Andy Garner, MD

Services (ODJFS) that Ohio Medi-caid is backdating administration fees

of PCV13 toMarch 18, 2010,the date onwhich the vac-cine becameavailable throughOhio’s Vaccinesfor Children

Program. The letter states that claimssubmitted between the dates ofMarch 18, 2010 and May 1, 2010,may be resubmitted for payment.

“As a practicing pediatrician, theOhio AAP’s work on successfullygetting Medicaid and the MedicaidManaged Care Organizations toretroactively reimburse for PCV13

Thanks to the persistence of theOhio AAP Chapter, Ohio pediatri-cians scored amajor victory.Ohio physicianscould receive upto a half a milliondollars in previ-ously deniedPrevnar 13 (PCV13) claims.

After much discussion, the OhioAAP received confirmation fromOhio Department of Job and Family

Newsmagazine of the Ohio Chapter, American Academy of Pediatrics Summer 2010

How to get payment

Gerald Tiberio, MD, Zanesville, apracticing pediatrician for more than30 years, became the new presidentof the Ohio AAP on July 1. His termwill run through June 30, 2012. Judy

Romano, MD, a general pediatricianfrom Martins Ferry, is the new presi-dent-elect. Andrew Garner, MD,PhD, treasurer, is a primary care pe-diatrician with University HospitalsMedical Practices in Westlake.

Delegates-at-large are: Jill Fitch,

MD, Columbus, Allison Brindle,

MD, Cleveland, and Robert

Murray, MD, Columbus.James Fitzgibbon, MD, Akron,

was elected to the Nominating Com-mittee.

Ohio pediatricians to receive up to $560,000 in previously denied claims.

National speakers featured atAnnual Meeting Nov. 5 & 6

You will NOT want to miss thisyear’s Annual Meeting!

National speakers, Ari Brown,

MD, and Meg Fisher, MD, willhighlight the event on Saturday,

Nov. 6 at the Marriott Northwest inDublin.

The controversial subject of

paren-tal refusal of vaccines is thetopic.

Award-winning pediatrician, andauthor of two best-selling books, Dr.Brown will speak on “Parental Re-fusal of Vaccines.” Dr. Fisher ofMonmouth Medical Center will

Judy Romano, MD

Managed care plans (MCPs) have

been notified by Ohio Medicaid re-

garding the reimbursement on de-

nied Prevnar 13 claims prior to May

1.

Physicians should:

• Contact the individual MCPs to

determine if the MCP will automati-

cally reprocess the denials, or

whether the provider should resub-

mit the claim to the MCP. The way

the reimbursements are handled may

vary from MCP to MCP.

• To find a list of MCPs go to:

http://jfs.ohio.gov/ohp/bmhc/ On the

right side is a green box labeled

“Participating Plans” this contains

links and contact information.See Annual Meeting...on page 15

See Prevnar...on page 19

New officersfor Ohio AAP

Ohio AAP successfullyargues for Prevnar 13reimbursement

“As a practicing pediatrician, the OhioAAP’s work on successfully gettingMedicaid and the Medicaid ManagedCare Organizations to retroactivelyreimburse for Prevnar13 pays foralmost 10 years of my Chapter dues.”

– Ryan Vogelgesang, MD

Gerald Tiberio, MD

See Legislation...on page 9

Ohio Pediatrics • Summer 20102

Ohio Pediatrics

A Publication of the Ohio Chapter,

American Academy of Pediatrics

Officers

President....Gerald Tiberio, MD, FAAP

President-Elect.....Judith Romano, MD, FAAP

Treasurer....Andrew Garner, MD, PhD, FAAP

Delegates-at-large:

Jill Fitch, MD, FAAP

Allison Brindle, MD, FAAP

Robert Murray, MD, FAAP

Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge Road, Suite 215

Worthington, OH 43085

(614) 846-6258, (614) 846-4025 (fax)

Lobbyist:Dan Jones Capitol Consulting Group

37 West Broad Street, Suite 820

Columbus, OH 43215

(614) 224-3855, (614) 224-3872 (fax)

Editor:Karen Kirk(614) 846-6258 or (614) 486-3750

www.ohioaap.org

Ohio AAP to make best of timing andanticipate a busy lame duck session

This is an active political year andwith it comes limited days of legis-lative work at the Statehouse. This isnot necessarily a negative fact if youare working to stop bad legislation.If you are working to pass good leg-islation, it can be frustrating. ForOhio AAP, our priority issues fallinto both categories. We will makethe best of timing and anticipate abusy lame duck session after theelections.

Looking at Ohio’s political land-scape, the May primary did not pro-duce any significant upsets. Theelection simply lays the groundworkfor a contentious battle for the gov-ernor’s office as former Congress-man John Kasich (R) challengesincumbent Gov. Ted Strickland (D).Both political parties will also befocused on victories in the auditor’soffice and secretary of state’s of-fice, two critical positions that playroles in redrawing district lines thatdetermine legislative districts for thenext 10 years. Additionally, a num-ber of races for seats in the OhioHouse will also be closely watchedas Republicans look to shift the 53-46 Democrat majority makeup ofthis important chamber.

Legislators returned to the State-house in May following a few weeksof break leading up to the primaryelections. Policymakers held an in-tense four to six weeks of committeeand session work in May and earlyJune before summer recess. Duringeven numbered years, all state repre-sentatives and half of the state sena-tors are up for election in their home

districts. The Statehouse halls arequiet over the summer months aslegislators refocus their priorities onworking in their district and prepar-ing for general elections. The legis-lators are not expected to return forfull legislative activity until after theNov. 2 elections.

Update on Legislation of Interest:

HB 122 (Boyd)/SB 98 (Patton) –

Physician designation bill

The Academy of Medicine ofCleveland and Northern Ohio andthe Ohio State Medical Association(OSMA) are working to advancethis legislation that would establishstandards for physician rating sys-tems established by health insurancecompanies. The bill would prohibitsuch systems from being based sole-ly on cost measures. HB 122 wasvoted out of House in February; SB98 has had a number of hearings incommittee. Both bills are pending avote in the Senate Insurance Com-mittee. Interested party meetings arebeing held over the summer withrepresentatives of the insurance in-dustry who stepped up their opposi-tion to the legislation in recentmonths.

HB 185 (Book/DeGeeter) – Prohib-

iting unilateral contract changes

Hearings have stalled in the OhioSenate on HB 185, legislation spon-sored by Reps. Todd Book and TimDeGeeter to clarify that any changesto a contract between a health insur-ance company and a provider besigned off by both parties. As the in-

surance lobby has stepped up theiropposition, it has become clearer thatthe bill will be a hard sell in the OhioSenate. HB 185 had opponent testi-mony on Feb. 9, and has not had ahearing since that time.

