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For years, the American Academy of Pediatrics (AAP) Coding Hotline has been a trusted resource for pediatricians and others with coding conundrums. Pediatric Coding Q&A: Expert Advice From the AAP Coding Hotline is a compilation of the hotline's \"greatest hits, \" featuring guidance from our coding experts on everything from coding for specific clinical conditions to applying both common and evolving coding concepts. Organized by clinical and coding topics, pediatricians, office managers, and coders will benefit from AAP Coding Hotline expertise and experience. Examples of topics include * Asthma * Attention-deficit/hyperactivity disorder * Behavioral health * Billing and claims completion * Breastfeeding and lactation counseling * Foreign body removal * Newborn care (hospital or office) Readers will also find tips for effective billing practices, appropriate documentation, capturing all reportable services, and modifier use. Bonus content includes resources to learn more about specific conditions and coding concepts, as well as a series of coding fact sheets.

This compendium of clinical practice guidelines and policy statements from the AAP helps equip clinicians to provide equitable and inclusive care to vulnerable and underserved pediatric populations.

Cerebellar ataxia (CA) and hereditary spastic paraplegia (HSP) are two of the most prevalent motor disorders with extensive locus and allelic heterogeneity. We implemented clinical exome sequencing, followed by filtering data for a 'movement disorders' gene panel, as a generic test to increase variant detection in 76 patients with these disorders. Segregation analysis or phenotypic re-evaluation was utilized to substantiate findings. Disease-causing variants were identified in 9 of 28 CA patients, and 8 of 48 HSP patients. In addition, possibly disease-causing variants were identified in 1 and 8 of the remaining CA and HSP patients, respectively. In 10 patients with CA, the total disease-causing or possibly disease-causing variants were detected in 8 different genes, whereas 16 HSP patients had such variants in 12 different genes. In the majority of cases, the identified variants were compatible with the patient phenotype. Interestingly, in some patients variants were identified in genes hitherto related to other movement disorders, such as TH variants in two siblings with HSP. In addition, rare disorders were uncovered, for example, a second case of HSP caused by a VCP variant. For some patients, exome sequencing results had implications for treatment, exemplified by the favorable L-DOPA treatment in a patient with HSP due to ATP13A2 variants (Parkinson type 9). Thus, clinical exome sequencing in this cohort of CA and HSP patients suggests broadening of disease spectra, revealed novel gene-disease associations, and uncovered unanticipated rare disorders. In addition, clinical exome sequencing results have shown their value in guiding practical patient management.

This compendium of clinical practice guidelines and policy statements from the American Academy of Pediatrics helps equip clinicians to provide equitable and inclusive care to vulnerable and underserved pediatric populations. It offers guidance on the care of such populations as immigrant children and their families; children and families who are black, indigenous or people of color; LGBTQ+ youth and their families; and more. Additionally, the compendium covers topics such as substance use disorders, trauma informed care, and care of youth involved in the legal system. Pediatricians, family medicine physicians, physician assistants, and nurse practitioners who care for children will find this collection useful.

