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AAFP National Conference

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July 28, 2022 – July 30, 2022

What is National Conference?
Simply put, the National Conference for Family Medicine Residents and Medical Students, from the American Academy of Family Physicians (AAFP), is the prime destination for family medicine residents and medical students who want to explore all the specialty has to offer.

The AAFP has hosted students and residents at National Conference for 47 years. We’re proud of National Conference because no other event exists that gives you the chance to interact with more than 3,000 peers, hundreds of residency programs, and leaders in the specialty—all in one convenient location. Learn more here

Covid-19: Pediatric Insights

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medical providers that the family and the child trust can be an invaluable source of information and a big part of the decision making – Dr. Elise Herman

The AHA, American Academy of Pediatrics and Children’s Hospital Association host this panel discussion on how pediatricians and hospitals can work with parents to build trust in the safety and efficacy of the COVID-19 vaccine for children.

American Hospital Association

Insights from pediatric health care leaders on COVID-19 vaccines for children

Earlier this week Dr. Elise Herman, KVH Pediatrics, joined other pediatric health care leaders for a panel discussion hosted by the American Hospital Association (AHA), American Academy of Pediatrics and Children’s Hospital Association.

To learn more visit www.aha.org/vaccineconfidence

Resources mentioned by Dr. Elise Herman:
Speakers:
  • Yvonne (Bonnie) Maldonado, M.D., Chief, Division of Pediatric Infectious Diseases, Stanford University School of Medicine
  • Lee A. Savio Beers, M.D., FAAP, Professor of Pediatrics and the Medical Director for Community Health and Advocacy at Children’s National Hospital, President of the American Academy of Pediatrics
  • Elise J. Herman, M.D., Pediatrician, Kittitas Valley Healthcare-Ellensburg, Washington
  • Andrew Pavia, M.D., Chief, Division of Pediatric Infectious Diseases, Primary Children’s Hospital
  • Moderator: Roxie Cannon Wells, M.D., President, Cape Fear Valley Hoke Healthcare, and AHA Trustee

Tick bites in children

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Contributor: Dr. Elise Herman, MD, KVH Pediatrics

Ahhh, summer! As that much anticipated warmer weather comes, it brings with it the risk of tick bites and the diseases they can cause. Knowing how to prevent tick bites, what to watch for if your child is bitten and how to remove ticks can make us feel more ready for outdoor adventures with our kids.

Ticks have 8 legs, flat oval bodies, and vary in size from the tiny deer tick (size of a poppy seed) to the wood/dog tick (size of an apple seed). They can swell to two or three times their usual size when they have had a blood meal. After sucking blood for 3-6 days, ticks fall off on their own, often leaving a small red bump. As it feeds on the blood, some of the tick’s spit gets transmitted to the host’s body and can cause infection. Ticks must be attached for at least 36 hours to spread infection.

Washington has fewer tick-borne diseases compared to other parts of the country, but we do have cases of Lyme Disease, babesiosis, tick paralysis, and tularemia. Lyme Disease is the most common tick-borne disease in our state and the US. It is most prevalent in the Northeast, mid-Atlantic, upper Midwest, and to a lesser extent on the West Coast. It is spread by the very small deer tick. 80% of Lyme Disease starts as a circular or oval red bull’s eye rash called erythema migrans at the tick bite location within 3-30 days of a bite. It can expand to up to 12 inches and lasts 2-3 weeks. Other signs of early Lyme Disease are fever, body aches, headache, chills, and neck stiffness. If Lyme disease is diagnosed early and treated with antibiotics, progressing to later stages of the disease is very unlikely. The later stages can involve bull’s eye rashes elsewhere on the body, joint pain, temporary facial paralysis, and limb weakness.

There are steps you can take to help prevent tick bites. Avoid dense, grassy or wooded areas, and stay to the center of the trail. Ideally, everyone should wear hats, light colored clothing, long sleeves, and long pants tucked into socks. You can spray permethrin on clothing (not the skin) to decrease tick attachment. Insect repellent containing 20-30% DEET is safe for children but you should minimize its use on very young children and infants. Do not use products that combine DEET and sunscreen since sunscreen needs to be applied more frequently than DEET. Do not apply DEET to the hands of young kids or near their eyes or mouth.

