2015 - August Edition

Paula J. Whiteman, MD, FACEP, FAAP 
President, AAP-CA2
Representative, AAP-District 
Welcome to the August edition of our monthly e-newsletter!
 
This edition features an article by Dr. Andrew Freedman on "The Circumcision Decision." By popular demand, we also feature the first part in a two-part series on the evaluation of short stature by Dr. Norman Lavin.

Each year, the AAP hosts rotating joint district meetings to allow leadership from different areas to meet, resulting in a more effective leadership collaboration. Last month was the AAP Joint District meeting for Districts III & IX, which took place near AAP headquarters in Chicago, Illinois. District III is composed of: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, and West Virginia. Please see the AAP map below for details. Last year, we met with District VII and the year before that, District VIII. Excitingly, we received the "Chapter of Excellence" Award at this meeting.
 
One of the meeting highlights was the keynote speech presented by our very own treasurer, Alice Kuo, MD, PhD, Med, FAAP. Dr. Kuo opened our eyes to "Examining the Social Determinants of Health." Her talk was excellent. She was so well received that we will have Dr. Kuo as one of our professors at our Annual Advances in Pediatrics CME Symposium in 2016.

 

District IX (CA) and III indicated by red arrows.
Our CQN4 Asthma collaborative continues to make substantial progress. Learning Session 3 took place on July 24th at Providence Tarzana Medical Center. We had two guest speakers, as well as speakers from AAP National, and our own Chapter. See below for details.

Lately, the AAP has been offering several MOC Part 4 QI projects.
Opportune for this, we feature an interesting article "Two Birds, One Stone" that gives a perspective on MOC Part 4 projects. The article extends an invitation to pediatricians in Ventura County who may be interested in participating in "Help Me Grow", both as a QI project, and as a means of obtaining MOC part 4 credit.

The Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) and the Section on Early Career Physicians (SOECP) are promoting a mentorship program for those of you interested in getting involved helping to guide the next generation of pediatricians.




Please feel free to get involved locally by contacting our chapter 2 executive director.
As always, I welcome your comments and suggestions.

 

Sincerely,

Paula Whiteman, MD, FACEP, FAAP
President, AAP-CA2
Representative, AAP-District IX CFMC

 

Please visit us on the web: aapca2.org 

 

Feature Articles

 

Andrew L. Freedman, MD, FAAP  

The Circumcision Decision - What does the "Benefits Outweigh the Risks" really mean?

Andrew L. Freedman, MD, FAAP 


Requesting a circumcision for your infant son remains a controversial decision and one which has engendered an increasingly animated public debate and strident advocacy. While for some it is a simple decision, others agonize trying to do the "right" thing. Pediatricians are often queried for their opinion and parents often resist answers that try to walk the line, spelling out pros and cons, instead they try to push their doctors to choose a side. Where should doctors go for advice; their own experience, a voluminous and conflicting scientific literature, vocal advocacy groups, or national guidelines.    Read full article...   Bio.
 


 

 

Norman Lavin, MD, PhD, FACE, FAAP
 
Why Evaluate Short Stature? Perhaps to Save a Life ! (A Clinical Perspective)

Part 1 of a two-part  series

Norman Lavin, MD, PhD, FACE, FAAP


Are we just indulging parental anxieties and cosmetic dreams? Why spend time and money to evaluate the "short child"? After 30 years of evaluating and treating children with short stature, I believe the most important answer is "to save lives." Having recently presented this perspective at conferences and grand rounds, the audience response is frequently one of uncertainty. Allow me, therefore to present the case of a 9-year-old girl as an example. Read full article...   Bio.



This article was originally published on the Los Angeles Pediatric Society website as part of their Specialist's Corner. It is now being re-published by request.

 

Advocacy
Kris Calvin, CEO AAPCA

SB 277 Passed to End Child Vaccine Exemption - Now What?

