New Treatments for Asthma
Asthma is a complex, heterogeneous chronic airway disease with high prevalence of uncontrolled disease. New therapies, including biologics, are now available to treat T2 high asthma. Treatment of T2 low asthma remains a challenge. Asthma guidelines need be to updated to incorporate new therapeutics. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Jenny Huang, Milind Pansare Source Type: research

Newborn Screening for Severe Combined Immunodeficiency
The T-cell receptor excision circle (TREC) assay is an effective screening tool for severe combined immunodeficiency (SCID). The TREC assay was designed to detect typical SCID and leaky SCID, but any condition causing low na ïve T-cell counts will also be detected. Newborn screening for SCID using the TREC assay has proven itself to be highly sensitive and cost-efficient. This review covers the history of SCID newborn screening, elaborates on the SCID subtypes and TREC assay limitations, and discusses diagnostic and ma nagement considerations for infants with a positive screen. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Mohammed Taki, Tayaba Miah, Elizabeth Secord Source Type: research

New Insights and Treatments in Atopic Dermatitis
Atopic dermatitis is a complex, chronic inflammatory skin disorder with significant morbidity. It is often a frustrating condition for both children and parents due to chronic and relapsing course. There is now an increasing understanding of the disease pathogenesis resulting in discovery of much wanted newer therapeutics and targeted therapies after a long time. Whether these interventions will result in sustained benefits or long term cure remains to be seen. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Shweta Saini, Milind Pansare Source Type: research

Humoral Immune Deficiencies of Childhood
This article reviews, in a case-based discussion, the most common of the humoral immune deficiencies; their presentations, diagnoses, treatments; and, when known, the genetic defects. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Marwa El-Bohy, Pavadee Poowuttikul, Elizabeth Secord Source Type: research

Innate Immunity
The innate immune response system forms an important line of defense by deploying a limited number of receptors specific for conserved microbial components. This deployment generates a rapid inflammatory response, while activating the adaptive immune system. Improvements in our understanding of the innate immune system have allowed us to explore various therapeutic strategies via modulation of the immune response. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Bani Preet Kaur, Elizabeth Secord Source Type: research

Pediatric Immunology and Allergy
This issue of Pediatric Clinics of North America focuses on some of the radical changes that have occurred in our field over the past few years and addresses some of the issues we still need to tackle. Food allergy prevention now involves early tolerance induction rather than avoidance of highly allergenic foods. Eosinophilic gut disease has its own set of practice parameters that differ for children and adults, and treatments are rapidly evolving for this disorder. Children with food allergies are now routinely challenged with the offending food, and in some cases, desensitized. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Elizabeth Secord Tags: Preface Source Type: research

The Ever-Expanding Base of New Knowledge
This issue of Pediatric Clinics of North America clearly illustrates why medical schools in the twenty-first century are actively seeking new ways to teach medicine. As noted by Dr Secord in her preface, there have been remarkable changes in our understanding of many of the basic premises of allergy and immunology, with significant advances in treatment accompanying this new understanding. This proliferation of new knowledge is certainly not limited to immunology and allergy; rather, it is being seen across the field of medicine. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Bonita F. Stanton Tags: Foreword Source Type: research

Pediatric Immunology and Allergy
PEDIATRIC CLINICS OF NORTH AMERICA (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Authors: Elizabeth Secord Source Type: research

Copyright
ELSEVIER (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Source Type: research

Contributors
BONITA F. STANTON, MD (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Source Type: research

Contents
Bonita F. Stanton (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Source Type: research

Forthcoming Issues
Substance Abuse (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Source Type: research

CME Accreditation Page
(Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 27, 2019 Category: Pediatrics Source Type: research

Diagnosis and Management of Food Allergy
Food allergy is an immune-mediated disease and must be differentiated from other adverse effects related to food that are non –immune mediated. Symptoms of immunoglobulin (Ig) E–mediated allergy can range from mild to severe, and life-threatening anaphylaxis may occur. Current recommended strategies for diagnosis include the use of skin prick tests, allergen-specific serum IgE, and/or oral food challenges. Management e ntails allergen avoidance and appropriate treatment of allergic reactions should accidental ingestions occur. Treatment approaches under investigation include immunotherapy as well as biologics a...
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Roxanne Carbonell Oriel, Julie Wang Source Type: research

Eosinophilic Esophagitis
Eosinophilic esophagitis is a recently defined condition that has dramatically increased in prevalence in the last several decades. It may occur at any age, but the clinical presentation in young children is often more vague than the classic solid food dysphagia and food impacting that are the major presenting symptoms of eosinophilic esophagitis in adults and adolescents. Successful therapies exist, including medications and dietary modifications, but disease typically recurs when the intervention is discontinued. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Heather K. Lehman, Weyman Lam Source Type: research

