Academic_Departments RSS : Gourt

Permanent PEDIATRICS Job in One Hour from NYC!! New York with Enterprise Medical Service

Join a Physician Owned and managed Multi-specialty group. Negotiable salary with productivity, full benefits package including mal-practice, health, vacation, CME, CME allowance, retirement and relocation

Permanent PEDIATRICS Job in Less than 1 Hour from Paducah, KY Kentucky with Enterprise Medical Service

Join one other male Pediatrician in a very busy practice, call 1-3 shared with 1 Ped at the Hospital. Pediatricians attend c-sections as needed. Salary 165k to 200k (depending on experience) plus productivity,

Permanent PEDIATRICS Job in Outstanding Position in Reading, PA Pennsylvania with Enterprise Medical Service

Join 3 full-time Pediatricians and 1 part-time in a very busy and exciting practice. Group would like to grow to 5 total Pediatricians in practice eventually. 1-4 call rotation for night and weekend

Permanent PEDIATRICS Job in Ped/Hosp need in Wichita, KS!! Kansas with Enterprise Medical Service

Join a Physician owned and managed clinic looking to add 2 Pediatric Hospitalist to their group. Call 1-3 right now, new schedule will be determined as new Hospitalists are hired. No c-section and delivery

Permanent PEDIATRICS Job in One Hour from Winston-Salem North Carolina with Enterprise Medical Service

Join a very well known and prosperous Pediatric Private Practice, loosing one due to retirement. Call rotation is 1-6, rounding on own patients and attending c-sections and deliveries as needed only.

Permanent PEDIATRICS Job in South of Altoona Excellent Financial Package Pennsylvania with Enterprise Medical Service

Join a 3 person group looking to add an additional Pediatric provider. Call 1-3, must be comfortable with circs and emergent c-sections. Excellent financial package, employed position offering 175k to

Permanent PEDIATRICS Job in Wichita Falls, TX Opportunity Texas with Enterprise Medical Service

Join a large Multi-specialty group with 5 Pediatricians and 1 PA. Call rotation is 1-6. Attend c-sections and deliveries as needed. Generous salary plus full benefits including mal-practice, CME,

Permanent PEDIATRICS Job in 3 Pediatric Needs in Connecticut Connecticut with Enterprise Medical Service

Three Pediatric Positions available in Connecticut! Meridan, CT-Call-1-6, Full-time Newington, CT-Call-1-6, Full-time Ensfield- CT- Call 1-3, Part-time None of the Pediatric opportunities have

Permanent PEDIATRICS Job in New Need in Southern Illinois Illinois with Enterprise Medical Service

Join a Pediatric practice with 3 other Pediatricians. No attendance to c-sections or deliveries, I placed current Neonatologist there over 5 years ago doing great and well respected. Call rotation is

Permanent PEDIATRICS Job in SE North Carolina Near Wilmington North Carolina with Enterprise Medical Service

Join 1 Pediatrician that is loosing 2, one due to retirement and other leaving for personal reasons. Call would be 1-3, goal 1-4, working with Duke Residents to help with call in the interim. Duties

Permanent PEDIATRICS Job in SW Texas Rio Grande Area Texas with Enterprise Medical Service

Join a female Pediatrician in a busy high Medicaid practice (85%). Take your own ER call Mon-Fri. and share weekend call with group locally, 1-3. Pediatric Hospitalists take all calls for vacation and

Permanent PEDIATRICS Job in Beautiful Nampa, ID!! Idaho with Enterprise Medical Service

Join 6 busy Pediatricians looking to add one more. Call 1-7. Do not attend c-sections and deliveries. Negotiable salary, 10k starting bonus. Full benefits package including mal-practice, health, vacation,

Permanent PEDIATRICS Job in Western Indiana Position Indiana with Enterprise Medical Service

Join a multi-specialty private practice. Call for Peds is 1-4. Peds do not attend c-sections and deliveries, only newborn rounds. Excellent 1 year income guarantee, 160k plus signing bonus or loan forgiveness.