Do a tick check of your child right after being outdoors where there might have been tick exposure. Look at the clothing first, then the skin and scalp. Don’t forget behind the ears, in the armpits and groin area. Showering may help prevent attachment. If you do find a tick, use tweezers to grasp it close to the skin; pull gently and slowly to remove. Try not to crush it when doing this and wash the area well afterwards.

It is important to remember that the chance of a tick bite causing any disease is extremely low. Only 2% of deer tick bites will cause Lyme Disease even in high-risk areas and here in Washington state we are at low risk of any tick disease. So, wherever your outdoor adventures take you and your kids this summer, a bit of planning to prevent tick bites and knowing how to handle them if they happen will help you to all enjoy those long summer days!

Talking about racism to children

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Contributor: Dr. Elise Herman, KVH Pediatrics

Racism is front and center now, and parents may wonder how to have important conversations with their child about diversity, equality, and discrimination. It helps to keep your discussion age-appropriate, share your feelings and listen to your child.

Under age 5 years – Studies have revealed that even infants notice different skin tones and preschool kids have been shown to view those who look like themselves more positively, so addressing racism early is important. Kids relate easily to the concept of fairness so it can simply be explained as treating someone unfairly based on how they look. Young kids may ask about why people’s skin colors are different. Explain simply that darker skin has more of the pigment melanin in it and that no skin color is ‘better’ than another. Celebrate human diversity by noting that “we are all human but can have lots of differences, too, making everyone special!”. Encourage your young child’s appreciation for diversity by reading books and playing with toys featuring people of different races.

6-11 years old – At this age, children are more aware of current events based on what they have heard and seen from adults, other kids and on the news or in social media. Ask your child about what they know and what questions they have. Kids this age understand empathy so discussing how it would feel to be judged unfairly can be helpful. Children of all ethnicities can be assured that people world-wide are upset about racism and are working to make things better.

12 and older – Kids this age are often very informed and have developed their own opinions about issues such as racism and protests. Discussing the news and current events and how it affects them opens the door to a deeper conversation. The same concepts of fairness and empathy apply, but now taking action may be a logical next step. It may be sharing something on social media, reading more about the history of oppressed peoples or attending an event.

All kids benefit from social experiences with a variety of people. Cooking food and listening to music of different cultures broadens our horizons. It is alright to let your child know that you are upset or sad about what is happening, but you also need to assure your child that they are safe in what can be a frightening time. This conversation will look different for families of color where the issue hits a lot closer to home than for whites.

As always, what we do and say speaks volumes to our children. It is vital that as parents we confront our own prejudices and biases and work to be more open and understanding. Let your kids see you speaking out against racism, embracing diversity and calling for justice for all people.

Traditional vs. Electronic Books and Your Child

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Contributor: Dr. Elise Herman, KVH Pediatrics

Simply put, reading to your child daily is one of the best things you can do as a parent. But does it need to be a traditional (paper) book or is an electronic book pretty much the same experience for your child? There have been studies that suggest reading a traditional book does have some advantages.

The Journal of the American Medical Association published a study in September 2019 that showed fewer ‘back and forth’ interactions between parents and toddlers when using an electronic tablet. This type of interplay is important as it builds connections in the brain and helps develop communication and social skills in children.

A recent study from the University of Michigan found that parents and kids interact more when reading a paper book and that communicating this way helped encourage healthy child development. Parents often asked how the story related to the child’s experiences or about the story and its characters. They also posed more open-ended questions, such as asking what the child liked about the story, which created more opportunities for a conversation between the two.

When parents and children are reading from a device, be it a table, computer or smart phone, interactions tend to be more focused on the technology itself. Comments about the device, instructions to not push buttons, how to set the volume if applicable, etc., can dominate the conversation. There has been research showing that “enhanced” digital books that have sound and animation can be distracting and therefore children do not remember the content as well.

