Monday, November 17, 2014

Language Issues Impede Obesity Counseling

A study from Texas demonstrates that in many cases language barriers are keeping pediatricians from talking to their Hispanic patients about their weight, even when those children are obese. Participant Alberta Jimenez said through an interpreter, “I could tell the doctor was trying to say something, and when I heard the word ‘pesado,’ I got excited, but actually the doctor just thought a pesado was Mexico's official unit of currency.”

In reviewing the 26 video recordings of wellness exams, researchers identified other culturally insensitive language blunders by clinicians. One, in trying to explain how Body Mass Index is calculated, actually said, “Se acepta dolares americanos?” Another, attempting to advise a patient on reducing sugar-sweetened beverage intake, asked for “dos cervezas por favor.” Officials from the Mexican consulate and US Foreign Service continue to work to smooth the resulting tensions.

Tuesday, November 11, 2014

Researchers Call School Lunch Pictures on Pinterest "Baloney"


A new study in the Journal of Nutrition Education and Behavior confirms what many parents have come to suspect: nobody really packs a lunch box like the ones people post on Pinterest, no one. Researcher Alisha Farris, a Ph.D. candidate at Virginia Tech University, led a team in evaluating the nutritional value of 560 packed meals for preschoolers and kindergarteners and 750 school lunches straight off of the steam table. Compared even to the lumps of random brown foodstuffs that pass for school lunch in this country, home-packed lunches had more calories, more fat, more saturated fat, more sugar, less protein, less fiber, less calcium, and less vitamin A.

An unnamed research assistant on the study stated, “I don’t know where these Pinterest moms are getting this stuff, probably from stock photos, because after unwrapping the first 250 lunches, I was ready to gag. I did not see a single star fruit face with blueberry eyes, not one pinwheel of turkey and low fat mozzarella wrapped in wheat flatbread, and no goji berries arranged in the shape of an American flag, just acres and acres of bologna and American cheese. Pinterest is, pardon my French, bullshit. That is French, right?”


Future studies will focus on whether the contents of Lunchables have less or much less nutritional value than the polystyrene trays they come in.

Monday, November 10, 2014

Laundry Pod Makers Respond

Detergent manufacturers were swift to respond to an article published in Pediatrics today describing thousands of toxic exposures to young children, most under age 3. Said a spokesperson, “We understand that our laundry pods resemble pacifiers, teething rings, candies, and other things that toddlers are supposed to put in their mouths. We are working closely with those industries to help them re-design their products so that they are less appealing to children. We feel that if candies, teething rings, etc. were to be sold in grays and browns and stored in childproof packaging, kids would quickly learn to distinguish them from our products. We appreciate your support as we work tirelessly to prevent childhood poisonings."

Sunday, November 9, 2014

The AAP's Don'ts and Don'ts of Bronchiolitis, Explained

A lot of clinicians are confused about the new American Academy of Pediatrics guidelines on treating bronchiolitis, released just in time for the wheezin’ season (see “wheezing” doesn’t really rhyme with “season,” but if you adopt a faux rural accent you can kind of make it work). To help, I’ve translated the technical language of the guidelines into plain English, using words like “wheezin’”. You’re welcome.

DIAGNOSIS

1a) Clinicians should definitely diagnose bronchiolitis. That way it looks like we know what we’re doing. This diagnosis should be made by taking a history, examining the child, then standing back and saying, “Looks like bronchiolitis.” Then go on to explain that this is not the same as the “bronchitis” that grandpa just got treated for with Zithromax at urgent care.

1b) Clinicians should get a worried look on their faces if the disease looks bad and say something like, “This looks pretty bad.”

1c) Whatever they do, clinicians should resist the urge to order chest x-rays or labs. You already know it’s bronchiolitis. What, are you going to act all surprised when the result comes back “Suspect bronchiolitis?”. Remember, no matter what you see in comic books, no amount of radiation will give the child superpowers.

TREATMENT

2) Once you have diagnosed bronchiolitis, run and get your office’s nebulizer. Take it to the parking lot and dash it to the concrete until it’s irreparably broken. What were you thinking, considering giving that kid albuterol? Now you won’t be tempted.

3) Go back in the office, open your code cart, and find the epinephrine. Look at it sternly and say, “I’m saving you for croup and anaphylaxis.” Close the code cart, and give the key to someone you trust to hide it from you until the patient leaves.

4a) Break into the ED late at night and steal all their hypertonic saline nebs to use for brining turkeys (I recommend a minimum of 3 liters for a 16 lb bird). It does not help bronchiolitis, but if they have it, they’ll use it.

