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Weekly review: Drowning prevention, coding updates, and more – Contemporary Pediatrics
Thank you for visiting the Contemporary Pediatrics website. Take a look at some of our top stories from last week (Monday, June 3, to Friday, June 7, 2024), and click on each link to read and watch anything you may have missed.
1.) With drownings on the rise, prevention conversations with caregivers are crucial
Drowning is something that happens quickly, it happens usually insidiously, and [it is] really difficult to unwind the damage from drowning as time goes by, said James Barry, MD, a pediatric emergency medicine fellow in Rochester, New York. It is why the National Drowning Prevention Alliance (NDPA) and the American Academy of Pediatrics (AAP) held a joint virtual panel to discuss drowning prevention strategies this summer.
Click here for the full article.
2.) 2024 coding update
This article will detail how a recently activated code, G2211, will increase practice revenue and provider compensation. It may take some time, however, for insurance carriers to begin reimbursing for this add-on code, so pediatricians should be prepared to challenge rejected claims.
Click here for the full article from Andrew J. Schuman, MD.
3.) Now available: upadacitinib to treat JIA, psoriatic arthritis in patients 2 years and up
Upadacitinib (RINVOQ; AbbVie) is now available for patients aged 2 years and older with active polyarticular juvenile idiopathic arthritis (pJIA) and psoriatic arthritis (PsA) who have had an inadequate response or intolerance to 1 or more tumor necrosis factor (TNF) blockers, according to a press release from AbbVie.
Additionally, the company announced that a new, weight-based oral solution RINVOQ LQ, is now available as an option for the pediatric populations.
Click here for the full article.
4.) Use of monoclonal antibodies for idiopathic chronic eosinophilic pneumonia
Investigators of a study published in BMC Pulmonary Medicine aimed to describe the type of evidence and extent of research regarding the use of monoclonal antibodies for idiopathic chronic eosinophilic pneumonia (ICEP), to control the disease and limit secondary effects.
Click here for full study details.
5.) FDA approves increased amifampridine maximum daily dose to treat Lambert-Eaton myasthenic syndrome
With the federal agency's decision, the maximum daily dose increased from 80 mg to 100 mg, for adults and pediatric patients who weigh more than 45 kg, allowing for greater flexibility in treatment regimens for the management of LEMS.
Click here for full approval details.
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Weekly review: Drowning prevention, coding updates, and more - Contemporary Pediatrics
A call to action for pediatrics: Caring for students with learning disabilities in custody and community settings | Pediatric … – Nature.com
Kesherim R. 31 Learning Disabilities Statistics, Prevalence & Facts. Supportive Care ABA. Accessed April 9. https://www.supportivecareaba.com/statistics/learning-disabilities (2024).
Barnert, E. & DeBaun, M. R. Increasing access to quality healthcare for children who are incarcerated: American Pediatric Society issue of the year (20232024). Pediatr. Res. 95, 610612 (2024).
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U.S. Department of Education. Individuals with Disabilities Education Act. Updated November 7, 2019. Accessed April 9. https://sites.ed.gov/idea/statute-chapter-33/subchapter-i/1401/30, (2024).
Cruise, K. R., Evans, L. J. & Pickens, I. B. Integrating mental health and special education needs into comprehensive service planning for juvenile offenders in long-term custody settings. Learn. Individ. Differ. 21, 3040 (2011).
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Bower, C. et al. Fetal alcohol spectrum disorder and youth justice: A prevalence study among young people sentenced to detention in Western Australia. BMJ Open 8, e019605 (2018).
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Moody, K. C. et al. Prevalence of dyslexia among Texas prison inmates. Tex. Med. 96, 6975 (2000).
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School-to-Prison Pipeline. ACLU. Updated 2024. Accessed April 9. https://www.aclu.org/issues/juvenile-justice/juvenile-justice-school-prison-pipeline, (2024).
Mallett, C. A., Quinn, L., Yun, J. & Fukushima-Tedor, M. The Learning Disabilities-to-Prison pipeline: Evidence From the Add Health National Longitudinal Study. Crime. Delinq. 69, 26432677 (2023).
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Lollini A. Youth justice and cognitive diversity: a review of law and neurodiversity: youth with autism and the juvenile justice systems in Canada and the United States. Alta Law Rev. 59 10371042 (2022)
Kim, B. K. E. et al. The school-to-prison pipeline for probation youth with special education needs. Am. J. Orthopsychiatry 91, 375385 (2021).
