Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA.

BACKGROUND: Infection with Rickettsia parkeri is an emerging tick-borne illness, often accompanied by fever and an eschar at the site of tick attachment. We present three cases of R. parkeri in Virginia residents. CASE PRESENTATIONS: Case 1 presented initially afebrile, failed to seroconvert to rickettsial antigens, and was diagnosed by DNA testing of the eschar. Case 2 presented febrile with eschar, no serologies were performed, and was diagnosed by DNA testing of the eschar. Case 3 presented febrile with eschar, serologies were negative for rickettsial antigens, and was diagnosed by DNA testing of the eschar. CONCLUSION: DNA testing of eschars represents an under-utilized diagnostic test and may aid in cases where the diagnosis is not made clinically.

Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum.

Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents' self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1-8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

Breastfeeding: a clinical imperative.

Hospital breastfeeding initiation rates (75%) show that most mothers in the United States want to breastfeed and are trying to do so. Even from the very start, however, mothers may not be getting the breastfeeding support they need. Low breastfeeding rates at 3, 6, and 12 months illustrate that women face multiple additional barriers to maintaining breastfeeding. What can we do to help more mothers be more successful? As healthcare providers, we need to be believers that breastfeeding is worth the effort. Perhaps most important for us is to realize that human milk is not simply a food but rather a complex, human infant support system. We can then articulate to families the importance of breastfeeding as a clinical imperative, a preventer of acute and chronic illness and disease. It will take integration, normalization, and mainstreaming of breastfeeding into our culture for acceptance and growth of the practice. Once we assist families in making educated decisions about breastfeeding, we need to provide supportive environments in our hospitals, medical practices, workplaces, and communities that implement the best ways to support breastfeeding. Breast milk is worth the effort, and the time has come to be ardent supporters of mothers and infants and their breastfeeding intentions.

Belly models as teaching tools: what is their utility?

Marble/ball models are often used to represent newborn stomach capacity; however, their accuracy has not been determined. The objective of this review was to analyze data on newborn stomach capacity and determine whether marble/ball models serve as accurate representations. A literature search yielded limited data, most emanating from the early 1900s. Data suggest that anatomic capacity of the newborn stomach varies with the birth weight of the infant. Physiologic capacity bears no relation to anatomic capacity of the newborn stomach but is a measure of the ability of the mother to produce milk and the newborn to ingest milk. Given the wide range of feeding volumes on days 1 and 3 and the reported 8-fold increase in average feeding volume during the same time period, it is best to acknowledge that feeding volumes like anatomic stomach capacity vary widely and do not lend well to visual representation by marble/ball models.