The following outline highlights important events in the next six and 12 months.

 

 

Timing

  • Nothing changes until January 1, 2016. Personal Belief Exemptions (PBEs) are legal until then, and "last" 6 months.
  • On January 2016, PBE language comes out of CA law. No more PBEs.
  • On July 2016, the full law becomes "effective."
  • Between January 1 and July 1, 2016 is a "funny window" for those unexpectedly starting or changing schools. Holding for state legal opinion.

"Grandfather" Clause

  • Children with existing PBEs do NOT need to "catch up on shots" .
  • Law will make "new era" for kids first starting child care/school now.
  • Does not reduce existing PBEs out there. (schools wanted this amendment due to cost/hassle/upset caused by "expelling" those who might refuse to catch up.

Medical Exemption

  • Fundamentally unchanged still: if in professional judgment of physician, if it is medically "unsafe" for a child to receive 1 or more vaccines.
  • New language in law calls out family history as one factor that can be considered (always been true).
  • Families can and will "doctor shop".

Home Schooling/Special Needs

  • New law applies to public, private and charter schools.
  • Only exempted schooling is home school.
  • Children with special needs/Individualized Education Programs (IEP) may receive only those specialized services in the classroom setting if not vaccinated *

 

* SB 277 provides that the new law does not prohibit a student who qualifies for an IEP from accessing any special education and related services required by his or her IEP.

The statutory language creates a special exemption for students with IEPs.  For example, a student with an IEP entering the 7th grade, who does not have a medical exemption affidavit and is not fully vaccinated after July 1, 2016, cannot be excluded from any classroom instruction if the instruction is part of his or her IEP.  Thus, if that student is in a regular classroom for 90% of the school day, but in a special education classroom for the remaining 10%, the District cannot exclude the student from either classroom.An argument can be made, however that a special exemption for students with IEPs runs counter to SB 277's legislative intent in that it permits unvaccinated students to enter classrooms and place other students at risk.  Such a risk is likely heightened when students with IEPs enter a classroom with other special needs students who may have weakened immunized systems due to their own disabilities.

 

The creation of an exemption for special needs students with IEPs, however, makes sense from a legal standpoint given that federal law requires school districts to provide qualified students with IEPs and does not include any immunization exemptions.  The legislature likely included this exemption so that SB 277 does not conflict with federally mandated requirements.

 

 

Only Applies to Specific Childhood Vaccines

  • "New" vaccines to prevent diseases may have PBEs (e.g, HPV)

 To access the exact SB 277 wording: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277  

 

Joint District Meeting - Chicago, IL


  
Leadership from the four California Chapters representing District IX, and leadership from Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, and West Virginia Chapters representing District III, met in Chicago for the AAP Annual Joint District meeting. 


 
  The meeting, which rotates participating Districts and location annually, was organized by the National AAP. Attendees enjoyed interesting presentations from AAP President Sandra G. Hassink, MD, MS, FAAP, Executive Director/CEO Errol Alden, MD, FAAP, as well as several guest speakersWe had an opportunity to meet with AAP President-Elect Candidates Lynda M. Young, M.D., FAAP, of Worcester, Mass. and Fernando Stein, M.D., FAAP, of Houston. It was nice to get to know them better and hear their inspirational ideas to move the AAP forward.

 

 

 

 

The closing lecture was an eyeopener on cyber safety. Feel free to access this meeting's presentations at: https://www.aap.org/en-us/my-aap/chapters-and-districts/District-Meetings/Pages/District-III-IX-Power-Point-Presentations.aspx

 

Stuart A. Cohen, MD, FAAP - Dist. IX Chair
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On right, AAPCA/District IX Chair, Stuart A. Cohen, MD, FAAP, introduces AAP Executive Director/CEO Errol Alden, MD, FAAP.

Pictured above, Dr. Alden receives a standing ovation in appreciation for his lifetime dedication to the Academy.