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Shields, L. B. E. & Flanders, K. Impact of Dyslexia and Health Literacy on Racial and Gender Disparity in the Incarcerated Population. J. Correct. Health Care J. Natl. Comm. Correct. Health Care 29, 169174 (2023).
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American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Joint statementLearning disabilities, dyslexia, and vision. Pediatrics;124(2):837844, (2009).
Handler, S. M. & Fierson, W. M. the Section on Ophthalmology and Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists. Learning Disabilities, Dyslexia, and Vision. Pediatrics 127, e818e856 (2011).
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Pediatric Associates to Deploy Innovaccer’s AI Platform to Enhance Quality of Care for 1.5 Million Patients – HIT Consultant
What You Should Know:
Pediatrics Associates, the leading private pediatric primary care group in the US, has partnered with Innovaccer Inc., a leader in healthcare artificial intelligence (AI).
The collaboration aims to leverage AI and data analytics to improve the quality of care for Pediatrics Associates over 1.5 million patients across 7 states.
Focus on Value-Based Care and Population Health
Pediatrics Associates prioritizes delivering comprehensive medical care to children and families. Their business model emphasizes value-based care and population health management (PHM). Innovaccers AI-powered PHM solution will equip them with the insights needed to effectively manage the health outcomes of their large patient population. This partnership signifies a shared commitment to using advanced technology to achieve superior healthcare outcomes.
Transforming Care Delivery with AI
The Innovaccer Healthcare AI Platform will empower Pediatrics Associates to:
We have an established relationship with the Pediatrics Associates team, and we are excited to be working with them again as we are setting a new standard for healthcare, where technology and compassion converge to enrich the lives of children and their families, said Abhinav Shashank, cofounder and CEO at Innovaccer. Pediatric Associates has an impressive track record in managing over 1.5 million lives across Medicaid and commercial contracts. Innovaccers AI-powered, scalable PHM platform will help them effectively manage patient populations to meet their goal of managing over 1 million covered lives in the next two years. We look forward to supporting Pediatric Associates in its mission to launch a new era of pediatric care that is both proactive and profoundly impactful.
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Milestones Pediatrics begins summer camp with sports at Rec Center – The Post-Searchlight – Post Searchlight
Published 12:30 pm Friday, June 7, 2024
With school out and summer in full swing, multiple summer youth programs are underway. One of these is Milestone Pediatric Therapys Camp Milestones, offered to children with behavioral, speech and physical disabilities. The camp will last through to July, with each week having a particular theme. This weeks theme is Sports Week, with the Recreation Authority offering the new Rec Facility for the week.
Kristen Palmer, CFO and occupational therapist at Milestone, spoke to the Post-Searchlight about the camps themes this year.
Next week is Farm Week, itll be at Spring Hill Tree Farm, she said. Then we have Self-Care Week, Water Week is the last week of June. In July we have Circus Week, and Camping Week.
This year has seen 140 children register for Camp Milestone, divided up into six groups a day. Aside from taking advantage of the new Recreation Facility, Camp Week will also see the kids visited by Smokey the Bear for the first time.
Im just grateful for the support of the community, all of our sponsors, Palmer said. We have a lot of young, adolescent and college-age volunteers that devote their time, and so we could not pull it off without them. She also thanked the Pilot Club for their donations.
Anyone looking to make a donation, be it money, food, or supplies, can either drop it off at Milestones office at 118 River Street, or call to arrange a pick-up.
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Chief Nursing Officer Honored with Miracle Maker Award – URMC
After more than 45 years serving as a nurse, a nurse practitioner, and a nursing leader at URMC, Sue Bezek, the chief nursing officer at Golisano Childrens Hospital, will be retiring.
Her career has been definedfrom the very beginningby a philosophy that emphasizes putting the needs of patients and families first.
Making a difference for people who were struggling with their health is what drew me in to the field, she said.
It didnt take long for Bezek to find a path in nursing that enabled her to fulfill this goal. While earning her BSN from Villa Maria College, Bezek became enamored with pediatrics during one of her training rotations as a student nurse. Her first nursing position was on the Infant and Toddler unit (4-1600) at Strong Memorial Hospital (SMH). After a year on that unit, she sought to augment her clinical skills in a pediatric intensive-care area and transferred to the NICU.
Soon after her transition to the NICU, she was elevated to the position of nurse leader. I think I was somebody who had an affinity for problem solving, but I still had to grow my skills to navigate the challenges of leadership, she said.
One of these challenges was earning the trust and respect of her peers after being promoted into leadership so early in her career. Bezek accomplished this by emphasizing collaborative problem solving with her team.
