Year book of pediatrics 2016 share CLB nhi khoa y huế

Year Book® Year Book of Pediatrics® 2016 Michael D Cabana, MD, MPH Allan M Goldstein, MD Pascal Scemama De Gialluly, MD, MBA Alan R Schroeder, MD ISSN 0084-3954 VOLUME 2016 • NUMBER SUPPL (C) • 2016 Elsevier Table of Contents Cover image Title page Adolescent Medicine The Evolution of Sexual Dysfunction in Young Men Aged 18–25 Years Abstract Commentary Efficacy of a Telephone-Delivered Sexually Transmitted Infection/Human Immunodeficiency Virus Prevention Maintenance Intervention for Adolescents: A Randomized Clinical Trial Abstract Commentary Adolescent Predictors of Young Adult Cyberbullying Perpetration and Victimization Among Australian Youth Abstract Commentary Inpatient Treatment of Children and Adolescents With Severe Obesity in the Netherlands: A Randomized Clinical Trial Abstract Commentary Blue Blocker Glasses as a Countermeasure for Alerting Effects of Evening Light-Emitting Diode Screen Exposure in Male Teenagers Abstract Commentary Allergy Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy Abstract Commentary Food Allergen Panel Testing Often Results in Misdiagnosis of Food Allergy Abstract Commentary Intranasal Triamcinolone and Growth Velocity Abstract Commentary Outcomes Following Gene Therapy in Patients With Severe Wiskott-Aldrich Syndrome Abstract Commentary Transplantation Outcomes for Severe Combined Immunodeficiency, 2000–2009 Abstract Commentary Anesthesia and Pain Management fMRI reveals neural activity overlap between adult and infant pain Abstract Commentary Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials Abstract Commentary Intraoperative Acupuncture for Posttonsillectomy Pain: A Randomized, Double-Blind, Placebo-Controlled Trial Abstract Commentary A Comparative Evaluation of Nebulized Dexmedetomidine, Nebulized Ketamine, and Their Combination as Premedication for Outpatient Pediatric Dental Surgery Abstract Commentary Transversus Abdominis Plane Block in Children: A Multicenter Safety Analysis of 1994 Cases from the PRAN (Pediatric Regional Anesthesia Network) Database Abstract Commentary Sucrose and Warmth for Analgesia in Healthy Newborns: An RCT Abstract Commentary Blood Impact of Individualized Pain Plan on the Emergency Management of Children With Sickle Cell Disease Abstract Commentary Controlled Trial of Transfusions for Silent Cerebral Infarcts in Sickle Cell Anemia Abstract Commentary Screening and Routine Supplementation for Iron Deficiency Anemia: A Systematic Review Abstract Commentary Growth Hormone Improves Short Stature in Children With Diamond-Blackfan Anemia Abstract Commentary Influence of the American Society of Hematology Guidelines on the Management of Newly Diagnosed Childhood Immune Thrombocytopenia Abstract Commentary Neonatal Vitamin K Refusal and Nonimmunization Abstract Commentary Child Development/Behavior Early Intervention for Toddlers With Language Delays: A Randomized Controlled Trial Abstract Commentary Identifying Autism in a Brief Observation Abstract Commentary Can Parents' Concerns Predict Autism Spectrum Disorder? A Prospective Study of High-Risk Siblings From 6 to 36 Months of Age Abstract Commentary Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism Abstract Commentary Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial Abstract Commentary Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT Abstract Commentary Dentistry and Otolaryngology Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease Abstract Commentary Effect of Antimicrobial Treatment of Acute Otitis Media on the Daily Disappearance of Middle Ear Effusion: A Placebo-Controlled Trial Abstract Commentary The Prevalence of Congenital Hearing Loss in Neonates with Down Syndrome Abstract Commentary Association Between Sleep Bruxism and Psychosocial Factors in Children and Adolescents: A Systematic Review Abstract Commentary Dermatology A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma Abstract Commentary Safety and Efficacy of Pimecrolimus in Atopic Dermatitis: A 5-Year Randomized Trial Abstract Commentary Melanoma Incidence in Children and Adolescents: Decreasing Trends in the United States Abstract Commentary Nickel contact dermatitis in children Abstract Commentary Endocrinology Gigantism and Acromegaly Due to Xq26 Microduplications and GPR101 Mutation Abstract Commentary Vitamin D treatment in calcium-deficiency rickets: a randomized controlled trial Abstract Commentary Validity of Self-Assessment of Pubertal Maturation Abstract Commentary Changes Over Time in Sex Assignment for Disorders of Sex Development Abstract Commentary Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes Abstract Commentary Gastroenterology Medical Status of 219 Children with Biliary Atresia Surviving Long-Term With Their Native Livers: Results from a North American Multicenter Consortium Abstract Commentary Significant Hepatic Involvement in