2017 - May Edition
Edward Curry, MD, FAAP   President, AAP-CA2
Welcome to the May 2017 edition of our monthly e-Newsletter.

This week the House of Representatives passed the American Health Care Act (AHCA).  If the AHCA would become law, millions of Americans would lose healthcare coverage.  Children's Healthcare would be adversely affected by the cuts to Medi-Cal in which over 45% of children receive health care insurance. Also, Preventative Services and mandated coverage for pre-existing conditions could be eliminated.   As this healthcare bill moves to the Senate, Federal Advocacy from all Pediatricians will be very important in order to protect Children's healthcare.  As we move forward, I am hoping you will add your voice to that of AAP to protect our children. 
On April 11, I was the Keynote Speaker for the California Head Start Coalition about Bright Futures Preventative Services Guidelines.   California has adopted the Bright Futures as their guidelines for providing healthcare for the children in Head Start.  This was a wonderful group of teachers, counselors, and administrators who are truly dedicated to education and healthcare of preschool children.  Head Start would love to collaborate with Pediatricians to share resources and provide screening for the children they are serving.  Over the next few months, I will be working with Head Start to reach out to Pediatricians in their local service area in order to foster this collaboration.  
On April 22, we had our Annual Pediatric Symposium, which had 116 attendees - the most ever. I would like to thank the residents who did poster presentations and oral presentations, as well as those who attended for making this one of the most successful Symposiums we have ever had.
Finally, we will be completing our HPV MOC QI project this month. I would like to thank the 12 practices and 30 pediatricians for all their dedicated work and effort in order to improve HPV vaccine initiation rate in 11 and 12 year old adolescents. Many of our practices and pediatricians have improved their HPV vaccine initiation rates to over 80% by using the QI tools and resources provided to them by this project.
Remember, we need your voice to speak up in order to protect our Children's Healthcare. That's all for now.

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Feature Article
When Hyperbilirubinemia Isn't Physiologic - A Modern Day Screening Approach
F. Tania Mitsinikos, MD, F AAP Clinical Fellow, PGY-6 -  Division of Gastroenterology, Hepatology, and Nutrition Children's Hospital Los Angeles.

Daniel Thomas, MD, FAAP - Director, Hepatology, Medical Director of Liver and Intestinal Transplant, Division of Gastroenterology, Hepatology and Nutrition,  Children's Hospital Los Angeles.

F. Tania Mitsinikos, MD, F AAP
Every pediatrician is well trained to screen and identify     
Daniel Thomas, MD, FAAP
neonates with hyperbilirubinemia. The American Academy of Pediatrics (AAP) has established guidelines for screening and management of neonates with hyperbilirubinemia 1 . Fortunately, the incidence of kernicterus, caused by unconjugated hyperbilirubinemia, has declined over the years and is estimated to be near 1 in 100,000, but is largely unknown due to lack of definitive epidemiologic studies, particularly in the United States 2,3 .  Risk factors for hyperbilirubinemia leading to neurotoxicity include: Isoimmune hemolytic disease, G6PD deficiency, asphyxia, sepsis, acidosis, and albumin <3.0 mg/dL, which differ somewhat from the risk factors for severe hyperbilirubinemia 4 . However, there is a larger group of neonates with conjugated hyperbilirubinemia that need our heightened attention due to long-term morbidity and mortality, which is only briefly touched upon in the AAP recommendations. Read full article...

Advocating in Front of the Senate Business, Professions and Economic Development  Committee

