Peds@CA2 eNews - July 2015 - Liquid Nicotine

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

Welcome to the July 2015 edition

of our monthly Newsletter

Congratulations to Dr. Richard Pan, FAAP! Dr. Pan and his coauthors worked tirelessly on SB277, which was signed by Governor Brown ending the personal belief exemption (PBE) for school and child care entry in CA.

This edition features an article by member-at-large, Cori Cross, MD, FAAP, on the dangers of liquid nicotine.

This developing topic is very timely. It is closely related to many of the resolutions on electronic cigarettes that were presented at the 2015 Annual Leadership Forum.

We have exciting news! Our very own Breastfeeding Committee Chair, Dr. Touraj Shafai, has been the recipient of many honors. We also congratulate Member-At-Large, Daniel Bruckner, MD, FAAP, on his new appointment.

Please see below for the awardees of the 19th Annual 2015 high school scholarships as well as highlights from various recent Town Hall events.

Our CQN4 Asthma collaborative is making substantial progress and is preparing for Learning Session 3 at Providence Tarzana Medical Center on July 24th. See below for details.

Gaper - Yawner (sculpture)

We had the opportunity to attend the opening reception for the Southern CA Medical
Museum. They have fascinating and unexpected treasures. My personal favorites were the NASH Logoscope, shaped like an old slide ruler where you input the symptoms and get a differential diagnosis, and the Gaper, which is a comedic sculpture of a person's head with their mouth open as if to swallow a pill used to mark Dutch chemist shops.

If you have an idea that you are passionate about to prepare in the form of a resolution for the National AAP, then please see our section on the resolution process. I have included a couple of sample resolutions to get you started.

Our very own AAP-CA CEO, Kris Calvin, wrote an intriguing mystery book. We have highlights from her book signing tour.

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 Article

Cori Cross, MD, FAAP, AAP-CA2 Member-At-Large

Liquid Nicotine:

Fatal Poison and Easy Access Makes this an Issue Pediatricians Must Address

Cori Cross, MD, FAAP, AAP-CA2 Member-At-Large

In general as pediatricians, we do a good job about counseling on potential poisons in the home. But there may be one fatal poison many of us have never thought to talk about with our patients and their families - liquid nicotine. This very new product, for a host of complicated reasons, has fallen outside both the FDA and the Poison Prevention Packaging Act and therefore is not required to have child resistant packaging. Liquid nicotine is often sold in small food coloring-like or dropper-like bottles that are brightly colored and filled with delicious smelling liquid in flavors like piña colada or cotton candy. There are no warning labels. The problem is that one of those little bottles could kill four toddlers. Read more ...

Advocacy

Kris Calvin, CEO AAP-CA

Great News!

California Governor Brown signs SB 277 to eliminate personal belief exemptions (PBE) for school and child care entry in CA!

AAP-CA applauds Senator Richard Pan, MD, Senator Ben Allen, their co-authors, and their staff, for this tremendous accomplishment - a landmark in public health legislation!

Thank you to the hundreds of AAP-CA member pediatricians who called and wrote in support of SB 277, often multiple times, showing persistence and dedication. Thank you to our partners: Vaccinate California, the California Immunization Coalition, the California Medical Association, the Health Officers Association of California, the California Academy of Family Physicians & others who joined the AAP-CA as leaders in advocacy to educate and enact SB 277. It took collaboration; this was a team effort.

Children and the public health are the clear winners!

Resolutions

                                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).

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:

EPA Administrator Gina McCarthy in Los Angeles

U. S. Environmental Protection Agency (EPA) Administrator, Gina McCarthy, met with leadership from several local organizations at a private meeting hosted by The American Lung Association (ALA) , in Los Angeles, CA, on June 26, 2015. The AAP, and AAP-CA2, are strong supporters of the joint forces between the EPA and the ALA to enforce policy that will improve air quality. It has been proven that the incidence of both COPD and asthma have increased despite measures taken in the past ten years. Poor air quality remains as a result of ongoing and evolving global climate change. Locally, there is a high incidence of respiratory illnesses in the vicinity of the 710 FWY, the transportation corridor connecting the Port of Los Angeles and the rest of LA County. Farther North, the San Joaquin Valley has experienced a rise in asthma. In this region, ongoing drought is a factor, which keeps particle pollution low to the ground, affecting patients with asthma and other respiratory conditions. The AAP-CA2 applauds Administrator Gina McCarthy for her advocacy for common-sense strategies to protect public health and the environment.

