Calcium Carbonate Urolithiasis in a Pediatric Patient: A Case Report.

Urinary stones composed of calcium carbonate are extremely rare, accounting for 0.01%-1.4% of urolithiasis (UL) cases. Urolithiasis is an infrequent condition in the pediatric population worldwide and in Mexico; nevertheless, the incidence in the Yucatán Peninsula is higher than that reported in other areas of Mexico and the world. Urolithiasis is the second most common urinary disease among pediatrics in the Yucatán Peninsula, which makes it an endemic region for this disease. We describe the case of a five-year-old male from the southeast region of Mexico who presented with signs and symptoms of urinary tract infection (UTI) and was diagnosed with bilateral staghorn stones of calcium carbonate, successfully treated by mini endoscopic combined intra-renal surgery, and dietary adjustments to prevent recurrence.

Pediatric Consultation-Liaison Psychology: Insights and Lessons Learned During the COVID-19 Pandemic.

COVID-19 has presented a variety of challenges to the provision of psychology services. In the first month of the pandemic, pediatric consultation-liaison (CL) psychologists reported significant changes in methodology of service delivery (Steinberg et al. in Clin Pract Pediatr Psychol 9:1, 2020). To better understand how and if these changes persisted, as well as other emerging trends, a follow-up study examined changes and challenges six months into the pandemic. An anonymous questionnaire assessed topics related to pediatric CL psychology including practice changes, perception of changes, and institutional support. The questionnaire was sent to the APA Society of Pediatric Society's special interest group listservs. Thirty responses were analyzed. Quantitative results showed participants' beliefs that telemedicine is equally efficacious to in-person services for outpatient psychological care, but less effective for inpatient care. Participants reported their perception of how institutions supported their safety, psychology trainee safety and training goals, and patient care. Qualitative results demonstrated that most psychologists experienced changes related to their dynamics with medical teams, which included changes in team efficiency, workload, transition, and team collaboration.

Incidence and Parental Perception of Cardiorespiratory Monitor Use in Preterm Infants.

The objective of this study is to examine the incidence and clinical indicators for use of cardiorespiratory (CR) monitor use. We also examined parents' perceptions on the usefulness of home CR monitoring when their preterm infants were discharged from the hospital. A retrospective patients record review was conducted to assess CR monitor use at discharge in preterm infants from January 1, 2016, to December 31, 2017. Participants received a telephone survey that examined parents' CR monitor experiences and use. Over the study period, forty-four infants were discharged home on CR monitor with the incidence rate of 8.1%. Of those, 28 parents were surveyed between 1 and 2 years post discharge. Most parents reported feeling secure but anxious using the CR monitor. Parents who reported experiencing false alarms frequently also reported having feelings of anxiety while using the CR monitor. Findings from this preliminary study support the importance of understanding the role of parent perceptions of families with infants on CR monitors.

Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations.

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups.

Primary Care Physicians' Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey.

BACKGROUND: Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians' perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. METHODS: We conducted a national online survey of 1550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ 2 test used to assess for differences. RESULTS: More respondents agreed that antibiotic resistance was a problem in the United States (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). In addition, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioids, smoking, and vaccine hesitancy. Approximately half (47%) believed they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. CONCLUSIONS: Primary care physicians generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.

OBJECTIVES: At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts. DESIGN: Eight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods. SETTING: Focus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles. PARTICIPANTS: Two focus groups were conducted in each city-one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated. RESULTS: Participants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will 'game the system' to improve their measures, and dissatisfaction and distrust of quality measurement in general. CONCLUSIONS: Stakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.

US State Statutes Banning Powdered Alcohol: Exceptions and Penalties.

To examine state statutes banning powdered alcohol, we identified relevant statutes in all 50 states and the District of Columbia through a search (initial search March 2016; follow-up search November 2016) using the legal research database LexisNexis. To identify the laws, we used the following search terms: "concentrated alcohol," "crystalline alcohol," "granulated alcohol," "palcohol," and "powdered alcohol." As of November 2016, 31 states had statutory bans on powdered alcohol. Statutes in 22 states outline penalties for violating the state's ban on powdered alcohol. Five states include suspension and revocation of alcohol beverage licenses and permits among the penalties. Thirteen states provide exceptions to their ban on powdered alcohol for bona fide scientific research. Twelve states have exceptions for powdered alcohol designed for commercial use or not intended for human consumption. With concerns expressed that powdered alcohol may lead to greater alcohol consumption, particularly among minors, the majority of state legislatures have demonstrated their willingness to restrict access to novel alcohol products to protect the public's health. However, the effectiveness of these laws should be evaluated if the product does become available.

Variability and Limits of US State Laws Regulating Workplace Wellness Programs.