So how best to read with your child? Although there seem to be real advantages to traditional books, reading from electronic books is still fine in addition to paper books. Here are some tips to make reading to your child the best experience:

– Read daily including at bedtime – and try not to rush
– Let your child choose the book at least some of the time (going to the library together also builds excitement for reading)
– Let your child hold the book and turn the pages
– Avoid electronic books that are “enhanced” with sound and animation
– During reading, ask questions about the story (“What do you think will happen next?”) and relate the story to your child’s life (“Remember when we went to the park and played like that?”)
– Encourage your child to point to things in the book (“Where is the rainbow?”)
– Read books with simple rhymes and repetition; your child will be more likely to ‘read’ along with you
– Make it fun! Silly voices and acting out the story makes reading very engaging to kids of all ages
– It is also good to encourage your child to look at books independently regardless of whether they can actually read yet

Be a good role model to your child, and read a lot at home. Since we don’t want our kids to see us always looking at electronic devices or a computer, make it a habit to read from traditional books, magazines and newspapers. And remember that whether it is a traditional book or at times an electronic book, it is wonderful that you are sharing reading with your child. Well done, Mom and Dad!

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Positional Plagiocephaly Prevention and Treatment

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“‘Tummy time’ while awake should start right away…”

Contributor: Dr. Elise Herman, KVH Pediatrics

When your infant is seen for a Well Child Exam, checking growth and development are the top concerns. Additionally, careful attention should be paid to your young child’s head shape. We are now in the middle of an ‘epidemic’ of head flattening, medically known as positional plagiocephaly, meaning a change in head shape due to positioning of the baby. Typically this is flattening of either side of the back of the head or symmetric flattening of the entire back of the head. This is not just a cosmetic concern as significant health issues can result from the altered head shape.

The flattening that can develop is related to a baby’s skull being relatively soft until about age 5-6 months. Babies spend a lot of time on their backs between sleeping (the recommended sleep position is on their back to decrease the risk of SIDS) and while awake until they are old enough to be rolling, sitting up,etc. If the head is turned to one side when sleeping (for example if the baby is turning to look towards a parent), this can result in localized flattening of one side of the back of the head. With this flattening on one side, it is then harder for the baby to turn their head to the opposite side. Over time the neck muscle on the flatter side can become tighter and shorter, causing the neck to stay in a twisted position (this is called torticollis). This may affect the shape of the face with jaw asymmetry and other changes. In some cases it can be related to problems with development if left untreated.

It is important to be pro-active to minimize the risk of infant head flattening. Your baby should absolutely sleep on their back, but otherwise should be up and off the back of their head a lot. ‘Tummy time’ while awake should start right away and not only helps head shape but increases the strength in your baby’s neck, chest and arms. Options for tummy time include having baby lay with their face/ chest on your chest or baby laying down over your lap. You can also have baby lay on the floor with a rolled small blanket to prop up their chest only until they are strong enough to push up on their arms. Begin with 5-10 minutes 3 times a day with a goal of about 60-90 minutes total a day by age 4 months. Babies often don’t like tummy time at first (it’s a lot of work for your little one!) but it gets easier as they get stronger.

If a baby has flattening on one side of the head, the baby can be laid down to sleep alternating their head in opposite ends of their crib or bassinet each night. This means they will have to turn their head the opposite way to continue to look at their parent and can improve head shape. Parents should alternate which arm they hold the baby in for feeding as well. Upright chairs like the Bumbo for babies not sitting yet are recommended at age 3-4 months. Front packs also help your baby be upright during the day.

If a baby has significant head turning with neck twisting (torticollis), physical therapy is usually started and can be very helpful to restore normal movement of the neck. If by 4-5 months there is significant flattening despite increasing tummy time, etc., a referral may be made for helmet therapy. Wearing a custom soft helmet with a foam liner that is adjusted over time, the head shape becomes more rounded. Helmet therapy is most effective between 4 and 12 months of age, and babies usually accept the wearing of the helmet very well. Most babies are treated with helmet therapy for 1-4 months.