Patients with Ornithine Transcarbamylase Deficiency Abstract Commentary Neonatal Hemochromatosis: Diagnostic Work-Up Based on a Series of 56 Cases of Fetal Death and Neonatal Liver Failure Abstract Commentary Outcomes of Infants Born to Women Infected With Hepatitis B Abstract Commentary Ability of Pediatric Emergency Medicine Physicians to Identify Anatomic Landmarks With the Assistance of Ultrasound Prior to Lumbar Puncture in a Simulated Obese Model Restrepo CG, Baker MD, Pruitt CM, et al (Univ of Alabama at Birmingham) Pediatr Emerg Care 31:1519, 2015§ A.F Miller, MD and R Rempell, MD, RDMS Evidence Ranking A Expert Rating Abstract Objectives Lumbar punctures (LPs) are typically performed using anatomical surface landmarks However, as body mass index increases, identifying surface landmarks becomes more difficult Ultrasound has been proposed as a tool for identifying these landmarks prior to LP This study evaluates the effectiveness of a brief training program in ultrasound identification of anatomical landmarks in a simulated obese model prior to completing an LP Methods Pediatric emergency medicine physicians completed a pretest questionnaire on ultrasound familiarity prior to an educational session Participants utilized ultrasonography without the assistance of palpation on a simulation LP model saving images for review Participants attempted LP on phantom models with simulated body mass indices of 35 and 40 kg/m2 Time to image acquisition and successful aspiration of cerebrospinal fluid from the model were recorded Two expert sonologists independently reviewed all images for correct landmark identification Results Seven of the 19 participants had previous familiarity with ultrasound The mean time to lumbar image acquisition significantly improved for all individuals from 176 seconds to 100 seconds (P = 0.003) Comfort level with ultrasound improved (P < 0.001) as well as comfort level in performing a lumbar ultrasound (P < 0.001) Adequate images were obtained in 96% of the attempts (55/57) The success rate at performing LP was 95% (54/57) Conclusions After a brief education intervention, pediatric emergency medicine physicians with little to no previous training in ultrasound can obtain adequate lumbar anatomic images and successfully perform LP in a simulated obese model Comfort level with ultrasound significantly improves with a short course in ultrasound fundamentals Commentary Point of care ultrasound (POCUS) use has been an established practice and skill set that is present in the general emergency department (ED) training However, this organized curriculum and comfort with POCUS is in its early stages with pediatric-specific ED providers and is currently being used by the minority of pediatric ED providers Although pediatric ED fellowship programs are beginning to train new graduating fellows in pediatric POCUS and recent attendings may have some experience, the majority of pediatric ED physicians who have not recently completed training have limited comfort with POCUS.1 On the other hand, lumbar punctures (LPs) are commonly performed in the pediatric ED, where evaluation of the febrile neonate demands frequent use of the skill Kessler et al demonstrated that first-pass success rates are poor in infant LPs and mechanisms to improve this should continue to be studied.2 Adolescents less commonly require an LP, but the procedure is considered a core skill in all age groups Although proceduralists continue to have the same approach and technique in both age groups, they can be polarizing given the physical characteristics of the patient, specifically body mass index (BMI) In patients with an elevated BMI, the procedure of an LP can be quite difficult, making landmarks hard, and even impossible, to palpate This makes the idea of using POCUS ideal for identifying landmarks in older, more obese patients with increased BMI And despite our comfort with the neonatal LP given the frequency with which we perform the procedure, our success rates are low, and POCUS may offer technique improvements The article by Restrepo et al adds to the literature in pediatric POCUS by addressing the issues of the feasibility of educating POCUS-naïve physicians in the pediatric ED in the use of POCUS for identification of landmarks and performance of an LP on a simulated obese model The results demonstrate that this educational intervention improves the success of LP in obtaining cerebrospinal fluid from this simulated model Although small educational interventions have been shown in the literature for the improved use of POCUS, none have shown this for this specific indication in the pediatric ED This study should entice pediatric POCUS curriculums to include this skill in their training; as this is a simple skill that can be learned by novice users of POCUS, not to mention users with a brief background and understanding basic principles of POCUS