Preschool vision screening.

Although a good case for preschool screening for vision defects can be made there is very little evidence that existing programmes are effective in practice. A comparative trial of three different methods of preschool vision screening is described. Some 7000 children initially aged 5 months (younger cohorts) and 30 months (older cohorts) in three matched areas entered the trial during 1987. During 18 months of follow up new visual and ocular defects among these children were ascertained through ophthalmology outpatients and from optician records. Screening at 35 months by an orthoptist based in the community is superior to conventional health visitor surveillance at 30 months and to an agreed programme of primary care screening for squint at 30-36 months as judged by screening sensitivity (100% v 50% v 50%) and the incidence of treated target conditions (17 v 3 v 5 per 1000 person years). A notable feature in the area served by the orthoptist is that 13 children received treatment for straight eyed visual acuity loss from among 1000 children whereas there were no such cases among 2500 in the comparison areas. In the younger cohorts (that is, screening at age 5-9 months) all three programmes showed equally poor results, only one of the eight treated target conditions arising from all 3500 younger children being screen detected.     

Preschool vision screening by family physicians

PURPOSE: To determine the rate of preschool vision screening in family practice. To evaluate attitudes and beliefs about the importance of, and barriers to, preschool vision screening. METHOD: Mail survey of a national sample of family physicians. RESULTS: The response rate was 35% (237 of 671 eligible respondents). Most (90%) considered preschool vision screening important. The majority (91%) included some component of the eye examination as part of their routine well-child care for preschool-aged children. The likelihood of formal screening increased with age (3 years, 36%; 4 years, 58%; 5 years, 73%; P < .01). Most (88%) used a wall chart to test for visual acuity. Stereoacuity was rarely (7%) tested. Barriers included the perception that children are uncooperative (39%) and that screening is too time-consuming (21%). Fifty-nine percent would only consider using a vision screening test if its false-positive rate was 10% or less. Some (26%) reported that all children should be examined by an optometrist or ophthalmologist prior to school entry, regardless of any screening. CONCLUSIONS: The rate of screening by family physicians is similar to that by pediatricians. Providing education regarding optimal vision screening strategies and expected outcomes of screening may be important for improving both the rate and the quality of preschool vision screening. Ophthalmologists may play an important role in this process through the feedback they provide to referring physicians.     

Preschool vision screening: a service in need of rationalisation.

A survey of health districts in England and Wales was carried out at the end of 1984 to ascertain among other things the range of current programmes for preschool vision screening. The response rate was 81.3%. Altogether 94% of districts reported screening for both reduced visual acuity and squint; two districts screened for neither. A great variety of different types of tests were in use and screening was carried out at a variety of different ages. A high proportion of districts were screening children for reduced visual acuity in infancy, although screening tests applicable at this age have not been shown to be effective. Districts screened for squint between one and four times. Collection of routine monitoring information by districts was poor.     

Preschool vision screening in Cornwall: performance indicators of community orthoptists.

The performance of community orthoptists was retrospectively assessed in a primary preschool screening programme that has been established in Cornwall since 1982. The outcome of screening was compared between random samples of two birth year cohorts corresponding to the second and fourth years of existence of the screening programme (1980, n = 298 and 1982, n = 300). The mean age at screening was significantly later for the second cohort (4.3 years compared with 4.4 years) but otherwise performance indicators improved in the second cohort. Community orthoptists achieved a sensitivity of about 90% and specificity of 99% during the study. It is unlikely that the more commonly used two tier system of health visitors referring to a community orthoptist could achieve this degree of accuracy.     

Pediatricians' screening urinalysis practices

OBJECTIVE: To determine pediatricians' routine screening urinalysis practices. STUDY DESIGN: This was a survey of a nationally representative sample of pediatricians practicing in the U.S. regarding their screening urinalysis practices in childhood. RESULTS: Of the 1502 pediatricians sampled, 653 eligible subjects participated, for an estimated response rate of 49.5%. The vast majority of participants (78%) routinely screen asymptomatic children with urinalysis in at least 1 age group. Pediatricians' screening urinalysis practice varies based on age group: 9% screen during infancy (<1 year), 60% screen during early childhood (1 up to 5 years), 55% screen during late childhood (5 to 12 years), and 58% screen during adolescence (13 to 20 years). The majority of pediatricians (58%) routinely screen more than 1 age group. Some 38% of the pediatricians surveyed believe that the overall health of children is improved by screening all asymptomatic children with urinalysis. CONCLUSIONS: Many pediatricians routinely conduct screening urinalysis during childhood, frequently at ages not recommended by the American Academy of Pediatrics.     

