The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats.

This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and-given the current format-its relevance.

Systematic Review of Childhood and Adolescent Risk and Prognostic Factors for Recurrent Headaches.

Unlabelled: Little is known about childhood and adolescent risk and prognostic factors for recurrent headaches. This systematic review 1) examined longitudinal evidence about factors associated with onset and course of recurrent headaches in childhood or adolescence, using meta-analysis where possible, and 2) evaluated the quality of this evidence using a modified Grading of Recommendations Assessment, Development and Evaluation framework. Through searching electronic databases, reference lists of included studies, and an electronic mail list we identified and included 23 articles reporting 19 cohorts.

Spatial Heterogeneity of Cortical Excitability in Migraine Revealed by Multifrequency Neuromagnetic Signals.

Unlabelled: To investigate the spatial heterogeneity of cortical excitability in adolescents with migraine, magnetoencephalography (MEG) recordings at a sampling rate of 6,000 Hz were obtained from 35 adolescents with an acute migraine and 35 age- and sex-matched healthy control participants during an auditory-motor task. Neuromagnetic activation from low- to high-frequency ranges (5-1,000 Hz) was measured at sensor and source levels. The heterogeneity of cortical excitability was quantified within each functional modality (auditory vs motor) and hemispherical lateralization.

Diagnostic criteria currently proposed for "ictal epileptic headache": Perspectives on strengths, weaknesses and pitfalls.

Purpose: When we published the diagnostic criteria for "ictal epileptic headache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity.

Methods: Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria.

Conclusions: EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously.

Enigmatic entity in childhood: clival chordoma from a tertiary center's perspective.

Purpose: Chordoma is a rare neoplasm that arises from embryonic notochordal remnants along the axial skeleton (i.e., clivus, sacrum) and the vertebral bodies.

A Survey of Caregiver Perspectives on Children's Pain Management in the Emergency Department.

Objectives: We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction.

Methods: This prospective survey examined a convenience sample of 97 caregivers (n=51 PED, n=46 GED) with children aged <17 years.

The evolution of headache from childhood to adulthood: a review of the literature.

Headache is one of the most common disorders in childhood, with an estimated 75% of children reporting significant headache by the age of 15 years. Pediatric migraine is the most frequent recurrent headache disorder, occurring in up to 28% of older teenagers. Headaches rank third among the illness-related causes of school absenteeism and result in substantial psychosocial impairment among pediatric patients.

The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache.

Unlabelled: Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors of pain-related functional outcomes in youth with chronic pain. Self-efficacy is a potential resiliency factor that can mitigate the influence that pain-related fear has on outcomes in youth with chronic pain. Drawing from theoretical assertions tested among adults with chronic pain, this study aimed to determine whether pain-related self-efficacy mediates the adverse influence of pain-related fear on functional outcomes in a sample of youth with chronic headache.

Specific music therapy techniques in the treatment of primary headache disorders in adolescents: a randomized attention-placebo-controlled trial.

Unlabelled: Migraine and tension-type headache have a high prevalence in children and adolescents. In addition to common pharmacologic and nonpharmacologic interventions, music therapy has been shown to be efficient in the prophylaxis of pediatric migraine. This study aimed to assess the efficacy of specific music therapy techniques in the treatment of adolescents with primary headache (tension-type headache and migraine).

Altered cortical activation in adolescents with acute migraine: a magnetoencephalography study.

Unlabelled: To quantitatively assess cortical dysfunction in pediatric migraine, 31 adolescents with acute migraine and age- and gender-matched controls were studied using a magnetoencephalography (MEG) system at a sampling rate of 6,000 Hz. Neuromagnetic brain activation was elicited by a finger-tapping task. The spectral and spatial signatures of magnetoencephalography data in 5 to 2,884 Hz were analyzed using Morlet wavelet and beamformers.

Maternal stress and childhood migraine: a new perspective on management.

Background: Migraine without aura is a primary headache which is frequent and disabling in the developmental age group. No reports are available concerning the prevalence and impact of migraine in children on the degree of stress experienced by parents. The aim of this study was to evaluate the prevalence of maternal stress in a large pediatric sample of individuals affected by migraine without aura.

Migraine therapeutics in adolescents: a systematic analysis and historic perspectives of triptan trials in adolescents.