A similar model has been proposed by Vieira et al for POCUS training in central venous catheter placement, a procedure that is done with low frequency but when performed with POCUS outcomes are improved.3,4 This article leaves plenty of future directions for further research, primarily in actual use of POCUS for identifying landmarks for LP on obese patients in a pediatric ED rather then a simulated experience Additional studies should compare POCUS versus standard landmark identification by palpation to evaluate time and number of attempts needed, rate of admission, in addition to assessing any changes in length of stay, as well as other ED efficiency benchmarks This simple educational intervention using simulation and POCUS is a clear indication of how simulation can be an excellent method of performing research on pilot applications This study allows for many additional questions to be asked and evaluated regarding this pilot application, specifically clinical outcomes, which can then be brought into our clinical practice References Vieira, R L., Bachur, R Bedside ultrasound in pediatric practice Pediatrics 2013; 133:1–3 Kessler, D., Pusic, M., Chang, T P., et al Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture Pediatrics 2015; 135:e1237–e1246 Vieira, R L., Gallagher, R A., Stack, A M., Werner, H C., Levy, J A Development and evaluation of a program for the use of ultrasound for central venous catheter placement in a pediatric emergency department Pediatr Emerg Care 2013; 29:1245– 1248 Gallagher, R A., Levy, J., Vieira, R L., Monuteaux, M C., Stack, A M Ultrasound assistance for central venous catheter placement in a pediatric emergency department improves placement success rates Acad Emerg Med 2014; 21:981–986 Original Article Restrepo, C G., Baker, M D., Pruitt, C M., et al, Ability of pediatric emergency medicine physicians to identify anatomic landmarks with the assistance of ultrasound prior to lumbar puncture in a simulated obese model Pediatr Emerg Care 2015; 31:15–19, doi: 10.1097/PEC.0000000000000330 Long-term Plans for Those Selecting Hospital Medicine as an Initial Career Choice Freed GL, McGuinness GA, Althouse LA, et al (Univ of Michigan, Ann Arbor; The American Board of Pediatrics, Chapel Hill, NC) Hosp Pediatr 5:169174, 2015§ J Percelay, MD Evidence Ranking A Expert Rating Abstract Background The proportion of the newly graduated pediatric workforce that becomes hospitalists has been increasing slightly over the past decade However, it is unknown what proportion of those who accept hospitalist positions as their first job intend to remain in the field longer term This is important to workforce projections regarding the magnitude of those who will function in this role Methods The American Board of Pediatrics incorporated a structured questionnaire within the online application process to the General Pediatrics certification application Respondents identified as residents or chief residents who selected “hospitalist position” as their immediate postresidency plan were the focus this study We compared survey responses by gender and location of the medical school attended Results Since the initiation of the general pediatrics certification examination application survey, 6335 completed the questionnaire 79% (n = 5001) were either in residency training or were a chief resident Of those, 8% (n = 376) reported they planned to work as a pediatric hospitalist immediately after completing residency Fewer than half (43%; n = 161) reported this to be their long-term career plan This finding varied by both medical school type and by gender Conclusions The majority of pediatric residents and chief residents who take hospitalist positions immediately after training do not intend for hospital practice to be the long-term focus of their careers As the field of hospital medicine continues to develop, understanding career trajectories can help inform current and future efforts regarding the potential for different mechanisms for training and certification Commentary Hospital Medicine has grown dramatically as a field since the term hospitalist was first introduced 20 years ago This growth has occurred despite a limited number of fellowship programs, less than 100 for both adult and pediatric hospitalists nationally The American Board of Internal Medicine and the American Board of Family Practice use recognition of focused practice as their approach to vetting the qualifications of hospitalists for adults In contrast, the pediatric hospitalist community recently submitted a formal petition to the American Board of Pediatrics (ABP) to create formal 2-year fellowships in pediatric hospital medicine (PHM) The survey data reported in this investigation by Freed et al will help guide ABP's decisions but only if the analysis is extended through a 15-20-year timeframe as noted below Freed's survey of graduating residents is a continuation