HB 198 (Lehner/Ujvagi) – Medical

Home Demonstration

HB 198, a bill creating a pilot pro-gram to advance medical educationin the patient-centered medical homemodel of care, was signed into lawon June 8. The new law creates the

Update from the Statehouse

The message of the outgoing presi-

dent of an organization is generally

laced with memories, accomplish-

ments, expressions of gratitude, recog-

nition of shortcomings, predictions

and announcements of future plans. It

is a time of reflection with philosophi-

cal analysis of decisions, process and

planning that culminated in the out-

comes and activities that defined the

term of leadership. The people who

know me will recognize that it’s just not going to happen

in this article.

I’ve got much more important things to say.

The Ohio AAP is a model of leadership from the bot-

tom up – an organization that is predicated on listening

to its members. Lines of communication have been ex-

panded, utilizing a myriad of technologies to connect

with members and stakeholders in the care and well-

being of children. The culture of our staff, Board of Di-

rectors, committee chairs, its members and Foundation

leaders is based on the belief that intelligent and motivat-

ed individuals can accomplish amazing things when tal-

ents are identified, directed and coordinated to achieve

key objectives.

The key ingredient to success is “involvement.”

This final note is an opportunity to close my term with

the theme that started it – get involved and express your

opinion.

I have witnessed amazing accomplishments by individ-

ual pediatricians who decided a change or an improve-

ment must be addressed. I have seen busy physicians be-

come engaged with the right people who provided advice

and direction, saved time through efficiency, found the

right doors to open, and moved an idea to reality. The

chemistry that results from such a common energy cre-

ates a foundation of success. One learns that defining

successful outcomes takes collaboration and debate –

something that is not accomplished alone. So, the fortu-

nate individual that expresses that, “something has got to

As terms end for our current slate of

Chapter officers, I would like to take

this opportunity to recognize them. Dr.

Terry Barber has been tireless as our

President. His many accomplishments

include three successful QI/MOC pro-

grams. These not only advanced child

health but provided significant member

benefits. Dr. Judy Romano served as

Treasurer, Chair of Early Child Educa-

tion and Child Care, and will move

into the office of President-elect. Drs. Jill Fitch, Andy

Garner, and Bob Murray were our delegates-at-large

providing pivotal direction and expertise. Dr. Garner will

begin a term as Treasurer.

Our success also is attributed to the office and staff

with Executive Director Melissa Wervey Arnold at the

helm. Her energy and expertise has catapulted Ohio into

the forefront of successful chapters. Her dedicated staff

includes Heather Hall, Elizabeth Kelleher, Karen Kirk,

and Joanne Gordon. Their combined efforts have been

key to our achievements.

As we move into my first year, there are many areas of

focus. The “My Story” program will encourage private

pediatricians to use a portable medical record for children

in foster care. Presently, three practices in our state have

utilized it with some success. Many of us have experi-

enced caring for children with little or no medical infor-

mation. Often serious mental health issues are not clearly

defined as well.

We will continue to sustain our efforts in the QI/MOC

arena. With developmental screening, asthma and obesity

programs, we are accomplishing much to advance child

health in Ohio. These programs also provide significant

member benefit and are attaining national recognition.

Obesity has become the target of programs throughout

the country. We are moving toward statewide expansion

of the Ounce of Prevention Program. Our goal is to pro-

vide AAP guidelines on obesity, nutrition and physical

fitness. Drs. Robert Murray and Amy Sternstein, have

See Dr. Barber...on page 6 See Dr. Tiberio...on page 6

Ohio Pediatrics • Summer 2010 3

Ohio Pediatrics

www.ohioaap.org

President’s Message

Gerald Tiberio, MDTerry Barber, Sr., MD

All I can say is,“Man, what a ride!”

Foster care, obesity,QI focus for 2010-11

Ohio Pediatrics • Summer 20104

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Ohio Pediatrics

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Case Study: AnteriorTalofibular Ligament Sprains

Editor’s note: The author of this

case study, Leonard Janchar, MD,

FAAP, is a pediatrician at the Smith

Clinic in Marion, Ohio, and is a

clinical assistant professor of pedi-

atrics at The Ohio State University

College of Medicine and Public

Health.

History:

Alexia is a 14-year-old soccer

player who rolled her right ankle

while running during a soccer

game.

Mechanism of injury:

Alexia turned the right ankle to

the inside (inversion) while her foot

was in the plantar flexion. She stop-

ped running, started limping, and

was unable to continue playing.

Past Medical History:

No previous ankle injuries.

Examination:

Inspection shows moderate swell-ing over the lateral aspect of theright ankle, but no visible deformityand no ecchymosis. Alexia points tothe anterior talofibular ligamentwhen asked where pain is the most.Physical exam of the left ankle re-veals no abnormalities. Next, exami-nation of the right ankle has find-ings of tenderness on palpation atthe anterior talofibular ligament.There is minimal tenderness on pal-pation at the distal fibula. No ten-derness is noted on palpation at thecalcaneofibular ligament or at theposterior talofibular ligament.

No findings are noted on exam ofthe medial side of the right ankle.

The patient is unable to stand onher right foot. The anterior drawertest is negative. (Alexia dangles herfoot over the edge of the exam tablewhile the examiner cups one handover the right heel and the otherhand is used to provide counterpressure on the tibia. Movement is asign of a positive test when com-pared to the uninjured ankle.)

Radiographs:

An X-ray is ordered because ofpain at the distal fibula, since theremay be a physeal injury. AP, lateral,and mortise views show the fibularphysis is closed and reveal no frac-ture.

Treatment:

Initially, Alexia was started onRICE.

R-est: no walking, crutches, anklebrace.

I-ce: to keep swelling down, 20 -30 minutes three-to-four times aday.

C-ompression: ACE wrap to re-duce swelling.

E-levation: Ankle above the heartfor 48 hours.

Rehabilitation program:

Alexia was then referred to asports-minded physical therapistwho began a three phase program:

Phase I: RICE, ibuprofen as neededto control pain, and early weight-bearing.

After swelling was reduced,Phase II was started with range ofmotion exercises: Heel cord stretch-es, ankle dorsiflexion, ankle inver-sion, ankle eversion, ankle alpha-bets, heel raises and hip abduction.Walking, then jogging, was added.

Phase III consisted of restoringsport-specific skills such as running,pivoting, jumping, balance, and ballhandling (dribbling, passing, andshooting). At the end of Phase IIIshe was able to run with full rangeof motion.

Return to play:

After finishing her formal therapysessions and continuing home exer-cises, Alexia was seen in the officeagain at two weeks post injury. Onexam, her right ankle showed noswelling and no tenderness to palpa-tion. She was able to hop on herright ankle without pain and couldbalance on the ankle with her eyesclosed for 30 seconds. She wascleared without restriction to resumesoccer.

– Leonard Janchar, MD

Pediatrician, Smith Clinic

Ohio Pediatrics

6 www.ohioaap.orgOhio Pediatrics • Summer 2010

Dr. Barber... from page 3

Dr. Tiberio...from page 3

be done,” discovers a slew of sup-

port from right next door.

