Utilization of Children with Special Health Care Needs (CSHCN) Screener© by O'ahu's pediatricians.

O'ahu's primary care physicians are in the process of implementing the Patient-Centered Medical Home (PCMH) model. The Medical Home Task Force recommends the implementation of the Children with Special Health Care Needs (CSHCN) Screener© as one of the two quality improvement programs that must be completed by each participating physician. This study sought to find how many pediatricians practice population health management and to determine barriers for incorporating population health management and care registries into practices. An online survey of 55 pediatricians in Hawai'i was conducted between January 10, 2012 and March 10, 2012. The survey contained questions regarding knowledge and use of population health management and investigated the utilization rate of the Screener©. This survey provides baseline data on the implementation of this recommended screener, and informs the process that will be necessary to ensure maximal adoption of recommendations. Sixty percent of the survey participants have not incorporated population health management into their routine practice. Twenty three percent did not have knowledge of population health management and 85% did not use a chronic disease registry. As of August 2011, 95% had not screened their patients with the Screener©. Reasons included not having heard of the Screener© and never having considered using a systematic process to ask patients to assess their health. Based on results, there are important educational goals that need to be accomplished in order for Hawai'i's physicians to transform their practices into effective PCMHs. Physicians will likely need instructional and monetary support to effectively change their practices into PCMHs.

A pediatric residency research requirement to improve collaborative resident and faculty publication productivity.

Involvement in a research project can teach training physicians about the scientific process involved in medicine. For this reason, the University of Hawai'i pediatrics department developed a Residency Research Requirement and Program (RRRP) in 2001. We studied a 14-year time period before and after the RRRP was initiated, and found a greater then ten-fold increase in resident publications and faculty involvement in these projects. Many of these manuscripts were the result of resident collaboration and this also increased significantly. The residents who later went into fellowship training were found to be more likely to publish their work. An RRRP encourages residents and faculty to become involved in research publications and other scholarly activities. Its development may help to motivate training physicians to learn important research skills.

Perspective on racial/ethnic birth weight.

OBJECTIVE: Comprehensive birth weight analyses of single primiparous infants of Samoan, Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, Japanese racial ethnic groups. Sampling of intrauterine growth designed to reflect antecedent intra- and extra-environmental factors and insure uniform racial-ethnic data for any later genetic and phenotypic birth weight modeling. STUDY DESIGN: Based upon predetermined relevant gestational age criteria, 121, 197 single primiparous infants birth weight records analyzed. The racial-ethnic basic research paradigms also specified parental diallelic crosses representing intra-and inter-ethnic racial ancestry. Hypotheses tested: 1) the mean birth weight of single primiparous infants of Samoan parentage will be significantly larger than the mean birth weight of similar single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage; 2) mean birth weight of single primiparous infants of only Samoan intra-parentage will be significantly larger t han the mean birth weights of single primiparous infants of only Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage and 3) mean birth weight of single primiparous infants Samoan mothers and non-Samoan fathers will be significantly larger than single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese mothers and non-Caucasian, non-Chinese, non-Filipino, non-Hawaii/Part Hawaiian and non-Japanese father. CONCLUSION: Two of three proposed associated hypotheses adopted: namely, that the mean birth weight of single primiparous infants of one, primary Samoan maternal parentage, and two, of only Samoan maternal and paternal parentage, will be significantly larger than their comparative counterparts. Hypotheses 3 based on Samoan mothers and non-Samoan fathers is tenable, but questionable relative to Caucasian parental background. Research highlights importance of control for potentially confounding variables and assets inherent in independent racial-ethnic cohort investigations.

Pediatric thoracic actinomycosis.

Two cases of pediatric thoracic actinomycosis are presented. A review of the English literature revealed forty-six additional cases in the last 25 years. The mean age of diagnosis was 10 years. The most common presentation was a mass associated with weight loss, fever, and cough. Actinomyces israelii was the most common causative organism. Prognosis was generally excellent after long-term therapy with penicillin.