From PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1062-1068 doi:10.1542/peds.2008-0564

The AAP Committee on Nutrition has updated its 1998 statement on the use of soy protein–based formulas in infant feeding.

In term infants, the few indications for use of soy formula in place of cow milk-based formula are: (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred. 
Note:
1) For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.
2) Most previously well infants with acute gastroenteritis can be managed after rehydration with continued use of human milk or standard dilutions of cow milk-based formulas. Isolated soy protein-based formulas may be indicated when secondary lactose intolerance occurs.
3)Isolated soy protein-based formula has no advantage over cow milk protein-based formula as a supplement for the breastfed infant, unless the infant has one of the indications noted previously.
4)Soy protein-based formulas are not designed for or recommended for preterm infants.
5)The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness.
6)Infants with documented cow milk protein-induced enteropathy or enterocolitis frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula. They should be provided formula derived from hydrolyzed protein or synthetic amino acids.
7)The routine use of isolated soy protein-based formula has no proven value in the prevention of atopic disease in healthy or high-risk infants.

Community North hospital will be providing monthly Grand Rounds with CME on pediatric topics effective October 1,2008.  We will provide these offerings on the 1st Wednesday of each month at 7:30 am, in the multi-service conference rooms on the 3rd floor of the professional building.  Breakfast refreshments will be served.

Our first speaker will be Community’s new pediatric neurologist, Dr Deb O’Donnell, who will be speaking on the Epidemiology of Seizures.  This will be a great opportunity to meet Dr O’Donnell and learn more about pediatric seizures.  If you have any questions about this, you can contact Dr Robert Lindeman at Community North’s pediatric unit 317-621-5474.

Community Health Network's e-Business team and staff at Community Regional Cancer Center launched the network's new myCommunity Express Check-In system Friday, August 29th, with much success. 

I just read a great post over at the Greystone blog that uses some of the statistics I frequently quote but mixes them with others I don't know to come to an interesting conclusion.  The quote that Neal discusses in his entry and one I hear a lot also is that "My patients don't use social media".

I like how he proves that the common stereotype that old people don't use the Internet just isn't true anymore.

From the reading I've been doing lately about personal health records I have collated/synthesized twelve characteristics that a personal health record (PHR) should have.

1. Provide patient education
    Along with storing a patient's health records, a personal health record should provide education about a patient's conditions, surgeries, medications, etc.

2. Lifelong and comprehensive
    The information in a personal health record needs to consist of the entire health history of a patient and include all health care providers the patient has seen.

3. Accessible from any place at any time
    The personal health record needs to be accessible by the patient and the health care provider whenever and wherever it is required.

4. Provide health management tools
    Features need to include tools that allow the patient to record their data and compare it to what it should be so that the patient can improve their health.

5. Private and secure
    Obviously, this characteristic is very important.  The patient information, both entered by the patient and what comes from the Electronic Medical Record (EMR), needs to be kept private and appropriate (or even more than necessary) security measures need to be used to keep the data secured.

6. Capture self reported values
    A personal health record must allow a patient to enter their own information if the data is missing or incomplete in what exists.

7. Patient controls what data is entered into their PHR
    The patient is able to add items to their personal health record and is able to control what data is put into their PHR, like data from their electronic medical record.

8. Access to the patient's EMR data
    To increase patient adoption, a personal health record must have the ability to interact with a patient's electronic medical record.  Information should flow to the PHR from the EMR and the patient should be able to send data to the EMR (which can be accepted or rejected by the physician as needed).

9. Secure patient-provider communications
    Not only should a personal health record provide health management tools, but a PHR should provide patients a method to communicate with their physician(s) to ask questions, report health measurements, etc.

10. Patient controls who has access to their information in the PHR
    A patient should be able to share data in their personal health record to whomever they feel is appropriate.  The patient should be able to control this at the level of each individual item in the personal health record, like a single condition, medication.

11. Transparent
    An audit trail needs to be available to the patient to see where the data items came from that are in their personal health record, who entered it, who has viewed each item and when.

12. Interoperability
    The information in a personal health needs to be in a format that can be exported or shared between personal health records, electronic medical records, etc.

See how Community Health Network's Personal Health Record stands up against these criteria.

I just finished diversity training last week - a requirement of my employment at Community Health Network - and it got me thinking about our health network's diversity initiatives.

Diversity training is admittedly not how I would have chosen to spend a full afternoon. I've lived lots of places, experienced many cultures, and engaged in similar training at former jobs--what would one more afternoon talking about it accomplish? But on reflection it was truly worthwhile. Community has created an engaging opportunity for employees to gather for a multi-disciplinary dialogue. Our instructor kept the energy level high and was willing to show her vulnerabilities to pave the way for others to participate. And who doesn't need reminding that not everyone shares your cultural values and ideas of proper behavior?