There is not enough space in this

entire issue of Ohio Pediatrics for

me to review the incredible number

of projects to improve care, access,

and support of children and pediatri-

cians in our state. When you think of

number of major centers for training

of our residents, the academic sup-

port that surrounds them, and the

practicing pediatricians and pediatric

specialists throughout the state that

test the knowledge, apply the princi-

ples, and evaluate the outcomes –

both good and “bad” – it becomes

abundantly clear that this organiza-

tion has what it takes to remain a

leader in health-care reform and

quality.

So, I make one final plea to the

reader of this article. If you have not

become involved with the Ohio

AAP in even a small way, you are

missing out in a big way. My only

disappointment is witnessing an idea

go untested or an individual physi-

cian’s talents go unused. Make a

decision right now to call or e-mail

the chap-ter office, one of the offi-

cers, or a committee member to find

out if there is something you could

do to improve our organization and

make a better life for a child. I guar-

antee that you will be enriched with

a new sense of personal and profes-

sional fulfillment that you have not

experienced before.

– Terry Barber, Sr., MD

Past President, Ohio AAP

been instrumental in guiding the

Chapter leaders with their expertise

and vast experiences.

Dr. Terry Barber has spent con-

siderable energy in the young physi-

cian/resident arena. We will continue

our efforts to engage them and nur-

ture their ideas. They are the “best

and brightest” and will lead us into

the future.

Our legislative/advocacy efforts

remain sustained and strong. Dr. Bill

Cotton continues as our valued

spokesperson. I had the opportunity

to accompany Bill on several State-

house visits. His delivery and people

skills serve us well.

I’d like to welcome Allison

Brindle, MD, Cleveland, our new

delegate-at-large.

There are numerous committee

chairs who promote our mission.

They continue to provide their re-

spective areas of expertise. The

fruits of their efforts are visible

throughout the state and often are

effective at the national level too.

We appreciate their valuable contri-

butions.

As for the future . . . .? The Chap-

ter will continue to seek ways to en-

gage you. Your time, talents, and

treasure are needed. We realize you

have strong commitments to Ohio’s

children. Please consider joining our

efforts to improve their health and

well-being.

– Gerald Tiberio, MD

President, Ohio AAP

Clark Kellogg toread at Breakfastfor Books

Described as an avid reader,

Clark Kellogg will show off his

reading skills

on Friday,

Sept. 10 at

Breakfast for

Books, the

annual fund-

raiser for

Reach Out and

Read Ohio.

Among his

favorite types of books are mys-

teries, spiritual novels, biogra-

phies and John Grisham novels.

However, at Breakfast for

Books, he will be reading his

favorite children’s book to

attendees.

Kellogg, CBS Sports College

Basketball Analyst, will be re-

turning to his alma mater to par-

ticipate in the fourth annual

Breakfast for Books event

which will be held at the Ohio

Union, on The Ohio State Uni-

versity campus.

The event will begin at 8:30

a.m., introducing attendees to

the Reach Out and Read pro-

gram, awarding the ROR Ohio

Champions of the Year Award,

and will conclude with Kellogg

addressing the crowd about why

literacy is important to him and

his family. A one-hour meet-

and-greet with Kellogg will be

held from 10 to 11 a.m. for

those purchasing VIP Tickets.

For more information, includ-

ing registration information, go

to the Ohio AAP website: www.

ohioaap.org

Clark Kellogg

Ohio Pediatrics

7www.ohioaap.org Ohio Pediatrics • Summer 2010

Unintentional injury leading cause of deathOnly halfway through the trauma

season, we are reminded daily in the

Emergency Department of the impor-

tance of injury prevention. Review of

the WISQARS (Web-based Injury

Statistics Query and Reporting Sys-

tem) data indicates that in 2007 there

were 330 unintentional deaths in

Ohio of children ages 0-18 years.

That is the equivalent of three Boeing

737s crashing a year in our state

alone!

Unintentional injury remains the

leading cause of death in Ohio from

ages 1-34 years. The leading cause of

injury deaths by age are: < 1 year –

suffocation, 1-4 years – drowning,

and 5-34 years – MV traffic. Hope-

fully this data and the information in

this article will help you in your anti-

cipatory guidance to your patients

and families.

Here is a brief review of some im-

portant injury prevention studies that

have come out in the last few years.

Car safety seats for children: rear

facing for best protection

Henary B, Sherwood CP, Crandall

JR, Kent RW, Vaca FE, Arbogast KB,

Bull MJ. Injury Prevention 2007;

13:398-402.This study showed that children in

rear-facing car seats were significant-

ly less likely to be injured than those

in forward-facing car seats in any

type of crash. Rear-facing car seats

were significantly more effective

than forward-facing car seats in pre-

venting injury in children ages 0-23

months.

AAP Policy Statement – Preven-

tion of Drowning; Technical Report

– Prevention of Drowning, Jeffrey

Weiss, MD, Committee on Injury,

Violence, and Poison Prevention.

Pediatrics published online May 24,

2010 DOI: 10.1542/peds.2010-1265.

In May, the AAP updated their

policy statement on drowning pre-

vention. The highlights include:

• Prevention of entanglement and

entrapment in pool and hot tub

drains by the use of special drain

covers, filter systems, and safety

vacuum-release systems.

• Four-sided fences and increased

supervision around inflatable, por-

table pools.

• A new study showed that swim-

ming lessons in children older than

1 years old does not increase the

risk of drowning. The AAP contin-

ues to encourage swim lessons for

most kids older than 4, but now the

AAP no longer advises against swim

lessons for children 1-4 years of age,

if they are developmentally ready.

• There is no substitute for close

supervision of children near water.

• Family members and caregivers

should be trained in CPR.

Primary Access to vehicles in-

creases risky teen driving behav-

iors and crashes: national per-

spective. Garcia-España JF, Gins-

burg KR, Elliot MR, Winston FK.

Pediatrics.2009 Oct;124(4):1069-

75.

The authors of this study did a

national survey of teen drivers. They

found that teen drivers with primary

access to a car (vs. shared access)

reported twice the crash risk, in-

creased likelihood of cell phone use

while driving, and speeding greater

than 10 miles per hour over the

posted speed limit.

Unintentional strangulation

deaths from the “Choking Game”

among youths aged 6-19 years –

United States, 1995-2007. Russell

P, Paulozzi L, Gilchrist J, Toblin R.

MMWR Morb Mortal Wkly Rep.

2008 Feb15;57(6):141-4.

The “choking game” is defined as

“self-strangulation or strangulation

by another person with the hands or

a noose to achieve a brief euphoric

state caused by cerebral hypoxia.” In

this report of deaths attributed to in-

tentional choking were collected and

analyzed. There were 82 deaths in

the U.S. from intentional choking

from 1995-2007. Of those, 86.6%

were male, with the mean age of

13.3 years, and 95.7% of deaths

occurred when the child was

alone. The article only reviews the

fatalities, and at this time there is no

data on “near miss” incidents, or

participation rates, but one could

presume that those numbers are

much higher. This is an important

topic to address with parents and

teens. Warning signs include:

• Mention of the choking game

(pass out game, blackout game,

scarf game, space monkey);

• Bloodshot eyes;

• Marks on the neck;

• Frequent, severe headaches;

• Disorientation after spending

time alone;

• Ropes, scarves, and belts tied to

bedroom furniture or doorknobs or

found knotted on the floor.