 

 

 

 

 

CA Chapter 2 Receives "Chapter of Excellence" Award

(Pictured below) During the Reception and Awards Dinner, AAP Executive Director/CEO Errol R. Alden, MD, FAAP, observes as AAPCA Co-Chair, Yasuko Fukuda, MD, FAAP, (in her best Katy Perry outfit) presented the Chapter of Excellence Award to AAP-CA2 leadership in recognition for a year of exceptional accomplishments.

From left: Treasurer Alice Kuo, MD, PhD, Med, FAAP; Executive Director Tomás Torices, MD; Vice President Ed Curry, MD, FAAP; and President Paula Whiteman, MD, FACEP, FAAP. This was the last Joint District Meeting for Dr. Alden before his announced "step-down" at the end of July, 2015.

  

 

 

(Right) AAP-CA2 Treasurer, Alice Kuo, MD, PhD, Med, FAAP, presented the topic "Examining The Social Determinants of Health". Upon outlining the current state of child health in the US, some facts included the following:

  • Almost a quarter of all children live in poverty
  • 16 million do not have consistent access to food
  • 1/3 are overweight or obese
  • Almost 20% have a mental health condition
  • 10 million have asthma. 

Dr. Kuo's presentation slides may be accessed by following this link, within the My AAP site (user and password required) https://www.aap.org/en-us/my-aap/Documents/chapters_districts_d3.9_kuo.pdf


 

Night On The Town

Following three days of intense conferences, representatives from AAP National and the four California chapters spent an evening at the Navy Pier on the Chicago shoreline of Lake Michigan: Dinner, Fireworks, and spectacular city views.

 

Pictured below, from left (Back) Co-Chair District IX SGA Bill Mason, MD, MPH, FAAP; CA2 Executive Director Tomás Torices, MD; and AAP National President Sandra G. Hassink, MD, MS, FAAP.

(Front) CA-3 Vice President Patricia Cantrell, MD, FAAP; CA-4 President Dean Jacobs, MD, FAAP; CA-3 President Wendy Wright, MD, FAAP; CA-2 President Paula Whiteman, MD, FACEP, FAAP; and CA-1 President Zoey Goore, MD, MPH, FAAP.

 

 

 

On right, District IX Vice-Chair, Yasuko Fukuda, MD, FAAP joins the group as they pose with the iconic and colorful "letters and numbers" sculpture on the Navy Pier. 

The sculpture, by artist John Adduci, spells out "WBEZ 91.5 FM" the Chicago Public Radio Station.

 

 

AAP Mentoring Program

 

Announcement from the Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) and the Section on Early Career Physicians (SOECP).

 

One of the newest and exciting programs - The AAP Mentorship Program!

 

Mentorship is an important tool for professional development and has been linked to greater productivity, career advancement, and professional satisfaction. The AAP recognizes that mentorship is critical in helping nurture future leaders and a key opportunity to engage existing members and leaders. The AAP Mentorship Program seeks to establish mentoring relationships between trainees/early career physicians and practicing AAP member physicians. A primary goal is to promote career and leadership development. Mentors will have opportunities to further develop leadership skills and learn about emerging trends from the next generation of their peers. Mentees will gain a trusted advisor and learn methods to enhance career advancement. And all parties will form professional relationships and share advocacy, professional, and research interests.

 

Becoming involved is very easy. The only requirement to participate is to be a national AAP member in good standing. Participants need only sign-up and complete an online mentor/mentee profile form (you can sign up to be both a mentor and mentee if you so choose). The profile form collects information on education/training, subspecialty interests, practice/professional/clinical interests, chapter affiliation and the amount of time the participant is willing to commit. Mentors/mentee pairs will have the ability to meet traditionally in person if they choose a local match or use one of several online tools to meet virtually.