We examined variability in state laws related to workplace wellness programs for public and private employers. We conducted legal research using LexisNexis and Westlaw to create a master list of US state laws that existed in 2014 dedicated to workplace wellness programs. The master list was then divided into laws focusing on public employers and private employers. We created 2 codebooks to describe the variables used to examine the laws. Coders used LawAtlas(SM) Workbench to code the laws related to workplace wellness programs. Thirty-two states and the District of Columbia had laws related to workplace wellness programs in 2014. Sixteen states and the District of Columbia had laws dedicated to public employers, and 16 states had laws dedicated to private employers. Nine states and the District of Columbia had laws that did not specify employer type. State laws varied greatly in their methods of encouraging or shaping wellness program requirements. Few states have comprehensive requirements or incentives to support evidence-based workplace wellness programs.

Vignette methodologies for studying clinicians' decision-making: Validity, utility, and application in ICD-11 field studies.

Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect "real world" phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a "hybrid" of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to "real life" behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians' diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations.

Las metodologías basadas en viñetas se utilizan frecuentemente para examinar los procesos de toma de decisiones, incluyendo los de profesionales sanitarios. No obstante, existen dudas sobre si las viñetas reflejan adecuadamente los fenómenos del "mundo real" permitiendo resultados y conclusiones válidas. Ofrecemos una visión de las características, variaciones de diseño, fortalezas y debilidades de estos estudios para examinar cómo los profesionales forman juicios clínicos (como el diagnóstico y tratamiento). Siendo "híbridos" de las encuestas tradicionales y los métodos experimentales, estos estudios pueden ofrecer la alta validez interna de los experimentos y la alta validez externa de las encuestas, para aislar múltiples factores predictivos del comportamiento de los clínicos. Un diseño adecuado para poner a prueba preguntas específicas acerca de los juicios y la toma de decisiones permite resultados altamente generalizables a la "vida real", sin las limitaciones éticas, prácticas y científicas de los métodos alternativos (observación, auto-informe, pacientes estandarizados, análisis de archivos clínicos). Concluimos con recomendaciones metodológicas que se ilustran tras una descripción del uso de las metodologías de viñetas para investigar las decisiones diagnósticas de los clínicos en los estudios de campo de casos y controles para la clasificación de los trastornos mentales y del comportamiento en la CIE-11.

State laws regulating prescribing of controlled substances: balancing the public health problems of chronic pain and prescription painkiller abuse and overdose.

Today, opiate-based prescription painkillers account for significant morbidity and mortality in the U.S. According to the Centers for Disease Control and Prevention, prescription painkiller overdose has reached epidemic proportions over the past decade. This article explores the focus on inadequate treatment of pain in the U.S. and the subsequent rise of prescription painkiller abuse, misuse, and overdoses. Since 2007, states have increasingly used their authority to address inappropriate prescribing. State strategies to address this complex problem have included: establishing and strengthening prescription drug monitoring programs, regulating pain management facilities, and establishing dosage thresholds above which a consult with a pain specialist is required. With chronic pain affecting at least 116 million adults in the United States, it will also be important to evaluate the impact these policies are having on legitimate access to pain care.

Emergency legal preparedness for hospitals and health care personnel.

During the past decade, hospital emergency preparedness has become a focus of local, state, and federal governments seeking to address emergencies or disasters that affect the public health. Integral to hospital emergency preparedness are numerous legal challenges that hospitals and their health care personnel face during declared states of emergencies. In this article, we evaluate legal requirements for hospital emergency preparedness, key legal concerns that hospitals should consider in emergency preparedness activities, and how the changing legal landscape during emergencies necessitates real-time decision making. We then analyze legal issues including negligence, discrimination, and criminal culpability that may arise during or after medical triage. Finally, we examine the legal risks of evading preparedness, specifically asking how a hospital and its personnel may be held liable for failing to plan or prepare for an emergency.

Legal themes concerning obesity regulation in the United States: Theory and practice.

Despite national health objectives to reduce the incidence of obesity to 15% of the population by 2010, public health data suggest that the incidence of obesity in the United States is actually increasing. The U.S. recognizes that it (like other industrialized countries) faces an epidemic of obesity and related health conditions. How can U.S. jurisdictions (federal, state, and local) and the private sector respond to this epidemic through laws and policies that are directly or indirectly designed to address obesity? This article analyzes the theoretical and practical roles of law as a tool to curb obesity in the U.S. It proffers ten major legal themes to address obesity among the U.S. population, including: (1) use of incentives to encourage healthier behaviors; (2) use of financial disincentives to discourage unhealthy behaviors; (3) requirements to improve food quality, diversity, or availability; (4) compensation for injured persons seeking recourse; (5) restriction of access to unhealthy foods; (6) regulations aimed at influencing consumer choices; (7) control of marketing and advertising; (8) creation of communities that support healthy lifestyles; (9) physical education/fitness requirements; and (10) insurance coverage mandates.