Mild traumatic brain injury in the

pediatric population: the role of

the pediatrician in routine follow

up. Kaye AJ, Gallagher R, Callahan

JM, Nance ML. JTrauma. 2010

See Injuries...on page 9

Ohio Pediatrics • Summer 20108 www.ohioaap.org

Ohio Pediatrics

Ounce Regional Trainings:Aug. 18, 2010 (Wednesday)Toledo

Oct. 5, 2010 (Tuesday)Youngstown

Oct. 12, 2010 (Tuesday) –Cleveland/Akron

Dates still being finalized forAthens and Cincinnati/Dayton.

Ounce webinars:Aug. 24, 2010 (Tuesday)10-11 a.m.

Aug. 27, 2010 (Friday)12-1 p.m.

Sept. 2, 2010 (Thursday)10-11 a.m.

Sept. 7, 2010 (Tuesday)12-1 p.m.

Sept. 14, 2010 (Tuesday) 5-6 p.m.

Sept. 22, 2010 (Wednesday)10-11 a.m.

Sept. 28, 2010 (Tuesday)12-1 p.m.

The final webinar date and timehas not yet been set.

Ounce QI/MOC TrainingNov. 4, 2010 (Thursday)

Full-day learning session atDublin Marriott, the same lo-cation as the Annual Meetingthe following day.

Ounce trainingsand webinars

Obesity prevention strategies discussedat regional workshops, through webinars

Introduced in 2007, the Ounce of

Prevention is Worth a Pound toolkit

was developed to address the grow-

ing epidemic of childhood obesity.

The goal was to provide primary

care providers with simple tools to

educate parents in obesity preven-

tion strategies by making good nutri-

tional and physical activity decisions

for their children.

The Ounce of Prevention program

was developed in collaboration with

the Ohio Chapter, American Acad-

emy of Pediatrics; the Ohio Depart-

ment of Health, Healthy Ohio; the

American Dairy Association Mid-

east; the Ohio Dietetic Association,

and Nationwide Children’s Hospital.

The Ounce of Prevention program

supplies those tools for well-child

visits from newborn through 6 years

old, with additional information

available up to 18 years old. Infor-

mation is also available on the bene-

fit of calcium, sports nutrition,

healthy snacking and portion sizing

for children through teens, as well as

anticipatory guidance information to

share with parents.

Through a Statewide Wellness and

Obesity Prevention Program Grant

awarded to the Ohio AAP, the

Ounce of Prevention information

and toolkit will be made available to

a minimum of 400 health-care pro-

viders throughout the state. These

trainings will be held regionally in

Toledo, Youngstown, Athens, and

between Cincinnati/Dayton, and

Cleveland/Akron.

Eight webinars will also be sched-

uled to provide this information to

doctors and nurses not available to

attend a regional training. A list of

dates and times for the regional

trainings and webinars is in the box

at right.

Additionally, a quality improve-

ment learning collaborative, with

Part IV MOC credit, will be con-

ducted starting in November, and

will run through June 2011. Prac-

tices will be asked to track BMI for

children at well-child visits, as well

as nutritional and physical activity

recommendations. Monthly confer-

ence calls will also be held to share

best practices within the participat-

ing groups.

The Ohio AAP is looking for 10-

15 practices to participate in the

learning collaborative. Leaders from

the practices will be invited to attend

a full-day face-to-face learning ses-

sion on Thursday, Nov. 4 in Colum-

bus. It will be held at the Dublin

Marriott, the same location as the

Ohio AAP Annual Meeting the fol-

lowing day. For more information

on any of the Ounce of Prevention

activities, contact Heather Hall at

hhall@ohioaap.org or (614) 846-

6258.

9www.ohioaap.org Ohio Pediatrics • Summer 2010

Ohio Pediatrics

Legislation... from page 2

Patient Centered Medical Home Edu-cation Advisory Group to implementand administer the project, includingdeveloping a set of expected out-comes. Ohio AAP, the OSMA andthe Ohio Academy of Family Physi-cians worked to ensure that the mod-el maintains physicians as physicianeducators and physicians as the leadin any primary care medical homemodel.

HB 373 (Carney/Wachtmann)/SB

210(Coughlin/Kearney) – Healthy

Choices for Healthy Children

After much debate and negotia-tions, the Ohio General Assemblypassed SB 210, legislation written toimprove the obesity problem manyOhio children face. The bill facedsignificant opposition from the edu-cation community arguing that thelegislation imposed burdensomemandates. The bill’s proponents ac-cepted a number of compromises tokeep the bill moving including creat-ing a “pilot program” for schools tocreate physical activity standards andto allow for districts to “opt-out” of arequirement for BMI screenings.Ohio AAP is pleased the bill passedproviding a number of key provi-sions to combat obesity includingproviding nutrition standards for a lacarte food and beverages in schools.

HB 267, Official Prescription Drug

Program, Introduced in House

Rep. Clayton Luckie (D-Dayton)continues to work to advance his billto create a mandatory prescriptionpad program in Ohio. The bill re-quires all prescribers in Ohio to pur-chase tamper-resistant pads from theOhio Board of Pharmacy. Prescrib-ers who lose or have pads stolenwould be required to report that in-

formation to the board. The boardwould then alert pharmacies of themissing prescriptions in an effort toreduce fraud. In an effort to compro-mise, Rep. Luckie has proposed re-ducing the annual fee for the padsfrom $250 annually to $100. Al-though HB 267 has not had a hearingfor months, Rep. Luckie continues totalk to interested parties about hisideas.

HB 442, Complementary and Alter-

native Medicine

Rep. Kenny Yuko (D-Euclid) hasintroduced a “perennial favorite” billin the legislature to allow for the un-regulated practice of alternative andcomplementary medicine. William

Cotton, MD, Past President of OhioAAP, testified in opposition to thisbill in May, sharing concerns that un-regulated medicine can pose signifi-cant risks to the children of this state.Ohio AAP has long argued that thestate needs to ensure alternative pro-viders have appropriate training and

Injuries... from page 7

Jun;68(6):1396-400.

Pediatricians were asked to deter-

mine levels of comfort for caring for

patients with mild traumatic brain

injury in routine follow up. Results

showed that 89% of respondents felt

that they were the appropriate pro-

vider for follow up, however only

61.2% thought that they were the ap-

propriate provider for follow up if

there had been any loss of con-

sciousness or persistent symptoms.

Fifty-nine precent of the pediatri-

cians indicated that they had not had

any continuing medical education on

traumatic brain injury. The authors

concluded that most pediatricians

feel comfortable following up pa-

tients with mild traumatic brain in-

jury, but it is important to have ap-

propriate resources available.Patients with concussions need

mental as well as physical rest forthe first 24-72 hours, or as long assymptoms persist. This means novideo games, driving, TV, parties, orschool tests. A great concussionmanagement guide for pediatricianscan be found on the Ohio AAP web-site look under Sports Shorts.