I would approach an issue and offer to the team: Heres how I think we could solve it, would you do it this way? How can we collaborate in finding solutions?
After two-and-a-half years in this position, Bezek took on a new role when the URMC Ambulatory Surgical Center opened in December of 1984. Bezek served as a Level II staff nurse, and was the only nurse on staff who had previous experience in pediatrics.
Bezeks three years in that position offered a great experience to learn about patients and clinicians across the URMC system, all while serving as a resource for her peers about pediatric care. I learned skills from my colleagues about caring for adult patients but also helped them learn about the care of children, she said.
While working at the ambulatory center, Bezek began her pursuit of an advanced educational degree in nursing and received a Pediatric Nurse Practitioner degree from the University of Rochester. She subsequently transitioned to serving as a Nurse Practitioner (NP) in various Pediatric Divisions in progressively more responsible roles.
Throughout these roles from serving as the first PNP in the new Pediatric HIV Program and then as a PNP in the Pediatric Primary Care Practice, to eventually ascending to senior leadership at GCH Bezek has been guided by words of Dr. Elizabeth McAnarney, former chair of the Department of Pediatrics.
She told me: If you keep your decisions focused on the right thing to do for the patient and family, all the other things will fall into place, said Bezek.
Bezek applied this approach at every level, first as a practicing NP serving patients directly, then in subsequent leadership roles as a senior nurse manager of the Outpatient clinic, followed by associate director of the Sovie Center for Advanced Practice, and subsequently, the director of pediatric nursing and then the inaugural Chief Nursing Officer for Golisano Childrens Hospital.
In leadership, you dont necessarily see your impact on a patient-to-patient basis, so you have to really listen to your team, who have these day-to-day experiences with patients and their families, and do collaborative problem solving while trusting their perspective, she said. This team-focused collaboration has also resulted in advocacy for initiatives that were aimed at improving both patient and staff safety in the past few years.
Through her tenure in leadership, Bezek focused on serving the needs of patients on a population-health level. As her responsibilities grew, so did GCH, from one floor on SMH to the major world-class facility that it is now. During this time, Bezek also witnessed the landscape of pediatric health care change.
The patient population that we care for is much more acute and complex than when I first started. The families have information at their fingertips through the internet. They have multiple, well-researched, and detailed questions that can make things tougher for clinicians to be at the ready for them and answer in a timely fashion. This requires more collaboration across specialties and more shared knowledge in order for us to serve families best, she said.
Sue Bezeks ability to solve problems creatively, build highly effective teams, and remain laser-focused on provision of high quality, family-centered care have made her an effective leader that has contributed greatly to the growth of GCH, according to Tim Stevens, MD, Chief Clinical Officer at GCH.
Nurses are the first point of care for many of our patients, so fostering a strong patient-first nursing culture is critical for building trust with our community, he said. Sue brings a thoughtful, inclusive, and family-focused approach to leadership that has shown great results toward helping children in the region and beyond.
In addition to her experience as a clinician and leader, Bezek has co-authored a few book chapters, has guest lectured at the University of Rochester School of Nursing, and has won several awards, including the 2010 Ruth Lawrence Academic Faculty Service Award in Community Service, and the 2012 Excellence in Nursing Leadership Award and the 2016 March of Dimes Nurse of the Year in Leadership.
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Chief Nursing Officer Honored with Miracle Maker Award - URMC
With drownings on the rise, prevention conversations with caregivers are crucial – Contemporary Pediatrics
With drownings on the rise, prevention conversations with caregivers are crucial | Image Credit: nata777_7 - nata777_7 - stock.adobe.com.
Drowning is something that happens quickly, it happens usually insidiously, and [it is] really difficult to unwind the damage from drowning as time goes by, said James Barry, MD, a pediatric emergency medicine fellow in Rochester, New York. It is why the National Drowning Prevention Alliance (NDPA) and the American Academy of Pediatrics (AAP) held a joint virtual panel to discuss drowning prevention strategies this summer.1
According to the Centers for Disease Control and Prevention (CDC), as of May 14, 2024, drowning deaths are on the rise in the United States, with over 4500 deaths reported each year from 2020 to 2022. These figures are 500 more per year compared to 2019. In children aged 1 to 4 years, drowning is the No. 1 cause of death in the United States.2
The best way to explain drowning to anybody is when you're submerged in water, you have this kind of panic response and you start flailing and at some point, you take a breath, said Barry. A breath leads to an aspiration or breathing in of the water, and that can disrupt the way that your body transitions oxygen and carbon dioxide across the lung and it actually disrupts the surface tension of the lungs, so you experience a lot of collapse of the lung. That leads to hypoxemia, or low blood oxygen, which can lead to loss of consciousness or apnea. That leads to bradycardia, which leads to arrest and then you have a lot of pulmonary edema, you can have neurovascular compromise.
