From The President
Volume 26, Issue 2, Spring 2016Evelyn Johnson, MD, FAAP, Presidentwww.GAaap.orgGeorgia ChapterAmerican Academy of PediatricsFrom the PresidentHappy Spring to All!!Well it is supposed to be Spring. The AAP annual LegislativeConference is in the Spring in Washington, DC. But it was literally freezing with the wind chill there. So “walking up to theHill” was a bit of a challenge. I love the Georgia AAP and allthe challenges and success that await us in this lovely state, buthaving the chance to represent our members and state at nationalevents is really exciting. Without the opportunity to compareyour situation to your colleagues in other states, you simply missout on appreciating the great things that are happening here andthe future opportunities available to us.Without the opportunity to compare yoursituation to your colleagues in other states,you simply miss out on appreciating the greatthings that are happening here and the futureopportunities available to us.First, it has been fantastic to pat ourselves on the back after sucha successful state legislative session, but it was even sweeter todescribe this experience to my colleagues across the US. We allworked exceptionally hard during the last session and continuedthat through this year with the oversight of our fearless leaderRick Ward, and Betsy Bates, our lobbyist. We found the niche—business model—that allowed us to grab the attention of ourlegislators and convince them how crucial keeping Georgia’skids well would be inevitably a monetary savings in the long runfor the state. Keeping kids insured and adequately compensatingphysician practices allows kids to stay well and keeps them outof ED. It seemed like such a simple message, but the approachwas so important. Thank you to each of you who contacted yourlegislators and let’s keep the communication open with themthroughout the year. An invitation to visit your office will givethem an even clearer picture of what we do.The AAP Annual Leadership Forum (ALF) in Elk Grove, Illinoisin March was another powerful meeting of pediatricians—bothgeneral and subspecialists, and chapter executive directors. Thechapters are so diverse in their structure, yet our goals are thesame: to provide the best care, every time for every child. Somehave staffs of 1, some of 4-5 and some have staffs of 20. Thisyear we were nominated for an award in the Very Large Chaptercategory, and it ended up being a very, very tight race betweenour chapter and Texas. While we aresure we faced a major challenge withMedicaid parity in 2015, Texas faceda heart-wrenching challenge with the“internment” of unaccompanied minors, and moms/children in their state.We thought we had it rough taking onthe state, but taking on the federalgovernment—well, I have to tip myhat to that effort and so their outcomeas winner in the Very Large Chaptercategory. ALF as you recall gives us(every pediatrician) the opportunity toEvelyn Johnson MD, FAAPaddress a policy that we feel needsPresidentupdating (or initially addressed) on anational level. The amount of time that goes into reviewing allthe submissions and staying within parliamentary standards istruly a herculean activity. We were well represented, from thenumber of resolutions submitted, to “scoring” of the resolutions,to our own Bob Wiskind serving as parliamentarian and keepingus civil.And on my second trip to the annual Legislative Conference inDC this year, I was again to experience the passion of our colleagues as we trek into the “not always friendly” political arena.This 2 ½ day training provides invaluable insight and directioninto the world of Congress. Last year we were assigned the taskInside this issue . School Based Health Centers, p. 4Food May Be Making Your Patients& You Sick, p. 6Right-sizing Pediatric Care, p. 7Survey of Pediatricians on ChildAbuse, p. 9Breastfeeding Matters: The Role ofthe Pediatrician, p. 14And more.