Allergic Rhinitis in Children and Adolescents
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further...
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Charles Frank Schuler IV, Jenny Maribel Montejo Source Type: research

Anaphylaxis in Children and Adolescents
Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction. Classically, anaphylaxis is an immunoglobulin (Ig) E –mediated reaction; however, IgG or immune complex complement-related immunologic reactions that lead to degranulation of mast cells can also cause anaphylaxis. Food allergy is the most common cause of anaphylaxis, followed by drugs. Patients with anaphylaxis commonly present with symptoms involvi ng skin or mucous membranes, followed by respiratory and gastrointestinal symptoms. Epinephrine is the drug of choice for treating anaphylaxis. Patients and caregivers should be educ...
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Pavadee Poowuttikul, Divya Seth Source Type: research

Pediatric Drug Allergies
Adverse drug reactions are frequently reported in pediatric patients. In this review article, the authors discuss pediatric drug allergies with emphasis on the most common culprits, beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The authors also discuss reactions to non-beta-lactam antibiotics and chemotherapeutics. Skin testing has not yet been validated for many drugs, although notable exceptions include penicillin and carboplatin. The gold standard for diagnosis in most cases remains drug challenge, and the need for penicillin skin testing prior to oral provocation challenge has been questioned in re...
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Shazia Lutfeali, David A. Khan Source Type: research

Biologic Agents and Secondary Immune Deficiency
Biologics are protein-based pharmaceuticals derived from living organisms or their proteins. We discuss the mechanism of action for currently approved biologics and a give summary of the studies on immune suppression from biologics. Most of these studies have been conducted with rheumatology patients, and many in adults. Their relevance for children is explored and existing gaps in data for children are highlighted. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Heather Axelrod, Matthew Adams Source Type: research

Pediatric Inner-City Asthma
Inner-city children with asthma are known to have high disease mortality and morbidity. Frequently, asthma in this high-risk population is difficult to control and more severe in nature. Several factors, including socioeconomic hardship, ability to access to health care, adherence to medication, exposure to certain allergens, pollution, crowd environment, stress, and infections, play an important role in the pathophysiology of inner-city asthma. Comprehensive control of home allergens and exposure to tobacco smoke, the use of immune based therapies, and school-based asthma programs have shown promising results in asthma co...
Source: Pediatric Clinics of North America - August 5, 2019 Category: Pediatrics Authors: Divya Seth, Shweta Saini, Pavadee Poowuttikul Source Type: research

Evidence-Based Medicine in the Clinical Learning Environment of Pediatric Hospital Medicine
The article begins with an overview of evidence-based medicine (EBM), including its history and core principles. Next, the article discusses how the current clinical learning environment has shaped EBM, including the accessibility and portability of technology; the access to electronic search engines and libraries; and the movement toward applying the best evidence through order sets, clinical guidelines, and pathways to work toward standardizing care. The article ends with a focus on how educators can influence a trainee ’s knowledge, skills, attitudes, and behaviors regarding EBM. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Authors: Nicholas Kuzma, Hans B. Kersten, Eric Douglas Thompson Source Type: research

Simulation in Medical Education for the Hospitalist
Simulation in medical education has grown due to an evolution in health care. It uses 4 main modalities to re-create a situation from the clinical environment to allow experiential learning and improve patient care. Simulation must be considered as an educational strategy within a larger curriculum. Building an exercise requires first developing goals and objectives and then designing the scenario. There are 4 phases of implementation, wherein the final debrief phase is critical for learning. Educators have used simulation for multiple curricular needs: communication skills, interprofessional education, clinical reasoning,...
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Authors: Jennifer H. Hepps, Clifton E. Yu, Sharon Calaman Source Type: research

An Evolving Clinical Setting for Education: Pediatric Hospital Medicine
This issue of the Pediatric Clinics of North America focuses on the rapidly evolving field of Pediatric Hospital Medicine (PHM). Although the articles within this issue broadly address the ways in which pediatric hospitalists and their colleagues have advanced child health in the inpatient setting, each article also specifically focuses on the way in which the role of education and training has also rapidly adapted and progressed within this changing landscape. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Authors: Amy J. Starmer, Matthew W. Ramotar, Nancy D. Spector Tags: Preface Source Type: research

How Did We Ever Do Without Them?
Now a central component of most departments of pediatrics, the emergence of the unique role of the “hospitalist” dates back less than 40 years. It is difficult to imagine a hospital without hospitalists now given their central role in patient care throughout the nation. Likewise, it is difficult to imagine a department of pediatrics without hospitalists, given their roles in teaching. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Authors: Bonita F. Stanton Tags: Foreword Source Type: research

Hospital Medicine and Clinical Education
PEDIATRIC CLINICS OF NORTH AMERICA (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Authors: Nancy D. Spector, Amy J. Starmer Source Type: research