Having some degree of head flattening even with lots of tummy time and upright positioning is fairly common and is not a problem if it is mild. Talk with your health care provider if you have concerns about your baby’s head shape; they can help determine if any specific treatment is needed.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

KVH awarded for practice transformation activities in Kittitas County

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Kittitas Valley Healthcare (KVH) came home from the Provider Recognition Awards with four awards from the Greater Columbia Accountable Community of Health on Wednesday evening, October 30.

KVH Hospital, KVH Family Medicine – Cle Elum and KVH Family Medicine – Ellensburg were each presented with the “Fighting for Change/War Room” Award by Jenna Shelton, GCACH’s Practice Transformation Navigator. This award recognizes the collaborative work being done by KVH and the other safety net organizations in our community towards practice transformation and the implementation of a Patient-Centered Medical Home. KVH also received the “Kittitas Beginner Opioid Resource Network (ORN) Award for work being done to reduce opioid abuse throughout the county.

“KVH has a team that brings nothing but excellence and dedication,” stated Jenner Shelton. “They have committed a space labeled as their ‘War Room’ where all of the practice transformation ideas and workflows have been built. They are a highly committed group.”

The GCACH’s mission is to advance the health of our population. The GCACH region includes nine counties and over 710,000 lives. Patient-Centered Medical Home (PCMH) is the strategic foundation for Greater Columbia’s work and puts the patient in the center of care. The result is better patient care, improved population health and lower healthcare costs. The PCMH acts as an “umbrella” that incorporates the majority of the work from the four project areas below:

  • Bi-Directional Integration of Physical & Behavioral Health – The focus is to address physical and behavioral health needs through an integrated network.
  • Addressing the Opioid Public Health Crisis – The focus is to reduce opioid related morbidity and mortality through prevention, treatment and recovery supports.
  • Chronic Disease Prevention & Control – The focus is implementation of the Chronic Care Model, a cornerstone of PCMH, with the goal being planned prevention and treatment strategies for individuals with chronic illnesses.
  • Transitional Care – The focus is to reduce avoidable admissions/readmissions to intensive care settings such as hospitals, psychiatric hospitals, skilled nursing facilities and prisons or jails. The goal of transitional care is getting the right care, at the right time, and the right place.

Let’s talk about vaping

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Contributor: Chelsea Newman, PA-C, KVH Family Medicine – Cle Elum

The news has recently been inundated with stories of a mysterious illness affecting those who use vaping products. The illness has led to serious lung disease and death in several previously healthy individuals. The CDC and FDA are currently investigating these vaping-linked illnesses and as of October 8, 2019 there are more than 1,299 lung injury reports and 26 confirmed deaths in the US linked to vaping products. Many of these cases involve vaping products containing nicotine and THC, the principle psychoactive ingredient of cannabis. Symptoms of the illness include coughing, shortness of breath, chest pain, fever, nausea, vomiting and diarrhea. Currently, no specific ingredient or chemical has been identified as the cause of the lung disease but all those affected have used vaping products.

Rates of vaping have been on the rise for several years and the most rapid increase has been with teenagers. Among the current vaping associated epidemic, more than 1/3 of reported lung injuries are in those 18 and younger. The 2018 National Youth Tobacco Survey found alarming increases in e-cigarette use among middle and high school aged students and 68% of kids using e-cigarettes are using flavored vape products. Manufacturers of these devices are directly appealing to children with flavors like bubble gum, cotton candy and watermelon. Devices are also made to resemble USB drives in order to discretely use without notice and deceive parents and teachers. Most e-cigarette and vapes contain nicotine, an extremely addictive substance that only reinforces the desire to smoke or vape. Nicotine also has a host of negative health impacts in the body and can alter the development of the maturing adolescent brain.

