Approximately 35.5% of U.S. children ages 6-11 are overweight or obese. Obesity prevention programs in the school setting have produced mixed results, but interventions conducted in the afterschool setting may increase healthy eating (HE) and physical activity (PA) beyond efforts in a typical school day. Studies to date have shown some success in increasing PA in this setting. Moreover, 23% of children grades K-5 attend afterschool care programs. Treatment successes using a family-based approach warrants parental involvement in this setting, but few studies have examined the impact of parent inclusion. The CATCH Kids Club is a curriculum aimed to increase HE and PA in the afterschool care setting with children grades K-5. The NIH We Can! is a family-based intervention geared towards parents of children ages 8-13 and aims to assist families in increasing HE and PA as well as reducing screen time. The current study sought to understand 1) school community perceptions of child obesity, nutrition, and PA, 2) current efforts of the afterschool care program to promote HE and PA, and 3) how a combined student- and parent- focused intervention could be integrated into afterschool care. Researchers conducted focus groups and tested measurement instruments with afterschool personnel and parents of children in the afterschool care program. All personnel (N = 12; 83% Female; 92% Caucasian) agreed that greater afterschool care health promotion efforts could be made. Over half the sample (58%) described afterschool snacks as “not very healthy” or “not at all healthy” and placed the average amount of daily PA at 1 hour. Barriers to healthy habits included mandates on individually wrapped snack purchases and space available for PA. Personnel demonstrated interest in learning the CATCH curriculum. However, personnel were concerned about amount of staff needed to deliver the program, effects of varying attendance levels of students, and parent participation due to busy schedules. Results revealed that parents (N = 8; 75% female; 100% Caucasian) had little knowledge of what occurred during the afterschool care program including types of snacks provided and amount of PA received. All parents were supportive of the implementation of CATCH Kids Club, and all expressed interest in participating in the We Can! sessions. Parents reported preference for short (30-45 minute), bimonthly sessions occurring upon child pick-up. Results suggest that delivering 2012 Appalachian Student Research Forum Page 81 CATCH Kids Club and the NIH We Can! curricula in the afterschool setting would be of interest to both personnel and parents and would be feasible if time-limited and convenient. These findings will contribute to the development of an afterschool care program pilot intervention, Wellness Partners, directed at both students 5-11 years of age and their parents using modified CATCH Kids Club and NIH We Can! curricula. This cluster randomized controlled pilot study utilizing both quantitative and qualitative methodologies will provide preliminary data to further refine and conduct a fully-powered, large scale trial of the intervention’s efficacy in preventing obesity

No description available.

Case Report: The Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative founded in 2009. Members elected to develop a project to address Tennessee’s low breastfeeding rates. The project aim is to improve the health of infants and mothers in Tennessee by increasing initiation and duration of breastfeeding through systematically promoting breastfeeding at prenatal care visits. The short-term project goal is to increase the fraction of infants who are fed breastfmilk at the maternal post-partum visit by 50% by March 2012. A toolkit of evidence-based practices was developed by an interdisciplinary project development team through a combination of face-to-face meetings and webinars. Published tools from the AAP, ACOG, ABM, and elsewhere were reviewed to complete this toolkit. Inclusion of a practice in the toolkit was based on evidence of effectiveness and consensus/approval by the project development team and pilot centers. Toolkit format and project protocols were designed to be consistent with other TIPQC projects. The target population for this project includes expectant mothers presenting for routine prenatal care in the outpatient clinic. Project outcomes will be measured at the first postpartum visit at 4-8 weeks post-delivery. The project pilot was launched in three TN practices in spring 2011. Participating practices will first establish a primary improvement team that includes relevant stakeholders and a project champion and team leader. Ongoing project support will be provided through regional learning session and webinars. In recognition of the range of needs and varied resources across the state, the toolkit includes a menu of “potentially better practices” (PBPs) that may be implemented individually, or as a bundle. Success of this project relies on high reliability (>90%) implementation of processes that promote breastfeeding in the prenatal clinic and the use of rapid Plan-Do-Study-Act (PDSA) cycles. Use of a web-based data-entry system through REDCap will allow practices to access on-demand run-charts and control charts for their project data as well as automated comparisons to project-wide aggregate data. The fractions of mothers’ exclusively feeding breastmilk, feeding both breastmilk and formula, and feeding exclusively formula at the first post-partum visit at 4-8 weeks post-delivery will be determined. The fraction of mothers with infants readmitted to the hospital after birth will be tracked as a balancing measure. Local audits will be used to evaluate reliability of implementation of potentially better practices. Discussion: This project may serve as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate dissemination and measured implementation of potentially better practices across a broad geographic region with highly diverse populations. The approach has the potential to increase breastfeeding rates and improve health and could be modified for application in delivery and postnatal settings.