Copyright
ELSEVIER (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Source Type: research

Contributors
BONITA F. STANTON, MD (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Source Type: research

Contents
Bonita F. Stanton (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Source Type: research

Forthcoming Issues
Pediatric Immunology and Allergy (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Source Type: research

CME Accreditation Page
(Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - June 21, 2019 Category: Pediatrics Source Type: research

Communication with Diverse Patients
Effective communication is key when providing quality health care. The dynamics of communication within the health care team and with the patient and family can be challenging. These challenges stem from the sharing of complex information, highly emotional topics, and health literacy barriers. Linguistic and cultural barriers can further aggravate these challenges. This section provides an overview of linguistic and cultural challenges related to patient-provider communication, strategies for effective communication with patients with limited English Proficiency via the use of interpreter services, and tips for how to teac...
Source: Pediatric Clinics of North America - May 23, 2019 Category: Pediatrics Authors: Jennifer K. O ’Toole, Wilma Alvarado-Little, Christy J.W. Ledford Source Type: research

Health Literacy in the Inpatient Setting
Health literacy plays a role in the events leading up to children ’s hospitalizations, during hospital admission, and after discharge. Hospitals and providers should use a universal precautions approach and routinely incorporate health-literacy-informed strategies in communicating with all patients and families to ensure that they can understand health informati on, follow medical instructions, participate actively in their own/their child’s care, and successfully navigate the health care system. Interventions that incorporate health-literacy-informed strategies and that target patients/families and health care...
Source: Pediatric Clinics of North America - May 23, 2019 Category: Pediatrics Authors: Alexander F. Glick, Cindy Brach, Hsiang Shonna Yin, Benard P. Dreyer Source Type: research

Family-Centered Rounds
This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 23, 2019 Category: Pediatrics Authors: Lauren A. Destino, Samir S. Shah, Brian Good Source Type: research

Pediatric Hospitalists Improving Patient Care Through Quality Improvement
This article reviews the industrial underpinnings of the quality improvement (QI) movement and describes how QI became integrated within the larger health care landscape, including hospital medicine. QI methodologies and a framework for using them are described. Key components that make up a successful QI clinical project are outlined, with a focus on the essential role of pediatric hospitalists and practical professional tips to be successful. QI training opportunities are reviewed with opportunities for hospitalists to get involved in QI on a national level. National QI networks are showcased, with multiple examples of a...
Source: Pediatric Clinics of North America - May 15, 2019 Category: Pediatrics Authors: Anupama Subramony, Irene Kocolas, Raj Srivastava Source Type: research

The Clinical Learning Environment and Workplace-Based Assessment
This article provides an overview of the role played by the clinical learning environment in providing opportunities for assessment of trainee performance and how those assessments can guide learning. It reviews the importance of competency models as frameworks to facilitate the creation of a shared mental model of what is to be learned between learners and supervisors. In addition, it discusses how assessment can be used to drive mastery learning as well as the components necessary for a program of assessment. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 15, 2019 Category: Pediatrics Authors: Duncan Henry, Daniel C. West Source Type: research

A Focus on Feedback
This article aims to provide the reader with foundational theories on feedback and strategies to use best practices for delivery. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 15, 2019 Category: Pediatrics Authors: Kheyandra D. Lewis, Aarti Patel, Joseph O. Lopreiato Source Type: research

Teaching at the Bedside
This article provides many strategies and approaches to bedside teaching designed to enhance education and communication among care team members as well as patients and their families. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 15, 2019 Category: Pediatrics Authors: Thuy L. Ngo, Rebecca Blankenburg, Clifton E. Yu Source Type: research

Pediatric Hospital Medicine
Although pediatric hospital medicine (PHM) is in its adolescence, it is already having a major impact on patient care, quality, safety, and education. Pediatric hospitalists have been front-and-center in the safety and quality movement, driving change as clinicians, applying evidence-based medicine to standardize practice and promulgate evidence-based guidelines, and playing a central role in optimizing the function of inter-professional teams. Pediatric hospitalists have championed the importance of patient-and family-centeredness of care and the need to incorporate principles of health literacy into all aspects of clinic...
Source: Pediatric Clinics of North America - May 15, 2019 Category: Pediatrics Authors: Matthew W. Ramotar, Theodore C. Sectish Source Type: research

Patient- and Family-Centered Care
This article aims to broaden pediatric hospital medicine providers ’ understanding of patient- and family-centered care (PFCC) and equip them to both implement and advance PFCC. The article discusses the origins and history of PFCC and reviews selected relevant literature. The article shares an overview of several existing frameworks for patient-centeredness, emp hasizing an emerging concept called coproduction. The article reviews several attitudes, skills, and infrastructure components that are considered essential prerequisites for effective coproduction. The article then highlights several strategies for promotin...
Source: Pediatric Clinics of North America - May 14, 2019 Category: Pediatrics Authors: Jennifer L. Everhart, Helen Haskell, Alisa Khan Source Type: research