(From left) AAP-CA2 Executive Director Tomás Torices, MD; ALA Director of Partner Engagement and Media Advocacy Jenny Bard; U.S. EPA Administrator Gina McCarthy; ALA Senior Director of Policy and Advocacy Bonnie Holmes-Gen; and ALA Policy Manager William Barrett.

U.S. EPA Administrator, Gina McCarthy (in blue) with representatives from several local organizations (Memorial Care, AAP-CA2, Climate Resolve, Dignity Health, CA Nurses Association, ALA, and the LA County Public Health Department) at a recent meeting held at the American Lung Association office, in Los Angeles, CA.

Awards and Recognition

The American Academy of Pediatrics, California Chapter 2 Announces the 19th Annual 2015 High School Scholarship Winners

The American Academy of Pediatrics, California Chapter 2, is pleased to announce that three outstanding Santa Barbara County High School graduates received the 2015 Medicine-Biological Sciences Scholarships. These students were honored at a ceremony held at the Fess Parker Hotel, Santa Barbara, California on Saturday June 19, 2015.

Over dinner, Dr. Curry shared anecdotes from medical school and residency, making a strong point of the importance of a strong foundation in the basic sciences for becoming a good physician.

Dr. Curry presented Jonathan, Yvette, and Elizabeth their awards. Here is a detailed overview of their accomplishments over the last four years.

Jonathan Cleek, from Carpinteria, CA, is a graduate of Carpinteria High School. Among his academic achievements, he scored 800 in his math SAT and graduated #1 in his class with a 4.40 GPA. A few of Jonathan's Honors and Awards include: AP Scholar of Distinction, Academic Excellence (4 years), Captain for both tennis and basketball teams, and "Mr Warrior" (Homecoming King), a coveted title for the senior male with the greatest class spirit. Jonathan volunteered his time at Santa Barbara Cottage Hospital for three years. Jonathan will be attending Westmont College with goal of becoming a surgeon. He is the recipient of a $700 scholarship.

Yvette Elsie Rivera Rojas, from Santa Maria, CA, graduated 19th in her class of 593 students at Pioneer Valley High School with a 4.0 grade point average. Yvette accumulated over 500 hours of volunteer time at Marian Regional Medical Center during her 4 years in High School. Academically, Yvette was the recipient of the Academic Excellence Award for four years in a row, and the National Academy of Future Physicians and Medical Scientists Award of Excellence, in Washington DC. Yvette will be attending University of California, Santa Cruz with goal of becoming a neurosurgeon. She is the recipient of a $700 scholarship.

Elizabeth Smith, from Santa Maria, CA, is a graduate of Ernest Righetti High School. Her academic achievements include an SAT math score of 700, a GPA of 4.42, and graduating 3^rd in her class of 497 students. She was the 4 time recipient of the Renaissance Award and Scholar Athlete Award, and was Co-President of the California Scholarship Federation. Elizabeth accumulated over 500 hours of volunteer time during her 4 years in High School , of which 250 hours were at Marian Regional Medical Center in the ED and NICU. Elizabeth calls herself "a farm girl", and explained how it was at the family farm where she began to understand the value of hard work.

Elizabeth will be attending California State University at San Luis Obispo with goal of becoming a physician. She is the recipient of a $700 scholarship.

The AAP-CA2 Medicine-Biological Sciences High School Scholarship was established in 1995 from an endowment set aside to fund a continuing annual scholarship for promising high school seniors with the desire to pursue the fields of medicine and biological sciences. Since 1995, American Academy of Pediatrics has awarded over 65 scholarships. The scholarship is limited to students in the seven Southern California Counties within the AAP-CA2 boundaries (Los Angeles, Kern, San Bernardino, San Luis Obispo, Santa Barbara, Riverside and Ventura) and the selection rotates annually between the regions. Applicants are submitted by the principal, vice principal or guidance counselor from the selected county's high schools. The applicants are judged based on many factors including, but not limited to: scholastic ability, economic need, expressed interest in science, achievements, etc. Finalists are all interviewed. This program was recognized by the national American Academy of Pediatrics with a special commendation as the first scholarship program organized by a chapter.

Funding for this scholarship program now comes from the general operating fund of the AAP California Chapter 2 and is supplemented by donations. We welcome additional donations to help us continue to fund this outstanding project, our AAP-CA2 Medical-Biological Sciences High School Scholarship.

Those wishing to make contributions to the chapter may do so by sending a check made out to: AAP-CA Chapter 2 mailing it to: AAP-CA2, P.O. Box 94127, Pasadena, CA 91109. You may also specify in the memo line a particular project to which you would like to contribute, for example, the High School Scholarship Fund, the Resident Research Award Fund, or the S. Michael Marcy Memorial Fund.

