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  1. Article: Role of Participation of Pediatricians in the "Activated Autism Practice" Program in Practicing Children With Autism Spectrum Disorders at the Primary Care Setting.

    Kairys, Steven W / Petrova, Anna

    Global pediatric health

    2016  Volume 3, Page(s) 2333794X16663544

    Abstract: Primary care of children with autism spectrum disorders (ASD) is an important public health concerns. In this survey study of 73 pediatricians, we determined whether pediatricians' practice of autism screening and perception of management of ASD is ... ...

    Abstract Primary care of children with autism spectrum disorders (ASD) is an important public health concerns. In this survey study of 73 pediatricians, we determined whether pediatricians' practice of autism screening and perception of management of ASD is associated with participation in a learning collaborative, "Activated Autism Practice". Overall, the majority recognized the lack of care coordination, inadequate time, poor reimbursement, and language difference as barriers to the delivery of medical care to children with ASD. Pediatricians with prior training were more likely to report use of autism-specific screening and understanding the different aspects of ASD management including the need to coordinate special services and long-term surveillance at pediatric sites. Therefore, participation in "Activated Autism Practice" may facilitate use of ASD-specific screening and manage ASD cases as a complex of neurodevelopmental/underlying problems with the need for enhancement of clinical attention and coordination of medical care at the pediatric primary care level.
    Language English
    Publishing date 2016-08-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2785531-4
    ISSN 2333-794X ; 2333-794X
    ISSN (online) 2333-794X
    ISSN 2333-794X
    DOI 10.1177/2333794X16663544
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  2. Article ; Online: Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE.

    Rinke, Michael L / Singh, Hardeep / Brady, Tammy M / Heo, Moonseong / Kairys, Steven W / Orringer, Kelly / Dadlez, Nina M / Bundy, David G

    Pediatric quality & safety

    2019  Volume 4, Issue 5, Page(s) e187

    Abstract: Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care.: Methods: ... ...

    Abstract Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care.
    Methods: During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented.
    Results: We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%).
    Conclusions: Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.
    Language English
    Publishing date 2019-09-30
    Publishing country United States
    Document type Journal Article
    ISSN 2472-0054
    ISSN (online) 2472-0054
    DOI 10.1097/pq9.0000000000000187
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  3. Article: Kawasaki disease following Rocky Mountain spotted fever: a case report.

    Bal, Aswine K / Kairys, Steven W

    Journal of medical case reports

    2009  Volume 3, Page(s) 7320

    Abstract: Introduction: Kawasaki disease is an idiopathic acute systemic vasculitis of childhood. Although it simulates the clinical features of many infectious diseases, an infectious etiology has not been established. This is the first reported case of Kawasaki ...

    Abstract Introduction: Kawasaki disease is an idiopathic acute systemic vasculitis of childhood. Although it simulates the clinical features of many infectious diseases, an infectious etiology has not been established. This is the first reported case of Kawasaki disease following Rocky Mountain spotted fever.
    Case presentation: We report the case of a 4-year-old girl who presented with fever and petechial rash. Serology confirmed Rocky Mountain spotted fever. While being treated with intravenous doxycycline, she developed swelling of her hands and feet. She had the clinical features of Kawasaki disease which resolved after therapy with intravenous immune globulin (IVIG) and aspirin.
    Conclusion: This case report suggests that Kawasaki disease can occur concurrently or immediately after a rickettsial illness such as Rocky Mountain spotted fever, hypothesizing an antigen-driven immune response to a rickettsial antigen.
    Language English
    Publishing date 2009-07-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2269805-X
    ISSN 1752-1947
    ISSN 1752-1947
    DOI 10.4076/1752-1947-3-7320
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  4. Article ; Online: Kawasaki disease following Rocky Mountain spotted fever

    Bal Aswine K / Kairys Steven W

    Journal of Medical Case Reports, Vol 3, Iss 1, p

    a case report

    2009  Volume 7320

    Abstract: Abstract Introduction Kawasaki disease is an idiopathic acute systemic vasculitis of childhood. Although it simulates the clinical features of many infectious diseases, an infectious etiology has not been established. This is the first reported case of ... ...