of the ABP's ongoing efforts to gather information on pediatric hospitalists Previous surveys from more than years ago studied PHM fellowship training programs and weighted samples of pediatric hospitalists and pediatric hospitalist group leaders In this earlier work, concerns were expressed about PHM long-term career opportunities and the overall viability of the field Yet PHM has continued to grow and mature Next to neonatology, PHM is the largest discipline-based section within the American Academy of Pediatrics, the annual PHM meeting attracts 800 hospitalists for a 4-day conference, and workforce estimates range from 3000 to 5000 practitioners Within this context, this most recent survey of graduating residents and chief residents reports that 8% of newly minted pediatricians are choosing hospital medicine as a career but that less than half of this group (43%) reports planning to continue in the field for more than years The strength and uniqueness of the study is that participation was mandatory for all applicants for initial ABP certification There is essentially a 100% response rate The weaknesses are important and readily acknowledged by the authors First, only plans are reported There was no follow-up of actual work experience Second, the opinions and perceptions of current residents not serve as a proxy for the opinions and perceptions of pediatricians out in practice Despite these limitations, the 43% figure seems a reasonable estimate for the ABP and others to use in workforce estimates for initial career plans No better data are available or necessary for this particular population or question Instead, policy makers and analysts need to take the next step with these data and explore long-term implications If one assumes that 400 new pediatric hospitalists join the workforce each year, over time even a seemingly low 43% retention rate results in significant growth After 15 years, there would be greater than 3200 hospitalists in total, approximately 80% of whom would be career hospitalists Specifically, assuming a steady attrition rate more than 5 years and no hospitalists at the start, the percentage of career hospitalists (and total number of hospitalists) is 56% (n = 1544) at 5 years, 72% (n = 2404) at 10 years, and 79% (n = 32 640 at 15 years.) In this context, a retention rate of about 50% seems appropriate for a new field with such high demand Turnover is crucial for consistent growth If instead the retention rate were 90%, in 10 years, there would be 3600 long-term career hospitalists, but job openings for new graduates would be very limited Boom and bust cycles do not generate a steady workforce How does this hypothetical model compare with reality? It's hard to say, because there is no formal way to survey practicing hospitalists and capture a random sample much less the entire universe But for a field that has been in existence for approximately 15 years, 3000 hospitalists is a conservative estimate of the total workforce In a survey of members of the American Academy of Pediatrics Section on Hospital Medicine (SOHM) conducted between 2012 and 2013 (n = 534, response rate = 42%), 92% of respondents reported long-term career plans as a hospitalist (70% full time, 22% part time.) Only 2% saw PHM as an interim career, and 6% were undecided In this sample, 57% of respondents had practiced in hospital medicine for ≥5 years, and 19% more than 10 years.1 This sample of hospitalists is not representative, it is biased toward individuals with sufficient enough career interest in PHM to join the SOHM, and in particular underrepresents pediatric hospitalists in community hospitals It would be a mistake to assume that the mature PHM workforce is somehow uncommitted to the field To answer this question, the ABP could simply apply a similar set of mandatory survey questions to current diplomates upon enrollment for maintenance of certification in general pediatrics This should capture a population of pediatricians with at least 5 years of work experience The information could be combined with data on graduating residents to describe the overall hospitalist workforce For now, the best available data indicate that most pediatric hospitalists are long-term hospitalists and that this number is significantly greater than the number of short-term hospitalists Moreover, the field is growing steadily Career hospitalists play major roles in the care of hospitalized children and the teaching of pediatric residents Research contributions are increasing Decisions about what is best for the future of pediatric hospital medicine and the children and families cared for by hospitalists should be based primarily on data from the roughly 3000 hospitalists who are in it for the long haul, not the initial career plans and perceptions of a much smaller number of graduating residents entering the field for the first time Reference Fisher