 

The program is set-up for both "traditional" long-term relationships, as well as short-term "flash" mentoring. The flash mentoring component allows for mentees to contact mentors for quick questions, set up 1-2 meetings, as well as participate in online topical forums and Q&A forums. Therefore, the time commitment and expectations can be tailored to fit each mentor/mentee pairs' needs.

 

and sign up to be a mentor and/or mentee today!

AAP login and password required.

 

We hope you will consider signing up (if you haven't already) as well as helping us spread the word by sharing this information with your colleagues in your various Chapters, Sections, Councils, and Committees. Please let us know of any questions or how we could be of assistance. We look forward to ongoing work together!

 

For kids,

 

Julia Pratt, MD and Maya Ragavan, MD

District IX SOMSRFT District and Assistant District Coordinator

 

Matt Diffley, MD, FAAP

District IX SOECP Representative

 

Engage with AAP SOMSRFT on social media: follow us on Facebook and Twitter

Engage with AAP SOECP on social media: follow us on Facebook

 

Click to download/print this announcement

 

Section on Early Career Physicians - March 2014
Section on Medical Students, Residents, and Fellowship Trainees - Feb 2014
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CQN4 Asthma QI Project - Update
Practices Met At Providence Tarzana Medical Center for Learning Session 3


Eleven practices continue participating in the AAP Chapter Quality Network Asthma Phase 4 Project. 

Learning Session 3 was led by Leadership from both the National AAP and CA Chapter 2 CQN teams, along with two guest speakers. This session, which took place on July 24th. marked the beginning of action period 3. During this stage, practices will focus on the following:

  • Patient/Family self management support, with an emphasis on Motivational Interviewing to accomplish important tasks, such as having an Asthma Action Plan that parents follow as indicated.
  • Spirometry. 
  • Strategies for project sustainability to continue providing optimal asthma care after the project ends in December.
Stephanie Marcy, PhD
Afif El-Hasan, MD

Stephanie Marcy, PhD of Children's Hospital 

Los Angeles presented Motivational Interviewing 

strategies to accomplish improved outcomes when 

dealing with the complexities of an Asthma Action Plan.

 

 

 

 

 

 

 

 

 

Afif El-Hasan, MD, a Kaiser Permanente Pediatrician in 

 Orange County and Governing Board Member with the

American Lung Association, presented compelling data

in his presentation: "Asthma and Air Pollution - 

Challenges of Environmental Justice", which included 

data from the State of The Air 2015 report.

 

 

State of The Air (SOTA) 2015

 

Despite tremendous progress in cleaning up the air, Southern California remains home to some of the most polluted air in the United States. Emissions from the transportation sector are the leading source of pollution in the region, bringing significant lung health burdens.  While even healthy adults and children are harmed by air pollution, most at risk are children, the elderly, those with heart and lung disease, diabetes, of lower socio-economic status, or proximity to major sources of pollution, like ports, rail yards or busy roadways. Click to view the report

 

 

 National and Chapter CQN4 Teams - From Left: AAP-CA2 Executive Director, Tomás Torices, MD / AAP QI Coach, Peggy Stemmler, MD, FAAP / AAP Data Analyst, Ed Wise / AAP-CA2 Secretary and CQN4 Asthma Leader, Chris Landon, MD, FCCP, CDM, FAAP / AAP Director of Quality Improvement Initiatives, Suzanne Emmer / and AAP-CA2 CQN4 Asthma Expert, Chris Harris, MD, FAAP.

  

Congratulations to the following practices for participating in this project:

  

Cesar Chavarria, MD, Inc.
Loma Linda University Health Care
Los Angeles Christian Health Center
Mandalay Bay Medical Group
Mission Pediatrics
Pediatric Diagnostic Center
Santa Paula West Pediatric Clinic
Sierra Vista Family Medical Clinic
Santa Barbara Asthma Consortium

Cottage Children's Hospital

Sansum Clinic -  Allergy/Pulmonology

Sansum Clinic - General Pediatrics 



 

AAP-CA2 would like to thank Providence Tarzana Medical Center for their continued support during CQN4 Asthma Learning Sessions 1 and 3.


