Current Issues in Transitioning from Pediatric to Adult-Based Care for Youth with Chronic Health Care Needs.

For over 25 years, with medical advances increasing the lifespan of YYASHCN, we have been aware of the need to improve health care transition to adult-based care services. Barriers to health care transition have been identified and in a number of settings, recognition of the problem and preliminary success has been achieved for pilot programs. Evidence-based solutions to improve health care transition for YYASHCN are needed. There are barriers at the patient, family, pediatric, and adult provider, and insurance system levels that must be overcome.

Impact of the information age on residency training: communication, access to public information, and clinical care.

Access to technology in practice helps physicians manage information, communicate, and research topics; however, those in training receive almost no formal preparation for integrating web-based technologies into practice. One reason for this is that many faculty-aside from junior faculty or those in recent generations-did not grow up using Internet communication, may use it minimally, if at all, in their own practices, and may know little about its forms and varieties. This report presents a case to illustrate how these disparities may play out in the supervisory situation and makes suggestions about helping supervisors integrate technology-awareness into their teaching.

Teaching and tomorrow: a novel recruitment program for a pediatric subspecialty.

OBJECTIVES: : In 2001, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition created Teaching and Tomorrow, a novel pediatric subspecialty recruitment program to provide prospective fellows the opportunity to participate in the society's annual meeting and to interact with current trainees and members. The aims of this report are to describe participant survey data from the first 4 years of the program and to explore potential influences of participation on outcomes and proposed career choices. MATERIALS AND METHODS: : Pre- and postprogram surveys were administered during opening and closing breakfast meetings, respectively, to ascertain demographics, certainty of career intent, factors influencing choice of specialty, and anticipated benefits from participation. RESULTS: : Among 189 applications, 107 (57%) participated and 107 (57%) matriculated into gastroenterology(GI) fellowship. The matriculation rate was similar between participants and nonparticipants. Among applicants who became GI fellows, there was a 42% lower odds of being female than male (OR 0.42; chi = 8.48, P < 0.01). Among participants who completed both pre- and postprogram surveys (n = 91) and who reported certainty about entering GI both before and after, 79% entered GI fellowship. Among participants who reported uncertainty about entering GI both before and after, 8% entered GI. More participants were interested in jobs as clinician-investigators and funded clinical or translational investigators. CONCLUSIONS: : In a selected population of pediatric residents with high interest in pediatric gastroenterology, there was no difference in the matriculation rate into pediatric GI fellowship training among those who participated compared with those who did not. However, those who eventually matriculated had a higher odds of being male than female. There was a high retention rate of participants who were initially certain and a modest conversion rate of those who were initially uncertain about pursuing a career in pediatric GI.

Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study.

OBJECTIVES: Allergic colitis is often diagnosed clinically in healthy infants with rectal bleeding and often treated with costly hypoallergenic formula. The true prevalence of allergic colitis is unknown. We tested the hypothesis that allergic colitis is overdiagnosed in healthy infants with rectal bleeding. The authors also determined whether rectal bleeding in infants without allergic colitis would resolve without diet change. METHODS: For the purposes of this study, allergic colitis was defined histologically as colonic mucosa with >or= 6 eosinophils per high power field and/or eosinophils in colonic crypts or muscularis mucosae. We surveyed all 56 Ohio NASPGHAN members to determine standard practice regarding the evaluation of rectal bleeding in infants. In addition, infants

Implementing an evidence-based acute gastroenteritis guideline at a children's hospital.

BACKGROUND: Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children's Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization. METHODS: Comparisons were made between patients seen during peak gastroenteritis months (December-May) before (fiscal year [FYs] 1994-1997) and after (FYs 1998 and 1999) guideline implementation. Data were extracted from hospital charts, clinical databases, and billing records. RESULTS: Following implementation, mean yearly ED encounters for AGE decreased 22% and mean yearly admissions decreased 33%. The percentage of admitted children with minor illness decreased (p = 0.002). Mean length of stay decreased 21% for children with minor illness (p = 0.0001) and 5% for others. Hydration status was noted in only 15% of ED charts examined but increased to 63% in FY 1998 and 86% in FY 1999 (p < 0.001). The proportion of admitted patients who advanced to a regular diet by discharge increased from 4.9% (FY 1997) to 23% (FY 1998) and 76% (FY 1999; p < 0.0001). Total inpatient days/year decreased by 43%. Mean hospital costs did not change significantly. DISCUSSION: Following implementation, fewer patients with AGE were seen in the ED and fewer were admitted to the hospital for care. Hospital stays were shorter, and children were more likely to resume their diets before discharge.