ES, Percelay JM, et al Growing strong: findings from the American Academy of Pediatrics hospital medicine workforce survey Presented at Pediatric Academic Societies Meeting, May 2014 Vancouver, BC PAS Meeting (Pediatric Academic Societies) Original Article Freed, G L., McGuinness, G A., Althouse, L A., et al, Long-term plans for those selecting hospital medicine as an initial career choice Hosp Pediatr 2015; 5:169–174, doi: 10.1542/hpeds.2014-0168 New Century Scholars: A Mentorship Program to Increase Workforce Diversity in Academic Pediatrics Pachter LM, Kodjo C (St Christopher's Hosp for Children, Philadelphia, PA; Univ of Rochester School of Medicine, NY) Acad Med, 2015 [Epub ahead of print]§ F.S Mendoza, MD, MPH Evidence Ranking A Expert Rating Abstract This article describes a program aimed to increase workforce diversity and underrepresented minority (URM) representation in academic pediatric medicine The New Century Scholars (NCScholars) program is a core program in the Academic Pediatric Association, the largest national organization for academic pediatric generalists The program selects URM pediatric (or medicine–pediatrics) residents who are interested in academic careers and provides each NCScholar with a junior and senior mentor, as well as travel grants to the Pediatric Academic Societies annual meeting where activities specific to the program are held, and provides ongoing mentorship and career counseling support The authors discuss the origination, operation, and changes to the program over the first 10 years of its existence, as well as outcome data for the participants in the program To date, 60 of the 63 NCScholars have finished residency and/or have made postresidency plans, and 38 of these URM pediatricians (63%) have entered academic careers The authors suggest that this type of mentorship program for URM pediatric trainees can be used as a model for other specialties and medical organizations Commentary Sometimes good ideas come at the right time! Now is the right time to think about how to diversify academic pediatrics because of the following The US Census Bureau predicts that in 2018, 50% of the US population 18 years and younger will be “minority”: African American, Hispanic, and Asian American This will affect clinical pediatrics as families with different cultures and languages enter our practices For decades, well-documented childhood health disparities have been reported for African American, Hispanic, and Asian-American children, but progress to eliminate them has been limited However, with the Affordable Care Act, there is both an opportunity and challenge to make progress in this area After almost 50 years of work to draw more minorities into medicine, the numbers of underrepresented minorities in medicine are still low in all fields of medicine Thus, while we need to continue to improve the “pipeline” for underrepresented minorities in medicine, we also need to ensure those currently in medicine maximize their leadership opportunities Lastly, the Institute of Medicine, the Association of American Medical Colleges (AAMC), and numerous academic societies state that improving our nation's health requires greater workforce diversity in all aspects of medicine: clinical care, education, administration, and research What should be done to address the implications of each of these statements for pediatrics? Although each is challenging, I believe that they are linked through the commonality of being more difficult to resolve without a diverse workforce in academic pediatrics Even the pipeline issue for underrepresented minorities in medicine will be more difficult if minority physicians are not visible to inspire those considering a medical career Perhaps more than any other field in medicine, pediatrics is seeing the demographic shift in its patient populations Yet a recent survey of departments of pediatrics demonstrates that the number of faculty who are underrepresented minorities remain low in academic pediatrics relative to their numbers in our society.1 It is clear that action is needed, but sometimes these problems seem so overwhelming that we are inhibited to act Fortunately, some do act to take on the challenge and can be successful as described in the article by Pachtner and Kodjo Their report about the New Century Scholars programs provides a model for what can be done to increase the diversity of academic pediatrics Through their program over a 10-year period, they were able to take 65 second-year underrepresented minority residents and have 63 completing the program with 38 (63%) entering academic careers This outcome needs to be viewed in the context of 2013 AAMC data, which show African American and Mexican American are only 3.2% and 0.5% of medical school faculty, respectively Thus, although the New Century Scholars program was not a big program, it demonstrated the possibilities of what can