AAP-CA2 Member-At-Large now Vice Chairman of Pediatrics, PTMC

AAP-CA2 would like to congratulate Member-At-Large Daniel Bruckner, MD, FAAP, for his recent appointment as Vice Chairman of Pediatrics, at Providence Tarzana Medical Center.

Congratulations, Dr. Bruckner!

AAP-CA2 Member Recognized by The California Legislature Assembly

Touraj Shafai, MD, FAAP, received an award from the California Legislature for his appointment to the Advisory Committee of Riverside County Children and Families Commission. Dr. Shafai has served 15 years on the Advisory Committee. Additionally, he was given a faculty appointment at University of California, Riverside (UCR) School of Medicine, and was appointed the chair of the CME committee at Riverside Community Hospital, affiliated with UCR medical school.

COMING EVENT: Town Hall - July 16, 2015

Chris Landon, MD, FCCP, CDM, FAAP

AAP-CA2 Secretary

July 16, 2015 - Town Hall Meeting, hosted by AAP-CA2 Secretary,

Chris Landon MD, FCCP, CDM, FAAP

Overview

This interactive CME accredited activity is designed for the entire CF treatment team. The activity features a live interview with a CF patient, case studies and open discussion. The activity is designed to address evidence-based treatment approaches and progress in the management of chronic airway infection in cystic fibrosis.

Ottavio's Restaurant

1620 Ventura Blvd.

Camarillo, CA 93010

(805) 482-3810

RSVP BY Monday, July 13, 2015

Register On-Line at www.abcomminc.com and go to Events/Clinical Insights

Or E-MAIL: Kristi Day at kday@abcomminc.com, CALL: (913) 384-0361, or FAX: form to (866) 353-6169

Click to view/download flyer

QI Opportunities and Special Projects

Seeking 10+ Practices to Participate in Bright Futures Project

The American Academy of Pediatrics Bright Futures Initiative is pleased to announce the launch of the Preventive Services Improvement - State Spread Project (PreSIPS2) learning collaborative - to improve the preventive health outcomes of young children based on Bright Futures.

Only five AAP Chapters will work with their state level partners (eg, public health, Medicaid/ ACOs/payers, academic pediatrics), families, and 10-15 pediatric practices (including 1 residency continuity clinic), to identify practical strategies that really work at the state and practice level to support implementation of preventive services guidelines for early childhood. AAP-CA2 will apply if interested practices express interest.

Measurement-based preventive services are the key to the "future" of Bright Futures.

Interested in learning more about PreSIPS2? Please register for an informational webinar:

Monday, July 13 @ 3pm ET / 2pm CT / 1pm MT / 12pm PT https://attendee.gotowebinar.com/register/2731932719569502722

The 2015 Duncan, Pirretti et al Pediatrics paper summarizes results of the original PreSIP work.

Click to read document

Please contact the chapter if you are interested in this project.

Reducing Diagnostic Errors - QI Project

The Practice Improvement Network is still requesting your participation in a project called Reducing Diagnostic Errors in primary Care Pediatrics (Project RedDE!), which is being conducted by the Practice Improvement Network, part of the Quality Improvement Innovation Networks (QuIIN) at the American Academy of Pediatrics and is funded by a grant from the Agency for Healthcare Research and Quality. As you know, diagnostic errors (missed, delayed or incorrect diagnoses) cause significant morbidity and mortality in children. Limited pediatric focused research on diagnostic errors highlights this problem: 54% of pediatricians report making diagnostic errors at least monthly and 45% report making harmful diagnostic errors at least annually. Project RedDE! will provide practicing physicians and their staffs with strategies, tools, and resources necessary to reduce diagnostic errors and patient harm in primary care.

Click to view full project description Click to view project application

New CQN Quality Improvement Opportunity for Practices-Adolescent Substance Use

The American Academy of Pediatrics (AAP) through its Chapter Quality Network (CQN) is offering a Practice Improvement to Address Adolescent Substance Use (PIAASU) learning collaborative. The purpose of the PIAASU project is to improve care for adolescents with substance use and mental health concerns. The AAP will collaborate with 4 chapters to increase the use of validated screening tools, successful brief intervention techniques, and referral to treatment for substance use and mental health concerns among pediatric practices. This program, like our CQN4 asthma project, would offer both American Board of Pediatrics Maintenance of Certification (ABP MOC) Part 4 credit and 20 credits of Performance Improvement Continuing Medical Education (PI CME). Please note that this would be a 2 year project . We would need to have a commitment from 10-15 pediatric practices to move forward and apply for this grant.

Please contact the chapter if this means of obtaining both MOC and CME interests you.