 
 


 

 

QI and MOC Part 4 Opportunities

 

Cindy Reed
Sharon Elmensdorp, PhD

Two Birds, One Stone: Linking Improvements in Developmental Screening to an MOC Part 4 Project


 

A Project Coordinated by Help Me Grow Ventura County

By Sharon Elmensdorp, Ph.D. and Cindy Reed


 

The Help Me Grow Quality Improvement Project - Ventura County


 

     

     Earning ABP-approved MOC Part 4 credits can be time-consuming, expensive and even confusing for practicing pediatricians. 1 Fortunately, many organizations are stepping up to the challenge of simplifying the process of completing quality improvement (QI) projects. One such project is the Developmental Surveillance, Screening and Linking Children to Services: The Help Me Grow (HMG) System which was developed by Help Me Grow National in collaboration with the Connecticut Children' s Medical Center. Help Me Grow (HMG) is a system that aims to connect at-risk children with services in their community. Built upon the idea of collaboration amongst providers in healthcare, early intervention, early care, and family support, HMG acts as a liaison and community partner between pediatric staff and other community agencies to specifically provide support around developmental surveillance, screening and subsequently referral to community agencies. Locally, Help Me Grow Ventura County was established as an affiliate partner in 2013 through the collaboration between several agencies including leadership from the Landon Pediatric Foundation, Ventura County Public Health and Tri-Counties Regional Center.  Read full article...


 For more information about this project or for pediatricians/practices in Ventura County interested in participating in the HMG QI project, please contact Cindy Reed at 805-981-6617.  http://www.helpmegrowvc.org

 


QI / MOC Part 4 Project 
"Stewardship in Improving Bronchiolitis"

Excellent opportunity if you see at least 50 cases of bronchiolitis per year in the ED/Hospital

The AAP is looking for thirty pediatric hospital teams to participate in a 12 month quality improvement project. The core improvement teams will be co-led by an inpatient physician and emergency department physician and will include at least 2 additional team members, such as a Respiratory Therapist and a nurse/nurse floor manager. 


 

Goal: improved bronchiolitis management across the continuum of care with project measures that apply to both the

inpatient and EM settings at your hospital. 

 

We are looking for hospital settings that manage at least fifty inpatient and/or emergency department cases of

bronchiolitis per year (inpatient or observational status with the primary diagnosis of bronchiolitis as defined by ICD-9

codes 466.11 and 466.19) in the 1 month to 23 months of age patient population. 

 

Click to download/print the full project description

 

Click Here to access the recording of an informational webinar that took place on 7/29/15

 

To express interest in project participation, please follow the link below to complete the project application:

https://www.surveymonkey.com/r/SIB_Recruitment_Application. Preference will be given to

hospitals with completed surveys received by August 14, 2015.

 

 

 

Call For Applications

 

 

The National Center for Medical Home Implementation (NCMHI) in the American Academy of Pediatrics (AAP) is collecting applications for innovative and promising practices in pediatric medical home implementation. All pediatric medical home stakeholders are eligible to apply, including individual AAP Chapters.

 

All applications will be reviewed by an expert panel and selected innovative and promising practices will be published on the NCMHI Web site.  Applications can be submitted electronically through this online survey, or submitted as an email attachment to medical_home@aap.org using the Microsoft Word® Document attached. Applications are accepted on a rolling basis, however the National Center encourages you to submit an application within the next month to be considered for publication in 2015. 

 

Apply electronically as mentioned above, or Download and email This Application 

 

 

 

 

CULTURAL

 

Remember to visit The Southern California Medical Museumlocated on the first floor of Western University of Health Sciences' Nursing Science Center, 350 S. Garey Ave. in Pomona, CA. 
Museum Building


Museum Chairman, Elliot Weinstein, MD, FAAP, (below, left) cordially invites the medical community to visit the new location. "We welcome interested individuals to consider participating in one or more of our activities. We are looking for people with an interest in history, medicine, publications, becoming a docent, fundraising, preservation, libraries, and many other fields and disciplines. Please contact us if you would like to belong to one of our committees".