    Abstract Abstract Introduction Kawasaki disease is an idiopathic acute systemic vasculitis of childhood. Although it simulates the clinical features of many infectious diseases, an infectious etiology has not been established. This is the first reported case of Kawasaki disease following Rocky Mountain spotted fever. Case presentation We report the case of a 4-year-old girl who presented with fever and petechial rash. Serology confirmed Rocky Mountain spotted fever. While being treated with intravenous doxycycline, she developed swelling of her hands and feet. She had the clinical features of Kawasaki disease which resolved after therapy with intravenous immune globulin (IVIG) and aspirin. Conclusion This case report suggests that Kawasaki disease can occur concurrently or immediately after a rickettsial illness such as Rocky Mountain spotted fever, hypothesizing an antigen-driven immune response to a rickettsial antigen.
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2009-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: The psychological maltreatment of children--technical report.

    Kairys, Steven W / Johnson, Charles F

    Pediatrics

    2002  Volume 109, Issue 4, Page(s) e68

    Abstract: Psychological maltreatment is a common consequence of physical and sexual abuse but also may occur as a distinct entity. Until recently, there has been controversy regarding the definition and consequences of psychological maltreatment. Sufficient ... ...

    Abstract Psychological maltreatment is a common consequence of physical and sexual abuse but also may occur as a distinct entity. Until recently, there has been controversy regarding the definition and consequences of psychological maltreatment. Sufficient research and consensus now exist about the incidence, definition, risk factors, and consequences of psychological maltreatment to bring this form of child maltreatment to the attention of pediatricians. This technical report provides practicing pediatricians with definitions and risk factors for psychological maltreatment and details how pediatricians can prevent, recognize, and report psychological maltreatment. Contemporary references and resources are provided for pediatricians and parents
    MeSH term(s) Authoritarianism ; Child ; Child Abuse/psychology ; Child Abuse/therapy ; Child Abuse, Sexual/psychology ; Child Abuse, Sexual/therapy ; Education/methods ; Humans ; Psychology, Child/methods ; Self Concept ; Treatment Failure ; Treatment Outcome
    Language English
    Publishing date 2002-04-01
    Publishing country United States
    Document type Guideline ; Journal Article ; Practice Guideline
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.109.4.e68
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  6. Article: Expanding the pediatrician's black bag: a psychosocial care improvement model to address the "new morbidities".

    Abatemarco, Diane J / Kairys, Steven W / Gubernick, Ruth S / Kairys, Jo Ann

    Joint Commission journal on quality and patient safety

    2008  Volume 34, Issue 2, Page(s) 106–115

    Abstract: Background: Behavioral, developmental, and psychosocial problems ("new morbidities") significantly affect the well-being of children ages 0-3 years. Practices generally fail to deliver consistent anticipatory guidance or counseling to parents. A ... ...

    Abstract Background: Behavioral, developmental, and psychosocial problems ("new morbidities") significantly affect the well-being of children ages 0-3 years. Practices generally fail to deliver consistent anticipatory guidance or counseling to parents. A multifaceted intervention was designed to increase the capacity of three very different practice types to adopt and implement Practicing Safety, a child abuse and neglect prevention program.
    Methods: Using a feasibility intervention study, a combination of organizational change approaches, including complexity science principles--self-organization, emergence, and co-evolution--were tested. The multimethod assessment process (MAP) was employed to understand the unique characteristics of each practice that could impede or promote innovation. Findings guided a facilitated, team-based change intervention, the Reflective Adaptive Process (RAP) to restructure psychosocial care.
    Findings: Each practice demonstrated fundamental changes in decision making, developmental assessment, and parent education processes. Practicing Safety tools were adopted and incorporated into daily routines. RAP team members exhibited new patterns of communication and relationships that supported organizationwide preventive service innovations.
    Discussion: The MAP and RAP interventions enabled study practices to integrate novel methods for prevention of child abuse and neglect into daily routines.
    MeSH term(s) Child ; Child Abuse/prevention & control ; Child Abuse/psychology ; Child, Preschool ; Feasibility Studies ; Humans ; Infant ; Infant, Newborn ; Models, Organizational ; Parent-Child Relations ; Pediatrics ; Physicians' Offices/organization & administration ; Primary Health Care ; Psychology
    Language English
    Publishing date 2008-01-31
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1189890-2
    ISSN 1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
    ISSN (online) 1938-131X ; 1549-425X
    ISSN 1553-7250 ; 1070-3241 ; 1549-3741
    DOI 10.1016/s1553-7250(08)34013-6
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  7. Article: Using a registry to improve immunization delivery.

