J-LSMS 2017 | Annual Archive

J-LSMS 2017 | Annual Archive

EDITOR D. LUKE GLANCY, MD

VOLUME 169 NUMBER 1 • JANUARY | FEBRUARY 2017

ESTABLISHED 1844

ASSOCIATE EDITOR L.W. JOHNSON, MD

BOARD OF TRUSTEES CHAIR, GEOFFREY W. GARRETT, MD VICE CHAIR, K. BARTON FARRIS, MD SECRETARY/TREASURER, RICHARD PADDOCK, MD ANTHONY P. BLALOCK, MD D. LUKE GLANCY, MD LESTER W. JOHNSON, MD FRED A. LOPEZ, MD

EDITORIAL BOARD MURTUZA J. ALI, MD RONALD AMEDEE, MD SAMUEL ANDREWS, II, MD BOB BATSON, MD EDWIN BECKMAN, MD GERALD S. BERENSON, MD

FEATURED ARTICLES

AMANDA STAIANO, PHD ARWEN MARKER, BA MICHELLE LIU, BS ELLERY HAYDEN DANIEL HSIA, MD STEPHANIE BROYLES, PHD

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CHILDHOOD OBESITY SCREENING AND TREATMENT PRACTICES OF PEDIATRIC HEALTHCARE PROVIDERS

C. LYNN BESCH, MD JOHN BOLTON, MD BRIAN BOULMAY, MD MICHELLE BOURQUE, JD JAMES N. BRAWNER, III, MD BRETT CASCIO, MD QUYEN CHU, MD WILLIAM PATRICK COLEMAN III, MD RICHARD COULON, MD LOUIS CUCINOTTA, MD VINCENT A. CULOTTA, JR., MD JOSEPH DALOVISIO, MD NINA DHURANDHAR, MD JAMES DIAZ, MD, MPH & TM, D r . PH JOHN ENGLAND, MD JULIO FIGUEROA, MD ELIZABETH FONTHAM, MPH, D r . PH EDWARD FOULKS, MD BEN GUIDER, MD

DAVID TADIN, MD ROBERTO QUINTAL, MD

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FEVER-INDUCED BRUGADA PATTERN MISDIAGNOSED AS AN ACUTE MYOCARDIAL INFARCTION

DAVID BALLARD, MD RYAN FRANSMAN, MD GUILLERMO SANGSTER, MD MATTHEW AYO, BS NAVDEEP SAMRA, MD OLUWAYEMISI OJEMAKINDE, MD ADAMWELLIKOFF CATHERINE CHAUDOIR, MD GUILLERMO SANGSTER, MD ALBERTO SIMONCINI, MD CARLOS PREVIGLIANO, MD DISHA ADELLE DESOUZA

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JEJUNAL CARCINOID TUMORS PRESENTING AS SMALL BOWEL OBSTRUCTION

HENRY G. HANLEY, MD ELIAS B. HANNA, MD LYNN H. HARRISON, JR., MD ROBERT HEWITT, MD

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THE NON-INNOCULOUS HILAR CALCIFICATION: RECURRENT PNEUMONIA SECONDARY TO BRONCHOLITH-ASSOCIATED ACTINOMYCES

MICHAEL HILL, MD LARRY HOLLIER, MD JOHN HUNT, MD BERNARD JAFFE, MD NEERAJ JAIN, MD

TRENTON L. JAMES, II, MD STEPHEN KANTROW, MD KEVIN KRANE, MD MAUREEN LICHTVELD, MD, MPH FRED A. LOPEZ, MD F. BROBSON LUTZ, JR., MD DAVID MARTIN, MD JORGE A. MARTINEZ, MD, JD ELIZABETH MCBURNEY, MD ELLEN MCLEAN, MD REINHOLD MUNKER, MD DAVID MUSHATT, MD STEVE NELSON, MD NORA OATES, MD DONALD PALMISANO, MD, JD, FACS PATRICK W. PEAVY, MD PAUL PERKOWSKI, MD PETERMAN RIDGE PROSSER, MD ROBERTO QUINTAL, MD RAOULT RATARD, MD, MS, MPH & TM ROBERT RICHARDS, MD

DEPARTMENTAL ARTICLES

CLINICAL CASE OF THE MONTH GROUP G STREPTOCOCCAL BACTEREMIA SECONDARY TO A BURNWOUND INFECTION

PAIGE DEICHMANN AMOL SURA CHARLES SANDERS, MD NISHA P. ARAVINDAKSHAN-PATEL, MD FRED LOPEZ, MD

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ECG CASE OF THE MONTH CONFUSION AND A SLOW HEART RATE

D. LUKE GLANCY, MD

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DONALD RICHARDSON, MD WILLIAM C. ROBERTS, MD DONNA RYAN, MD JERRY ST. PIERRE, MD CHARLES SANDERS, MD

RADIOLOGY CASE OF THE MONTH INTUSSUSCEPTION IN ADULTS: IS THERE A LEAD POINT?