IntroductionPatients with IBD suffer a high prevalence of psychological disorders and co-morbid depression. The true impact of psychosocial factors on the risk of experiencing a disease flare is unknown.MethodsWe investigated associations between psychosocial factors and time to soft flare (patient-reported poorly-controlled disease) and hard flare(soft flare plus CRP >5 mg/L or faecal calprotectin(FC) >250 mcg/g and change in treatment) in adults with IBD in self-reported clinical remission.Participants were recruited as part of the PREdiCCt study across 47 UK sites and followed up prospectively for 24 months.At study entry, participants provided samples for standardised FC analysis and completed questionnaires evaluating anxiety(HADS-A), depression(HADS-D), sleep quality(PSQI), physical activity(GPAQ) and somatization(PHQ15). Soft flares were self-reported via monthly online questionnaires, hard flares were recorded by FC and CRP testing at time of soft flare and by end-of-study phenotyping.We conducted survival analyses with Cox frailty models for time to soft- and hard flare, performed separately for Crohn’s disease(CD) and UC/IBDU cohorts, adjusting for baseline FC, sex, index of multiple deprivation, hospital site ± age.ResultsA total of 1641 participants[CD=830, UC/IBDU=811] were included, 36%[n=595; CD=280, UC/IBDU=315] reported soft flare and 13%[n=219; CD=99, UC/IBDU=120] experienced hard-flare.Risk of hard flare was increased for UC patients with elevated HADS-D scores of 8-10(p<0.001, 95%CI 1.51-4.47) and 11-21(p=0.042, 95%CI 1.02-4.64), and decreased for those who met WHO-recommended exercise levels(p=0.034, 95%CI 0.43-0.97).Risk of soft flare was significantly associated with HADS-A scores, HADS-D scores(UC/IBD), sleep disturbance(CD) and somatization(table 1).Abstract O85 Table 1 Baseline Questionnaire Score Soft Flare Hard flare CD UC/IBDU CD UC/IBDU Anxiety(HADS-A) 8-10 p=0.001 (95% CI 1.21-2.22) p=0.08(0.96-1.72) p=0.78(0.64-1.81) p=0.46(0.73-1.97) 11-21 p<0.001 (1.37-2.52) p=0.015 (1.07-1.99) p=0.64(0.66-1.92) p=0.13(0.88-2.48) Depression(HADS-D) 8-10 p=0.09(0.95-1.98) p=0.005 (1.07-1.99) p=0.37(0.71-2.45) p<0.001 (1.51-4.47) 11-21 p=0.39(0.77-1.91) p=0.042 (1.01-2.65) p=0.95(0.42-2.25) p=0.042 (1.02-4.64) Sleep(PSQI) ≥5 p<0.001 (1.22-2.04) p=0.1(0.96-1.52) p=0.55(0.74-1.72) p=0.32(0.82-1.80) Somatization(PHQ15) 5-10 p=0.001 (1.30-2.90) p=0.004 (1.14-2.05) p=0.043 (1.02-3.44) p=0.35(0.79-1.95) 10-15 p<0.000001 (1.94-4.53) p=0.020 (1.06-2.10) p=0.19(0.79-3.18) p=0.78(0.61-1.90) 15-30 p<0.000001 (2.34-6.45) p=0.004 (1.24-3.02) p=0.044 (1.02-5.40) p=0.98(0.44-2.21) Exercise(GPAQ) ≥minimum recommended by WHO p=0.38(0.85-1.51) p=0.73(0.79-1.39) p=0.63(0.56-1.41) p=0.034 (0.43-0.97) ConclusionsWe assessed a range of psychosocial factors in a large IBD cohort. We identified depression as a risk factor for hard flare and exercise as a protective factor, both in UC. Sleep disturbance, somatization, anxiety and depression were associated with soft flare in IBD.

This convenient reference provides clinicians with point-of-care guidance on the assessment and treatment of chronic and acute asthma in infants, toddlers, school-aged children, and young adults.   This quick reference is perfect to have on hand during evaluation and diagnosis, determination of a treatment course, and communication with patients and parents about asthma triggers, management strategies, a customized treatment plan, and follow-ups.   It includes current approaches to asthma diagnosis and management, office pulmonary testing, clinical index tools, stepped approaches to treatment by age, maintenance and control, exacerbations, medication guidance with updated recommendations, and much more.   CONTENTS INCLUDE * Approach to Evaluation * Diagnosis * Office Pulmonary Function Testing * Exacerbation Assessment * Respiratory Scoring Tools * Classifying Severity by Age * Intervention Overview * NIH/NHLBI Stepwise Approaches to Management * FeNO: NIH/NHLBI Recommendations * GINA Stepped Approaches to Treatment * Maintenance and Control * SABAs * Inhaled Corticosteroids * LABAs and LTRAs * Inhaled Anticholinergic Agents * Systemic Corticosteroids * Anti-immunoglobulin E Therapy * Other Biologics * Trigger Management * Exercise-Induced Bronchoconstriction * Asthma Control Test * Tobacco Use/Vaping and Asthma * Get Valid Spirometry Results Every Time

This convenient reference provides clinicians with point-of-care guidance on the assessment and treatment of chronic and acute asthma in infants, toddlers, school-aged children, and young adults.