Prevention strategies can save lives, which is why it is important that your patients caregivers and family members understand signs and symptoms and how to execute prevention initiatives that are lacking across the country. The CDC stated in a May 2024 report that nearly 40 million adults in the United States do not know how to swim, and over half of adults have never taken a swimming lesson.2
Something that I recommend to parents, even if it's a weekend course, even if it's a day with an EMS team, learning about rescue breathing, learning about basic life support is critical in preventing some of the long-term damage that happens after drowning, said Barry. The quicker that you're able to take care of the patient, the better their outcome will be.
Access to these lessons and courses has played a role in the recent rise in drownings across the country according to the CDC, which stated that self-reported swimming ability can be linked to access based on historical and social factors. Cost associated with swimming lessons or overall availability of lessons in some communities are factors that may have contributed to the 40 million adults who do not know how to swim.2
Disparities have also emerged in the research, as the CDC noted the highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons. The federal agency reported that 63% of Black adults and 72% of Hispanic adults reported never taking a swimming lesson.2
The CDC, NDPA, and AAP remind providers, and caregivers directly, how important basic prevention strategies are, such as fences that fully enclose and separate the pool from the house. They should be at least 4 feet high with self-closing and self-latching gates, according to the CDC.2
It's very important to have a fence around a pool, Barry reiterated. [Wearing a] life jacket at all times in any kind of watercraft [is also important]. A lot of pediatricians do a really good job of this, but it's always important to remind families with intellectually or cognitively delayed or impaired children, [that} they should have a lifejacket on regardless of what body of water they're in. Regardless of who's with them. It's extremely important for those patients.
Drowning rates are significantly higher for children and youth with special health care needs, especially neurodivergent kids and adolescents and those with seizure disorders, said Benjamin D. Hoffman, MD, FAAP, president of the AAP, in a Letter from the President published in May 2024. Building awareness and supporting programs to help address these kids needs can save lives.3
In toddlers, the AAP noted backyard pools present the greatest risk for drowning. Its important to recognize children are entertained by water, and if they can get to water, they will, said Hoffman in a May 2024 virtual panel. And if they get to water when there arent barriers in place to prevent access, tragedy can ensue.1
Treating drowning quickly and robustly is critical after a submersion incident, even if that incident doesnt seem serious.
It's really important for those children to get evaluated if they are having those pulmonary symptoms in the first 8 hours, even if you feel like it wasn't a real submersion, said Barry. I say this to every pediatrician as an emergency doctor, if you have a concern about the child after submersion incident, send them into the emergency department (ED). It's always important to just get that screened chest X ray to see if there's any kind of pulmonary injury to prevent a lot of that compromise later.
When it comes to drowning prevention, it starts with caregivers and parents, as theyre going to be the primary personnel dealing with a submersion incident or water difficulties in general that involve their child.
Its really important to counsel parents on water safety, Barry added. Counsel parents on making sure their children know how to swim, making sure their children know how to put on a life jacket and wear life jacket properly. Its critical to kind of press parents on these skills, these ways to recognize, and these supervision techniques that they should be practicing.
References:
1. NDPA And AAP share life-saving insights on childhood drowning prevention ahead of official start of summer and water recreation season. NDPA. Press release. May 24, 2024. Accessed June 6, 2024. https://ndpa.org/ndpa-and-aap-share-life-saving-insights-on-childhood-drowning-prevention-ahead-of-official-start-of-summer-and-water-recreation-season/
2. Drowning deaths rise in the United States. CDC. Press release. May 14, 2024. Accessed June 6, 2024. https://www.cdc.gov/media/releases/2024/s0514-vs-drowning.html
3. Hoffman B. Warmer weather leads to more drownings; what you can do to keep kids safe. AAP News. May 1, 2024. Accessed June 6, 2024. https://publications.aap.org/aapnews/news/28682/Warmer-weather-leads-to-more-drownings-what-you?searchresult=1?autologincheck=redirected
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EEG and ECG are overused in children with breath-holding spells – Contemporary Pediatrics
EEG and ECG are overused in children with breath-holding spells | Image Credit: Contemporary Pediatrics
Electrocardiography (ECG) and electroencephalography (EEG) studies are conducted far more often than is necessary in children who experience breath-holding spells (BHSs). This was the main finding of a retrospective study in 519 Swedish patients younger than 10 years who were diagnosed with BHS during a 15-year period.
