Objectives: Emergency medicine (EM) trainees are expected to learn to provide acute care for patients of all ages. The American Council for Graduate Medical Education provides some guidance on topics related to caring for pediatric patients; however, education about pediatric topics varies across residency programs. The goal of this project was to develop a consensus curriculum for teaching pediatric emergency care.Methods: We recruited 13 physicians from six academic health centers to participate in a three-round electronic modified Delphi project. Participants were selected on the basis of expertise with both EM resident education and pediatric emergency care. The first modified Delphi survey asked participants to generate the core knowledge, skills, and experiences needed to prepare EM residents to effectively treat children in an acute care setting. The qualitative data from the first round was reformulated into a second-round questionnaire. During the second round, participants used rating scales to prioritize the curriculum content proposed during the first round. In round 3, participants were asked to make a determination about each curriculum topic using a three-point scale labeled required, optional, or not needed.
Results:The first modified Delphi round yielded 400 knowledge topics, 206 clinical skills, and 44 specific types of experience residents need to prepare for acute pediatric patient care. These were narrowed to 153 topics, 84 skills, and 28 experiences through elimination of redundancy and two rounds of prioritization. The final lists contain topics classified by highly recommended, partially recommended, and not recommended. The partially recommended category is intended to help programs tailor their curriculum to the unique needs of their learners as well as account for variability between 3-and 4-year programs and the amount of time programs allocate to pediatric education.
Conclusion:The modified Delphi process yielded the broad outline of a consensus core pediatric emergency care curriculum.E mergency medicine (EM) physicians acquire proficiency in the emergent management of all patients including pediatric patients during their training. Despite the growth of pediatric EM as a subspecialty, pediatric EM (PEM) subspecialists only care for 10% to 20% of the pediatric patients in the emergency setting across the United States.1 The remaining 80% to 90% of pediatric emergency care patients are cared for by EM physicians and/or general practice pediatricians.2-5 The Accreditation Council for Graduate Medical Education (ACGME) requires EM residents to have approximately 20% of their patient encounters with patients less than 18 years of age, including the critical care of infants and children.6 While time dedicated to pediatrics has increased in recent years, 7 concerns remain as to whether this allows sufficient experience to develop the mastery level competency for the EM physician to effectively care for children. 4,7 Although the type of clinical experiences available is beyond the...
Among 2609 subjects, 2036 (78%) had skeletal survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, skeletal survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for skeletal survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) CONCLUSIONS: Skeletal surveys identify new fractures in an important fraction of children referred for subspecialty consultation with concerns of physical abuse. These data support guidelines that consider skeletal survey mandatory for all such children <24 months of age and support a low threshold to obtain skeletal survey in children as old as 36 months.
A741process timelines, requested reimbursement mode, STC, RPA, MoHD, discrepancy between requested conditions and MoHD, information from BIA and ICER value if applicable, and key findings from available clinical analyses. ConClusions: Health care systems based on public money should treat all applicants equally if the conditions for the decision are similar and should provide equal access to benefits for patients with similar needs. The database gathers information on all precedent decisions of marketing authorization and public payer practices of similar products or similar indications. This approach opens up the possibility for improvement of transparency and decision-making practices not only in Poland, but in each country.
PRM62CoMPaRison of iCd-9 to iCd-10 CRosswalks deRived By PhysiCian and CliniCal CodeR vs. autoMated Methods
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