Current problems in pediatric and adolescent health care
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Physician well-being is associated with benefits for physicians, patients, and health care systems. Well-being encompasses many inter-related attributes, including but not limited to resilience, fulfillment, joy in work, and burnout. Among these, burnout has been studied most widely, and has been found to be more frequent among medical trainees and professionals than in the general population. ⋯ The negative effects of burnout include decreased patient satisfaction, increased medical errors, and increased costs. Physician burnout has been associated with both organization-level drivers that contribute to an imbalance between resources and workload for physicians, and individual-level drivers related to resilience practices and attitudes. This paper reviews the literature on the epidemiology, drivers, and implications of physician burnout.
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Curr Probl Pediatr Adolesc Health Care · Feb 2019
ReviewImplicit Bias: What Every Pediatrician Should Know About the Effect of Bias on Health and Future Directions.
Implicit bias has entered modern discourse as a result of our current sociopolitical climate. It is an area that has been largely explored in the social sciences, and was highlighted in the landmark 2003 IOM report, Unequal Treatment, as a contributor to racial/ethnic health disparities. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, thus leading to assumptions about groups. ⋯ Implicit biases can be unlearned via debiasing strategies, but these have not been examined extensively amongst health care providers. Future research must rely on more than pre- and post-IAT measurements to examine the effect of these strategies on improving patient outcomes. Additionally, healthcare system leadership must prioritize implicit bias trainings for students and medical staff and make greater tangible efforts to improve workforce diversity as a debiasing strategy.
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Curr Probl Pediatr Adolesc Health Care · Dec 2018
ReviewContraception for Adolescents with Medically Complex Conditions.
Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have developed, published, and updated evidence-based guidelines to support medical providers in the provision of contraceptives to patients with specific medical conditions or characteristics. The goal of these guidelines is to provide recommendations on the safe use of contraceptives with the goal of removing unnecessary medical barriers to access and use of contraceptives, thus decreasing the number of unintended pregnancies. Many medical conditions increase a patient's risk of venous thromboembolism; a risk that may also be increased with specific contraceptives. ⋯ Details of the considerations that should be used in providing contraceptive care to adolescents with each of these medical conditions, as per WHO and CDC guidelines, are provided in this review. The ultimate goal in contraceptive counseling is the balancing of risk and benefit to arrive at the best therapeutic option, maintaining patient preference as a priority, as that will enhance adherence and comfort with the contraceptive method. Each patient must be assessed for pregnancy risk and be allowed full risk reduction and education regarding contraceptive options.
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Vocal fold motion abnormalities in children are the second most common form of laryngeal pathology seen in children, and often present in the first 24 months of life. A thorough evaluation of the aerodigestive tract will include an examination of the vocal folds, and a proper diagnosis is essential in order to decipher the etiology of swallowing, voicing and breathing abnormalities. This article reviews the workup, management options and clinical outcomes of unilateral and bilateral vocal fold motion impairment in the pediatric population.
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Curr Probl Pediatr Adolesc Health Care · Jul 2017
ReviewCalming the Storm: Dysautonomia for the Pediatrician.
Dysautonomia is a potentially life-threatening syndrome seen in many different types of brain injuries. It involves paroxysmal sympathetic hyperactivity and typically includes a constellation of symptoms, including: tachycardia, tachypnea, hyperthermia, hypertension, diaphoresis, hypertonia, and/or decerebrate or decorticate posturing. ⋯ Early management can help prevent comorbidities including secondary brain injury while also improving patient outcomes. This discussion serves as an overview of dysautonomia with a focus on management in the pediatric population including an example of a clinical algorithm and a review of the commonly used medications.