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

On Monday, April 24th, I returned to Sacramento to represent the American Academy of Pediatrics, CA in front of the Senate Business, Professions and Economic Development Committee. On that day, I spoke in opposition to two bills: SB 392 Bates, SB 501 Glazer, and in favor of one: SB 794 Stern.
SB 392 Bates would call for a study to determine the effects on access to care before implementing the recommendations of the CA Dental Board requiring an end to the single operator-anesthetist model for children under 7 yo in dental settings. We stand in opposition to this bill as it does not put a child's safety first. Current data shows that there are 9,300 anesthesia providers in the state of CA who could provide the necessary additional services.
Senator Henry Stern with Dr. Whiteman at the State Capitol in Sacramento.
SB 501 Glazer disregards and omits the most important recommendation of the CA Dental Board relative to pediatric anesthesia use, which is the elimination of the use of the single operator-anesthetist model for deep sedation and/or general anesthesia for children under age 7 yo.
SB 794 Stern is a bill focusing on the labeling and packaging of marijuana edibles, now that marijuana is legal. Some of the bill highlights with regards to marijuana edibles include: that the packing design not be appealing to children or easily confused with commercially sold candy or foods that do not contain marijuana; that the marijuana edible be scored by standardized serving size not to exceed ten (10) milligrams tetrahydrocannabinol (THC); that the marijuana edible be sold in packaging that is both tamperproof and child resistant, and, if the marijuana edible contains more than one serving, that the packaging be resealable. Senator Stern represents Senate District 27, which falls within our Chapter boundaries.
AAP-CA is in support of SB 794. This bill is also consistent with the intent of my number one resolution from the 2014 ALF, which focused on marijuana advertising that could be perceived as directed towards children.

In The Community

A Note of Thanks to Dr. Edward Curry and the AAP-California Chapter 2.

Edward Curry, MD, FAAP
This past year, the Los Angeles County Office of Education (LACOE) Head Start program has had the  privilege of partnering with the AAP-CA Chapter 2 during California's transition to the  Bright Futures CHDP periodicity schedule.  To get this information to other Head Start programs, we invited Dr. Curry to share his expertise on Bright Futures at the annual California Head Start Association Health Institute in San Diego this past April.  He provided the opening keynote presentation to approximately 300 Head Start health, nutrition, mental health, and family service staff from throughout California.  He presented on Bright Futures periodicity and resources, as well as social determinants of health and Adverse Childhood Experiences (ACEs). Dr. Curry's keynote was the perfect opening to a conference that focuses each year on current health issues for vulnerable and high risk children and their families in California.  LACOE Head Start, as well as the other Head Start programs in Southern California look forward to continuing our partnership with our local AAP chapter.

Jenifer L. Lipman, RN, CPNP
LACOE Head Start Health Consultant

Wednesday, May 3rd, 2017 in Santa Barbara - Town Hall/Dinner Meeting

Santa Barbara Area Representative Brian Santacrose, MD, FAAP, hosted a Town Hall/Dinner Meeting at Stella Mare's Restaurant on Wednesday, May 3rd. Guest lecturer, Jacob Offenberger, MD presented on  Diagnosing and Managing Seasonal Allergic Rhinitis, with a focus on a nasal spray treatment option. The event was attended by local Santa Barbara pediatricians.   We thank Timothy Viramontes and Mylan for generously sponsoring this event.

Guest lecturer, Jacob Offenberger, MD (on left) speaking with AAP-CA2 Santa Barbara Area Representative, Brian Santacrose, MD, FAAP as guests began to arrive at Stella Mare's Restaurant.

Jimmy Kimmel Reveals Details of His Son's Birth & Heart Disease

In case you've missed it, it's worth mentioning that Jimmy Kimmel shared a heart touching story this past week on live television. In this 13-minute clip, Mr. Kimmel talks about the birth of his son, and the events that unfolded just three hours after the baby was born. This is an excellent real life story that puts in perspective pre-existing conditions and healthcare. Click the image if you would like to watch the video.