The Georgia Pediatrician is the newsletter of theGeorgia Chapter/American Academy of PediatricsEditor: Alice Little Caldwell, MDEmail: acaldwel@augusta.edu1330 West Peachtree St. NW, Suite 500Atlanta, GA 30309-2904Phone 404-881-5020 Fax 404-249-9503 www.GAaap.orgBOARD OF DIRECTORSPresidentEvelyn Johnson, MD, BrunswickVice PresidentBen Spitalnick, MD, SavannahSecretaryKim Megow, MD, ValdostaTreasurerMinor Vernon, MD, MaconPast PresidentRobert Wiskind, MD, AtlantaHonorary PresidentsRandy Barfield, MD, AtlantaEdward Conner, MD, MaconExecutive DirectorRichard W. Ward, CAEDISTRICT REPRESENTATIVESDistrict IDistrict IIDistrict IIIDistrict IVDistrict VDistrict VIDistrict VIIDistrict VIIIDistrict IXDistrict XDistrict XIDistrict XIIDistrict XIIIDistrict XIVDistrict XVDistrict XVIRobersteen Howard, MD, RomeMelissa Boekhaus MD, MabletonHugo Scornik, MD, ConyersCedric Miller, MD, AtlantaJudson Miller, MD, AtlantaJeff Lewis, MD, AtlantaLynette Wilson-Phillips MD,ClarkstonKimberly Stroud, MD, ToccoaKim Blevens, MD, Warner RobinsCharles Scarborough, MD, AugustaW. Steen James, MD, PeachtreeCityApril Hartman, MD , ColumbusDixie Griffin, MD, TiftonMichelle Zeanah, MD, StatesboroIvette Rico, MD, SavannahDavid Sprayberry, MD, BishopJamie Rollins, MD, CantonTania Smith, MD, AlbanyMEDICAL SCHOOL DEPT. CHAIRSLucky Jain, MD, EmoryCharles Linder, MD, Medical College of GeorgiaAnthony Pearson-Shaver, MD, Mercer/MaconYasmin Tyler-Hill, MD, MorehouseEric Pearlman, MD, Mercer/SavannahFrom the President.ContinuedPublic Health News & Chapter Updatesof lobbying for reauthorization of CHIP, and I cannot express in words howgreat it felt when as we were parting back to our homes, Congress was actuallyvoting on that important program and it indeed passed. Most recently anothertopic we were challenged with at the 2015 training, was regulation of ecigarette refill packaging, and hearing that too passed recently is truly special.This year the ask involves the Reauthorization of the Child Nutrition Act. Asyou may recall this funding covers WIC, as well as summer meal programs forkids, and free breakfast and lunches. The Senate has already passed out of theAgriculture Committee unanimously a bipartisan bill: The Improving ChildNutrition Integrity and Access of 2016. This was not the AAP’s initial forayinto this large budget item, as Dr. Sandy Hassnick had been involved closely intestifying to the committee. Our “ask” today for the Senators was to pass thisbipartisan bill, and to the Congressmen, to build on and improve on the keypoints that the Senate had included in their bill. Fortunately, our Senators’ andCongressmen staffers were well versed in the topics and our task was not oneof convincing them of the positives, but offering personal experiences that il-Pointers on HPV Vaccinefor Pediatric PracticesI hope those who are involved on our QI Projects areenjoying the experience, and your practice is seeing thebenefits.lustrated the positive benefits of these programs for our kids, and pregnantmoms. Hearing the experiences that some of the state delegations had wasastonishing. I am happy to report that our pediatric colleagues from across thecountry stood their ground and I do believe there are staffers and hopefullymembers of Congress who tonight have a clearer understanding of how theseprograms keep our kids healthy from the start and keep them healthy and functioning well in school, and ultimately deliver them as healthy adults with lesschronic disease that erodes our economic systemBack on the local front, we are into all the QI projects now. I hope those whoare involved on our QI Projects are enjoying the experience, and your practiceis seeing the benefits. We have a number of webinars coming up this springand summer: Georgia Newborn Screening Updates, Public Health Update onthe Reporting of Neonatal Abstinence Syndrome, Developmental and AutismScreening, Georgia’s Minor’s Rights to Reproductive and Behavioral HealthService and more!. You can check out dates/times on our website. And ofcourse, Peds by the Sea is right around the corner on June 8-11. If you haven’talready, make your reservations soon as hotels are filling up.Oh, and don’t forget to get outside and enjoy--whether it’s relaxing or exercising. Your choice, just have fun!! Peace.Evelyn Johnson, MD, FAAPChapter PresidentBrunswickRESIDENT REPRESENTATIVESAbbas Zaidi, MD, EmoryScott Darby, MD, Medical College of GeorgiaAnastacia Lambrou, MD and Adjowa Walker, MD,Mercer/MaconRoxanne Samuels, MD, MorehouseAmber Teague, MD, Mercer/SavannahPAGE 2VOLUME 26, ISSUE 2, SPRING 2016There are safe and effective vaccinesrecommended by the Centers for DiseaseControl and Prevention (CDC) and theAmerican Academy of Pediatrics (AAP)to protect against certain strains of Human Papillomavirus (HPV) that causecancers in males and females, as well asgenital warts. Right now across the nation, almost half of our youth is protected through vaccination, but we cando better. Most parents who hear aboutthe opportunity to prevent HPV infectionand cancers want their children protected. Chances are that parents in yourpractice want this level of care, too.almost half of our youth isprotected through vaccination, but we can do better.Pediatric office staff have the opportunity to help prevent cancer. Here aresome steps you may want to pass on tothem:Understand Why Its ImportantEvery year in the United States, 27,000people still get cancer caused by HPV.That's one person every 20 minutes