ABSTRACT
Produce prescription programs (PPPs) are place-based interventions at the intersection of public health and local food advocacy. These programs have expanded significantly across the United States since 2010, particularly taking off in the state of West Virginia. This article draws on a 4-y institutional ethnography of PPP programs and associated policy. Although the possibilities of building support for improving community health alongside the livelihoods of small-scale producers is compelling, there exists an overall decontextualization from broader social and political determinants of health. This article concludes that although programs are able to meet some acute needs for program participants and provide income for small-scale producers, this decontextualization results from a lack of consideration of wider systems within policy and program construction, leading to missed opportunities for food system transformation.
Subject(s)
Abducens Nerve Diseases/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Mastoiditis/diagnosis , Otitis Media/diagnosis , Pneumonia, Bacterial/diagnosis , Trigeminal Neuralgia/diagnosis , Actinomycosis/diagnosis , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Coinfection , Diagnosis, Differential , Fatigue/etiology , Fusobacterium Infections/diagnosis , Fusobacterium nucleatum , Gram-Positive Bacterial Infections/drug therapy , Humans , Male , Peptostreptococcus , Pneumonia, Bacterial/drug therapy , Recurrence , Sulbactam/therapeutic use , Syndrome , Weight LossABSTRACT
OBJECTIVES: Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents. METHODS: Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient's (a) complexity and (b) illness severity. Scores were compared across provider type. RESULTS: Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3-4) versus primary and cross-covering providers (median, 4.0; IQR, 3-4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1-5, versus cross cover, 3.5; IQR, 1-5) or illness severity ratings (night shift, 2.0; IQR, 1-4, versus cross-cover, 3.0; IQR, 1-6) when comparing provider types giving a handoff. CONCLUSIONS: We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.
Subject(s)
Hospitalization , Hospitals, Pediatric , Internship and Residency , Patient Handoff , Physicians , Hospitalists , Humans , Patient Handoff/standards , Surveys and QuestionnairesABSTRACT
Objective. To evaluate the association between documenting excess weight and ordering screening tests. Methods. We retrospectively reviewed well-child visits for patients 2 to 18 years old at a pediatric resident clinic. We evaluated visits of patients with body mass index ≥ 85th percentile for documentation of excess weight in the electronic medical record (EMR) and screening tests ordered. Associations were investigated with χ(2) tests. Results. Of 522 patients, 215 (41%) were overweight (19%) or obese (22%). Among obese and overweight patients, 92/215 (43%) had documentation of excess weight in the EMR. Screening tests were ordered for 39/92 (42%) patients with a diagnosis of excess weight versus 8/123 (6.5%) of those without one (P < .001). Conclusions. Documentation rates of excess weight by practitioners were low and worse for younger children and those with milder degrees of excess weight. Documenting excess weight in the EMR was highly associated with ordering of screening tests.
ABSTRACT
CME EDUCATIONAL OBJECTIVES1.Recognize the transverse nasal crease and its association.2.Identify treatment options for milia in the nasal crease.3.Identify cutaneous findings associated with atopy in children. An 8-year-old male presented for evaluation of a lesion across his nasal bridge. This had been worsening and getting more prominent over the last 6 months. He frequently rubbed his nose with the palm of his hand due to rhinitis. His medical history was significant for asthma, allergic rhinitis, conjunctivitis, and resolved peanut allergy. He lived with his parents and was the youngest of five children. The boy's family history was significant for atopy in parents, and a sister with anaphylaxis to tree nuts. There was no family history of severe or scarring acne vulgaris. Review of systems was normal.