OBJECTIVES To conduct a systematic review and analysis of trial data submitted to the US Food and Drug Administration (FDA) to identify possible causes for the failure of pediatric trials of triptans for treatment of migraines. DATA SOURCE The FDA website for drug information and published literature. STUDY SELECTION All pediatric efficacy and pharmacokinetics trial data of drugs used for abortive treatment of migraine submitted to the FDA from January 1, 1999, through December 31, 2011.

Can headache impair intellectual abilities in children? An observational study.

Background: The purpose of this study was to assess the cognitive functioning of children affected by headache, pinpointing the differences in intelligence style between subjects affected by migraine without aura and subjects with tension-type headache.

Methods: The study population consisted of 147 children (mean age 10.82 ± 2.

Influenza and pneumococcal vaccinations for patients with chronic obstructive pulmonary disease (COPD): an evidence-based review.

Unlabelled: In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support).

A Unified, Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression.

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction.

Moyamoya: to cut or not to cut is not the only question. A paediatric neurologist's perspective.

The paediatric neurologist is usually the clinician who makes the diagnosis of moyamoya in children, yet most of the debate in the literature has focused on surgical management of the condition. Semantic confusion and variable use of the term among neuroradiologists continues to be unhelpful. Increasing recognition of moyamoya, for example in sickle cell disease, and the publication of clinical guidelines encouraging referral for surgical evaluation highlight the need to identify and engage with management of the condition.

Child and parental perspectives of multidimensional quality of life outcomes after kidney transplantation.

Kidney transplantation is an optimal therapy for pediatric patients with end-stage kidney disease. This pilot study sought to examine multidimensional QOL outcomes after kidney transplant using VAQOL and General Health, the PedsQL 4.0, PedsQL End Stage Renal Disease Module, and Impact on Family Module.

Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents.

Atomoxetine (Strattera(R)) is a selective norepinephrine (noradrenaline) reuptake inhibitor that is not classified as a stimulant, and is indicated for use in patients with attention-deficit hyperactivity disorder (ADHD). Atomoxetine is effective and generally well tolerated. It is significantly more effective than placebo and standard current therapy and does not differ significantly from or is noninferior to immediate-release methylphenidate; however, it is significantly less effective than the extended-release methylphenidate formulation OROS(R) methylphenidate (hereafter referred to as osmotically released methylphenidate) and extended-release mixed amfetamine salts.

Pseudopapilledema in a pediatric kidney transplant recipient.

IIH is a syndrome of increased intracranial pressure characterized by headache, visual disturbance, papilledema with normal cranial neuroimaging. It is associated with many factors in childhood. From the renal perspective renal insufficiency, chronic dialysis, steroid treatment, and recombinant human growth hormone have been associated with IIH.

[The relationship between headache and sleep disorders: findings from an epidemiological study in a population of Spanish school-age children].

Introduction: Headache and sleep disorders have a high impact in children, both from the point of view of prevalence and from the perspective of the quality of life of the subjects who suffer their consequences. AIM. To determine the prevalence of sleep disorders among the child population that suffers from headaches.

Basilar invagination managed with electroacupuncture and Chinese herbal medicine: the report of a rare case in a pediatric patient.

Background: A 13-year-old girl who suffered from basilar invagination managed with electroacupuncture and Chinese Herbal medicine is presented in this report. This is a rare disease. The condition was misdiagnosed by many biomedical specialists over a period of 5 years.

Agreement of parents and children on characteristics of pediatric headache, other pains, somatic symptoms, and depressive symptoms in an epidemiologic study.

Background: The objective of the present study was to assess the concordance between parent and child report regarding different domains of pediatric health, headache in particular. In addition, the influence of potential moderator variables on the agreement between parents and children was examined.

Methodology: In an epidemiologic study on a randomly drawn sample of households with at least 1 child in the family between 7 and 14 years of age (community registries), various pediatric health disturbances (headache, other pains, somatic symptoms, and depression/anxiety) were assessed via both child (from the age of 9 y on) and parent report (n=3461).

Understanding and managing children's recurrent pain in primary care: A biopsychosocial perspective.

Recurrent pains in childhood are those that occur at least three times within three months and interfere with daily activities. The most common reasons for pain are headaches and abdominal pain, and the great majority of these have no serious or treatable physical cause. Instead, a functional analysis of the antecedents and consequences of the pain for the child is needed.

Epilepsy in women: special considerations for adolescents.

Adolescence is a time of many changes. It is a time of growing independence, physical and emotional change, accompanied by social insecurity. Girls tend to enter puberty ahead of their male peers, growing and changing physically.