Effective guidelines for counseling parents before discharging a newborn.
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Counseling↗
Biomedical subjects
Virginia A Moyer
Publications and source records attributed to Virginia A Moyer.
Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force.
BACKGROUND: Developmental dysplasia of the hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability. OBJECTIVE: We sought to gather and synthesize the published evidence regarding screening for DDH by primary care providers. METHODS: We performed a systematic review of the literature by using a best-evidence approach as used by the US Preventive Services Task Force. The review focused on screening relevant to primary care in infants from birth to 6 months of age and on interventions used in infants before 1 year of age. RESULTS: The literature on screening and interventions for DDH suffers from significant methodologic shortcomings. No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns who are at risk for DDH. A significant proportion of hip abnormalities identified through clinical examination or ultrasound in the newborn period will spontaneously resolve. Very few studies examine the functional outcomes of patients who have undergone therapy for DDH. Because of the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of rigorous comparative studies, the effectiveness of interventions is not known. All surgical and nonsurgical interventions have been associated with avascular necrosis of the femoral head, the most common and most severe harm associated with all treatments of DDH. CONCLUSIONS: Screening with clinical examination or ultrasound can identify newborns at increased risk for DDH, but because of the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of intervention on functional outcomes, the net benefits of screening are not clear.
Early Diagnosis↗
Lessons from Hurricane Katrina, tsunamis, and other disasters.
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Asia, Southeastern↗
Screening for overweight in children and adolescents: where is the evidence? a commentary by the childhood obesity working group of the US Preventive Services Task Force.
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Adolescent↗
Gaps in the evidence for well-child care: a challenge to our profession.
BACKGROUND: Up to one third of visits to pediatricians involve health supervision (well-child care), and recommendations for office-based preventive interventions have dramatically expanded. We reviewed the evidence for the effectiveness of these interventions. METHODS: The well-child care recommendations of 7 major North American organizations were tabulated. Three types of health supervision interventions were recommended, ie, behavioral counseling, screening, and prophylaxis. For recommendations common to at least 2 of the 7 organizations, evidence of effectiveness was sought from systematic reviews and clinical trials. Immunizations were not considered for this review, because they have been reviewed elsewhere. RESULTS: Forty-two preventive interventions were recommended by > or =2 of the organizations. Limited clinical trials show that counseling can change some health risk behaviors; repeated intensive counseling is most likely to be effective. Harmful effects were shown for a few behavioral counseling interventions. Trials have been conducted for only 2 of the recommended screening interventions; therefore, rigorous evidence supporting screening is very limited. Trials support the use of folate to prevent neural tube defects, trials of iron supplementation do not address developmental outcomes, and trials were not found for the other recommended prophylactic interventions. CONCLUSIONS: Limited direct evidence was found to support the recommended interventions. Because a large number of interventions are routinely recommended and often mandated and because the implementation of any recommendation may cause harm (including the displacement of other beneficial activities), these recommendations should be based on the strongest possible evidence. When recommendations are made, supporting evidence should be clearly stated.
Adolescent↗
Understanding and using diagnostic tests.
Every diagnostic test causes additional cost if not additional risk. The cost and risk are justified if the test result is likely to change what is done for patients. This includes a diagnostic test that does not alter therapy but provides important prognostic information for the parents. Whether the test result changes therapy depends on: the action threshold (the probability of disease at which the clinician offers the therapy or intervention because it would do more good than harm). the patient's pretest probability of disease. the test performance (measured by LRs, sensitivity, and specificity). For all tests there is an inverse relationship or trade-offbetween sensitivity and specificity. A good diagnostic test is one in which this trade-off is relatively small within the range of sensitivities and specificities that are clinically relevant. When diagnostic tests are used in low-risk subjects (as in screening tests), the performance of the test is critical because missing a significant number of cases is considered unacceptable and subjecting healthy individuals to the repercussions of false-positive test results is also problematic. The decision to introduce a screening program also depends on the availability and cost of screening and diagnostic tests, the potential for testing to cause harm, the prevalence and prognosis of the condition, the availability of effective treatment, and the importance of presymptomatic treatment.
Diagnostic Tests, Routine↗
A vertically integrated core pediatric education.
The objective of this study was to implement and evaluate a vertically integrated general pediatrics rotation that includes inpatient ward, newborn nursery, and ambulatory components in a format intended to mimic real-world pediatric practice. Separate ward, well-baby nursery, and ambulatory rotations were combined into a 4-month block rotation. Two parallel teams staff the inpatient ward and newborn nursery; on alternating days, the admitting team staffs an afternoon clinic, seeing ward and nursery patients in follow-up as well as regular clinic and referral patients. Two group meetings were held during each rotation for 2 years, and questionnaires were distributed to participating residents. All 90 residents who rotated through the combined service participated in at least 1 group meeting, only 26 returned questionnaires that limited evaluation of the program. The most important positive feature of the rotation was the continuity of patient care allowed by combining the venues into 1 rotation and by the longer duration of the rotation. Concerns included the challenges of time management and fluctuations in workload across the 3 patient care venues. Upper level residents reported that the rotation confirmed career decisions for primary care. These preliminary observations suggest that a vertically integrated rotation provides improvement in perceived continuity of care and introduces residents to the time management challenges of primary care pediatrics.
Continuity of Patient Care↗
Effect of a teaching skills program on faculty skills and confidence.
BACKGROUND: Although education is a central mission of medical schools, effectiveness of faculty as teachers is variable, with many faculty lacking formal training. Therefore, a series of sessions around teaching skills was developed. OBJECTIVE: To improve the skill, confidence, and comfort levels of faculty who teach general pediatrics. METHOD: A faculty development program consisting of nine 1-hour sessions on a variety of topics and a 3-hour workshop on Feedback and Evaluation was provided to all faculty members in a single academic division. The program was evaluated with a needs assessment and a quantitative postprogram self-assessment. A qualitative e-mail survey was performed 3 years after completion to assess durability. RESULTS: The 13 full-time faculty members (10 women) in the Community and General Pediatrics Division attended a mean of 6.5 sessions each (range 4-10). All 13 participants completed the 22-item postprogram survey regarding comfort with and knowledge of teaching techniques. Statistically significant change was seen for all items. Comments from the open-response section reflected specific improvement in the area of feedback and the need for increased time to focus on teaching. Responses to the follow-up survey (46% response rate) were positive about the program in general and about the continued use of the skills that were learned in the program. CONCLUSIONS: Busy general pediatric faculty attended a majority of sessions in a faculty development program on teaching. Skill and comfort levels significantly improved in many of the areas covered, and the skills were still being used 3 years later.
Ambulatory Care↗