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BACKGROUND: The female genital exam is often omitted from the routine physical. This limits familiarity with normal findings and represents a missed opportunity to evaluate girls for urogenital abnormalities. Continuity clinic offers an opportunity to develop and test a teaching intervention to address this problem. OBJECTIVE: To describe the effect of precepted genital exams on resident confidence and comfort with the exam as well as knowledge and documentation of genital anatomy. METHODS: A controlled trial was conducted in 10 continuity clinics at Children's Hospital, Columbus, Ohio. Residents in 5 clinics reviewed genital anatomy, exam positions, and documentation examples. They were asked to complete 6 precepted exams of girls aged 1-6 years during well-child care over a 6-month period. Residents were given pre- and posttests assessing knowledge of, confidence, and comfort with the genital exam. Pre- and poststudy genital exam documentation was reviewed. RESULTS: Ninety-seven percent of the intervention group, compared to 73% of the control group, answered 4 or 5 on a 5-point scale of confidence with regard to recognizing a normal exam (5 = highest) following the intervention (P = .01). Ninety-four percent of the intervention group and 64% of the control group answered 4 or 5 with regard to how comfortable they were performing genital exams (P = .01). Knowledge scores and documentation of genital anatomy did not differ between groups. Thirty-two percent of residents had the full intervention. CONCLUSIONS: Resident confidence and comfort increase with precepting. Precepting did not improve knowledge or documentation of genital anatomy. We advocate use of this preliminary data to design and test future educational interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE. To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization. DESIGN. Randomized, unblinded controlled study. SETTING. Columbus Public Health Department Immunization Clinics. PARTICIPANTS. One hundred forty-nine 4- to 7-year-old children. INTERVENTION. Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles. RESULTS. Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P < .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores. CONCLUSIONS. A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged. [ABSTRACT FROM AUTHOR]

The pediatric clinic at Kapi'olani Medical Center provides dental varnish to prevent decay. A chart review (conducted August 1-31, 2017) revealed that only 49.6% of eligible children received varnish. Among those who did not receive varnish, no explanation was provided in 83.9% of the charts. This quality improvement project was designed to increase delivery and documentation of dental varnish. The participants were 14-15 pediatric and psychiatry residents (11 present for all cycles). Cycle 1 interventions were a 5-minute resident educational session on the importance and process of fluoride varnish, and visual reminders on all order entry computers in the clinic. Cycle 2 intervention consisted of a prompt added to the clinic's default well child visit templates requiring notation of whether varnish was given and a reason if not. Data for cycle 2 was collected over 6 weeks as some residents chose to use their own templates, serving as an unplanned comparison group. Application of varnish increased to 77.7% (P < .001) after cycle 1, and was statistically unchanged for cycle 2 (74% (P = .24)). Documentation of reason for lack of varnish was missing in 80% (P = .59) after cycle 1 and 17 % (P < .001) after cycle 2 (with prompt). In the cycle 2 comparison group using their own templates, the varnish application rate was 71% (P < .001) with no explanation for lack of varnish 84% of the time (P = .95). Brief educational interventions may result in increased use of fluoride varnish in resident-based clinics. Task based prompts or stop measures in electronic medical record templates can improve documentation, which can inform efforts to improve varnish application., Competing Interests: None of the authors identified any conflicts of interest., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Objective: To evaluate the effect of 2 anticipatory guidance styles (maternal focused [MOMS] and infant focused [Ounce of Prevention]) directed at mothers of infants aged newborn to 6 months on their infant feeding behaviors at 1 year compared with routine advice as outlined in Bright Futures (BF)., Methods: This is a cluster randomized trial. A total of 292 mother/infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus, Ohio. Intervention-specific brief advice and 1-page handouts were given at each well visit. In addition to infant weights and lengths, surveys about eating habits and infant feeding practices were completed at baseline and 12 months., Results: Baseline data revealed a group with high rates of maternal overweight (62%) and obesogenic habits. At 12 months, the maternal-focused group gave their infants less juice (8.97 oz vs 14.37 oz, P < .05), and more daily servings of fruit (1.40 vs 0.94, P < .05) and vegetables (1.41 vs 1.03, P < .05) compared with BF mothers. Ounce of Prevention mothers also gave less juice (9.3 oz, P < .05) and more fruit servings (1.26 P < .05) than BF., Conclusions: Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity.