Permanent PEDIATRICS Job in Central Mississippi Mississippi with Enterprise Medical Service

Join a busy Multi-specialty group, current Ped/Neonate is looking to semi retire and just do Neonatology. Currently shares call with local Ped, 7 days on call and 7 days off call, after hours call

Permanent PEDIATRICS Job in Eastern North Carolina University - PED-ENDO Need North Carolina with Enterprise Medical Service

Eastern North Carolina University setting in need of Pediatric Endocrinologist as faculty of teaching medical students. Rank and title commensurate with qualifications and experience. Financial package

Permanent PEDIATRICS Job in Beautiful East Texas Position Texas with Enterprise Medical Service

Join a two physician group that is looking to add a third due to growth. Call rotation is 1-3 and they do attend c-sections and delivers as needed/that could change. Salary position of 175k plus 10k

Permanent PEDIATRICS Job in New Pediatric Postion in Kansas City, MO Missouri with Enterprise Medical Service

Join a busy Pediatric practice consisting of 2 Pediatricians and 3 NP's. Call rotation is 1-3, 1-4. Pediatricians do not attend c-sections and deliveries. Negotiable salary with full benefits including

Permanent PEDIATRICS Job in North Central Indiana Indiana with Enterprise Medical Service

North Central Indiana group seeks hospital employed Pediatric Endocrinologist due to patient demand. Will be busy from start with broad patient referrals from 1.3 million draw area. Financial package

Permanent PEDIATRICS Job in Beautiful Jonesboro, AR Arkansas with Enterprise Medical Service

Join a family owned and operated private practice looking to add 2 more Pediatricians to their practice. Current call rotation is 1-3, all triage calls at night taken by Childrens in Little Rock. Attend

Permanent PEDIATRICS Job in Beautiful Alamosa CO Seeks 2nd PED Colorado with Enterprise Medical Service

Medical Center in Alamosa is recruiting for a 2nd Pediatrician to join a single specialty group. Need is due to community growth. Candidate will need to cover at risk deliveries. $165-$180k 2 year

ANNOUNCEMENT: Call for Photographs

ABOUT THIS JOURNAL: About This Journal

THIS MONTH IN ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE: This Month in Archives of Pediatrics & Adolescent Medicine

ARTICLE: Effect of Telephone Calls From Primary Care Practices on Follow-up Visits After Pediatric Emergency Department Visits: Evidence From the Pediatric Emergency Department Links to Primary Care (PEDLPC) Randomized Controlled Trial

Objective To test whether follow-up phone calls to counsel families about pediatric emergency department (PED) use and primary care availability made after an index PED visit would modify subsequent PED use. Design Longitudinal prospective randomized intervention. Setting An urban academic children's hospital. Patients A total of 4246 individuals aged 0 to 21 years from each of 4 participating primary care practices recording an index PED visit from April through December 2005. Intervention Follow-up phone call from the primary care practice within 72 hours of the initial PED visit to counsel about the availability of after-hours advice and when to access the PED. Main Outcome Measures All subsequent visits to primary care practices, PED, pediatric subspecialists, or for inpatient hospitalization during a 365-day follow-up period. Logistic and ordinary least squares regressions estimated unadjusted and adjusted odds ratios of follow-up visits, controlling for covariates. Results Of the 2166 intervention subjects, 816 (37.7%) recorded follow-up PED visits compared with 819 (39.4%) of the 2080 control subjects (P = .26, not significant). The adjusted odds of a follow-up visit being to the PED rather than to another venue was significantly less for intervention than for control subjects (odds ratio, 0.88; confidence interval, 0.82-0.94), indicating decreased intensity of PED use. Conclusion Follow-up phone calls from primary care practices after PED visits counseling patients on the use of primary care and emergency services can modulate subsequent care-seeking behavior and decrease future PED use.

ARTICLE: Access to Pediatric Trauma Care in the United States

Objectives To catalog trauma center resources and estimate access to age-specific trauma care for children younger than 15 years in the United States. Design Cross-sectional study collating information from national, state, and local trauma systems authorities to create a catalog of verified pediatric trauma centers (PTCs) and self-designated "candidate" trauma centers. Access-to-care calculations were estimated using all US block groups and prior validated methods. Setting United States. Patients Children in the US younger than 15 years. Main Outcome Measures The PTC statuses of hospitals in the United States. Percentages of pediatric populations (by state and population density) having access (by ground or air) within 60 minutes to a PTC. Results A total of 170 verified PTCs were identified in 41 states (including the District of Columbia). An estimated 71.5% of pediatric patients were within 60 minutes of a verified PTC by air or ground transport, 43% if ground transportation only was considered. An estimated 17.4 million children did not have access to a PTC within 60 minutes. Access ranged from 22.9% of the population in the most rural areas of the United States to 93.5% in the most urban. The addition of 24 candidate centers increased coverage to 77.4% of the pediatric population being within 60 minutes of a PTC. Conclusions Current pediatric trauma resources vary greatly by state and population density, with many children, particularly in rural areas, underserved. A thorough standardized catalog of verified PTCs is necessary to accurately assess pediatric trauma needs now and to optimize future trauma system planning for children.

