Pediatric Primary Care Billing Trends After the 2021 Evaluation and Management Coding Changes.

This cross-sectional study examines the differences in billing trends for pediatric patient care compared with adult care after the 2021 evaluation and management (E/M) policy changes.

Age and Probability of Spontaneous Umbilical Hernia Closure.

This cohort study of children younger than 6 years uses electronic health records to investigate whether a child's age is associated with the probability of spontaneous umbilical hernia closure and to refine guidelines for surgical repair.

Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.

BACKGROUND AND OBJECTIVES: Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians. METHODS: We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups. RESULTS: For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001). CONCLUSIONS: In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.

Imaging in a Rare Case of Neonatal Arterial Tortuosity Syndrome.

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive disorder that affects the connective tissue. The incidence of ATS is not well known and to date only 106 patients have been described in the literature. ATS affects medium and large size arteries, leading to widespread elongation and intensification of the average vessel tortuousness, responsible of several loops and kinks. Like other connective tissue disorders, ATS can present with joint laxity, hernias, pectus excavatum, scoliosis or other musculoskeletal abnormalities, and ocular defects. Due to the extreme variability of clinical symptoms and the fact that ATS has no curative management, prompt diagnosis is of tremendous importance to prevent disease-associated complications. In this situation, imaging techniques have a central role. In this study, we describe a rare case of a male newborn with tortuosity and lengthening of the main arterial and venous medium and large caliber branches with associated aortic coarctation who passed away prematurely. The finding of aortic coarctation in a newborn with ATS has rarely been described in the literature.

The Antibiotic Likelihood Index: A New Measure of Antimicrobial Stewardship for Pediatric Primary Care Based on Reason for Visit.

BACKGROUND: Quality metrics for antibiotic prescribing by pediatricians are limited. We sought to define a novel measure that assesses clinicians' overall antibiotic prescribing. METHODS: Using electronic health record (EHR) data from 2018 to 2019 for children 3 months to 17 years of age from 53 practices within a large pediatric network, we grouped encounters into Reason for Visit categories using the classification system of the National Ambulatory Medical Care Survey and analyzed the proportion of encounters with an antibiotic prescription. Categories were sorted according to the attributable proportion of encounters with an antibiotic prescribed. The proposed metric-the Antibiotic Likelihood Index (ALI)-was defined as the proportion of encounters with an antibiotic prescribed among categories that accounted for >80% of all encounters with an antibiotic prescribed. The ALI was calculated for the entire network and for individual prescribers, and the distribution among prescribers was described. RESULTS: Six Reason for Visit categories-cough, ear complaints, fever, sore throat, rash, and congestion/upper respiratory infection-accounted for 82.4% of all antibiotics prescribed. Among the 222 682 encounters for the top 6 categories combined, 67 368 (30.3%) had an antibiotic prescribed, defined as the ALI for the entire sample. The index among individual prescribers ranged from 7.5% to 57.2% (interquartile range 24.3% to 34.9%). The correlation for individual prescribers between 2018 and 2019 was high (R2 = 0.80). CONCLUSIONS: The ALI, a proposed new metric of pediatric antibiotic prescribing, can be readily calculated from EHR data and captures the range of antibiotic prescribing among pediatricians for common clinical scenarios.

Development of visual perception of others' actions: Children's judgment of lifted weight.

Humans are excellent at perceiving different features of the actions performed by others. For instance, by viewing someone else manipulating an unknown object, one can infer its weight-an intrinsic feature otherwise not directly accessible through vision. How such perceptual skill develops during childhood remains unclear. To confront this gap, the current study had children (N:63, 6-10 years old) and adults (N:21) judge the weight of objects after observing videos of an actor lifting them. Although 6-year-olds could already discriminate different weights, judgment accuracy had not reached adult-like levels by 10 years of age. Additionally, children's stature was a more reliable predictor of their ability to read others' actions than was their chronological age. This paper discusses the results in light of a potential link between motor development and action perception.

Variant and invariant features characterizing natural and reverse whole-body pointing movements.

Previous investigations showed that kinematics and muscle activity associated with natural whole-body movements along the gravity direction present modular organizations encoding specific aspects relative to both the motor plans and the motor programmes underlying movement execution. It is, however, still unknown whether such modular structures characterize also the reverse movements, when the displacement of a large number of joints is required to take the whole body back to a standing initial posture. To study what motor patterns are conserved across the reversal of movement direction, principal component analysis and non-negative matrix factorization were therefore applied, respectively, to the time series describing the temporal evolution of the elevation angles associated with all the body links and to the electromyographic signals of both natural and reverse whole-body movements. Results revealed that elevation angles were highly co-varying in time and that despite some differences in the global parameters characterizing the different movements (indicating differences in high-level variable associated with the selected motor plans), the level of joint co-variation did not change across movement direction. In contrast, muscle organization of the forward whole-body pointing tasks was found to be different with respect to that characterizing the reverse movements. Such results agree with previous findings, according to which the central nervous system exploits, dependently on the direction of motion, different motor plans for the execution of whole-body movements. However, in addition, this study shows how such motor plans are translated into different muscle strategies that equivalently assure a high level of co-variation in the joint space.