be done What if this program had been 2 or 3 times as large? What if all pediatric academic organizations had similar programs? These are not just questions but suggestions as to how to diversify our academic pediatric workforce The Pachter and Kodjo article gives us the anatomy of an effective program It started with committed individuals who were able to engage an organization, the Academic Pediatric Association (APA), in their vision of bringing more diversity to academic general pediatrics That vision resonated with the organization's board and membership, which was key in the program's success, leading not only to APA members as faculty mentors but also providing financial support to the program when needed The components of the program were straightforward: engage minority residents in the possibility of an academic career, give them examples of role models, energize them about the idea of doing academics, keep them connected with their mentors and peers, and assess the success of the program quantitatively and qualitatively Each of these added to the success of the program, but they are also statements of what is missing in our residency programs As the authors state in their discussion, these activities are important, “because many trainees may not have these supports locally at their residency program.” This should make us reflect as to what more we can do locally to support academic workforce diversity In reflecting on my experience as a dean for minority advising for the past 30 years, it strikes me that the New Century Scholars program addresses the key components of inspiring minorities to pursue academic careers First, it creates for them the possibility of an academic career, something they may not have considered nor have been encouraged to pursue Second, an academic career becomes more real if someone like them can be seen in the role or at least someone who can relate to them in a personal manner; this is the importance of a role model Third, they have to “live” the role This is where the New Century Scholars program support for attending the annual Pediatric Academic Society meeting was key for the minority residents This provided the vision of a future in which they could be part of an academic community Lastly, as noted by the authors, the program provided the social connectedness to a new community of mentors and peers that gave them an alternative professional world beyond their residency program Given that underrepresented minorities are usually very few in any residency program, having the opportunity to link socially with individuals of similar backgrounds sharing a common interest in pursing academics may lower the barriers to an academic career Finally, in a world of ideas, the good ones need to be supported and funded Pachter and Kodjo have provided us with the idea whose time has come, an idea for pediatrics that is essential if we are going to address the health issues of our children As a pediatric community, we need to stand behind programs like the New Century Scholars and do all in our power to make them successful Reference Mendoza, F S., Walker, L R., Stoll, B J., et al Diversity and inclusion training in departments of pediatrics Pediatrics 2015; 135:707–713 Original Article Pachter, L M., Kodjo, C., New century scholars: a mentorship program to increase workforce diversity in academic pediatrics Acad Med 2015; : – , doi: 10.1097/ACM.0000000000000669 [[Epub ahead of print]] Medical Communication Companies and Industry Grants Rothman SM, Brudney KF, Adair W, et al (Columbia Univ, NY) JAMA 310:2554-2558, 2013§ R Steinbrook, MD Evidence Ranking B Expert Rating Abstract Importance Medical communication companies (MCCs) are among the most significant health care stakeholders, supported mainly by drug and device companies How MCCs share or protect physicians' personal data requires greater transparency Objective To explore the financial relationships between MCCs and drug and device companies, to describe the characteristics of the large MCCs, and to explore whether they accurately represent themselves to physicians Design We combined data from the 2010 grant registries of 14 pharmaceutical and device companies; grouped recipients into categories such as MCCs, academic medical centers, disease-targeted advocacy organizations, and professional associations; and created a master list of 19,272 grants Main Outcomes and Measures Determine the distribution of funds from drug and device companies to various entities and assess the characteristics of large MCCs Results Of the 6493 recipients of more than $657 million grant awards from drug and device companies, 18 of 363 MCCs received 26%, academic medical centers received 21%, and disease-targeted organizations received 15% For-profit MCCs received 77% of funds (208 of 363) Among the top 5% of MCCs, 14 of 18 were for-profit All 18 offered continuing medical