CQN4 Asthma QI Project - Update

Improvements as Practices Implement QI Measures in Asthma Management

Eleven practices continue participating in the AAP Chapter Quality Network Asthma Phase 4 Project. Four months into the project, reports show an improvement in the number of patients receiving Optimal Asthma Care, a measure consisting of four components:

Assessment of asthma control
Stepwise approach used to identify treatment options or adjust therapy
Asthma action plan
On a controller medication if a persistent asthmatic.

From 29% in February, to 75% in Five Months

The image below shows data representing the eleven participating practices as a group. As a group, a total of 490 patient encounters have been uploaded onto the National Asthma Registry. Upon project start, only 29% of patients were receiving Optimal Asthma Care. Last month we reported that as of May 31, data showed a marked improvement at 61%. As of June 30th, practices demonstrated a further increase to 75%. The goal for this metric is for 90% of patients to be receiving Optimal Asthma Care by December 2015.

Congratulations to the following practices:

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

Next CQN4 Event:

Learning Session 3 (LS3) - Friday, July 24th from 8AM to 5PM at Providence Tarzana Medical Center. Curriculum content will include spirometry (theory and practical exercises with spirometers on site), motivational interviewing, and coding.

We thank Providence Tarzana Medical Center for hosting this learning session once again.

CULTURAL

The Southern California Medical Museum celebrated its Grand Opening this past June 26th on the first floor of Western University of Health Sciences' Nursing Science Center, 350 S. Garey Ave. in Pomona, CA.

The Historical Committee of the San Bernardino County Medical Society (SBCMS) was founded in 1982 by Merlin A. Hendrickson, MD, to collect and preserve medical artifacts, record the history of medicine in Southern California, and educate the public about the importance of medicine and its fascinating history. The SBCMS Medical Museum became the Southern California Medical Museum in 2003.

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

Nash Logoscope - a differential diagnosis aid.

The Collections (right) are housed in cabinets located in the conference room. They are arranged to emphasize the various specialties of medicine, dentistry, pharmacy, nursing and allied medical fields and to give the visitor the opportunity to learn about the instruments and tools used in the past and the present. Items include: pills, patent medicines, shock producing electrical devices, surgical tools, hard rubber syringes, ether masks, trephines, microscopes, tooth extractors, historical stethoscopes, examples of medical quackery, plus many other fascinating objects. Changing exhibits are designed to highlight private collections of exceptional interest.

Pictured below: Museum Chairman, Elliot Weinstein, MD, FAAP, provides a detailed description of an exhibit to AAP-CA2 President, Paula Whiteman, MD, FACEP, FAAP, during a museum preview a day prior to the grand opening.

The Doctor's Office is a life-sized diorama recreating a typical 1900-1930's era examination room. A doctor is seated at his roll-top desk while a mother and her child stand nearby. In the room are equipment and other items that might be found in an office: an examination table, scale, supply cabinet, microscope, a black leather medical bag, and many other items. (pictured: Museum Chairman, Elliot Weinstein, MD, FAAP, with AAP-CA2 President, Paula Whiteman, MD, FACEP, FAAP.)

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

COMMUNITY SPOTLIGHT

AAP-CA CEO, Kris Calvin, who has recently released her new book, held a Book Signing/Meet the Author event at Vroman's Bookstore, in Pasadena, CA, this past June 12th. In attendance were AAP-CA2 president Paula Whiteman, MD, FACEP, FAAP, AAP-CA2 executive director, Tomás Torices, MD, and AAP-CA2 past president Mary Doyle, MD, FAAP, accompanied by her husband, John C. Doyle, J.D., who had the honor of reading the first chapter to the audience.

(From left) Dr. Paula Whiteman, John Doyle, J.D., Kris Calvin, Dr. Mary Doyle.

TOWN HALLS: Event Highlights

Pediatricians gathered at a Town Hall Meeting, hosted by Ken Saul, MD, FAAP - AAP-CA2 Member-At-Large, on June 10, 2015, at Maggiano's in Woodland Hills. Guest speaker Blaise Leo Congeni, MD, a pediatric infectious disease specialist from Akron Children's Hospital, presented on the importance of vaccination against Serogroup B Meningococcal disease.

High Desert pediatricians convened at a Town Hall meeting on June 24, 2015 - Hosted by Damodara Rajasekhar, MD, FAAP - AAP-CA2 Area Representative for San Bernardino County (High Desert), guest speaker, Kevin M. Shannon, MD, presented on the management of hyperlipidemia in children with obesity, and the role of statins. Dr. Shannon is professor of pediatric cardiology at UCLA School of Medicine.