Attitudes toward pediatric rheumatology among residency-trained pediatricians.

BACKGROUND: Pediatric rheumatology (PR) is a relatively new and rare subspecialty in emerging countries. This study aimed to investigate physicians' attitudes toward and real-life clinical practice in PR among residency-trained pediatricians in Thailand. METHODS: An electronic questionnaire was developed and sent via email to pediatricians from Thailand who completed their residency training between 2007 and 2015. Confidence in treating and managing children with rheumatic diseases was rated using a 5-point Likert scale. RESULTS: The response rate was 281 out of 902 (31%), and the mean ± standard deviation age of respondents was 33.8 ± 2.7 years. Confidence was rated as adequate for history taking of children with rheumatic diseases (mean 2.76, 95% confidence interval [CI]: 2.66-2.91), but low for musculoskeletal (MSK) examination (2.42, 95% CI: 2.29-2.54), arthrocentesis (2.01, 95% CI: 1.91-2.11), and rheumatology investigation (2.49, 95% CI: 2.39-2.60). Confidence was high for diagnosis and management of Henoch-Schönlein purpura (3.83, 95% CI: 3.74-3.92) and Kawasaki disease (3.46, 95% CI: 3.38-3.55), but low for juvenile idiopathic arthritis (JIA) (2.41, 95% CI: 2.30-2.52) and chronic systemic vasculitis (1.97, 95% CI: 1.85-2.08). Confidence to perform an MSK examination and arthrocentesis was significantly higher in respondents who had a full-time pediatric rheumatologist working in their pediatric residency training center (P = 0.02, P = 0.01, respectively), and in those who had experienced a PR rotation (P < 0.001, P = 0.01, respectively). Most respondents agreed that more teaching in PR is essential (95.3%) and that case-based discussion was the preferred teaching method. CONCLUSION: The self-rated confidence of pediatricians was low in MSK examination, arthrocentesis, and rheumatology investigation and therefore, teaching on PR is needed.

Comparison between the Efficacy of Switch Therapy and Conventional Therapy in Pediatric Community-Acquired Pneumonia.

OBJECTIVE: Compare the treatment outcomes ofswitch therapy and conventional therapy inpediatricpatients aged one month to five years old, diagnosed with community-acquired pneumonia who required hospitalization. MATERIAL AND METHOD: The present study was performed and approved by the Siriraj Research Ethics Committee. With informed consent, 57 patients whofitted the inclusion criteria were randomized into two groups, 1) the switch therapy group (SWT), who switched their method of receiving antibiotics from IV to oral within 24 hours after clinical improvement and body temperature under 37.8 °C at least eight hours, and 2) the control group, the group treated as routine general practice. Chi-square tests, Fisher's exact tests, unpaired t-tests, and Mann-Whitney U tests were used in analysis. A non-inferiority analysis to estimate 1-sided 95% CIs was performed to determine the greatest difference (worst case) between groups. RESULTS: There were no significant differences in age, sex, clinical presentations, and antibiotics provided between the two groups. A statistically significant reduction in length of hospital stay was found in the SWT group (P = 0.019), whereas the readmission rate for both groups was not significantly different (p = 0.66). Morbidity and mortality were not found in either groups. The SWT group demonstrated non-inferior efficacy comparing to control group (difference 20%; p<0. 001). CONCLUSION: In pediatric community-acquired pneumonia, early switching from administer IVantimicrobial agents to oral form when clinical signs improved were safe and effective. Switch therapy showed non-inferiority outcomes compared to conventional therapy, and had advantages in shortening the length ofstay and indirectly lowering the cost of hospitalization.

Patient expectations for health supervision advice in continuity clinic: experience from a teaching hospital in Thailand.

BACKGROUND AND OBJECTIVE: To evaluate the ability ofpediatric residents in a continuity clinic to meet patient expectations regarding health supervision advice. MATERIAL AND METHOD: This was a cross sectional prospective study conducted at the continuity clinic (COC) and outpatient well-child clinic (OPD-WCC) at the Department of Pediatrics Siriraj Hospital in 2008. The patients attending both clinics over a four-week period were asked to participate in a 2-part questionnaire. The first part, participants were asked to rank six health supervision topics in the order of their perceived importance. After the visit, the participants rated the advice quality given in each topic. The top three most-desired advices were termed 'Priority Topics 'and the researchers categorized the visit quality as Interactive, Informative, or Missed Opportunity (MO) according to the participants 'perceived level of interaction. The participants were not aware of the 'Priority Topic' grouping prior to their participation. Main outcome measures were the proportions of Interactive visits and MO visits in for each of the six focus topics in the COC vs. OPD-WCC setting. RESULTS: The COC setting reported more Interactive sessions when the topic is discipline (31.6%, 9.1%, p<0.05) than the OPD-WCC group, as well as more Informative sessions when the topics were behavior and dental care. There were also more MO in dental (50%, 0%, p< or =0.05) and discipline 50%, 15.8%, p<0.05) among the OPD-WCC than the COC group. CONCLUSION: Physicians are better able to meet their patient's expectation regarding health supervision in a continuity setting. They are also more likely to be interactive regarding their advice and are less likely to miss the opportunities to address issues desired by their patient.

Parental awareness of household injury prevention: adequacy of anticipatory guidance for well childcare.

OBJECTIVE: To study parental perception of risk for household injury in children younger than six years in both continuity clinic and outpatient unit. MATERIAL AND METHOD: Sixty-six caregivers of children who attended continuity care clinic and outpatient unit were included in the present study. Data was obtained by questionnaire that contained questions regarding injury prevention awareness in four areas in the house. They were the food preparing area, bedroom, play area, and the area surrounding the house. Injuries are categorized as fire, burn, electrical shock, fall, struck injury, poisoning, drowning, strangulation, suffocation, and laceration wound. Frequency of parental awareness in each injury prevention is reported. RESULTS: Most of the participants have awareness of fire, burn, electrical shock, drowning, poisoning, laceration wound, strangulation, and suffocation prevention but only 25 to 38% of them have awareness in struck injury prevention. CONCLUSION: Tailor-made anticipatory guidance about injury prevention especially household injury prevention should be a major role of pediatrician in addition to health supervision, immunization, and disease detection. Our study shows parents' perception of household injury prevention should be improved.