education: 14 offered live and 17 offered online CME courses All required physicians to provide personal data Ten stated that they shared information with unnamed third parties Eight stated they did not share information, but almost all added exceptions None required explicit physician consent to their sharing policies Conclusions and Relevance Medical communication companies receive substantial support from drug and device companies Physicians who interact with MCCs should be aware that all require personal data from the physician and some share these data with unnamed third parties Commentary Although medical communication companies are important sources of continuing medical education and online continuing medical education (CME) courses, many physicians know little about them and their many roles in health care As this article establishes, pharmaceutical and medical device companies provide considerable support to medical communication companies; the companies not only offer CME but require that physicians provide personal data Some companies share physicians' data with third parties that they do not identify The relationships of medical communication companies to industry and physicians have been difficult to ascertain because information about their industry contracts and grant awards has not been publicly available The availability of 2010 registries of grants from 14 pharmaceutical and device companies, posted on their websites, allowed these researchers to shed light on the financial relationships The study could not determine all industry support for medical communication companies; however, these drug and device manufacturers awarded a substantial $657 million in grants in 1 year alone The broader questions are what roles medical communication companies should have in collecting personal information and in CME? Physicians' personal information can be used to target advertising and other marketing efforts Physicians should be able to decide for themselves whether they wish to receive targeted advertising or other marketing In 2013, according to the Accreditation Council for Continuing Medical Education, about one-fifth of CME providers brought in more than $1 million in commercial support, but half brought in $100 000 or less and about one-quarter none at all Nonetheless, it is difficult to determine whether a CME presentation is biased based on whether it is supported by industry or the extent to which promotion sneaks into an otherwise balanced educational presentation It is likely, however, that industry support influences the range of CME topics and that topics having to with the use of drugs and medical devices are overrepresented compared with other topics Although it is important for physicians to keep up with new medical products, advances and new information in other aspects of practice may receive short shrift in industrysupported CME Pharmaceutical and device companies are businesses seeking to make profits, not charitable or educational organizations Thus, they have an interest, regardless of the number of safeguards against conflicts of interest in CME, in increasing sales of their products Other organizations that sponsor CME, such as medical schools or nonprofit physician membership organizations, are usually less reliant on commercial support than medical communication companies Such organizations provide CME on many topics that are important to the profession, and many hours of instruction But their courses and other activities cannot fill all the needs and may be more expensive The availability of convenient, inexpensive, and sometimes “free” CME, either online or in person through the top medical communication companies highlighted in the study, is attractive Physicians, however, can choose whether to obtain their CME through medical communication companies or academic medical centers, medical schools, and professional societies By better understanding the various roles of medical communication companies in health care, physicians can make better decisions about CME and when to share their personal data Original Article Rothman, S M., Brudney, K F., Adair, W., et al, Medical communication companies and industry grants JAMA 2013; 310:2554–2558, doi: 10.1001/jama.2013.281638 .. .Year Book Year Book of Pediatrics 2016 Michael D Cabana, MD, MPH Allan M Goldstein, MD Pascal Scemama De Gialluly, MD, MBA Alan R Schroeder, MD ISSN 0084-3954 VOLUME 2016 • NUMBER SUPPL... Abstract Commentary The Prevalence of Arrhythmias, Predictors for Arrhythmias, and Safety of Exercise Stress Testing in Children Abstract Commentary Prediction by Clinicians of Quality of Life for Children and Adolescents with Cardiac Disease... Commentary Dentistry and Otolaryngology Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease Abstract Commentary Effect of Antimicrobial Treatment of Acute Otitis Media on the Daily Disappearance of