– Sarah Denny, Vice Chair,

Injury, Violence & Poison

Prevention Committee

oversight as they take the health andsafety of Ohioans into their hands.HB 442 is being heard in the HouseCommerce and Labor Committee thatis chaired by Rep. Yuko.

SB 86 (Buehrer) – Expanded quali-

fied immunity for ED docs

SB 86, a bill to expand qualifiedimmunity for physicians working inemergency departments and thosewho provide disaster relief servicespassed out of the Ohio Senate onMay 19. The bill included a compro-mise to change the legal standard forphysicians in emergency rooms to aslightly lesser standard of “recklessdisregard.” The higher standard of“willful and wonton disregard”stands for health-care providers pro-viding disaster relief services. SB 86now heads to the House for furtherconsideration. It has been referred tothe House Civil and CommercialLaw Committee.

– Capitol Consulting Group

Ohio AAP Lobbying Team

10 Ohio Pediatrics • Summer 2010 www.ohioaap.org

Ohio Pediatrics

Reach Out and Read launches “Summer of a Million Books” campaign

Reach Out and Read, the nation-wide early literacy program,launched a bold new campaign togive a brand-new, age-appropriatebook to one million children in needbefore Labor Day. The Summer of a

Million Books campaign unitesReach Out and Read pediatriciansand family physicians at 4,500 hos-pitals and clinics across the countryin their mission to prepare Ameri-ca’s youngest children to succeed inschool.

Reach Out and Read Ohio is lead-ing the effort in our region and themedical providers have pledged todistribute nearly 59,000 books tochildren in need during the cam-paign.

Reach Out and Read developedthe Summer of a Million Books inconjunction with United We Serve:Let’s Read. Let’s Move. initiative,which aims to promote communityservice and combat illiteracy andchildhood obesity. Reach Out andRead is a national partner of Let’sRead. Let’s Move. an administra-tion-wide effort led by PresidentBarack Obama, First Lady MichelleObama, and the Corporation forNational and Community Service.

“According to the most recentNAEP reading test, two-thirds ofAmerican fourth graders cannot readproficiently,” said Earl Martin Phal-en, Chief Executive Officer ofReach Out and Read. “We can’t af-ford to wait until children arrive atschool to help them develop basicreading and language skills. Wemust intervene much earlier – in thefirst years of life – when we canhave the greatest impact on their

cognitive development and pros-pects for success. That’s what theSummer of a Million Books is allabout.”

Reach Out and Read targets chil-dren who are at greatest risk forschool failure and illiteracy, andprovides them with high-qualitychildren’s books and their parentswith reading tips and guidance onthe importance of reading aloud.Fourteen research studies confirmthat Reach Out and Read works –families served by the program readtogether more often, and their chil-dren enter kindergarten better pre-pared to succeed, with larger vocab-ularies, stronger language skills, anda six-month developmental age overtheir peers.

The key to Reach Out and Read’ssuccess is the messenger – pediatri-cians and family physicians. Partici-pating doctors and nurse practition-ers incorporate the Reach Out andRead model into every regularcheckup for children between 6months of age and the time theyenter kindergarten. Because 96% ofU.S. children see their doctor atleast once a year and because of thetrust that parents have in theirchild’s doctor, the pediatric checkupis the ideal opportunity to promoteearly literacy and school readiness.

Last year, Reach Out and Read’s26,500 participating medical pro-viders served 3.9 million childrenand families at 4,500 hospitals, clin-ics, and pediatric practices nation-wide. The 139 Reach Out and ReadPrograms in Ohio serve more than165,000 infants, toddlers, and pre-schoolers annually.

If it succeeds, the Summer of a

Million Books campaign will pro-vide one million families with thetools and the guidance they need toprepare their children to succeed inschool. In order to accomplish thatgoal, Reach Out and Read’s doctorsand nurse practitioners must distri-bute almost 1,000 books every daybetween Monday, June 21 (first dayof summer), and Monday, Sept. 6(Labor Day).

The doctors and nurses in severalhospitals, community health centersand private practices will receivehelp distributing those books fromOhio Representatives in July andAugust. Rep. John Boccieri, Rep.Marcia Fudge and Rep. JeanSchmidt will be reading to children,and distributing books, during visitsto their districts this summer.

To support the Reach Out andRead “Summer of a Million Books”campaign, go to the Ohio AAPwebsite at http://www. ohioaap.org/foundation/ reach-out-and-read.

If you have questions, pleasecontact Heather Hall, at hhall@ohioaap.org, or call her at (614)846-6258.

www.ohioaap.org Ohio Pediatrics • Summer 2010 11

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www.ohioaap.org Ohio Pediatrics • Summer 2010 13

INTRODUCTION

An ankle sprain or ankle ligament injury is a medical condition in

which one or more of the ligaments of the ankle are stretched, torn,

or partially torn.

MECHANISM OF INJURY

• 85% of ankle injuries are due to inversion forces to the

lateral aspect of the ankle.

• Twisted forces may cause high sprains or a syndesmosis

sprain (connection between the tibia and fibula).

ANATOMY

• The anterior talofibular ligament (ATFL) is the first or

only ligament to be injured in the majority of ankle

sprains.

• Other lateral ligaments: Calcaneofibular ligament

(CFL), posterior talofibular ligament (PTFL).

• Medial Ligament: Deltoid ligament.

• Syndesmosis ligament.

HISTORY

• Determine mechanism of injury: How force was applied to

foot and position of foot at time of injury.

• Ask about past ankle injuries.

• Understand requirements of athlete’s sport to guide

treatment program.

ExAMINATION

• Inspection: swelling, ecchymosis, deformity.

• Palpation: Examine uninjuried ankle first

1. Location of pain at sites:

• Fibular shaft

• Distal fibular physis

• Anterior talofibular ligament

• Calcaneofibular ligament

• Posterior talofibular ligament

• Tibial physis

• Deltoid ligament

• Syndesmosis ligament

2. Determine functional limitations: Ability to stand,

walk, run, jump, pivot, balance

• Special tests

1. Anterior drawer test (ATFL laxity).

Sports ShortsGuidelines for Pediatricians

This information is available on the Ohio Chapter, American Academy of Pediatrics’ Web site at www.ohioaap.org

Ankle Sprains2. Talor tilt test (CFL laxity).

3. Modified Romberg test (proprioception

deficit).

• Radiographs

1. Standard views: AP, lateral, and

mortise views to determine if a facture

(especialy an avulsion fracture) is

present.

2. 15-20% of ankle sprains may have a

fracture.

INITIAL FIRST AID (RICE)

•     Rest ankle by not walking on it - crutches.

• Ice to keep swelling down – 20 to 30 minutes

three to four times a day.

• Compresion dressings – ACE wrap to reduce

swelling.

• Elevate ankle above heart for 48 hours.

REHABILITATION PROGRAM AND RETURN TO

PLAY

• Prescribe treatment or refer to sports-minded

physical therapist for rehabilitation program.