PROS - Pediatric Research in Office Settings
Heide Woo, MD, FAAP and David Feazell, MD, FAAP -  PROS Chapter Coordinators
PROS had a wonderful and energizing Spring Meeting in Chicago.
PROS, Pediatric Research in Office Settings, is currently recruiting for a NEW STUDY
is a study looking at effectiveness of text messages to parents to remind and encourage timely receipt of the booster flu vaccine for the subpopulation of infants and children who need it.  Consenting the parents will be done remotely over the phone, making it an easy study for pediatricians and practitioners to incorporate into the daily office flow.  No special EMR, or any EMR, is required to participate.  Work required by the office is:
  1. Offer the study to parents whose infants and children getting their first of two doses of flu vaccine by simply asking interested parents to send a text message to the study team.  The study team will take care of the rest!
  2. At the end of the flu vaccine season, check the flu vaccine record for those patients enrolled, apx 40-50 patients per practice.  
Within each practice, half the enrolled parents will serve as the control and will not receive the study text message reminders but the practice will continue with usual practice.
PROS is also recruiting for new members, and encouraging all current members, to sign up and join PROS BRIEFBrief Response to Improv E the Field.  PROS BRIEF will be a twice per year survey on topics relevant to current or pending studies as well as to issues of interest to the practicing pediatrician.  The survey will be short and have a quick turn around for results and feedback to the participating practitioners.  There is also be an opportunity to discuss the results and make comments or raise related topics in a process of "deBRIEFing".  For those already in PROS, look for the invitation postcard in the mail, and for those who are not yet in PROS, but are interested in joining, contact PROS to sign up!  And invite your friends and colleagues to join as well!
Two studies will be recruiting soon:  BMI2+ and STOP-HPV, both based on use of EMR.
Do you have PCC EMR?  Are you interested in prevention and treatment of childhood overweight and obesity?  If so, BMI2+ will be recruiting soon.  In order to join as soon as recruitment starts, join PROS now and let us know that you are interested the BMI2+ study.  Those who participate in the study will get expert MI training taught by one of the world's experts on motivational interviewing.  In addition, participants in the intervention arm will also get MOC4 credit for all their efforts.
STOP-HPV will studying missed opportunities for the HPV vaccine by use of EMR alerts and office system enhancements.  This study also will award MOC4 credits.  We are not yet set on which EMR will be used for the study but let  PROS know if you are interested.
PROS has 2 studies currently active:  DART, an antibiotic prescribing and parent communication study, and HEMPP, an adolescent marijuana counseling study. 
Other studies are awaiting funding or in development. 
To join PROS or get more information, please feel free to contact us at hwoo@mednet.ucla.edu or dfeazell@mednet.ucla.edu  or visit www.aap.org and search under PROS, or email the AAP PROS staff at PROSops@aap.org .

Advances in Pediatrics Symposium REPORT
About 30 participants kicked off the day with a session on Morning Mindfulness led by Jerome Front, LMFT. There was a didactic component describing research-based benefits of mindfulness for both physicians and their patients, as well as how to blend intention with attention and present moment awareness. The session concluded with a guided mindfulness meditation period with group reflection and processing.

AAP-CA2 President Edward Curry, MD, FAAP  led the day for over 100 health care providers in attendance, made up of physicians (pediatricians and pediatric sub-specialists), pediatric residents, nurses, nurse practitioners, physician assistants, and licensed marriage and family therapists.

Edward Curry, MD, FAAP

Dr. Lawrence F. Eichenfield  spoke on Atopic Dermatitis with the "itch that rashes" versus the "rash that itches." He discussed the differential diagnosis of atopic dermatitis as well as the new treatment now available and what is on the horizon. 

Some pearls: If  you use moisturizer after bathing and don't let the skin dry out, then there is no reason to avoid bathing.  It is important to use the topical steroids for a few days after resolution of symptoms.
Lawrence F. Eichenfield, MD

Breaking news: If you have an infant less than 6 months of age with a severe atopic dermatitis, consider an emergent allergist referral for skin prick test. Based on the skin response, they may perform early peanut feeding to avoid the development of peanut allergy.
In the post-lecture discussion it came up that allergic rhinitis with rubbing of the eyes can cause peri-ocular eczema. FML ophthalmic ointment may be used for up to 5 days so as to avoid the development of glaucoma.

