Notes

Patient-Reported Testing Burden associated with Breasts Magnetic Resonance Imaging Among Women Using Ductal Carcinoma In Situ: A good Supplementary Study of the ECOG-ACRIN Most cancers Analysis Class (E4112).
The set of institutions publishing pediatric research in Hawai'i has diversified over time. This analysis of the pediatric research in Hawai'i can be used by researchers, funders, and policy makers to direct future research efforts to improve the health of children in Hawai'i.Psychological distress leading to burnout is an important issue during medical school. While studies have researched interventions in the pre-clerkship years, very few have targeted the clerkship years. To improve the wellness of third year medical students, the following interventions were implemented (1) prompted students to identify two wellness goals in the areas of personal and physical well-being and (2) encouraged students to participate in meditation and chair yoga sessions during their pediatrics clerkship. Students completed pre- and post-clerkship wellness surveys. The interventions led to a small but significant improvement in the wellness of students, particularly in mental, physical, emotional, social, and spiritual well-being.Further expansion of a wellness curriculum to all clerkships during the entire third and fourth years may result in reduced burnout and sustained improvements in wellness during post graduate training and practice.One in 6 US children experience food insecurity, signifying that at some time during the last year their household did not have sufficient food, money, or resources to feed their family. These children experience little intake of fresh fruits and vegetables (FV), a risk factor for chronic disease, including obesity. Produce prescription programs provide vouchers to purchase fresh FV at participating retailers. The Keiki Produce Prescription (KPRx) Program feasibility study was conducted through a partnership between the Waianae Coast Comprehensive Health Center's Pediatrics and Health Promotion Department's Farmers'Market and the University of Hawai'i nutrition faculty. Pediatricians provided patients with a prescription (Rx) to purchase FV from the Farmers' Market ($24 per month for three months). Of the 193 Rx distributed, 125 patients participated in part of the program, while 34 completed the full program. Parents, pediatricians, clinic staff, and community members expressed overwhelming support of the program. Parents of participating children completed an exit interview that identified themes surrounding motivation to participate, benefits to child and family, and future recommendations. It identified the need to improve program retention efforts. Participants reported lifestyle benefits for both the child and family and recommended educational resources. Aresearch protocol was developed to address the following objectives (1) streamline referrals, (2) enhance retention, (3) quantify program impact, and (4) identify barriers to participation. Subsidies have the potential to increase FV consumption, improve overall health, reduce chronic diseases in adulthood, and result in substantial healthcare cost savings.Methamphetamine use is widespread among pregnant and reproductive-aged women in Hawai'i. Women who use methamphetamine require comprehensive care that is gender specific and tailored to their needs. In Hawai'i, more services are needed to solve this serious public health problem. The authors present three cases of methamphetamine use with negative maternal and fetal outcomes. The first case describes a pregnant woman with daily methamphetamine use who experienced cardiac arrest with subsequent preterm delivery and maternal death due to global anoxic brain injury. The second case describes a pregnant woman with daily methamphetamine use which exacerbated her chronic hypertension and led to intrauterine fetal demise. The third case describes a pregnant woman with current methamphetamine use who experienced preeclampsia and a cerebrovascular accident necessitating preterm delivery. Methamphetamine remains a serious public health concern for the United States and especially in the state of Hawai'i.Improving oral health outcomes in Hawai'i for children and families remains a high priority. Children in the state are leading the nation with the highest caries rates, while women before, during, and after pregnancy are failing to receive regular and necessary dental care resulting in poor health outcomes. To answer for this need, an educational intervention was conducted among families enrolled in the Kapi'olani Medical Center for Women and Children's Women, Infant, and Children program (WIC) in O'ahu. The project included the following activities (1) identification the oral health beliefs and behaviors of families, (2) providing oral health education to families, and (3) reassessing beliefs and behaviors in 3-6 months to document the impact of theeducation session. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women. Of the 81 families, 40 representing84 children completed the follow-up oral health questionnaire. Results of the assessment and education demonstrated a positive impact on the family's oral health behaviors. Parents were 6.61 times as likely to report using fluoride toothpaste in the follow-up visit compared to their initial visit (95% confidence interval [CI] = 3.12-14.00). Additionally, statistically significant changes were noted in the frequency of children's daily tooth brushing (odds ratio [OR] = 2.15, 95% CI = 1.33-3.46), as well as in the incidence of children receiving fluoride varnish application over time (OR = 2.66, 95% CI = 1.50-4.73). These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai'i.The high prevalence of childhood obesity highlights the need for effective weight management interventions. This study evaluated a family-based weight management program (Nutrition+Exercise+Weight Management; NEW Keiki) in overweight and obese children and their adult caregivers. Data were collected on overweight (body mass index, BMI = 85th-94th percentile) and obese (BMI > 95th percentile) children (n = 75, 5-14 years) and their adult caregivers (n = 104). Seventy-one percent of the enrolled children identified as Native Hawaiian, Pacific Islander, and/or Filipino (NHPI+F). Families participated weekly in a multidisciplinary lifestyle program for 8-9 weeks (intervention phase); follow-up visits occurred at 6-months and 12-months post-intervention. Long-term data (14-50 months post intervention) were collected by chart review for the children. Change in children's BMI z-score and adult BMI were analyzed. The effects of ethnicity, acceptance of government assistance, and program attendance were evaluated. Participants identifying as NHPI+F and/or receiving government assistance had higher baseline BMI z-scores and BMIs. In children, BMI z-score decreased from baseline at all evaluation visits (-0.05 at 2 months [P less then .001], -0.07 at 6-month follow-up [P less then .001], -0.04 at 12-month follow-up [P = .05], -0.06 at long-term follow-up [P = .01]). At the 2 month visit BMI decreased from baseline for adults (-0.39 [P less then .001]). Decreases in BMI z-score and BMI were independent of program attendance, ethnicity, and acceptance of government assistance. This study, unique in its inclusion of both adults and overweight children, supports the effectiveness of a community-developed program to address weight management in an ethnically diverse population.In the state of Hawai'i, nearly all pediatric surgical care is delivered on the main island of O'ahu at the state's primary tertiary children's hospital. Outpatient clinic visits require patients and families to travel to O'ahu. The direct and opportunity costs of this can be significant. The objective of this study was to characterize potential telehealth candidates to estimate the opportunity for telehealth delivery of outpatient pediatric surgical care. A retrospective chart review including all patients transported from neighbor islands for outpatient consultation with a pediatric surgeon on O'ahu over a 4-year period was performed. Each patient visit was examined to determine if the visit was eligible for telehealth services using stringent criteria. Direct, insurance-based costs of the travel necessary were then determined. Demographic data was used to characterize the patients potentially affected. A total of 1081 neighbor island patients were seen in the pediatric surgery clinic over 4 years. Thirty-one percent of these patients met criteria as candidates for telehealth visits. The majority of patients came from Hawai'i and Maui. Most patients were identified as Native Hawaiian or Asian. The average cost per trip was $112.53 per person, leading to a potential direct cost savings of $37,697 over 4 years. Over 30% of outpatient pediatric surgical encounters met stringent criteria as candidates for telehealth delivery of care. Given the significant number of patients that met our criteria, we believe there is an opportunity for direct, travel-based cost savings with the implementation of telehealth delivery of outpatient pediatric surgical care in Hawai'i.Experience with pediatric transport and pediatric-specific training for paramedic students and practicing paramedics is lacking nationally. Kapi'olani Community College (KCC) conducts the only paramedic training program in the state and has recently expanded its pediatric training section. KCC and the John A. Burns School of Medicine (JABSOM) collaborated on a simulation-based pediatric pre-hospital provider training course titled PediSTEPPs-H (Pediatric Simulation Training for Emergency Pre-hospital Providers in Hawai'i), which was developed and piloted in 2019, to supplement the students' didactic and clinical experiences. The program was developed using Kern's 6-step approach to curriculum development in medical education. The PediSTEPPs-H pilot course was co-facilitated by faculty from both campuses and enrolled 12 students in the first cohort. Program evaluation demonstrated high student satisfaction and included feedback regarding curriculum elements for further refinement. The PediSTEPPs-H pilot program evaluation provided direction that the course be offered annually for all KCC paramedic students and as continuing professional development program for practicing paramedics in Hawai'i.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. selleck products 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 less then .
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