The purpose of Practical Pediatrics is to offer providers current information relevant to the care of infants, children and adolescents in the outpatient setting. Following the presentations, attendees should be better able to:
Review factors associated with teen driver crashes.
Describe the evidence for improved outcomes with the patient-centered medical home model.
Interpret commonly ordered rheumatologic laboratory tests.
Recognize and manage dermatologic disorders.
Review the epidemiology of pertussis in the United States and North Carolina.
Review current U.S. Medical Eligibility Criteria for contraception for pediatric and adolescent populations.
Review the importance of motor vehicle crashes as a leading cause of child injury and death.
Discuss MOC Part 4 requirements for quality improvement.
Discuss managing a patient with an acute illness and type 1 diabetes.
Review the common clinical manifestations of spina bifi da in children.
Describe the trends in designer drugs of abuse nationally and regionally.
Review criteria for autism spectrum disorders from the DSM-V.
Review the evaluation for microcytic anemia.
Submit a question to Dr. Laurence B. Givner
View Doctor Profile LAURENCE GIVNER: I'm going to just do briefly community-acquired MRSA and talk about prevention of recurrent infections due to MRSA. So really, all we have-- or I think all we have to recommend at this point is improving hygiene measures. Because we see, certainly, lots of kids with recurrent skin and soft tissue infections due to MRSA. And if you look at the CDC's website, what they recommend is improving personal hygiene. Cover infected wounds so you don't spread it to other people in the family or at school or wherever. Keep nails short so you don't dig and scratch and cause other wounds that will get infected. Frequently wash hands. Bathe and wash linens in hot water. And don't share personal items, razors, linens, things like that. Decolonization. That's the controversial area. And I want to talk a little more about that. All things have been tried. Rifampin orally. Mupirocin in the nares three times a day for a month. Chlorhexidine body wash. Clorox bleach in the bath, 1 teaspoon per gallon of water twice a week. And I apologize to those of you like Dr. Ford here, who was at the Medical Society talk that I gave the other night, because I talked about this there. So I apologize for those who heard that talk and heard my jokes already there. I had invited Shelly Kaplan to give an American Academy of Pediatrics talk on this because Shelly's a big fan of Clorox bleach in the bath. And I knew he was going to talk the next day about his recommendation of 1 teaspoon per gallon of water of Clorox bleach. And we were at the dinner, he and his wife and me and mine. And I said, are you really going to recommend 1 teaspoon of Clorox bleach per gallon of water in the bath tomorrow during your talk? He said, yes, I am. And I said, do you even think that most people know how many gallons of water are in the bath? And he looked at me across the table and he just said, Givner, not everybody is as stupid as you are. But none of these has been shown to reliably work. And nasal cultures also aren't really recommended because the bug just doesn't live there. It also lives in the axilla. It lives in the groin. It lives in other areas. So nasal cultures alone don't tell you whether or not they have it. But Shelly, being the good scientist that he is. And he's not just a good friend, but I think he's one of the top clinicians in the country in pediatric infectious diseases. He got funding, and he decided to study that Clorox bleach in the bath that he's recommended all these years. And he just published this this year, 2014, in Clinical Infectious Diseases. So he studied the population three months to 18 years old. And he put 1 teaspoon of Clorox per gallon of water, just like he recommended. This is what he recommended for his study population. He recommended they do it 15 minutes two times a week for three months. And then over the next 12 months, he studied this group that had had a staph aureus infection. Did they have another, then, medically attentive recurrence in the next 12 months? And in those in the bleach bath population, almost 500 patients, there was a recurrence rate of 17%. In the control group, almost 500 patients again, there was a recurrence of 21%. And this was not statistically significant difference. So there was no benefit. Both groups were recommended to practice good personal hygiene like we talked about. But there was no benefit to the Clorox bleach baths.