• Phase I: Rest, protection, early weightbearing.

•  Phase II: Strengthening, flexibility, aerobics.

• Phase III: Restore sport specific skills.

• Return to play: When full ROM, ability to hop

and balance (proprioception restored) on affected

ankle.

• Recovery time: 2-6 weeks depending on severity

of injury.

• Follow-up: 1-2 weeks after injury.

PREVENTION OF ANKLE INJURIES

• Proper treatment and full rehabilitation of

previoius ankle sprains will help to prevent

recurrent ankle sprains.

• External support is effective for chronic ankle

instability.

Author: Leonard Janchar, MD, FAAP

Sports Shorts is provided by the Home and School Health

Committee of the Ohio Chapter, American Academy of Pediatrics.

14 Ohio Pediatrics • Summer 2010

WHAT IS AN ANKLE SPRAIN?

An ankle sprain is a common injury in which ligaments that connect the ankle bones are stretchedor torn.

• 25,000 ankle sprains occur every day.• 15% of all sports-related injuries are ankle

sprains.• Also called twisted ankle, rolled ankle, or ankle

ligament injury• Many ankle sprains result from previous ankle

sprains.• 85% of ankle sprains are lateral ankle sprains.• High ankle sprains involve the connection

between the tibia and fibula.

WHAT TO DO WHEN AN ATHLETE HAS AN

ANKLE SPRAIN?

• Occurs when foot is turned or rolled beyond motions that are considered normal for the ankle.

• Pain, swelling, inability to walk or run may occur.• RICE (Rest, Ice, Compression, Elevation) for

injured area and seek evaluation.• Do not apply heat.

WHAT WILL MY DOCTOR DO TO DIAGNOSE

AND TREAT MY ANKLE SPRAIN?

• Determine position of foot at the time of injury and how injury occurred.

• Determine location of pain.• Evaluate functional limitations (inability to stand,

walk, run, jump, pivot, balance).• Understand requirements of athlete’s sport to

guide treatment program.• Examine ankle.• Order X-rays if needed.• Prescribe treatment or refer to sports-minded

physical therapist for rehabilitation program.• Refer if fracture present for further evaluation and

treatment.

Sports ShortsGuidelines for Parents, Athletes

This information is available on the Ohio Chapter, American Academy of Pediatrics’ Web site at www.ohioaap.org

Ankle SprainsTREATMENT AND RETURN TO PLAY

• Phase I:

1. Rest and protection (wraps, braces, casts, crutches).

2. Control inflammation (ice and anti-inflammatory drugs, ibuprofen and naproxen sodium).

3. Early weight bearing.4. Beginning exercises such as writing

alphabet with toes.

• Phase II:

1. After swelling reduced, start strengtheningand range of motion exercises.

2. Start aerobic activities as tolerated – walking, then jogging.

• Phase III:

1. Restore balance, agility and sport-specific skills.

2. Make transition back to sport.

• Return to play when athlete has:1. Run with full range of motion.2. Hop on affected ankle without pain.3. Show balance while performing single

leg-stance on affected ankle.

• Recovery time frame is two to six weeks depending on severity of injury.

PREVENTION OF ANKLE INJURIES

• Proper treatment and full rehabilitation of previous ankle sprains will help to prevent recurrent ankle sprains.

• External support is effective for chronic ankle instability.

Author: Leonard Janchar, MD, FAAP

Sports Shorts is provided by the Home and School Health Committee

of the Ohio Chapter, American Academy of Pediatrics.

15www.ohioaap.org Ohio Pediatrics • Summer 2010

Developmental screening, diagnosiscontinues to spread across the state

Ohio Pediatrics

As of July 2010,100 practice sitesall over the statehave joined a Con-cerned About De-velopment Learn-ing Collaborative(CADLC). Thesepractices have hadamazing successin using the prin-ciples of improvement science to in-tegrate general developmental, so-cial-emotional and autism screeninginto their daily work flow.

Practices that completed theirwork in June 2010 and practices thatbegan their work in early 2010 haveachieved screening rates of 90% orhigher at a pace that is much fasterthan ever expected. The passion andcommitment of the physician cham-pions and their staff is the key totheir success. They have worked dil-igently to make small changes rapid-ly, and then have built on thosechanges with additional changes.The guidance and support fromCarole Lannon, MD, MPH, and

her team from the Cincinnati Chil-dren’s Center for Health Care Qual-ity has allowed CADLC to performbeyond expectations.

In April 2010, psychoeducationalevaluation teams and medical pro-viders from 25 counties came to-gether for training to develop Com-munity-Based Diagnostic Partner-ships. Teams from all of these coun-ties are working together to developenhanced evaluations and diagnosticservices for young children withconcerns about social and communi-cation delays. Marilyn Espe-Sher-

windt, PhD, and Abbie McCauley,

PhD, at the Family Child LearningCenter in Tallmadge have developedan innovative web-based model forsupporting the psychoeducationalteams in becoming fully reliable inadministration and scoring of theADOS, which is considered to be avaluable test for determiningwhether or not children are in theautism spectrum. Their medical part-ners will review and interpret the de-velopmental testing, perform differ-ential diagnosis, and make recom-

Autism Diagnosis Education Pilot Project

mendations to families regarding nextsteps. The teams will have on-goingtechnical support from John Duby,

MD, and Marilyn Espe-Sherwindt toassure that they reach a high level ofconfidence and competence inproviding developmental diagnosticservices in their communities.Specialists across the state areavailable to assist with the morechallenging cases.

One of the keys to the project’ssuccess has been that many localchampions have stepped forward toengage their colleagues in their com-munities in these efforts. Amongthem is Carrie Campanelli, MD,

from Austintown Pediatrics. Dr.Campanelli learned about CADLC ata town hall meeting held in Youngs-town. She saw the benefit that couldcome to the children and families inthe Mahoning Valley from develop-ing a systematic approach to earlyidentification of developmental con-cerns. She led an effort to recruitseven other practices in her area tojoin CADLC and attend a learningsession hosted in Youngstown. Thiswork has led to remarkable im-provement in collaboration betweenpediatricians and Help Me Grow inthe Mahoning Valley, with docu-mented increases in referral to HelpMe Grow and linkages with commu-nity resources. This is a great exam-ple of how local people in local situ-ations can design and implement lo-cal solutions to important issues.

– John C. Duby, MD, FAAPADEPP Medical Director

John Duby, MD

Annual Meeting... from page 1

speak on “Vaccines, Not Just forBabies.”

Pre-Annual Meeting workshops onFriday, Nov. 5 will deal with immu-nization coding presented by Rich-

ard Tuck, MD; tools to use in yourpractice regarding parental refusalpresented by Ryan Vogelgesang,

MD, and Chris Rizzo, MD; andRobert Frenck, MD, and Dr.

Fisher will discuss case-based com-

mon pediatric problems. The Friday evening reception will

provide an opportunity to networkwith colleagues and exhibitors and avisit with Columbus Zoo animals.