In most patients, BHS began and was diagnosed before the age of 2 years, and 26 patients (2.6%) were 3 months or younger at onset. Of the 61 children (11.8%) with comorbidities, asthma was the most frequent culprit. Anger was the most common trigger (in approximately half of patients), followed by pain and head trauma. Many patients were unresponsive during a spell; 43.4% experienced unconsciousness and 71.5% had seizures.
As for diagnostic procedures, although EEG was performed in 30.4% of patients, the study findings indicated pathology in only 6 children (3.6%), 4 of whom received a concomitant epilepsy diagnosis. An ECG was performed in 45.1% of patients, with pathology indicated in only 2 patients (0.9%). Blood samples were investigated at diagnosis in 37.2% of patients, and 10 patients (5.6%) had anemia, 2 of whom had iron deficiency. Another 13 patients had signs of iron deficiency.
Based on these results and those of earlier studies, investigators developed an algorithm indicating that only 7.7% of patients with BHS require an ECG at BHS diagnosis, a much lower proportion than the 45.1% of those who had undergone the test in the study sample. In addition, although almost one-third of children in the study group received an EEG, the algorithm would have called for the EEG in none of these children because they all had typical spells. Investigators also noted that they found pathological hemoglobin and iron levels in many patients who underwent blood analysis. As a result, their algorithm suggests an increase in blood sampling to recognize iron deficiency and anemia.
THOUGHTS FROM DR FARBER:
I was taught that a classic BHS, diagnosed by careful history, did not require any workup.Findings from this study support this with a useful algorithm, although it does suggest testing for iron deficiency (simple enough to do) in children with more than 1 episode.The authors do not routinely recommend an EEG, even though more than 70% of children (a huge number in my experience) had seizures with the BHS. Reference:
Schmidt SH, Smedenmark J, Jeremiasen I, Sigurdsson B, Eklund EA, Pronk CJ. Overuse of EEG and ECG in children with breath-holding spells and its implication for the management of the spells. Acta Paediatr. 2024;113(2):317-326. doi:10.1111/apa.17020
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EEG and ECG are overused in children with breath-holding spells - Contemporary Pediatrics
New Close To Home Center to Open in Grove City – Newswise
Newswise (COLUMBUS, Ohio) Nationwide Childrens Hospital announced plans today to expand its Close To Home network by opening a new center in Grove City. The new center will expand convenient access to urgent care and specialized pediatric services for families in Grove City and surrounding areas.
Planned services at the center, to be located at 1350-1370 Stringtown Road east of Interstate 71, include urgent care, lab services, imaging and EKG testing, and clinical therapies. The Grove City Close To Home Center is anticipated to open in 2026.
Central Ohio continues to grow, and Nationwide Children's wants to provide the best access to pediatric care for the entire region, said Tim Robinson, chief executive officer of Nationwide Childrens Hospital. Our new Close To Home Center in Grove City will help more children receive the care they need, when they need it.
Close To Home centers offer community-based diagnostic and therapeutic services for newborns, children and young adults, with services varying by location. Nationwide Childrens currently operates 23 Close To Home centers in central Ohio, with plans to open locations in Zanesville and Athens this year.
We and our children are truly blessed to welcome a Nationwide Childrens Hospital Close To Home center with urgent care to our community, said Grove City Mayor Richard L. Ike Stage. For 130 years, Childrens has provided the highest level of care for every child in need, now caring for children in 45 countries across the globe.
About Nationwide Childrens Hospital
Named to the Top 10 Honor Roll on U.S. News & World Reports 2023-24 list of Best Childrens Hospitals, Nationwide Childrens Hospital is one of Americas largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs, as well as prioritizing quality and safety, are part of what allows Nationwide Childrens to advance its unique model of care. Nationwide Childrens has a staff of more than 14,000 that provides state-of-the-art wellness, preventive and rehabilitative care and diagnostic treatment during more than 1.7 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Childrens physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Childrens Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities. More information is available at NationwideChildrens.org.
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Psychological Therapies Can Reduce Pain Catastrophizing After Breast Cancer Surgery – Anesthesiology News
Psychological Therapies Can Reduce Pain Catastrophizing After Breast Cancer Surgery Anesthesiology News
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