I don't have much interaction with patients, so I especially enjoyed learning about some of the tools available to clinicians when communicating with patients from diverse backgrounds. In addition to having Spanish language interpreters on staff, language differences can be overcome with the use of our language line phone service. These specially-designed telephones have two receivers that connect the clinician and patient with an interpreter who can facilitate the conversation. Additionally, Community recently implemented CultureVision technology, a web-based reference to help clinicians understand cultural preferences as they relate to health care. The best part is that it's accessible from any of our network computers.

In addition to meeting the needs of our increasingly diverse patient population, Community also fosters diversity in the workplace. On one hand, that's obvious--how could a workforce of over 10,000 employees not be diverse? But on the other, it is a choice that the network has made. An example is the recognition that Community Hospital North will receive at Noble of Indiana's 2008 Annual Celebration. Community will receive the Employment Award for hiring persons with developmental disabilities and furthering their job growth.

While I have provided just a few of the many examples of Community's commitment to diversity, you can read more on our Web site. It's an evolving initiative that will continue to focus on creating exceptional experiences for our patients, families, physicians and employees.

We seem to be getting a lot of new videos posted lately. Here is an overview video of our Maternal Fetal Medicine program, featuring Lauren Dungy-Poythress, M.D and Deborah Skannal, M.D.

This post is a bit overdue, but since I am on a roll, I will feature some content that was recently uploaded to our YouTube channel.

Another quick post featured a recently produced video from our New Media Lab. One week ago, Jan Bingle, Community Health Network's Cheif Nursing Officer, was honored by the Community Health Network Foundation with the Jack Heiney Award. 

This post is overdue by a week, but better late than never.

Daniel Rench, Vice Preseident of e-Business here at Community Health Network, had the opportunity to present our myCommunity membership program to some local media last Wednesday.

Take a look a the overview video we produced for the event, as well as some of the coverage by the Indianapolis Star.

One component that is frequently missed or downplayed in other personal health records (PHRs) is the patient education aspect.   I read some articles that state that this is one necessary component of a personal health record.  About 75% of online users search for health information on the Internet according to the Pew Internet Group and this statistic has held true for a several years now.

Community Health Network’s PHR is tightly integrated with the consumer health library and has been since it was designed and built two years ago.  A patient can add a record to their PHR and become better informed about their health at the same time.  And when a patient uses their personal health record eCommunity.com recommends other health content related to what the patient entered into their PHR.

Transactions are important on a health care website but also, just as important is patient education.  Most health care providers realize this but we have not only bought the obligatory consumer health information library, we have embraced it and used it for other applications on the website like the PHR.

Community Hospital North was the title sponsor at the Flavor of Fishers on August 2, and in addition to hosting a medical tent at the event, the hospital's Bamboo Cafe was one of the featured food vendors. At my exercise class earlier this week, one of the ladies mentioned how much she enjoyed the vegetable salad that was offered. I asked Chef Diana, food service supervisor at Community Health Network, if she would be willing to share the recipe, and she gladly obliged:

Summer vegetable rainbow salad
Makes about six 1-cup servings

3 cups shredded green cabbage
1 cup diced plum tomatoes
1 1/2 cups broccoli florets
1 medium zucchini, gut julienne
1 medium green pepper, cut julienne
1 medium red pepper, cut julienne
1/2 cup shredded carrots
1 1/2 tsp kosher salt

Directions: Combine all ingredients. Toss to combine. Add dressing and toss to coat. Cover. Chill. Best if made 2-3 hours ahead of time.

Dressing
2 T fresh squeezed lime juice
3 T red wine vinegar
1/2 tsp lemon pepper blend
1/4 tsp black pepper
1/4 tsp kosher salt
1/4 tsp minced garlic
4 1/2 T olive oil

Directions: Combine all ingredients. Whisk until well blended.

Click here for a video demonstration of the salad preparation, where Chef Diana provides some extra tips and variations on the recipe.

Flavor of Fishers was a one-day event, but you don't have to wait until next year to enjoy Chef Diana's creations. The cafes at Community Health Network's hospitals offer flavorful and healthy food options year round.

Vitamin D Deficiency in Young Children

Suboptimal vitamin D levels are common in healthy infants and toddlers.
From: Arch Pediatr Adolesc Med. 2008;162(6):505-512.

Recent research suggests that vitamin D deficiency is more common than we once thought. To examine vitamin D status in young children, Boston investigators determined vitamin D levels (25-hydroxyvitamin D) in 247 infants (age, birth to 1 year) and 133 toddlers (age, 1–2 years) during routine visits at an urban primary care clinic.

The prevalence of vitamin D deficiency (<20 ng/mL) was 12%, and 40% of children had suboptimal vitamin D levels (<30 ng/mL). Prevalences were similar in infants and toddlers. Among children with vitamin D deficiency, wrist and knee radiography revealed that 8% had rachitic changes, and 33% had evidence of demineralization. The only factors independently associated with vitamin D deficiency were breast-feeding without supplementation in infants and low milk intake in toddlers.