ofevery day, all year long. HPV causes cancers of the mouth orthroat and anus in men and women, aswell as cancer of the penis in men ANDcancers of the cervix, vagina, and vulvain women. There are many more pre-cancers ofthe cervix requiring treatment that canhave lasting effects on a woman's fertility.HPV is so common that almost everyonewill be infected at some point. We have no way of knowing whowill go on to get cancers caused by HPVonce they are infected. Most people infected with HPV willnever know they are infected. Even if someone waits until marriage to have sex, or only has one partnerin their entire life, they could still beexposed if their partner has been exposed.The HPV vaccine is effective! It prevents infection with the most commonVOLUME 25, ISSUE 2, SPRING 2016and aggressive HPV types that causecancers.Make a Strong RecommendationBundle the adolescent vaccines and givea strong recommendation for boys andgirls age 11-12. This is as simple as saying (while handing them the VIS); Today your child needs 3 vaccines;HPV, Tdap, HPV and Meningococcal. Do you have any questions for thedoctor?Or Today your child is due for 3 vaccines. They're designed to protect yourchild from the cancers caused by HPVand from meningitis, tetanus, diphtheria,& pertussis. Do you have any questionsfor the doctor?Adolescents may not want to get threevaccines in one visit, but we know patients this age don't come to the officethat often, so giving the 3 vaccines inone visit is the best way to make surethey are protected.Giving three vaccines at one visit is safeand the protection we are offering adolescents is important and can save lives.Finish the 3-Dose SeriesStarting the series is an important step,but three shots are required for full protection. So before the patient leaves theoffice after HPV vaccination #1, makesure to set appointments for doses 2 &3.Make sure that systems are in place toremind patients of their vaccine appointments.If a patient misses an appointment, asystem to flag and recall patients is important.(Original article published on the American Academy of Pediatrics webpage)EPIC Immunization Program is ready to scheduleyour 2016 Program!The EPIC Immunization program isoff to a great start this year. The 2016curriculums are updated with the 2016immunization schedule, new immunization data and great tools and resourcesfor your practice. EPIC Immunizationoffers six curriculums to meet your staffeducation needs: Childhood, Adult,Combo, Women’s Health, School, andCoding for Childhood Immunizations(GA Chapter AAP Members Only).EPIC is a physician led; peer-to peerimmunization education program designed to be presented in the private physician office and involves the participation of the complete medical team(provider, nurse, medical assistant, officemanager, etc.). The program is free, offers CME and contact hours for participating physicians and nurses, and provides a valuable resource box filled withuseful immunization tools for your office.Start planning to have your in-officeEPIC Immunization Program. We arescheduling programs for 2016 NOW!Visit the GA EPIC website (gaepic.org)or EPIC Facebook page (Educating Physicians in their Communities) to receiveup-to-date information or resources. ForThe program is free, offersCME and contact hours forparticipating physicians andnurses, and provides a valuable resource box filled withuseful immunization toolsfor your office.more information or to request an EPICprogram, contact the EPIC staff: JannaMcWilson, MSN, RN, Program Directorat 404-881-5081 or Shanrita McClain,Program Coordinator at 404- 881-5054.Five Hospitals Now “BabyFriendly”Georgia has five Baby Friendly Hospitals and many others are working towardthat goal. One criterion to becomingBaby Friendly is to, “Foster the establishment of breastfeeding support groupsand refer mothers to them on dischargefrom the hospital or clinic”. This is notalways an easy task since hospital staffmay not be aware of all the breastfeedingservices in their community. Finding(Continued on page 4)PAGE 3
Public Health News & Chapter Updatesservices such as WIC, support groups, breastfeeding classes, andprivate lactation assistance has just gotten easier with ZIPMilk.ZIPMilk now has over 300 listings of physicians, lactation consultants, support groups, etc. for families looking for breastfeeding assistance and information. If you would like to list yourselfas a breastfeeding supportive physician just go to the website,www.ZIPMilk.org. Start referring your moms to this site today.Schedule a EPIC Breastfeeding Program for your practice today!The EPIC Breastfeeding Education Program is ready to visit yourpractice. If you haven’t had a program recently please contactArlene Toole, atoole@gaaap.org to request a program or go toour website www.gaepic.org to download an EPIC program request form. Remember our programs are free!Plans are on underway to begin a pilot toscreening all infants born in Georgia forPompe and MPS1 early this summer.from fighting off routine infections. Because their immune system is not functioning properly, children with SCID usually dieby the age of two from infections without prompt treatment.Screening for SCID can also detect other conditions associatedwith low T cells. If diagnostic testing is requested, parents andhealth care providers are asked to take certain precautionarymeasures such as avoiding administration of live vaccines - norotavirus vaccine, avoid daycare