So what can be done? How can we as healthcare providers, teachers, parents, family members and friends help discourage vaping and e-cigarette use among those that we care about?

One strategy is to talk about it. Don’t assume the sweet, 14-year-old volleyball player sitting in front of you wouldn’t do that kind of thing. Kids are impressionable and easily swayed by peer pressure. Whether you are talking with your patient, student, child or friend, don’t be afraid to ask about vaping use. Be non-judgmental and give advice out of concern. Learn about the variety of vaping products and delivery systems available so that you can recognize them.

We should also be talking with adults who vape. Vaping has been touted as a smoking cessation aid for some but there are significant health risks associated with continued use of nicotine and with so called nicotine-free vape. There are several carcinogens in the agents used to aerosolize the vapor. Also, kids with parents that vape are more likely to think it is safe or acceptable.

Another strategy to curb use is to make these products less appealing and less available. Earlier this month, the Washington State Board of Health passed emergency legislation to ban the sale of all flavored vape products. This legislation lasts only until February 2020 and will be up for renewal. While it helps to address some current safety concerns, it is also a strategy to curb adolescent use and to make these products less appealing and less available while investigators look for the cause of this vaping epidemic.

If you or someone you know is vaping and would like to quit, there are abundant resources to help. Washington also has several resources including counseling with a smoking cessation coach at 1-800-QUIT-NOW or www.quitline.com. There is also a new free app called 2Morrow cessation with a customized quit plan with lessons, daily messages and reminders and access to a live coach. Healthcare providers are on the front line of treating nicotine addiction and a great resource for behavioral and medical strategies to help abstain. Please contact your local health care provider or health department for more help on smoking cessation.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Collaborative Care

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KVH Contributor*

Auren O’Connell, DNP, PMHNP
KVH Family Medicine – Cle Elum

In a medical emergency or when you are not feeling well, one word often comes to mind, “doctor”. According to Merriam-Webster, “The word doctor comes from the Latin word for ‘teacher,’ itself from docere, meaning ‘to teach.'” 

Patient education and teaching are not my first expectation when I seek medical care. “Give me something to feel better” or “make me better” is often on my mind.

Thankfully, many medical conditions are easily treatable and only require brief treatment or interventions. Other conditions are not so simple, requiring occasional follow-up and/or chronic management.

As a society we are living longer, and as we age we are more vulnerable to chronic conditions and mismanagement thereof. If managing our health condition didn’t seem like enough, then comes the cost and coordination of various visits, all of which can snowball and seem overwhelming. 

As a whole, healthcare and funding are transitioning from volume-based (fee for service) to value-based (fee for value). Within this paradigm shift, evidence-based practice models of team-based collaborative care are being deployed, most targeting chronic conditions and/or mental health problems.

There are many terms being tossed around: integrated, medical home, collaborative care, chronic care management, etc. All these terms are important, but all emphasize patient-centered, collaborative, and team-based interventions.

At the core of these models is an emphasis on teaching and collaboration by all members of the care team, including the patient, who teaches the care team about his/her own strengths, needs, and preferences.

The primary care provider is the head coach on the team and is empowered to deliver comprehensive and connected healthcare through a shared treatment plan with measurement-based targets. Nurses and/or care managers help to coordinate the treatment plan, offer self-management support, and answer questions by phone and in person visits.

All of this equates to more value and resources for both the patient and the team.

Quality and collaboration are core values of Kittitas Valley Healthcare. In my experience as a psychiatric nurse practitioner, whole health and value-based healthcare is at the core of what drives both leadership and providers within Kittitas Valley Healthcare. Fortunately, reimbursement models with payers are emerging which will allow for expansion of value-based healthcare that emphasizes quality evidence-based interventions, care coordination support, and collaboration for patients who need it most.

Your primary care provider may approach you about participation in our new chronic care management program or our collaborative behavioral healthcare program, which will be launching in the future. I plan to share more on collaborative behavioral healthcare at a later date, but these are my thoughts on value-based healthcare and collaboration as a whole. 

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.