Transcutaneous bilirubin measurements correlate with serum bilirubin measurements in neonates. They permit rapid measurements but do not provide fractionation information. Background information of bilirubin measurements is reviewed. The role of transcutaneous bilirubin measurements in the emergency department is reviewed.

Background: Conducting longitudinal research studies with low-income and/or minority participants present a unique set of challenges and opportunities., Purpose: To outline the specific strategies employed to successfully recruit and retain participants in a longitudinal study of nutritional anticipatory guidance during early childhood, conducted with a low-income, ethnically diverse, urban population of mothers., Methods: We describe recruitment and retention efforts made by the research team for the 'MOMS' Study (Making Our Mealtimes Special). The 'multilayered' approach for recruitment and retention included commitment of research leadership, piloting procedures, frequent team reporting, emphasis on participant convenience, incentives, frequent contact with participants, expanded budget, clinical staff buy-in, a dedicated phone line, and the use of research project branding and logos., Results: Barriers to enrollment were not encountered in this project, despite recruiting from a low-income population with a large proportion of African-American families. Process evaluation with clinic staff demonstrated the perception of the MOMS staff was very positive. Participant retention rate was 75% and 64% at 6 months and 12 months post-recruitment, respectively. We attribute retention success largely to a coordinated effort between the research team and the infrastructure support at the clinical sites, as well as project branding and a dedicated phone line., Conclusions: Successful participant recruitment and retention approaches need to be specific and consistent with clinical staff buy in throughout the project., (Published by Elsevier Inc.)

This pilot study evaluated the effectiveness of a nurse-delivered home-visiting program during the postpartum period that included a low-intensity smoking relapse-prevention intervention. A prospective two-group design was used. Participants were women who had quit smoking during their pregnancy. They were invited to participate during postpartum hospitalization on a university hospital postpartum ward. A brief intervention during postpartum hospitalization, a home visit, and two follow-up phone calls over a 1- to 2-month period were compared with a routine home visit without any prescribed focus on tobacco use. The main outcome was biochemically verified smoking abstinence at 3 and 6 months postenrollment. Abstinence was defined as a salivary cotinine level of 14 ng/ml or less. At 3 months postenrollment, 26.4% of the intervention group were classified as abstinent, compared with 12.4% of the comparison group (OR = 2.4, 95% CI = 1.16-4.98). At 6 months, the proportion of the intervention group categorized as abstinent was 21.5%, compared with 10.2% of comparison group participants (OR = 2.5, 95% CI = 1.13-5.71). Greater than three times as many in the intervention group remained abstinent at both times (18.2%), compared with the comparison group (5.2%; OR = 2.4, 95% CI = 1.16-4.93). The effectiveness of this brief, low-cost, and potentially replicable intervention in improving the rate of persistent postpartum smoke-free status for women who quit smoking during pregnancy is encouraging. A randomized trial of the approach is warranted.

Objective: Our objective was to evaluate women with clinical signs or chemical evidence of androgen excess by corticotropin stimulation testing., Study Design: Seventy-six women with evidence of androgen excess were evaluated by corticotropin stimulation testing. Results were examined by plasma levels of dehydroepiandrosterone sulfate, androstenedione, and testosterone. Conception in those infertile women with androgen excess was also assessed. Data were evaluated with Fisher's exact test., Results: Of 41 women with dehydroepiandrosterone sulfate levels greater than 2.8 micrograms/ml, 17 (41.5%) had a positive corticotropin stimulation test (stimulated 17 alpha-hydroxyprogesterone value exceeded baseline value by 2.7 times). No statistically significant association was found between androstenedione or testosterone excess and a positive corticotropin stimulation test. In 14 infertile women with dehydroepiandrosterone sulfate levels greater than 2.8 micrograms/ml and a positive corticotropin stimulation test, 7 (50%) conceived when given low-dose prednisone (p less than 0.005)., Conclusion: Corticotropin stimulation testing is warranted in women with clinical signs of androgen excess and dehydroepiandrosterone sulfate levels greater than 2.8 micrograms/ml.

In learning a black-white discrimination response, the efficiency of rhesus monkeys with lesions of the anterior frontal cortex varies inversely with the spatial separation of the discriminative stimuli from the places of response and reward. Though there is a similar relationship in intact animals, impairment of learning due to discontiguity is greater in the animals with brain lesions.