Final report of the FOPE II Education of the Pediatrician Workgroup.

This report from the FOPE II Education of the Pediatrician Workgroup assesses the current status and future trends of pediatric education. The attributes of each level of the education process (undergraduate, residency, fellowship, continuing medical education [CME]) are considered within the framework of lifelong learning. The pediatric education of nonpediatrician providers is carefully considered. The Workgroup proposes and describes a new model for pediatric education that encompasses educational needs assessment, curriculum development and outcomes evaluation. Particular attention is paid to CME, with a review of the strengths and problems of the current system. The proposal for improving CME in the 21st century highlights the need for each pediatrician to have a "CME home," and several models and scenarios are explored. Appendices summarize the results of several surveys conducted on behalf of the Workgroup, and list societal trends and advances in pediatric health care that will influence pediatric education in the future. Pediatrics 2000;106(suppl):1175-1198; pediatric education, educational needs assessment, curriculum development, outcomes evaluation.

Installing systems successfully in managed care organizations.

The installation of a new administrative system is a tremendous undertaking for any organization, affecting every area of the operation. Often, because of time and budget constraints as well as the perception that change is not immediately necessary, many organizations wait until there is no option but to change systems--then make the changes under short time frames. For a large, multisite organization, the issues are the same but the complexity increases tremendously.

Hyperlipidemia in children.

Advances toward improving cardiovascular health of tomorrow's adults lie both in acknowledging that the pathogenesis of atherosclerosis begins in childhood and in considering the influence of environmental factors on genetic endowment of risk. Based on current understanding of lipoprotein transport processes, an array of genetic disorders with various degrees of atherogenicity can be classified according to the predominant lipoprotein density class, as represented by a standard lipid profile, and then further defined by assaying apolipoproteins and their receptors, lipoprotein transport enzymes, or the respective variant genes. Alternatively, a simple and potentially cost-effective representation of multifactorial influences on lipid transport is provided by an assessment of apolipoprotein particle composition using serial immunologic precipitation of apolipoproteins while on their intact plasma lipoproteins. A comprehensive intervention strategy can be based on identification of inherited risk and the effects of nongenetic factors, which include dietary excess, inactivity, disease states, and medications.

Injuries associated with child safety seat misuse.

The charts of 370 children under the age of two years who presented to a pediatric emergency department between September 1988 and August 1989 were reviewed. Twenty-seven patients (7% of the total) had injuries associated with child safety seat (CSS) misuse. Thirteen were infants and toddlers injured as motor vehicle occupants when improperly restrained--CSS harness not properly connected (8), use of an improper device (3), and CSS not anchored to the car seat (2). Fourteen were infants under one year of age who were injured falling in their CSS. Injuries included minor head trauma (17), linear skull fracture (5), concussion (1), femoral fracture (1), depressed skull fracture with epidural hematoma (1), cervical vertebral fracture (1), and intraventricular hemorrhage (1). Nine patients were hospitalized. Injuries associated with CSS misuse may be more common than previously recognized and can result in significant injury. Educational efforts should focus on correct usage.