Process Metrics and Outcomes to Inform Quality Improvement in Pediatric Hospital Medicine
This article provides an overview of the selection, development, and use of process and outcome measures for pediatric hospital medicine quality improvement initiatives. It reviews commonly used categories of process and outcome measures and provides a list of common sources and repositories of previously validated measures. It also provides a blueprint for the development of novel measures. The relative merits of various data collection methods are discussed (eg, medical record abstraction, administrative, surveys), along with guiding principles for disseminating the results of quality improvement evaluations on a local a...
Source: Pediatric Clinics of North America - May 13, 2019 Category: Pediatrics Authors: Arti D. Desai, Amy J. Starmer Source Type: research

Interprofessional Teams
This article addresses the current and desired future state of interprofessional practice in pediatric hospital medicine. It focuses on identifying optimal team composition and work patterns, describing the value of parent involvement on both the patient ’s care team and on operational teams, describing the need for interprofessional education, and identifying outcomes associated with interprofessional teamwork. The article also identifies challenges and opportunities for growth as interprofessional teamwork increasingly becomes a standard practic e within healthcare settings. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 13, 2019 Category: Pediatrics Authors: Jennifer Baird, Michele Ashland, Glenn Rosenbluth Source Type: research

Communication at Transitions of Care
This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 13, 2019 Category: Pediatrics Authors: Shilpa J. Patel, Christopher P. Landrigan Source Type: research

Coming to America: Regulatory Oversight of United States Immigration Policies
This article briefly covers the history of immigration from the US perspective, including the demographic variation over time and the ever-changing policies. Displaced children and their families are facing increasing challenges to their health and overall wellbeing. Since enactment of the Immigration and Nationality Act of 1965, the needs of minors have been caught up in complex immigration policy. Recognition of the unique needs of minors and the Dreamers must be addressed as part of comprehensive immigration reform or in more targeted legislative proposals. The challenges posed by the magnitude and scope of the immigrat...
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: James A. Stockman Source Type: research

International Migration and Immigration Issues Related to the United States
This article briefly examines the scope of international migration –related issues and issues related to the migration of individuals and families across the southern border of the United States. Immigration issues include designing oversight policies consistent with international treaties yet tailored to suit the unique circumstances of recipient countries; inte grating refugees and asylum seekers; and dealing with undocumented foreigners who have gained entry across a border. Most importantly, ways must be found that allow accompanied and unaccompanied minors to live a full and healthy existence as they wend their ...
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: James A. Stockman Source Type: research

Immigrant and Refugee Health
We describe the work of CDC’s Divisio n of Global Migration and Quarantine and partners in developing and implementing these strategies. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Tarissa Mitchell, Michelle Weinberg, Drew L. Posey, Martin Cetron Source Type: research

The Intersection of Urban and Global Health
This article points a lens at the intersection of these 2 fields, highlighting what they can learn from each other. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Nora L. Jones, Julia Burger, Ashleigh Hall, Kathleen A. Reeves Source Type: research

Developing a Community Response
This article addresses the special and unique health challenges faced by pediatric immigrant patients, and ways to address t hese challenges by leveraging community partnerships and a holistic approach to care. The article draws on the experience of Community Volunteers in Medicine, a nonprofit, philanthropy-funded health clinic that offers free medical, dental, and behavioral care to the uninsured of Chester County, Penn sylvania.” (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Mary Brennan Wirshup, Sarah Poutasse, Adriana Deverlis Source Type: research

Clinical Tools for Working Abroad with Migrants
There are an estimated 68.5 million displaced persons worldwide, about one-half of whom are under the age of 18  years. The health needs of migrants are complex and dynamic along their journey. When structuring health care services for migrants abroad, there is not a one-size-fits-all approach and programming must be adaptable, practical, relevant, sustainable, and ideally integrated into the host country’ s health care system. In this article, we the examine clinical and public health priorities for migrant health care abroad and practical resources for health care professionals who wish to put their ideals int...
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Ryan McAuley Source Type: research

Clinical Tools Working at Home with Immigrants and Refugees
At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Chloe Turner, Anisa Ibrahim, Julie M. Linton Source Type: research

Advocating for Immigration Policies that Promote Children ’s Health
Immigration laws and policies, as well as related media and public discourse, have a direct and significant effect on the health and well-being of children and families. The purpose of this article is to identify the impact of family immigration status and immigration laws on children ’s health, to understand the legal system that immigrant children face, and to describe opportunities for health care professionals to engage in advocacy at the systems level, from the local community to Capitol Hill. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - April 27, 2019 Category: Pediatrics Authors: Julie M. Linton, Jennifer Nagda, Olanrewaju O. Falusi Source Type: research