nd Ed; WASI-2) and sustained attention (Continuous Performance Test, 2nd Ed; CPT-2). Environmental factors included the Economic Hardship Index (EHI), guardian employment status while in pediatric care, and the number of persons living in the household. Use of adult ambulatory services was measured by the number of outpatient visits per patient-year. The association between cognitive performance and the latency from pediatric to adult care, adult care retention and environmental variables was examined using the 2-sample t test if the data were normally distributed or the Wilcoxon rank-sum test otherwise. Categorical variables were analyzed with the Chi-square test or Fisher's exact test. Transition outcomes were also analyzed as continuous variables using univariate linear regression. All reported p-values are two-sided. Results: Eighty adolescents with SCD ages 15-18 years at the time of their cognitive assessment (58% male, 63% HbSS/HbSβ0-thalassemia) were included; most transferred <6 months from the last pediatric visit Table 1). Of these 80 patients, 61 and 43 had sufficient follow-up time to examine their retention in adult care 12 and 24 months after transfer, respectively. Fifty out of the 61 patients (82%) remained in adult care > 12 months, and 31 of the 43 (72%) remained in adult care >24 months after their first adult visit. Higher Full-Scale IQ was associated with establishing adult care ≤2 months from last pediatric visit (Table 1; Figure 1A, 1B). Belonging to families with fewer children, smaller households and a higher WASI-2 Verbal Comprehension Index were associated with establishing adult care ≤6 months from last pediatric visit. Better CPT-2 Commissions performance (less attention deficit) was associated with increased adult care retention at 12 and 24 months (Table 2; Figure 1C,1D). Having a working guardian was associated with less retention at 12 months (p=0.01), whereas having an unemployed primary guardian was associated with greater retention at 24 months (p=0.02). Further, an employed guardian was associated with greater utilization of adult ambulatory services (p=0.01). EHI was not significantly related to transition outcomes. No relationship was found between adult ambulatory services and neurocognitive assessment. Conclusion: Neurocognitive deficit (lower IQ and attention deficits) may decrease short and long-term engagement in adult care among youth with SCD as demonstrated by longer latency periods between pediatric and adult care and shorter adult care retention. Socio-economic factors may also play a role in transition outcomes but require further investigation. Investigation of disease modifying therapies that preserve cognitive function should be prioritized. Interventions that account for patients' cognitive level and their environment should be considered in the individualization of transition plans. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; Amphivena Therapeutics: Research Funding; Incyte: Consultancy; Tioma Therapeutics (formerly Vasculox, Inc.):: Consultancy; Cell Works: Consultancy; Bioline: Consultancy; Celgene: Consultancy; RiverVest: Consultancy; WUGEN: Equity Ownership. Wang:Agios Pharmaceuticals: Consultancy; Novartis: Consultancy. Zhao:MBIO: Other: St. Jude Children's Research Hospital has an existing exclusive license and ongoing partnership with Mustang Bio for the further clinical development and commercialization of this XSCID gene therapy. Kang:MBIO: Other: St. Jude Children's Research Hospital has an existing exclusive license and ongoing partnership with Mustang Bio for the further clinical development and commercialization of this XSCID gene therapy. Hankins:National Committee for Quality Assurance: Consultancy; NHLBI: Research Funding; Global Blood Therapeutics: Research Funding; Novartis: Research Funding; LYNKS Foundation: Research Funding; NHLBI: Honoraria; ASPHO: Honoraria; Bluebird Bio: Consultancy.

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Santos, Ana Paula Pires dos, and Vera Mendes Soviero. "Caries prevalence and risk factors among children aged 0 to 36 months." Pesquisa Odontológica Brasileira 16, no. 3 (September 2002): 203–8. http://dx.doi.org/10.1590/s1517-74912002000300004.

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The aim of this study was to assess the prevalence of caries and risk factors in outpatients of the Pediatric Ambulatory of the Pedro Ernesto University Hospital aging up to 36 months. After signing informed consent forms, the parents answered a structured questionnaire in order to evaluate risk factors for dental caries, including socioeconomic status, oral hygiene and dietary habits. A single investigator carried out the dental examination which assessed the presence of caries, biofilm and gingival bleeding. The data were analyzed by means of the Epi Info program, utilizing the chi-squared test. The children’s mean age was 22.9 months. The prevalence of caries, including white spot lesions, was 41.6%, and the mean def-s was 1.7 (± 2.5). The most affected teeth were the maxillary incisors, and the most common lesion was the white spot. No significant associations were found between the prevalence of caries and socioeconomic status, frequency of oral hygiene, nocturnal bottle- and breast-feeding or cariogenic food and beverage intake during the day. However, the association between caries and oral hygiene quality (dental biofilm) was statistically significant (p < 0.001). The results suggest that the presence of a thick biofilm was the most important factor for the occurrence of early childhood caries in the evaluated sample.

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Hsu, Chien-Ning, Guo-Ping Chang-Chien, Sufan Lin, Chih-Yao Hou, Pei-Chen Lu, and You-Lin Tain. "Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease." Journal of Clinical Medicine 9, no. 2 (January 25, 2020): 336. http://dx.doi.org/10.3390/jcm9020336.

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Chronic kidney disease (CKD) is associated with high risk for cardiovascular disease (CVD). Gut microbiota-dependent metabolites trimethylamine (TMA), trimethylamine N-oxide (TMAO), and dimethylamine (DMA) have been linked to CKD and CVD. We examined whether these methylamines are correlated with cardiovascular risk in CKD children. A total of 115 children and adolescents with CKD stage G1–G4 were enrolled in this cross-sectional study. Children with CKD stage G2–G4 had higher plasma levels of DMA, TMA, and TMAO, but lower urinary levels of DMA and TMAO than those with CKD stage G1. Up to 53% of CKD children and adolescents had blood pressure (BP) abnormalities on 24-h ambulatory BP monitoring (ABPM). Plasma TMA and DMA levels inversely associated with high BP load as well as estimated glomerular filtration rate (eGFR). Additionally, CKD children with an abnormal ABPM profile had decreased abundance of phylum Cyanobacteria, genera Subdoligranulum, Faecalibacterium, Ruminococcus, and Akkermansia. TMA and DMA are superior to TMAO when related to high BP load and other CV risk factors in children and adolescents with early-stage CKD. Our findings highlight that gut microbiota-dependent methylamines are related to BP abnormalities and CV risk in pediatric CKD. Further studies should determine whether these microbial markers can identify children at risk for CKD progression.

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Journal articles on the topic 'Ambulatory Pediatric Association'

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