Introductory address for the American Pediatric Society's 2015 John Howland Award Recipient, Catherine D. DeAngelis.

Presented by Julia A. McMillan, MD, Professor of Pediatrics, Executive Vice Chair, Department of Pediatrics, and Associate Dean for Graduate Medical Education, Johns Hopkins University School of Medicine, at the 2015 Annual Meeting of the Pediatric Academic Societies, San Diego, CA.

The promise and challenges of next-generation genome sequencing for clinical care.

With increased speed and decreased costs, next-generation gene sequencing has the potential to improve medical care by making possible widespread evaluation of patients' genomes in clinical settings. The entire genome of an individual can now be sequenced in less than 1 week at a cost of $5000 to $10,000; the cost will continue to decline. Analyses based on next-generation sequencing include whole-genome sequencing and whole-exome sequencing; DNA sequences that encode proteins are collectively known as the exome.

Title VII and the development and promotion of national initiatives in training primary care clinicians in the United States.

The Title VII, Section 747 (Title VII) legislation, which authorizes the Training in Primary Care Medicine and Dentistry grant program, provides statutory authority to the Health Resources and Services Administration (HRSA) to award contracts and cooperative agreements aimed at enhancing the quality of primary care training in the United States.More than 35 contracts and cooperative agreements have been issued by HRSA with Title VII federal funds, most often to national organizations promoting the training of physician assistants and medical students and representing the primary care disciplines of family medicine, general internal medicine, and general pediatrics. These activities have influenced generalist medicine through three mechanisms: (1) building collaboration among the primary care disciplines and between primary care and specialty medicine, (2) strengthening primary care generally through national initiatives designed to develop and implement new models of primary care training, and (3) enhancing the quality of primary care training in specific disease areas determined to be of national importance.

Computer-based documentation: effects on parent-provider communication during pediatric health maintenance encounters.

Objective: The goal was to investigate the impact of a computer-based documentation tool on parent-health care provider communication during a pediatric health maintenance encounter.

Methods: We used a quasiexperimental study design to compare communication dynamics between clinicians and parents/children in health maintenance visits before and after implementation of the ClicTate system. Before ClicTate use, paper forms were used to create visit notes.

Pediatric patients with sickle cell disease: use of complementary and alternative therapies.

Objective: Despite clinical advances, sickle cell disease (SCD) remains a difficult, chronic medical condition for many children and youth. Additional treatment strategies, including complementary and alternative medicine (CAM) therapies, would be welcome to enhance the clinical care of SCD patients. This study's objective was to identify CAM therapies that are currently used by families for children with SCD, and to investigate SCD families' interest in CAM.

Computer-based documentation: effect on parent and physician satisfaction during a pediatric health maintenance encounter.

Objective: To investigate the impact of a computer-based documentation (CBD) tool on parent and physician satisfaction with a pediatric health maintenance encounter.

Design: The project used a preintervention and postintervention design. The preintervention group visits used paper-based forms for data entry, whereas the postintervention visits used CBD.

Parent-pediatrician communication about complementary and alternative medicine use for children.

Anonymous self-report surveys of a convenience sample of caregivers accompanying children to the pediatrician for acute or well visits at 4 pediatric practices in the Washington, DC area from July through November 1998 were evaluated. Three hundred seventy-eight (85%) of 443 caregivers approached participated. The 348 surveys completed by parents (92%) were analyzed.

The APA/HRSA Faculty Development Scholars Program: introduction to the supplement.

Background: The purpose of this project was to improve pediatric primary care medical education by providing faculty development for full-time and community-based faculty who teach general pediatrics to medical students and/or residents in ambulatory pediatric community-based settings. Funding for the program came through an interagency agreement with the Health Resources and Services Administration (HRSA) and the Agency for Healthcare Research and Quality (AHRQ).

Methods: A train-the-trainer model was used to train 112 scholars who could teach skills to general pediatric faculty across the nation.

Overview of the educational scholarship track.

The educational scholarship track represented 1 of 3 tracks of the Ambulatory Pediatric Association/Health Resources and Services Administration faculty development initiative. Two cohorts of participants (N = 38), selected via a peer-review process, took part in a series of three 2-day workshops presented over an 18-month period designed to assist experienced pediatric faculty in becoming more proficient educators. The program was developed through an iterative needs assessment process and consisted of 7 major areas of study and skill development: principles of adult learning; teaching skills; feedback and evaluation; the workshop as a teaching and faculty development tool; curriculum development, implementation, and evaluation; research in medical education; and scholarship and promotion.

Evaluation activities to strengthen an injury prevention resource center for urban families.

The Johns Hopkins Children's Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center's priority population. This article describes the CSC's development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents' safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services.

Genetics in primary care: a USA faculty development initiative.

The Genetics in Primary Care (GPC) project is a USA national faculty development initiative with the goal of enhancing the training of medical students and primary care residents by developing primary care faculty expertise in genetics. Educational strategies were developed for the project by an executive committee with input from an advisory committee, comprising individuals with primary care, medical education and genetics expertise. These committees identified the key issues in genetics education for primary care as (1) considering inherited disease in the differential diagnosis of common disorders; (2) using appropriate counseling strategies for genetic testing and diagnosis, and (3) understanding the implications of a genetic diagnosis for family members.

Longitudinal care improves disclosure of psychosocial information.

Background: While longitudinal primary care is thought to promote patient rapport and trust, it is not known if longitudinality helps overcome barriers to communication that may occur when the patient and physician are of different ethnicities and/or sexes.

Objective: To examine if longitudinal pediatric care ameliorates disparities in parent disclosure of psychosocial information associated with ethnic and gender discordance between parent and physician.

Design: Longitudinal, observational study of parent-physician interaction at early visits and over the course of 1 year.

Does a clinical pathway improve the quality of care for sickle cell anemia?

Background: Clinical pathways are often implemented to improve care, yet their effect on quality of care and outcomes is often not evaluated. The Johns Hopkins Children's Center instituted a clinical pathway in early 1996 to improve the care for pediatric sickle cell vaso-occlusive crisis (VOC) and used a retrospective before-after study to describe how quality of care and outcomes changed after introduction of the pathway.

Results: Physicians used the pathway in 43% of eligible admissions, with use decreasing over time.

How delinquent youths acquire guns: initial versus most recent gun acquisitions.

Background: Access to firearms among delinquent youths poses significant risks to community safety. The purpose of the study was to describe how a group of criminally involved youths obtained guns.

Methods: Youths were randomly selected from a juvenile justice facility to participate in a semistructured, anonymous interview.

Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial.

Objective: To present the results of an intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home visits, and an on-site children's safety center where parents receive personalized education and can purchase reduced-cost products.

Design: Pediatricians were randomized to a standard- or an enhanced-intervention group. Parents of their patients were enrolled when the patient was 6 months or younger and observed until 12 to 18 months of age.