ARTICLE: Peace of Mind and Sense of Purpose as Core Existential Issues Among Parents of Children With Cancer

Objective To evaluate issues experienced by parents of children with cancer and factors related to parents' ability to find peace of mind. Design Cross-sectional survey. Setting Dana-Farber Cancer Institute and Children's Hospital, Boston, Massachusetts. Participants One hundred ninety-four parents of children with cancer (response rate, 70%) in the first year of cancer treatment. Main Outcome Measure The Functional Assessment of Chronic Illness Therapy–Spiritual Well-being sense of meaning subscale. Results Principal components analysis of Functional Assessment of Chronic Illness Therapy–Spiritual Well-being sense of meaning subscale responses identified 2 distinct constructs, peace of mind (Cronbach = .83) and sense of purpose (Cronbach = .71). Scores ranged from 1 to 5, with 5 representing the strongest sense of peace or purpose. One hundred forty-seven of 181 parents (81%) scored 4 or higher for questions related to sense of purpose (mean [SD] score, 4.4 [0.6]). Only 44 of 185 parents (24%) had scores in the same range for peace of mind (mean [SD] score, 3.2 [0.9]) (P < .001). In a multivariable logistic regression model, parents had higher peace of mind scores when they also reported that they trusted the oncologist's judgment (odds ratio [OR] = 6.65; 95% confidence interval [CI], 1.47-30.02), that the oncologist had disclosed detailed prognostic information (OR = 2.05; 95% CI, 1.14-3.70), and that the oncologist had provided high-quality information about the cancer (OR = 2.54; 95% CI, 1.11-5.79). Peace of mind was not associated with prognosis (OR = 0.74; 95% CI, 0.41-1.32) or time since diagnosis (OR = 1.00; 95% CI, 0.995-1.003). Conclusions Physicians may be able to facilitate formulation of peace of mind by giving parents high-quality medical information, including prognostic information, and facilitating parents' trust.

ANNOUNCEMENT: Topic Collections

ARTICLE: Screening for Traumatic Exposure and Posttraumatic Stress Symptoms in Adolescents in the War-Affected Eastern Democratic Republic of Congo

Objective To explore adolescent mental health in the eastern Democratic Republic of Congo, scene of a complex emergency since 1996. Design Community cross-sectional data obtained using a cluster sample approach. Setting From November 5, 2007, through February 5, 2008, we assessed 13 secondary schools in 4 selected health zones in the Ituri district. Participants One thousand forty-six adolescents and young adults aged 13 to 21 years completed a self-report questionnaire. Main Exposures War-related traumatic events, posttraumatic stress symptoms, and sociodemographic variables. Main Outcomes Measures The Adolescent Complex Emergency Exposure Scale, specifically designed for this region, screened for exposure to potentially traumatic events, and the Impact of Event Scale–Revised measured symptoms of posttraumatic stress consistent with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Results Among the 477 girls (45.6%) and 569 boys (54.4%) in the study, 95.0% reported at least 1 traumatic event. On average, adolescents were exposed to 4.71 traumatic events, with higher exposure rates reported in boys, older groups, rural and urban areas, and respondents whose mother or father was dead. Of 990 respondents, 52.2% met symptom criteria for posttraumatic stress disorder. Symptom scores were strongly related to cumulative trauma exposure; however, the strength of this relationship differed slightly across living area groups for girls. Conclusion Adolescents in the eastern Democratic Republic of Congo are highly exposed to political violence, putting them at a considerable risk—mediated by living area and sex—to develop posttraumatic stress symptoms.

ARTICLE: Effect of Maternal Psychopathology on Behavioral Problems in Preschool Children Exposed to Terrorism: Use of Generalized Estimating Equations to Integrate Multiple Informant Reports

