Adherence Rate of Pediatric Lipid Screening at a Rural, Independently Owned Primary Care and Multispecialty Clinic.

BACKGROUND: In 2011, the AAP endorsed the recommendation of National Heart Lung and Blood Institute (NHLBI) for universal lipid screening in children 9-11 and 17-21 years old given the increasing prevalence of pediatric obesity. In 2017, a study conducted by the AAP showed low adherence with universal pediatric lipid screening. The purpose of this retrospective chart review is to assess the adherence rate for pediatric lipid screening at a rural, independently owned primary care and multispecialty clinic. METHODS: Patient data were compiled from the electronic medical record. Inclusion criteria include patients 9-11 or 17-21 years of age between Jan. 1, 2014-Dec. 31, 2019, with an appointment indication of well-child examination or annual physical. RESULTS: A low percentage of patients underwent a fasting lipid panel in both the 9-11 (n = 663) and 17-21 (n = 118) years age group, 3.3 percent and 4.2 percent respectively. Of those who underwent a fasting lipid panel, 59.0 percent in the 9-11 age group and 80.0 percent in the 17-21 years age group had at least one abnormal lipid level. Of the population classified as overweight and obese, 6.3 percent (16 out of 255) of the 9-11 years age group and 6.1 percent (three out of 49) of the 17-21 years age group underwent a lipid panel screen. DISCUSSION: The data show low adherence with universal lipid screening for patients ages 9-11 and 17-21 years old. Poor adherence may be due to inconsistent endorsement by professional medical societies and incongruent recommendations in the EMR. Further studies are required to determine the national adherence rate with the NHLBI recommendation.

Parenting Children with ADHD.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children, affecting 4-12 percent of school-aged children, and can profoundly affect their academic achievement, well-being, and social interactions. While it is easy to think of a diagnosis of ADHD as a concern primarily for the children affected, it is important to recognize that chronic developmental and behavioral conditions affect all family members. METHODS: This study utilized the ADHD Common Sense Parenting (CSP) program developed by Boys Town for the specific population of parents of children diagnosed with or suspected to have ADHD from ages 6-12 in the Yankton, South Dakota, area. Ultimately, effectiveness was determined by improvement in parental knowledge and skills when interacting with their children as assessed by the degree of improvement in parental well-being determined by PHQ-9, GAD-7, and the Boys Town CSP pre/post-test evaluation scores. The study period consisted of a five-week recruiting period, followed by a two-hour, once-weekly, seven-week parenting skills course. RESULTS: Overall, the study did not have sufficient evidence to state whether the ADHD CSP course was effective at improving all outcomes measured. There were statistically significant changes in several subscales in the CSP evaluation scores (supportive behavior, conduct problems, and emotional symptoms). Positive trends were noted in both PHQ-9 and GAD-7 scores. CONCLUSIONS: The positive changes in all measures indicate that this course could help improve parenting skills, stress levels, and both school and home outcomes for children with ADHD.

T-Cell Lymphoblastic Lymphoma Presenting as Acute Clavicular Pain.

An anterior mediastinal mass has a broad differential. We report a case of a large anterior mediastinal malignancy in a pediatric patient presenting with left-sided supraclavicular pain without symptoms of cardiopulmonary compromise. The mass was revealed with CT imaging and diagnosis of T-cell lymphoblastic lymphoma was confirmed after supraclavicular lymph node biopsy. The patient was initially treated with methylprednisolone for cytoreduction and a combination of rasburicase and allopurinol for asymptomatic tumor lysis syndrome. There was then a 34-day induction phase of chemotherapy with vincristine, daunorubicin, PEG-asparaginase, and intrathecal methotrexate. CSF sampling and bone marrow biopsies were both negative at the end of induction. The patient is currently in the consolidation phase, taking cyclophosphamide, cytarabine, and 6-MP, and is tolerating the treatment well.