A members-only breakfast on Sat-urday will update attendees on OhioAAP projects and activities. Theawards luncheon will follow theSaturday workshops.

For more details go to the Ohio

16 Ohio Pediatrics • Summer 2010 www.ohioaap.org

Ohio Pediatrics

Ohio AAP Foundation golf outing Aug. 31Support the Ohio AAP Foundation by participating in

the 2010 Ohio AAP Foundation Golf Outing! This year’s

event will be held at Rattlesnake Ridge Golf Club in

Sunbury, Ohio on Tuesday, Aug. 31.

The best ball

scramble will tee

off at noon, with

boxed lunches

available on the

golf cart. Once

play is complete,

an awards ceremony with light hors d’oeuvres will be

hosted to recognize the best foursomes, contest winners

and raffle winners.

On-course contests and mulligans will be made avail-

able at registration the day of the outing. Cost is $175 for

an individual golfer, or $600 per foursome. Registration

fee includes green fees, golf cart, lunch, awards and light

hors d’oeuvres.

To register, visit http://www.ohioaap.org/ foundation, or

contact Heather Hall at hhall@ohioaap.org.

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www.ohioaap.org 17Ohio Pediatrics • Summer 2010

Ohio Pediatrics

“Summertime

and the livin is

easy…” wouldn’tit be wonderful tosing along withGershwin and be-lieve those words?I do hope thatsome of your sum-mer is easy but Iam confidentmost are working, as always, caringfor patients, managing offices andpursuing the advocacy issues that areour mission in life.

The issues currently in front of theAAP are ever-more challenging andyour state chapter leadership will beincreasingly involved in ensuring thatthe best of the Affordable Care Act(ACA) is implemented to benefit ourpatients and practices. Under devel-opment are the regulations for Mean-ingful Use of Health Information

District V Report

Marilyn Bull, MD

Challenging advocacy issues aheadTechnology under the guidance ofthe AAP leadership and Chris Leh-mann, MD, who accepted the chal-lenge of directorship of the ChildHealth Information Center fundedby the AAP. Watch for an announce-ment soon with regard to new guide-lines and payment to practitionersthat will begin in May 2011.

Hopefully, you have seen the mostrecent blog “Helping PediatriciansBreathe” by AAP President JudithPalfrey, MD, that comprehensivelyoutlines the AAP involvement andconcerns regarding immunizationreimbursement. Several successeshave been realized and challengesremain, but the AAP is at the fore-front of the battle. Without ensuringthe support of immunizations in pri-mary care, the days of bacterialmeningitis and death from pertussisthat many remember and others canonly imagine, will return. For a full

perspective please read Dr. Palfrey’sblog on the AAP website.

Although the news about the dis-aster in Haiti has mostly vanishedfrom TV and newspapers, we knowthat suffering is far from over. TheAAP response has been ongoing andpediatrician representatives havemade several trips to assess howbest our resources can be used. TheFriends of Children response wasmost heart-warming and some of ourfunds will be used to support theHaitian medical students and resi-dents to help ensure a continuoussource of health care.

The issues of health-care financereform often may feel like a tidalwave but we all realize it is impor-tant to remain in the boat and staythe course.

– Marilyn J. Bull, MD, FAAP

Chairperson, District V

Two receive CATCH Implementation GrantsTwo community pediatricians

were awarded 2010 Community

Access To Child Health (CATCH)

Implementation Grants this spring.

Fran Hickey, MD, Cincinnati,

was awarded $12,000 for his project

“Outreach to Hispanic Families with

Down Syndrome.” Dr. Hickey no-

ticed that less than half the estimat-

ed number of Hispanic children in

the greater Cincinnati area with

Down Syndrome were being treated.

He has piloted a project to work

with the Down Syndrome Associa-

tion of Greater Cincinnati to reach

out to the Hispanic community to

increase awareness of the necessity

of medical attention for these chil-

dren with Down Syndrome.

Ganga Srinivas, MD, Cleveland,

was awarded $12,000 for her project

“Peer to Peer: Sustainable Breast-

feeding Advocacy.” Using a peer

counselor model, she will evaluate

knowledge and practices, determine

barriers, educate, and support fami-

lies in their breastfeeding and early

childhood nutrition choices from the

prenatal period through the first

year. She is collaborating with WIC

and local breastfeeding groups.

Kirstin Weerdenburg, MD, a

resident at the Cleveland Clinic, has

been awarded a resident funds grant

of $3,000 for her project “Targeting

Early Developmental Interventions.”

Her project will place early inter-

vention personnel in resident conti-

nuity clinic sites. Residents on their

advocacy rotation will also assist in

developmental assessments, parent

education, and referrals for at-risk

patients.

The goal of CATCH funding is to

connect children to medical homes

and needed services by collaborat-

ing with others in the community.

Call us if you have an idea!

– Jonna McRury, MD, and

Mark Redding, MD

State CATCH Coordinators

18 Ohio Pediatrics • Summer 2010 www.ohioaap.org

Ohio Pediatrics

Ask teens for help with social media

James Fitzgibbon, MD, director of Adolescent Medicine at Akron Children’s, and

a presenter at the Ohio AAP Open Forum Meeting in May, is interviewed by a

local television station on the potential risks to teens’ privacy and personal safety

using the Internet.

During the AAP’s May 21 Open

Forum Meeting in Akron, Drs.

Peggy Stager and Georgette

Constantinou shared some insights

about navigating the Internet. Their

message was clear – the Internet is a

rewarding place both for kids and

teens but there are potential risks to

their privacy and their personal safe-

ty. There is no question that today’s

teens and “tweens” connect with one

another, to their communities, and

the rest of the world via digital tech-

nology much more so than any previ-

ous generation. Just as most of us are

getting comfortable using e-mail as a

preferred method of communication,

new social media sites come on the

scene to challenge us as we struggle

to keep up with our ever-advancing

teens.

Dr. Stager, interim chair of the

Department of Pediatrics at Metro-

Health Cleveland, spoke about these

new technologies and showed exam-

ples of these sites and how they are

being used by our children and

teens. She explained that we need to

learn about social media and be will-

ing to interact with our teens and

tweens around Internet issues.

One suggestion was to ask your

kids to help you use the various

social networking sites. This is a

good way to begin a conversation

with your children about these sites,

and at the same time, learn some of

their online habits.

From a safety standpoint, parents

should keep the computer in a com-

mon area in the home, and should be

aware of how much time their kids

are spending online. It’s important to

share information and concerns with

our children to discourage them

from gossiping, spreading rumors or

bullying, and make sure that we set

good examples in our own use of

social media. Make sure that your

kids are well aware of safety fea-

tures that every social media venue

has, and make sure that they are

using them.

For parents who want more infor-

mation, the AAP provides many

avenues, for example, safetynet.

aap.org addresses many safe and

common sense approaches to the

media. Dr. Constantinou recom-

mended a pamphlet called Net

Cetera: Chatting with Kids About

Being Online, go to www.

onguardonline.gov/topics/

net-cetera.aspx. The pamphlet ad-

dresses such things as how to talk

with your kids, advice for parents,

communicating online, parental con-

trols and other safety issues. Free

copies of this brochure are available

at http://bulkorder.FTC.gov.