Tracy Zaslow, MD, FAAP, CAQSM
AAP-CA 2 member-at-large Dr. Tracy Zaslow  discussed  Keeping Your Head in the Game: Update on Concussion in the Young Athlete .  The incidence of concussion is on the rise; however, this may be related to more and better diagnosis. What is a concussion? Getting a "ding" or the "bell rung", that is a concussion. This can be due to a either direct or indirect impact regardless of whether or not the person lost consciousness. While neuroimaging is not needed to diagnose concussion, CT scan can be valuable in the acute period for concerns of intracranial bleeding and/or skull fractures; MRI is reserved for those with prolonged symptoms to rule out underlying brain anomalies. And, it's important to remember that CT/MRI only show brain structure, and a negative result does not exclude concussion. 
For soccer balls, size matters. Size 3 for < 9 yo, Size 4 for age 9-13 yo, Size 5 for age 14yo and older. Stitched balls are better than molded. Use a FIFA-certified ball which is designed not to absorb water and become heavier.  Use of soccer headgear may promote a false sense of security for the athlete. Mouth guards do not help decrease the risk of concussion but are recommended to decrease dental injury. Most important take-home point: When in doubt, SIT it OUT.

AAP-CA CEO, Kris Calvin discussed approaches to advocacy: The process of urging a person or entity that has the power to make or influence a decision to do so they way you wish.  It is important to develop you priorities for your advocacy plan. Kris went through a role playing exercise as to how to reach out and speak to your legislators in a non-partisan way. Please go to the AAP-CA website advocacy tab for a list of bills focusing on the AAP-CA advocacy priorities with links to letter of support or opposition, if available.

Kris Calvin, CEO, AAP-CA

Alice Kuo, MD, PhD, Med., FAAP
During the lunch business meeting, AAP-CA2 Vice President, Alice Kuo, MD, PhD, Med., FAAP updated the membership on issues at the federal level pertaining to child health. Most notably, the American Health Care Act (aka Republican health care bill) having provisions which would be detrimental to child health by limiting federal spending on Medicaid, abolishing a comprehensive benefits package that includes Bright Futures, and not covering pre-existing conditions. In addition, the conditions facing undocumented children and accompanied minors at the border are inhumane and pediatricians and other child advocates have been working diligently to improve the situation at the border for children and families.

Bill Mason, MD, MPH, FAAP

AAP-CA2 past-president, Bill Mason, MD, MPH, FAAP discussed the latest on Kawasaki Disease. He provided an overview about Kawasaki Disease followed by an overview of the latest information as published in Circulation at the end of March, 2017. He also spoke about the recurrence of Kawasaki Disease and how important it is to evaluate a reoccurring fever post-hospital discharge. Tachycardia may be a marker for those who are most at risk for recurrent fever.

Thank you to our staff, Sarah Skoda (Center)  and 
volunteers Basilio Torices and Dana Anderson. 

S. Michael Marcy Memorial Lecture Series

Stephanie Marcy, PhD
There were two S. Michael Marcy Memorial Lectures this year. The first was given by the late Dr. Marcy's daughter, Stephanie Marcy, Ph.D on the Forgotten Child. She discussed the significant impact on healthy children of having a sibling with a chronic illness. The lecture featured videos of patients and families sharing personal experiences regarding their challenges and perspectives in coping with illness.

It is important to understand parents' fears regarding vaccine hesitancy. The pediatrician-parent relationship is important in changing the parents' attitudes to vaccines.

At the end of the day, AAP-CA2 president Ed Curry, MD, FAAP wrapped up with an overview of the day's learning. We hope to see you at our symposium next year!!!

Symposium report kindly provided by Dr. Paula Whiteman.

2017 Symposium Posters

AAP-CA2 held the first pediatric poster presentation competition organized by SOPT trainee representative, Dr. Christine Thang. There were nine resident poster presentations and two oral presentations. During the general session, Dr. Matthew Stutz (Image below, top left) from UCLA presented his research on " Predictors of Pediatric Palliative Care Consultation"  and Dr. Brian Lonquich (Image below, top right) from UCLA on his experiences in " The Wall Just Got Ten Feet Higher." Please click THIS LINK to view the program outlining all presenters and board reviewers.

2017 Symposium Raffle Winners

Congratulations to the winners of our AAP-CA2 Symposium Raffle:

Dr. Uzma Ali
AAP Purple kids patterned silk scarf:

Bliss Jensen; Dr. Rachel Esmond; Dr. Gerard Edrain
The book "One Murder More" by Kris Calvin, AAP-CA CEO: 
Dr. Susan Scheiner; Dr. Melissa Orkin
Discounted $99 special rate for the 2018 AAP-CA2 Advances in Pediatrics Symposium.