or contact with any source ofinfection, use only leuko-depleted, irradiated, CMV negativeblood products if transfusions are needed.Cystic Fibrosis Testing: A national backlog currently exists forthe cystic fibrosis (CF) mutation analysis kit after a voluntaryrecall of all kits was made due to a manufacturing defect by thevendor. The Georgia Public Health Laboratory (GPHL) has notbeen able to perform the CF mutation analysis on specimens withelevated levels of the primary marker (immuno-reactive trypsinogen, IRT) since April 1st. The GPHL is working with DPH toconduct repeat screenings on infants screened with the affectedkits and will announce when testing will resume. We will continue to keep you updated on this issue.Georgia WIC NewsNewborn Screening UpdateThe Georgia AAP has been tracking several Georgia Departmentof Public Health (DPH) issues related to newborn screening. Thefollowing is a summary of these issues. If you have any questions, please contact Fozia Khan Eskew at the Georgia AAP viaemail at feskew@gaaap.org or via phone at 404-881-5074.Pompe & MPS1: Plans are on underway to begin a pilot toscreening all infants born in Georgia for Pompe and MPS1 earlythis summer. Pompe and MPS I are both progressive, inheritedlysosomal storage disorders. Although there is no cure for theconditions, monitoring and treatments are available. Pompe disease is a disorder of glycogen storage. Infants who are affectedcan have enlarged hearts and profound muscle weakness progressing to death if untreated. MPS I is a multisystem disorderwith variable presentations including an early onset neurodegenerative form. MPS I symptoms may include developmental delay, coarse features, skeletal anomalies, recurrent infections, andorganomegaly. Results will NOT appear on the newborn screenreport as this is a pilot project. If the results are normal, notification will not be sent. If the results are abnormal, Emory NewbornScreening Follow-Up Program will fax a letter notifying you ofthe results, and we will call the provider listed on the NBS card.The Georgia AAP continues its long partnership with the GeorgiaWomen, Infants & Children Nutrition Program. This year ourwork involves providing medical expertise and consultation onWIC policies for children on special formulas, creation of an additional prescribing algorithm for children age (1 and older), andenhancing relationships with practices and hospitals by providingoutreach visits. Thank you to our members for your continuousfeedback on helping improve collaboration between pediatricpractices and WIC. Your feedback is always appreciated andnecessary for this partnership.Need a WIC workshop in your practice?Do you have questions about WIC? We are currently providingWIC workshops to practices and hospitals in the metro Atlantaarea. If you are interested in receiving an update on WIC policiesin your practice, please contact Kylia Crane, RD, LD to schedulea workshop at kcrane@gaaap.org or 404-881-5093.The School Based Health Center (SBHC) is a model of healthcare delivery that has been recognized as an effective means ofproviding quality healthcare for children that can significantlyreduce barriers to health care for those living in poor communities.1-3 SBHCs offer increased access to quality care for students by eliminating barriers such as cost, transportation, andhours of operation, and the lack of knowledge around how tomanage one’s health and when to access care. In addition,SBHCs provide a sense of security to parents who rest assuredin the knowledge that their child’s health care is covered at noSince school is where children spend a largemajority of their time daily, the SBHC offersan opportunity for pediatricians to extendthemselves beyond the boundaries of theiroffices and transform their approach to provide care.or low cost; to school leaders who recognize that prompt attention to student illness means a faster return to the classroomand thus improved academic performance; and to employerswho appreciate that employee productivity is affected whenDiathrix AdIt’s hard to treatwhat you can’t see.Diatherix’s Gastrointestinal Panelidentifies up to 13 pathogens –all from a single swab!Assists in improving core measuresStrengthens community health initiativesLowers costs per patient dayReduces LOS and ISO daysEnhances antimicrobial stewardshipDecreases readmission penaltiesSCID: Plans to screen for Severe Combined Immunodeficiency(SCID) should be implemented by mid to late April 2016. Duringthe pilot phase of screening, results will not appear on the NBSreport. The Emory Newborn Screening Follow-Up Program willfax a letter notifying you and call the provider listed on the NBScard regarding screening if screening results require further investigation. SCID is an inherited condition that prevents childrenPAGE 4School-Based Health Centers: Key Concepts& Status in Georgia866.979.4242 / www.diatherix.com 2016 Diatherix Laboratories, LLC. All rights reserved. 022616VOLUME 26, ISSUE 2, SPRING 2016VOLUME 25, ISSUE 2, SPRING 2016they are unable to attend to their sick children
Understand Why Its Important Every year in the United States, 27,000 people still get cancer caused by HPV. That's one person every 20 minutes of every day, all year long. HPV causes cancers of the mouth or throat and anus in men and women, as well as cancer of the penis in men AND cancers of the cervix, vagina, and vulva in women.
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