Objective To examine whether the number of maternal psychopathologies is associated with increased clinically significant behavioral problems in preschool children exposed to disaster, using child behavior ratings from multiple informants. Design Cross-sectional study. Setting Lower Manhattan, New York, New York. Participants One hundred two preschool child-mother dyads directly exposed to the World Trade Center attacks. Exposures Maternal disorders: 2 (posttraumatic stress disorder [PTSD] and depression), 1 (depression or PTSD), or none. Main Outcome Measures Maternal depression and PTSD were self-reported. Child behavioral problems were rated by mothers and teachers using a standardized behavioral checklist. For each informant, we created separate dichotomous variables that indicated whether the child's behavioral problems were severe enough to be clinically significant. We then used an analytic technique (generalized estimating equations) that integrates the child behavioral problem ratings by the mother and teachers to derive a more reliable indicator of clinically significant child behavioral problems. Results The rate of clinically significant child behavioral problems increased linearly relative to the number of maternal psychopathologies. The number of maternal psychopathologies was associated with a linear increase in functional impairment. Compared with children of mothers without psychopathologies, children of mothers with depression and PTSD were at greater risk for several clinically significant problems, notably, aggressive behavior (relative risk, 13.0), emotionally reactive behavior (11.2), and somatic complaints (10.5). Boys were more likely to have clinically significant behavior problems than were girls. Conclusion Concurrent maternal depression and PTSD was associated with dramatic increases in the rate of clinically significant behavioral problems in preschool children, particularly boys, 3 years after the World Trade Center attacks.

ANNOUNCEMENT: Sign Up for Alerts--It's Free!

ARTICLE: HLA-DR4 as a Risk Allele for Autism Acting in Mothers of Probands Possibly During Pregnancy

Objectives To test whether HLA-DR4 acts in the mother, possibly during pregnancy, to contribute to the phenotype of autistic disorder in her fetus. Design Transmission disequilibrium testing in case mothers and maternal grandparents. Setting Previous studies have consistently shown increased frequency of HLA-DR4 in probands with autism and their mothers, but not their fathers. However, this has been documented only in case-control studies and not by a more direct study design to determine whether HLA-DR4 acts in mothers during pregnancy to contribute to autism in their affected offspring. Participants We genotyped for HLA-DR alleles in members of 31 families with parents and maternal grandparents. Probands with autism were tested using the Autism Diagnostic Observation Schedule–Western Psychological Services and Autism Diagnostic Interview, Revised. There was 80% power to detect an odds ratio of 3.6. Participants were all families from New Jersey and were similar in number to earlier studies of autism and HLA-DR4. Outcome Measures Analysis was by standard transmission disequilibrium testing. As a secondary test we examined the possibility of maternal imprinting. Results Significant transmission disequilibrium for HLA-DR4 was seen (odds ratio, 4.67; 95% confidence interval, 1.34-16.24; P = .008) for transmissions from maternal grandparents to mothers of probands, supporting a role for HLA-DR4 as an autism risk factor acting in mothers during pregnancy. Transmission disequilibrium was not seen for HLA-DR4 transmissions from parents to probands or from mothers to probands. Conclusions The HLA-DR4 gene may act in mothers of children with autism during pregnancy to contribute to autism in their offspring. Further studies are required to confirm these findings.

ANNOUNCEMENT: Submissions

ARTICLE: Receipt of Special Education Services Following Elementary School Grade Retention

Objective To estimate the proportion of children who receive an Individualized Education Program (IEP) following grade retention in elementary school. Design Longitudinal cohort study. Participants Children retained in kindergarten or first (K/1) grade and third grade, presumably for academic reasons, were followed up through fifth grade. Main Outcome Measure Presence or absence of an IEP. Results A total of 300 children retained in K/1 and 80 retained in third grade were included in the study. Of the K/1 retainees, 68.9% never received an IEP during the subsequent 4 to 5 years; of the third-grade retainees, 72.3% never received an IEP. Kindergarten/first-grade retainees in the highest quintile for socioeconomic status and those with suburban residence were less likely to receive an IEP than retained children in all other socioeconomic status quintiles (adjusted odds ratio, 0.17; 95% confidence interval, 0.05-0.62) and in rural communities (0.16; 0.06-0.44). Among K/1 retainees with persistently low academic achievement in math and reading, as assessed by standardized testing, 38.2% and 29.7%, respectively, never received an IEP. Conclusions Most children retained in K/1 or third grade for academic reasons, including many of those who demonstrated sustained academic difficulties, never received an IEP during elementary school. Further studies are important to elucidate whether retained elementary schoolchildren are being denied their rights to special education services. In the meantime, early-grade retention may provide an opportunity for pediatricians to help families advocate for appropriate special education evaluations for children experiencing school difficulties.