4b) If the child is admitted to the floor, and the hospitalist uses nebulized hypertonic saline, do not be insulting about it. The data are still unclear, and besides, you already have your turkey brine for this Thanksgiving.

5) Do not give steroids to children with bronchiolitis. They will grow unusually large muscles and be elected governor of California, where their unfortunate personal decisions will cloud their legacies.

6a) Don’t bother giving oxygen unless the patient’s oxygen saturation is under 90%. To do otherwise will make you look like a big wimp who’s frightened of a little old O2 monitor.

6b) Don’t use continuous pulse oximetry in the first place. You have eyes and a stethoscope, right? When children are really hypoxic, many of them will take on a bluish tint, like in the movie Avatar.

7) Do not use chest physiotherapy for infants with bronchiolitis. Do you really think that beating a kid like a drum with a cupped hand does something other than provide full employment for respiratory therapists? That said, sometimes the rhythm is pleasing and helps soothe you to sleep.

8) Step away from the antibiotics. Bronchiolitis is a virus, you know that, right? It causes a fever and rales, right? So dude, unless pus is streaming from the ear, why do you want to also invite diarrhea into this picture? 

9) If bronchiolitis is interfering with a child’s hydration, put in an IV or an NG tube and help the kid out. Congratulations, finally you have an intervention! Pat yourself on the back, you did good.

PREVENTION

10a) Pavilizumab is a total racket, okay? We don’t care how many lunches the reps brought your staff, if the infant in question was born after 29 weeks gestation and didn’t have chronic lung disease or heart disease, leave it. Expect your local detail person to cry a little, but remember, he’s not thinking about the wellbeing of your patients. He’s remembering a puppy he lost when he was 7.

10b) For infants born before 32 weeks and who have lung and heart disease, go ahead and give the pavilizumab. That detail person has a family to feed.

10c) Give it 5 times in the first year of life. You can’t stand to see your drug rep cry, and he also has a boat payment to make.

11a) If you’ve touched a patient with bronchiolitis, wash your friggin’ hands! You were wearing gloves? So what? Is a little soap gonna kill you? Make sure you wash adequately by singing all of Wagner’s Ring Cycle.

11b) Alcohol hand sanitizer works, too, especially for those who can’t sing in German.

12a) Ask about tobacco smoke exposure when you see a kid with bronchiolitis. If you get a positive answer, gently shake your head from side to side and sigh heavily.

12b) Explain why you are so very disappointed about 12a.

13) Encourage moms to breastfeed exclusively for the first 6 months of an infant’s life by saying, “You wouldn’t want your baby to get bronchiolitis, now would you?” Nothing builds a therapeutic relationship like fear and guilt.

14) When diagnosing bronchiolitis, give parents and caregivers a handout to read. People love handouts, and they meet Meaningful Use guidelines. Make sure you get a new handout that explains why you’re doing nothing about the bronchiolitis. Then, get to the next room quickly. Remember, it’s the wheezin' season!



Saturday, November 8, 2014

You Don't Say!


Researchers using sophisticated microphones and computers reported in this month's Pediatrics that dads talk to their infants about 1/3 as much as moms between birth and age 7 months. Reaction from outraged fathers was swift. Dan Rogers of Akron, Ohio, father of 3, said, "Whoa." LaShawn Coleman of Memphis, Tennessee took to Twitter to proclaim, "#Hmmm." Dr. Johann Schlemmer, tenured professor of linguistics and child development at Harvard was quoted opining, "Well..." Clearly this research has opened a floodgate of paternal opinion, and we will continue to follow the debate until the groundswell of conversation finally ebbs.

Thursday, November 6, 2014

Welcome to Likelihood Ratio

When the editor of Pediatric News asked me to start the Needles blog in 2011, no one had ever succeeded in making pediatrics hilarious on a regular basis. Many of my loyal readers agree that, after 126 Needles columns, they’re still waiting. Now I’m starting “Likelihood Ratio,” where I hope that one of the commenters will finally pull it off.

Those of you with medical or statistical training will recognize a likelihood ratio as that formula you had to write on the palm of your hand right before the test so you wouldn’t flunk. In case you’ve since washed your hands, it’s a calculation that tells you whether the sensitivity and specificity of a test makes it even worth doing or whether the test will just make you and the lab more money while simultaneously giving the appearance that you’re a smart and caring clinician. 


Like “Needles,” this blog will be a place to explore developments in the pediatric literature and to ask ourselves, “Should I even care?”. If all goes well, we’ll laugh together, we’ll learn together, and I’ll get offered lucrative speaking engagements in attractive destinations. Don’t worry, I’ll post photos. Welcome, then, to Likelihood Ratio. I hope you’ll like it.