Cholesterol screening in pediatric practice

Four pediatricians introduced a portable cholesterol analyzer into their group practice. Their experience is described on the basis of 12 months of screening in 1665 children and adolescents. The overall 50th and 90th percentile values for a subgroup of 1406 routinely screened children were 156 and 197 mg/dL, respectively, but there was marked variation in these values among specific age and sex groups. Cholesterol levels decreased by age group during the early teenage years and increased thereafter, these changes occurring at ages approximately 2 years younger for girls than for boys. Further analysis of screening results for 398 sibling pairs demonstrated significant concordance between paired cholesterol levels when classified by the respective age- and sex-specific 90th percentile values for each member of the pair. Sibling pairs in which both members' cholesterol values exceeded their 90th percentile value were identified 2.4 times as frequently as expected (confidence interval 1.1 to 4.5, P = .029). The observations reported here indicate that office-based cholesterol screening in a pediatric practice may be both practical and useful, although further consideration of screening criteria is needed. Age- and sex-specific reference values for cholesterol levels during childhood could improve screening results. Special emphasis should be directed toward screening siblings of children in whom high cholesterol levels have been detected.     

Vaccine storage practices in pediatric offices.

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.     

The impact of pediatric vision disorders in adulthood

In addition to refractive errors such as myopia and astigmatism, ocular disorders that occur in infants, toddlers, and children may present lifelong problems for the child. Conditions such as strabismus, amblyopia, and retinopathy of prematurity may require adaptations in adulthood. In addition, vision disorders that occur in childhood may manifest as problems well into adulthood. When visual impairment is present, there may be further effects on overall health, self-perception, educational attainment, job choices, and a number of other social factors.     

Immunization practices among pediatric transplant hepatologists

Vaccination of pediatric liver transplant candidates and recipients represents an opportunity to decrease infectious complications following transplant. Although vaccine recommendations exist, studies have shown that many transplant candidates and recipients are under‐immunized. The goals of this study were to assess among pediatric transplant hepatologists: (i) current immunization practices before and after transplantation, (ii) involvement of an ID physician in the transplant evaluation, and (iii) perceptions about vaccine safety and barriers to immunization. An 80‐item e‐mail survey of pediatric transplant hepatologists at centers in the United States and Canada participating in the SPLIT consortium was conducted from December 2014 to March 2015. The overall response rate was 80% (73/91), representing 97% (32/33) of SPLIT centers. Fifty percent of programs routinely involved an ID physician in the transplant evaluation. Administration of palivizumab was routinely considered by 48% of hepatologists pre‐transplant and by 41% post‐transplant. Live vaccines were recommended by 26% of hepatologists after transplant. About 10% of hepatologists reported concern that live vaccines after transplant could induce rejection. There is wide variation in immunization practices among transplant hepatologists. Specific evidence‐based protocols are needed to guide immunization practices in transplant candidates and recipients.     

Influenza immunization practices among pediatric oncologists

PURPOSE: To describe the opinions of pediatric oncologists regarding the use of influenza vaccine in children with cancer and to identify factors that influence practitioners' recommendations about influenza vaccine. MATERIALS AND METHODS: A survey was sent to members of the Children's Oncology Group to inquire about their clinical experience and practice setting, opinions regarding the use of the influenza vaccine in children with cancer, and factors that influence their recommendations. RESULTS: Of 803 pediatric oncologists identified, 434 (54%) responded. Depending on the type of tumor, 65% to 69% of pediatric oncologists indicated that they routinely recommend influenza vaccine for children being treated for cancer. Respondents were much more likely to recommend influenza vaccine for children with various types of cancer if they indicated that: 1) their practice has guidelines regarding the use of influenza vaccine (odds ratios ranging from 7.2 to 11.7); 2) influenza infection is very significant (odds ratios ranging from 1.4 to 3.7); and 3) influenza vaccine is effective (odds ratios ranging from 7.2 to 14.9). CONCLUSIONS: The majority of pediatric oncologists routinely recommend influenza vaccine for children being treated for cancer; however, a significant number of pediatric oncologists do not. Clarification of the benefit of influenza vaccine for children with cancer and the institution of practice guidelines may increase the use of the influenza vaccine among pediatric oncologists.     

Career counseling practices in pediatric residency training programs

Although there has been an emphasis on career satisfaction in pediatrics and on motivators that impact on resident career selection, little attention has been directed toward the career development process in pediatric residency training. This report summarizes the results of a survey conducted of 155 pediatric residency program directors about their counseling practices. Implications of the results and recommendations are discussed to improve this process.     

Best practices in the pediatric pretransplant psychosocial evaluation

Assessment of psychosocial functioning is an often‐included component of the pretransplant evaluation process. This study reviews several domains of assessment that have been related to post‐transplant outcomes across solid organ transplant populations. These include evaluation of patient and family past adherence, knowledge about the transplantation process, and their neurocognitive, psychological, and family functioning. To date, few comprehensive pretransplant evaluation measures have been standardized for use with children; however, several assessment measures used to evaluate the aforementioned domains are reviewed throughout the study. Additionally, this article discusses some developmental, illness‐specific, and cultural considerations in conducting the psychosocial evaluation. We also discuss ethical issues specific to the pediatric psychosocial evaluation. Recommendations are advanced to promote a comprehensive evaluation that identifies family strengths and risk factors as they begin the transplant journey.