ANNOUNCEMENT: Trial Registration Required

ARTICLE: Audible Television and Decreased Adult Words, Infant Vocalizations, and Conversational Turns: A Population-Based Study

Objective To test the hypothesis that audible television is associated with decreased parent and child interactions. Design Prospective, population-based observational study. Setting Community. Participants Three hundred twenty-nine 2- to 48-month-old children. Main Exposures Audible television. Children wore a digital recorder on random days for up to 24 months. A software program incorporating automatic speech-identification technology processed the recorded file to analyze the sounds the children were exposed to and the sounds they made. Conditional linear regression was used to determine the association between audible television and the outcomes of interest. Outcome Measures Adult word counts, child vocalizations, and child conversational turns. Results Each hour of audible television was associated with significant reductions in age-adjusted z scores for child vocalizations (linear regression coefficient, –0.26; 95% confidence interval [CI], –0.29 to –0.22), vocalization duration (linear regression coefficient, –0.24; 95% CI, –0.27 to –0.20), and conversational turns (linear regression coefficient, –0.22; 95% CI, –0.25 to –0.19). There were also significant reductions in adult female (linear regression coefficient, –636; 95% CI, –812 to –460) and adult male (linear regression coefficient, –134; 95% CI, –263 to –5) word count. Conclusions Audible television is associated with decreased exposure to discernible human adult speech and decreased child vocalizations. These results may explain the association between infant television exposure and delayed language development.

ARTICLE: Screening for Asymptomatic Chlamydia Infections Among Sexually Active Adolescent Girls During Pediatric Urgent Care

Objective To develop and evaluate an intervention to increase Chlamydia trachomatis (CT) screening among sexually active adolescent girls during pediatric urgent care. Design Ten pediatric clinics were randomly assigned to an intervention (5 clinics) or control group (5 clinics). The proportion of sexually active girls screened for CT was estimated over 18 months (April 2005-September 2006). Setting Large health maintenance organization in northern California. Participants Pediatric clinics providing urgent care services for adolescent girls aged 14 to 18 years. Intervention In the intervention clinics, a team of providers and clinic staff met monthly to redesign their clinic system to improve CT screening during urgent care. Controls received an informational lecture on CT screening. Main Outcome Measures Clinic-specific proportions of sexually active adolescent girls screened for CT. Results The change over time in clinic-specific CT screening rates in urgent care was significantly greater in the intervention group than in the control group (likelihood ratio, 21 = 18.7; P < .001). Between baseline and the fifth intervention period, the proportions of girls screened for CT increased by 15.93% in the intervention group and decreased by 2.13% in the comparison clinics. Conclusions The intervention significantly improved the proportion of adolescent girls screened for CT during urgent care. Despite this success, substantial barriers to screen for CT in urgent care remain. Innovative strategies to provide basic information about CT, other sexually transmitted infections, and pregnancy are greatly needed since many teens are never seen for preventive care in a given year.

ARTICLE: Sports Practice Among Adolescents With Chronic Health Conditions

Objectives To compare the level of sports practice between adolescents with chronic health conditions (CHCs) and control peers and to examine the reasons given by adolescents with CHCs for not practicing any sports in comparison with the control group. Design School survey. Setting Postmandatory schools. Participants A total of 6790 students (3275 females) aged 16 to 20 years, grouped as adolescents with CHCs (355 females, 354 males) and control peers (2920 females, 3161 males). Main Exposure Chronic health condition was defined using a noncategorical approach including adolescents with a chronic disease and/or a physical handicap. Main Outcome Measures Sports practice, barriers to sports practice among individuals not practicing any sports, and biological, psychological, socioeducative, and physical activity characteristics. Results Males with CHCs were less likely than control males to practice sports, whereas no significant difference was observed for females. Chronically ill youth were significantly more likely to report having a CHC as a barrier for not practicing sports. However, the most frequently reported barrier was preference for other activities for males with CHCs and lack of time for control males and for females with and without CHCs. Conclusions Having a CHC seems to influence sports practice among males but not females. We recommend that practitioners dealing with adolescents remember to take into account sports practice as part of the care of young patients with CHCs.

REVIEW ARTICLE: Quality Improvement Strategies for Children With Asthma: A Systematic Review

Objective To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care. Data Sources Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles. Study Selection Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations. Interventions Must have included 1 or more QI strategies for the outpatient management of children with asthma. Main Outcome Measures Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions). Results Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics. Conclusions A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.

SPECIAL FEATURE: Picture of the Month--Quiz Case

SPECIAL FEATURE: Picture of the Month--Diagnosis

EDITORIAL: Approaches to Chlamydia Screening: One Size Does Not Fit All

EDITORIAL: The Forgotten Victims of Posttraumatic Stress Disorder

THE PEDIATRIC FORUM: Collaboration With Pediatric Call Centers for Patient Recruitment

CALL FOR PAPERS: Theme Issue on Palliative Care, Dying, and Bereavement

ADVICE FOR PATIENTS: Chlamydia Screening: A Routine Test