Comment: As noted by an editorialist, the level of vitamin D that truly represents deficiency in asymptomatic children is uncertain. However, because demineralization of bone during childhood can have lifelong consequences, ensuring adequate intake of vitamin D is important. The American Academy of Pediatrics recommends 200 IU of supplemental vitamin D for all breast-fed infants, unless they are receiving 500 mL daily of vitamin D–fortified formula or milk. They also recommend that toddlers consume 500 mg of calcium in their diet daily to assure adequate stores.

AAP Issues New Guidelines on Cholesterol Screening (Significant Revision)

Below is a policy on a clinical report appearing in the July issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children. The policy statement, "Lipid Screening and Cardiovascular Health in Childhood," recommends cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes. Screening should take place after age two, but no later than age 10.  The best method for testing is a fasting lipid profile. If a child has values within the normal range, testing should be repeated in three to five years. For children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered. Younger patients with elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling. The statement also recommends the use of reduced-fat dairy products, such as two percent milk, for children as young as one year of age for whom overweight or obesity is a concern.

We think video is a great medium for communicating patient and employee experiences at Community Health Network.

We invite you to check out the latest videos we have available through our Women's Services and Cancer Care Web sites. You can watch the stories of two cancer voyagers, as well as learn more about Community's breast health navigators.

Visit eCommunity.com/women or eCommunity.com/cancercare

What do you think of use of videos to tell stories? Leave us a comment!

Although this is not a direct patient or family experience, it does point to the exceptional efforts of Community staff in helping those in need.

Community Health Network is supporting Columbus Regional Hospital and its employees, following devastating floods last month. Community is donating $100,000 to the Columbus Regional Hospital Foundation’s Flood Recovery Fund, to aid in the flood relief efforts at the hospital, which suffered $110 million in damages from record flooding on June 7. In addition to the monetary donation, Community Health Network has supported Columbus Regional by employing staff primarily at Community Hospital South and the Indiana Surgery Center-South, with a smaller percentage of staff employed at Community Hospital East. To date, more than 40 employees are working in the network, with the majority of positions including medical/surgical; intensive care unit (ICU); progressive care unit ( PCU); post-anesthesia care unit (PACU); surgical; behavioral care; and case management registered nurses. Other health care professionals, including LPNs, physicians, surgical technicians and instrument technicians have also been employed. Once Columbus Regional reopens, employees who were temporarily hired by Community will go back to Columbus to resume their jobs. Community does not plan to hire these employees long-term.

“We are pleased to help employees at a sister hospital get back on their feet,” said Bill Corley, president and CEO of Community Health Network. “Their work experience with Community is an opportunity for them to maintain and improve their skills during this disaster period. Community has taken great strides to provide a complete orientation experience prior to employment.”

Press release >>

We are pleased to introduce Dr. Michael Leins as our blogger for the Family Medicine Residency program.  Please stay tuned for more details!

John W. Fleming, MD
Assistant Director

  Graduation. The very last day of our two week orientation to the program Hundreds of people including the interns, were all formally invited to the Garrison banquet hall for the class of 2008 commencement.  This was an intimate and much anticipated event. People who have been with the program for 30 years or more were in attendance.  The printed programs at each seat featured the eight graduates. It was on reading this that it sunk in - we're all going to have to give speeches! Not tonight, not us anyway, but in three years we'll be the eight up there . 


 
    Excitement and terror came over me, again.  You would think that after two weeks I would have been used to it, but this was at a level I've seldom experienced.  Only once before, actually.  When getting my wife's engagement ring melted down to redesign it.  With the wedding date set in stone and empty-handed, the anticipation of those anxious days approached unbearable.  December's ceremony came and she had her ring, thank God, seeing it for the first time.  
     A three year horizon set, and I find myself with a familiar anticipation - having only raw materials and fear.  Community trains great Family doctors, as evident by this night.  As we interns take our first steps into the fire we see a glimpse of our refinement.  Surrounded by doctors who have gone through the program,  and those graduating on stage, is an immense encouragement.  

    
    For those of you looking into the program, which should be all of you, I will let you in on a little secret that may help postpone the inevitable.  THE FACULTY AND NURSING STAFF ARE TAKING NOTES. EVERYTHING YOU DO CAN AND WILL BE USED AGAINST YOU AT THE ROAST  BEFORE GRADUATION.  Apparently they've already got a "pen incident" on me from my residency interview.   

(I forgot to include some points I wanted to make in my last post so I thought I would make another post.)

The word kipple implies that what fills up spaces is junk which I forgot to mention.  What I was getting at is that my hard drive filled up with junk, items that I wanted to keep at the time I saved them but since there is so much stuff, I may never look at it again.

I am a hoarder and the main motivation behind it is that if I don't grab it when I see it, it might not be available when I want to read it, watch it, whatever.  Some of my favorite writers' books go in and out of print quickly so if I don't purchase the book when I can, I might not be able to get it later.  I generally don't read, watch or use whatever I download or buy right away but I am saving it for later.  Right now I am reading two books that I bought several months ago.  I will keep books for years that I haven't read yet but plan to just because they might go out of print.

And sometimes I am right and they do go out of print.