Children with Congenital Adrenal Hyperplasia (CAH) have a higher chance of hypertension. The likelihood of hypertension is higher in CAH children who get fludrocortisone medication and have an over-suppression. Plasma renin activity (PRA) is a sensitive indicator when the fludrocortisone dose is insufficient. The objective of this study is to assess the relationship between plasma renin activity with hypertension in 21-hydroxylase-deficient (21-OHD) CAH children. This cross-sectional observational analytical study was conducted in 2019 at the Pediatric Endocrinology Outpatient Clinic in Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. The subjects were 21-OHD CAH children, aged >6 months to 18 years who had already taken hydrocortisone with or without fludrocortisone for at least 6 months, and were divided into hypertension and non-hypertension groups. The subjects were selected by a consecutive sampling method. Data was analyzed using SPSS software (version 23.0) with unpaired test analysis and multiple logistic regression test. Statistical significance was achieved if P<0.05. Forty 21-OHD CAH patients were included, and 20 subjects (50%) had hypertension. A higher incidence of hypertension was found in salt-wasting CAH than in simple virilizing types (59.3% vs 30.8%). There was a significant mean difference in PRA levels between hypertension and non-hypertension groups in salt-wasting patients (P=0.016). A significant difference between the last dose of hydrocortisone with the number of hypertension patients in salt-wasting patients (P=0.032) was found, and low PRA levels showed a 1.09 times higher risk of hypertension. Children with salt-wasting CAH with low PRA levels had a higher risk of getting hypertension.

Electrospinning has been widely used to fabricate fibrous scaffolds for cartilage tissue engineering, but their small pores severely restrict cell infiltration, resulting in an uneven distribution of cells across the scaffold, particularly in three-dimensional designs. If bio-electrospraying is applied, direct chondrocyte incorporation into the fibers during electrospinning may be a solution. However, before this approach can be effectively employed, it is critical to identify whether chondrocytes are adversely affected. Several electrospraying operating settings were tested to determine their effect on the survival and function of an immortalized human chondrocyte cell line. These chondrocytes survived through an electric field formed by low needle-to-collector distances and low voltage. No differences in chondrocyte viability, morphology, gene expression, or proliferation were found. Preliminary data of the combination of electrospraying and polymer electrospinning disclosed that chondrocyte integration was feasible using an alternated approach. The overall increase in chondrocyte viability over time indicated that the embedded cells retained their proliferative capacity. Besides the cell line, primary chondrocytes were also electrosprayed under the previously optimized operational conditions, revealing the higher sensitivity degree of these cells. Still, their post-electrosprayed viability remained considerably high. The data reported here further suggest that bio-electrospraying under the optimal operational conditions might be a promising alternative to the existent cell seeding techniques, promoting not only cells safe delivery to the scaffold, but also the development of cellularized cartilage tissue constructs.

This handy visual aid guides clinicians in discussions with patients and parents about the importance of vaccines, the diseases they help prevent and the various vaccines recommended. The chart includes infographics and clinical images to help illustrate why vaccines remain important in preventing diseases. Vaccines covered include influenza, varicella (chickenpox), human papillomavirus infection, polio, meningitis, and much more.   The chart also includes information for health care professionals about the origin and nature of the diseases and current recommendations for vaccine schedules. Topics Include * Consider Simultaneous Administration of Multiple Vaccines for a Happier Visit * Diphtheria, Tetanus, and Acellular Pertussis (DTap, Tdap, Td) * Haemophilus influenzae Type B (Hib) * Hepatitis A and Hepatitis B * Human Papillomavirus Infection * Influenza (Flu) * Measles, Mumps, and Rubella (MMR) * Meningitis * Community-acquired Pneumonia * Polio * Rotavirus * Varicella (Chickenpox)