Dr. Leila Yoonessi
1/2 off one year of AAP-CA2 membership:

Dr. Sharon Pollock
2 Galaxy tickets:

Save The Dates!
Friday, May 19, 2017 at CHLA CHLA logo

The 4th Annual Updates in Developmental-Behavioral Pediatrics Conference.

Friday, May 19, 2017 from 9:30am-3:00pm.
Location: Children's Hospital Los Angeles. CMEs available.

Saturday, May 20, 2017 in Los Angeles

2017 Los Angeles County Disaster Healthcare Volunteers-Surge Unit Conference

A half-day event to be held at Luminarias Restaurant on Saturday, May 20th, 2017, from 8 a.m. to 12 p.m.  Please arrive at 7:00 a.m. to register, enjoy a free breakfast, and meet other Surge Unit volunteers. Free parking is also available.
Registration - Click to Print the Flyer
Registration is required to attend the conference. Please RSVP by Tuesday, May 9th. The first 100 people to register will receive a free LA County Surge Unit shirt! Shirts and jackets are also available for purchase.

Please click on the link to register

If you have any questions or problems registering, please contact the Surge Unit office at (562) 347-1649 or surgeteam@dhs.lacounty.gov

Tuesday, June 13, 2017 in Woodland Hills -  Town Hall / Dinner Meeting
Ken Saul, MD, FAAP Member-At-Large AAP-CA2

Please join AAP-CA2 Member-At-Large Ken Saul MD, FAAP as he hosts an evening of professional development at Maggiano's.

Topic: P revention of SIDS and Post Partum Depression

Speaker: Harvey Karp, MD

Date: June 13, 2017 at  6:30 PM. Please note: This is on a Tuesday.
LOCATION: Maggiano's of Woodland Hills.

RSVP: Please email Dr. Ken Saul  to save your seat.

Wednesday, June 21, 2017 in Oxnard -  Town Hall / Dinner Meeting
Melissa Ruiz, MD, MPH, FAAP

Please join District IX Early Career Physician Representative, Melissa Ruiz, MD, MPH, FAAP for a Town Hall on Developmental Screening Resources.

Sponsored by Help Me Grow Ventura County, Dr. Ruiz will be presenting on the evidence for developmental screening, trauma screening and screening for unmet social needs. 

Over 10 community organizations to which providers can refer when they identify something on the screening will be in attendance and be available to answer questions. 

Four of these organizations will speak about how to most effectively refer patients to them.

Date: June 21, 2017 at  6:00 PM. 
LOCATION: Tri-Counties Regional Center Conference Room in Oxnard.

RSVP: Please email the Chapter to reserve your seat, at chapter2@aap-ca.org

Please help by completing this Survey
Adolescent Sexual Health Survey for Pediatricians

Christopher Prestel, MD, FAAP
Pediatric Infectious Diseases Fellow, PGY-5
Emory University is conducting research on HIV prevention in adolescents and is looking to recruitpediatric infectious diseases providers and general pediatricians for a brief (5-7 minute) online survey.   Your response will help researchers understand what the current practices are for HIV prevention among high-risk adolescents. 

The short survey is anonymous and closes on June 30th, 2017.  For questions or concerns, please contact co-investigator Christopher Prestel at cpreste@emory.edu

The survey may be found here or by going to the following address: https://redcap.choa.org/redcap/surveys/?s=998NJE7LWX

CDC Updates & LAHAN Alerts
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Visit the LAHAN website.

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Charitable Donations
AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
  • The Committee on Service, Education, and Mentoring, which awards scholarships to pediatric residents for outstanding research projects. 
  • The S. Michael Marcy Memorial Lecture, which helps sponsor a portion of our annual Advances in Pediatrics Conference in his honor.

AAP-CA2 Video: We Are The AAP-CA Chapter 2 -  2017

Thank you for your support
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Please visit our website at  http://aapca2.org/