StatPearls Publishing Review Series strives to help you learn the pearls in advanced pediatrics for medical students. This text contains 1200 multiple-choice questions with explanations that are linked to additional online references.

No description available.

Office Care of Women covers a wide range of topics which are pertinent to the provision of excellent healthcare. Common gynecologic topics are discussed in depth, as well as non-gynecologic medical conditions which are frequently faced by female patients. This book is designed as a single source reference which covers the majority of topics seen by clinicians as they care for women patients in the office setting. The fifty chapters include topics unique to female patients but also include other health conditions which are affected by the patient's gender. The authors of this book span six specialties and three continents thereby giving the reader a comprehensive source of information to improve the healthcare of women.

No description available.

No description available.

Background: In recent years, the Accreditation Council for Graduate Medical Education (ACGME), and the Ambulatory Pediatric Association (APA) have developed detailed resident learning objectives and competencies. Maintaining adequate documentation that residents are fulfilling these objectives and competencies is a challenge. Objectives: To develop and evaluate use of an internet based curriculum, EPIC (East Tennessee Pediatric Internet Curriculum) to facilitate teaching and evaluation of the core competencies. Methods: Goals and content for the site were developed based on literature review and input from a pediatric internet committee. Resident internet-based learning is being evaluated using pre- and post- surveys over a six month period. Results: EPIC is a central location for residents to access information, including announcements, phone lists, and scheduling information. Educational content is organized around the six core competencies for resident education. For example, “Medical Knowledge”consists of a portfolio system developed for the ambulatory clinic. Portfolios include a checklist of pertinent information to be covered during a patient encounter and a related downloadable article to enhance resident knowledge. The section also includes links to other learning resources. An interactive discussion forum exists to facilitate discourse on medical and residency-related topics. Residents also complete online pre- and post- test questions during every clinical rotation and receive instant feedback on their responses. All 11 residents completed the pre-survey. Frequent or very frequent internet use was reported by 54% of residents to answer specific clinical questions and 45% of residents for general medical learning during the work day. Conclusion: Pediatric residents already utilize the internet to access medical information. EPIC accommodates residents’varying schedules and is a useful adjunct to other teaching and evaluation methods.

Case Report: Through the Tennessee Initiative for Perinatal Quality Care (www.tipqc.org), four pilot prenatal (Family Medicine and OB-GYN) practices representing academic and private groups from across the state established primary improvement teams including relevant stakeholders. An online toolkit of evidence-based practices and published tools from the AAP, ACOG, ABM, and elsewhere was developed by an interdisciplinary team and provided to pilot practices. The toolkit included a menu of “potentially better practices” (PBPs) that could be implemented individually, or as a bundle. Success of this project relied on use of rapid Plan-Do-Study-Act (PDSA) cycles. Pilot practices were educated on basic QI procedures, data collection, toolkit content, etc. and shared experiences through monthly webinars called “Huddles”. Regional trainings were also provided at various intervals by the TIPQC staff. Before implementation of a PBP, each practice collected their baseline breastfeeding rate at the 4-8 week postpartum visit. Practices used a web-based, HIPAA-compliant data-entry system through REDCap. The project was reviewed and approved by the Institutional Review Boards (IRBs) of participating pilots, and funded under an agreement with the state of Tennessee. PBPs implemented by the pilot practices included: - Providing resident and provider education - Distributing written literature on breastfeeding benefits and advice - Providing written breastfeeding prescriptions - Having patients view educational breastfeeding videos - Creating a breastfeeding-friendly office environment Baseline pilot data revealed that at presentation for the first postpartum visit, 28.1%, 23%, and 49% of mothers were exclusively feeding breastmilk, feeding a mix of breastmilk and formula, and exclusively feeding formula, respectively (n=196). Baseline data was successfully collected, and early data following the first PDSA has been collected across the four pilot participants. For participating practices, this is the first time they have systematically looked at their 6-week breastfeeding rates. Open communication and brainstorming across the various practices has been very helpful. A numbers of challenges have been cited, including time constraints related to large volumes of patients and inability to extract data electronically, coordination of efforts among large numbers of providers and staff who may be unfamiliar with breastfeeding, and a need for more family, hospital, and community provider support for breastfeeding. Discussion: This quality improvement prenatal breastfeeding promotion pilot project provides insight into the process of team building and use of thin data sets to drive practice level improvement, and lays the groundwork for statewide spread, where challenges encountered in the pilot centers can be addressed. Participants are now looking at the reliability of their implementation, and determining whether their initial selections from the menu/toolkit were effective.