LORENA GARZA, MD NHAN NGUYEN, MD JEREMY NGUYEN, MD CYNTHIA HANEMANN, MD

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OLIVER SARTOR, MD CHARLES SCHER, MD RICHARD SPECTOR, MD LEE STEVENS, MD JACK P. STRONG, MD PRAMILLA N. SUBRAMANIAM, MD KEITH VAN METER, MD DIANA VEILLON, MD HECTOR VENTURA, MD

CHRIS WINTERS, MD GAZI B. ZIBARI, MD

JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY

Childhood Obesity Screening and Treatment Practices of Pediatric Healthcare Providers Amanda Staiano, PhD; Arwen Marker, BA; Michelle Liu, BS; Ellery Hayden, Daniel Hsia, MD; Stephanie Broyles, PhD

Obesity is characterized by a body mass index (BMI) ≥ 95th percentile and affects 17% of youth in the United States. 1 Family- based, intensive, multidisciplinary behavioral intervention has been proven efficacious to treat childhood obesity, 2 including sustainedweight lossupto10yearsafter theprogram. 3 TheUnited States Preventive Services Task Force (USPSTF) recommends that clinicians screen all children ages six years and older for obesity, then offer or refer them to an intensive and comprehensive behavioral intervention for obesity treatment if necessary. 4 The interventions should include dietary, physical activity, and behavioral counseling; be moderate (>25 to 75 contact hours) to high (> 75 contact hours) intensity; and delivered over at least six months. 4,5 This recommendation aligns with the stage 3 comprehensive multidisciplinary intervention of the four-stage treatment approach recommended by the Expert Committee convened by the American Medical Association, Centers for Disease Control and Prevention, and American Academy of Pediatrics. 6 While one survey evaluating clinicians’ screening practices for obesity was recently conducted among tertiary care hospitals, 7 this study sought to document how pediatric primary care providers and allied health professionals manage their patients’ weight and whether these primary care providers follow clinic practice guidelines. Most pediatric medical visits occur in primary care settings, 8 and the primary care setting offers an opportunity for early detection and intervention to achieve a healthy weight. Further, the extent to which health care providers screen for obesity-related comorbidities such as type 2 diabetes mellitus (T2DM) in youth is not known, despite an escalation in cases of pediatric T2DM in recent years. 9 The American Diabetes Association 10 and American Academy of Pediatrics 11 recommend screening children who are overweight (BMI ≥ 85th percentile) This study evaluated physicians’ childhood obesity screening and treatment practices. A26-question surveywas delivered topediatric providers in-personor viamail, e-mail, or fax throughout Louisiana. Fifty-sevenproviders completed the survey, themajority inprimary care clinics. Five providers met at least four of seven clinical guidelines, but no provider met all of the guidelines. Whereas 88% of providers screened for obesity, 7% met guidelines for referring patientswithobesity toweightmanagement services. Six providers offered interventions that included all recommended components (i.e. dietary, physical activity, and behavioral counseling). One intervention met intensity guidelines (i.e. >25 hours delivered over at least six months). Barriers to offering services included lack of reimbursement and poor compliance by families. Solutions to overcome treatment barriers should be identified to increase the provision of health care services for children with obesity.

and have any two additional risk factors for diabetes every three years upon reaching age 10 or puberty. Recommended screening tools are based on hemoglobin A1c criteria or plasma glucose criteria. The objective of this study was to identify pediatric healthcare providers’ current obesity and T2DM screening practices and the referral or provision of behavioral interventions for the treatment of childhood obesity.

METHODS

Participants

A survey was directly distributed to 677 health care providers located in 164 clinics in 28 cities in the United States state of Louisiana. The survey was distributed to an additional 675 stakeholders including representatives from the Louisiana chapter of the American Academy of Pediatrics, insurance groups, advocacy groups, and academia throughout the state, with a letter requesting that the stakeholder forward the survey to primary care providers. In total, 70 providers started and 57 completed the survey (26 online and 31 completed by hand), for a response rate of 10% (among providers directly solicited) and a completion rate of 81%. Pennington Biomedical Research Center’s Institutional Review Board approved the protocol and survey. No formal written consent was administered, but the following was included on the survey to notify participants that responses were collected for research purposes: “Your participation in this survey is voluntary and you do not have to participate if you do not want

2 J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017

JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY

to. By submitting this survey, you provide your consent for our research team to review and use the information you share with us. Your responses will be kept confidential.”

(4%), and a clinical psychologist also provided information. The types of physicians represented included pediatricians, pediatric subspecialists (endocrinologists and a gastroenterologist), combined internists/pediatricians, and family practitioners.

Description of Survey and Procedures

Providers’ Screening and Treatment Practices

The survey consisted of 26 multiple-choice and open-ended questions pertaining to the provider’s current practices in childhood obesity and T2DM screening and the pediatric weight management services offered at the provider’s facility. The USPSTF guidelines included: 1) screen for obesity if age ≥ 6 y; 2) if obese, refer to intervention; 3) offer obesity intervention with diet, physical activity, and behavioral counseling; 4) offer intervention lasting ≥ 6 months; and 5) offer intervention consisting of > 25 contact hours. The guidelines for T2D screening included: 1) screen for T2DM and 2) T2DM screening includes hemoglobin A1c or glucose. 10,11 The survey also queried the provider’s medical specialty and clinic location. Surveys were hand delivered, emailed, mailed, and/or faxed to recipients over a 6-month period (i.e. January to June 2015). An open-access link to the survey was listed on a website that targeted primary care providers. The online version of the survey was deployed by the Research Electronic >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108 Page 109 Page 110 Page 111 Page 112 Page 113 Page 114 Page 115 Page 116 Page 117 Page 118 Page 119 Page 120 Page 121 Page 122 Page 123 Page 124 Page 125 Page 126 Page 127 Page 128 Page 129 Page 130 Page 131 Page 132 Page 133 Page 134 Page 135 Page 136 Page 137 Page 138 Page 139 Page 140 Page 141 Page 142 Page 143 Page 144 Page 145 Page 146 Page 147 Page 148 Page 149 Page 150 Page 151 Page 152 Page 153 Page 154 Page 155 Page 156 Page 157 Page 158 Page 159 Page 160 Page 161 Page 162 Page 163 Page 164 Page 165 Page 166 Page 167 Page 168 Page 169 Page 170 Page 171 Page 172 Page 173 Page 174 Page 175 Page 176 Page 177 Page 178 Page 179 Page 180

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