Elliot Weinstein, MD, FAAP - Museum Chairman

The Southern California Medical Museum is the only museum in Southern California dedicated to the collection and preservation of medical artifacts and the recording of the history of medicine in Southern California and the West. The SCMM is supported by donations and funds through the museum portion of the Physicians Memorial Gift and Benevolence Fund, a non-profit, 501(c)(3) charitable organization.

 

Hours of operation will be Fridays and Saturdays 1PM to 5PM, and the second Saturday of each month 1PM to 9PM coinciding with Downtown Pomona Artwalk. Admission: Adults $5  Students $3
For more information, please visit their website:  http://www.socalmedicalmuseum.org
Save The Dates!
Ken Saul, MD, FAAP
October 7, 2015 - Town Hall Meeting with host Ken Saul, MD, FAAP

Topic: Food Allergies
Speaker: TBA
Location: Maggiano's, Woodland Hills

 

April 16, 2016

The 27th Annual Southern California Postgraduate Pediatric Conference

Advances in Pediatrics

 

At the Sheraton Universal Hotel

 

Dr. Pickering
Dr. Reyes

Please mark your calendars now for next year's conference on Saturday, April 16, 2016.


 

Next year, our S. Michael Marcy Memorial Lecture speaker 

will feature Larry K. Pickering, MD. FAAP from the CDC.

 

Carlo Reyes, MD, MS, Esq., FACEP, who is an emergency medicine physician, 

pediatrician, and lawyer, to speak regarding Healthcare Risk Management.


Resolutions Reminder for ALF

 

Paula J. Whiteman, MD, FACEP, FAAP 
President, AAP-CA2
Representative, AAP-District IX CFMC

Submitting Resolutions - Process Update

 

Paula J. Whiteman, MD, FACEP, FAAP

President, AAP-CA2
Representative, AAP-District IX CFMC

If you are passionate about a particular idea or topic that you feel should be a priority for the National AAP, then please consider submitting a resolution.

 

Please see the Guidelines for Submitting Resolutions and the Writing and Submitting a Resolution - A step by step approach documents as well as a sample resolution template.

 

I have included two sample resolutions to assist you. One resolution was my #1 MJ resolution, which was a late resolution and thus has wording reflecting that. The other resolution on tap water went straight to the consent calendar at the Annual Leadership Forum (ALF), Which means it was felt to be a well written, concisely worded with clear intent as well as being a topic without controversy presented with adequate supporting background material.

 

Please feel free to contact the chapter, if you need to assistance with the process.

 

Submitted resolutions must have a sponsor for consideration at ALF.

 

While the resolution submission deadline for the National AAP is midnight CST on Dec. 1, 2015, in order to have time to refine any resolutions and meet internal deadlines for AAP-CA2  sponsorship and possibly, district (AAP-CA) sponsorship, please submit them to the chapter by October 1, 2015.

 

Please click the links below to access the corresponding documents:

 

Submitting Articles for Publication in Our Newsletter


 

Have you written original clinical work you would like to share?

Do you have any news you that would like to publish in our newsletter?


AAP-CA2 invites you to submit your ideas, accomplishments, news, pictures...

For article submission guidelines, please click here.

If you are interested in advertising, please email the Chapter.

 

AAP-CA2 Video: We Are The AAP-CA Chapter 2
We Are The AAP-CA Chapter 2
We Are The AAP-CA Chapter 2



Thank you for your support
Sincerely,
AAP-CA2
PO Box 94127 Pasadena, CA 91109
(818) 422-9877
Please visit our website at http://aapca2.org/