    Kairys, Steven W / Gubernick, Ruth S / Millican, Adrienne / Adams, William G

    Pediatric annals

    2006  Volume 35, Issue 7, Page(s) 500–506

    Abstract: The NJIPSP was successful in encouraging a group of small urban practices to adopt the use of immunization registry and to transform immunization delivery from a mechanistic well-child service to a visible, monitored process of care. The project ... ...

    Abstract The NJIPSP was successful in encouraging a group of small urban practices to adopt the use of immunization registry and to transform immunization delivery from a mechanistic well-child service to a visible, monitored process of care. The project represents a unique combination of technology, public-private collaboration, and well-established quality improvement techniques. The change process involved the whole office as a team in adopting new immunization delivery roles and services. The greatest barrier to acceptance of the registry was (and continues to be) the need for manual data entry as the primary source of data collection, rather than electronic data transfer from other systems. The manual entry of data was labor intensive for participating practices and affected data measurement. Despite this barrier, however, the majority of practices substantially improved the quality of their immunization delivery practices in multiple areas. The rapid movement of primary care practices toward some form of electronic record may reduce this barrier and increase the percentage of practices willing to use a community registry. Practices that engaged collectively in the change process gained momentum from the group effort. Equally important was the public health partnership that helped identify and reduce improvement obstacles. Sustainability of practice-based immunization changes will rely, in part, on the registry's ease of use and the continued visibility of public health at the practice level. Active practice level collaboration by public health adds great value to change efforts. We believe that the best possible immunization delivery relies on both technology (registries and the EMR) and effective office systems. Projects like the NJIPSP are models for systems that integrate technology, practice change, and quality improvement, and their success has the potential to foster the spread of this approach to other primary care practices (especially in New Jersey). The NJIPSP combination of office-based change approaches and an active partnership and hands on involvement with public health has the potential to support the delivery of consistently excellent immunization delivery.
    MeSH term(s) Child, Preschool ; Health Promotion/organization & administration ; Humans ; Immunization/statistics & numerical data ; Infant ; New Jersey ; Registries ; United States
    Language English
    Publishing date 2006-07-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 195430-1
    ISSN 0090-4481
    ISSN 0090-4481
    DOI 10.3928/0090-4481-20060701-06
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    Zs.A 1347: Show issues Location:
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  8. Article ; Online: Diagnostic Errors in Primary Care Pediatrics: Project RedDE.

    Rinke, Michael L / Singh, Hardeep / Heo, Moonseong / Adelman, Jason S / O'Donnell, Heather C / Choi, Steven J / Norton, Amanda / Stein, Ruth E K / Brady, Tammy M / Lehmann, Christoph U / Kairys, Steven W / Rice-Conboy, Elizabeth / Thiessen, Keri / Bundy, David G

    Academic pediatrics

    2017  Volume 18, Issue 2, Page(s) 220–227

    Abstract: Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, ...

    Abstract Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics.
    Methods: As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models.
    Results: DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values.
    Conclusions: DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.
    MeSH term(s) Anemia/diagnosis ; Child ; Child, Preschool ; Chlamydia Infections/diagnosis ; Clinical Laboratory Techniques/statistics & numerical data ; Depression/diagnosis ; Diagnostic Errors/statistics & numerical data ; Female ; Gonorrhea/diagnosis ; HIV Infections/diagnosis ; Humans ; Hypertension/diagnosis ; Lead/blood ; Logistic Models ; Male ; Mass Screening/statistics & numerical data ; Pediatrics ; Pharyngitis/diagnosis ; Prehypertension/diagnosis ; Primary Health Care ; Quality Improvement ; Streptococcal Infections/diagnosis ; Syphilis/diagnosis ; Thyrotropin/blood
    Chemical Substances Lead (2P299V784P) ; Thyrotropin (9002-71-5)
    Language English
    Publishing date 2017-08-10
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2483385-X
    ISSN 1876-2867 ; 1876-2859
    ISSN (online) 1876-2867
    ISSN 1876-2859
    DOI 10.1016/j.acap.2017.08.005
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