At the end of our day there were

many questions, stories were shared,

and I think all of us left with a better

appreciation for the need to know

about social media. By sharing so-

cial media use with our children, we

may better understand their use of it

and be available to help if needed.

– James Fitzgibbon, MD

Chair, Adolescent Committee

Georgette Constantinou, PhD, a pedi-

atric psychologist at Akron Children’s

Hospital, shares some insights about

cyberbullying with attendees at the

Ohio AAP Open Forum in Akron.

Ohio Pediatrics

19www.ohioaap.org Ohio Pediatrics • Summer 2010

Young physicians receive advocacy training

Attendees at the first Ohio AAP Young Physician & Pediatric Trainee Advocacy

Workshop, held in May at the Statehouse, walked away with valuable information

about the legislative process and tips on interacting with the media.

More than 50 residents, fellows

and young physicians from Cincin-

nati, Columbus, Cleveland, Akron

and Toledo, participated in a half-day

legislative advocacy training session

on May 18 at the Statehouse.

The Ohio AAP Young Physician &

Pediatric Trainee Advocacy Work-

shop started off with a lunch follow-

ed by Ohio AAP Executive Director

Melissa Wervey Arnold and Terry

Barber, Sr., MD, (chapter president

at the time) providing advocacy re-

sources available through the chapter

and explaining current advocacy pro-

jects and opportunities.

Tracy Intihar, lobbyist for the Ohio

AAP, introduced participants to the

state legislative process, highlighting

the necessary steps to introduce new

bills into law.

Nationwide Children’s Hospital

Government Relations specialist,

Matt Peters, presented “Advocacy

101.” He explained how to get start-

ed as an advocate, and the methods

and strategies for effective advocacy

projects.

William Cotton, MD, Ohio AAP

Past President, and medical director

of the primary care clinics at Nation-

wide Children’s Hospital, taught ef-

fective strategies for physicians to

interact with the media.

Closing remarks were given by

Antoinette Eaton, MD, former Na-

tional AAP President.

Ohio Congressmen Randy Gardner

and John Patrick Carney shared their

perspectives on how physicians can

communicate effectively with elected

officials. They also discussed current

health-care issues being addressed in

the Legislature.

Following the workshop, attendees

were invited to the Ohio Children’s

Hospital Association reception. Par-

ticipants had an opportunity to meet

with executives from children’s hos-

pitals across the state.The advocacy workshop, spon-

sored by the Ohio AAP, was free to

all attendees. Following the successof this event, the committee is look-ing forward to establishing the advo-cacy workshop as a biannual event.

– Natalie Riedmann, MD, PGY-1

Nationwide Children’s Hospital

Prevnar... from page 1

pays for almost 10 years of myChapter dues,” says Ryan Vogelge-

sang, MD, a Parma pediatrician.When the Chapter was notified

from concerned members that theirPCV13 claims were being denied,the Chapter immediately called theOhio Department of Health (ODH),then talked to ODJFS, meetingswere held with ODJFS and finally aletter of concern was sent to ODJFS.After further investigation it wasfound that Ohio Medicaid’s switchover date from PCV7 to PCV13 wasMay 1 which did not coincide withCenters for Disease Control’s (CDC)switch over date of March 17. As aresult, Ohio Medicaid was denyingreimbursement for any claims priorto May 1.

ODH estimates that 56,000 doses

of PCV13 were shipped betweenMarch 18 and May 1, 2010. At $10per dose administered, that’s approx-imately $560,000 in claims thatwere denied.

The Ohio AAP felt that Ohio pedi-atricians were being penalized forfollowing what was spelled out tothem in a memo from ODH thatthey must switch to PCV13 and thatthat only PCV13 could be ordered.The memo proceeded to explainreturn policies on VFC PCV7, andprivately purchased PCV7 doses.

If you have questions or concernsregarding the Prevnar 13 decision,you may contact Melissa Senter atODJFS at melissa.senter@odjfs.ohio.gov, or call 614-752-4323, orcal the Ohio AAP at 614-846-6258.

among infants 3 months of age oryounger.

Due to waning immunity againstpertussis, adults and adolescents mayserve as reservoirs of the disease. Inan international study of 91 infantswith pertussis, the source of the ill-ness – identified and described byrelationship to the infant, age, andhousehold status – was determinedfor 44 infants. The study found thatwhen a source was identified, house-hold contacts were responsible forinfant pertussis 73% to 82% of thetime. Family members, especiallymothers, were identified as the majorsource of transmission:

• Parents in 55% of cases.• Siblings in 16% of cases.• Friends, cousins, or part-time care

takers in 12% of cases.• Aunts and uncles in 10% of

cases.• Grandparents in 6% of cases.

Pertussis cases on the rise

Several studies indicate a totalyearly adult and adolescent pertussisburden of between 800,000 and 3.3million cases in the United States.One reason for the continuing inci-dence of pertussis may be that immu-nity to pertussis “wears off” overtime – approximately 5-10 years aftercompleting the childhood vaccinationseries. This means that adults andadolescents who think they have im-munity can be susceptible to pertussisand may unknowingly transmit thedisease to infants.

In fact, patients with pertussis mayhave symptoms and still go undiag-nosed. The ACIP recognizes that thediagnosis of pertussis can be difficultto confirm, particularly with test re-

Ohio Pediatrics • Summer 2010 www.ohioaap.org

Ohio Pediatrics

20

Pertussis transmission may be reduced

See Pertussis...on page 22

In 2005, the Food and Drug Ad-ministration licensed two combina-tion tetanus, diphtheria, and acellularpertussis (Tdap) vaccines to helpprotect adults and adolescentsagainst the threat of pertussis. Untilthat time, pertussis vaccination waslimited to infants and young chil-dren.

With the availability of Tdap vac-cines, the Advisory Committee onImmunization Practices (ACIP) ofthe Centers for Disease Control andPrevention (CDC) recommends thatadults and adolescents 11-64 yearsof age receive a single booster doseof Tdap in place of a single dose oftetanus and diphtheria (Td) boostervaccine. Tdap vaccine is now thestandard of care, helping to provide

adults and adolescents with protec-tion against pertussis, and potential-ly reduce the spread of the disease toinfants.

ACIP also recommends that healthcare professionals who have directpatient contact receive Tdap, espe-cially those who have direct contactwith infants less than 12 months.

Threat to the entire family

Although infrequently, adults andadolescents diagnosed with pertussiscan be hospitalized with complica-tions and even rib fractures from in-tense coughing.

Many infants with pertussis arehospitalized, and some cases may befatal. From 2004 through 2006, 84%of the deaths from pertussis occurred

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chock full of great ideas,” Dr.Anderson-Willis said. “What was inthe forefront of my mind was mydaily grind – overweight kids withoverweight problems.”

Dr. Anderson-Willis did what shecould to improve her patient’shealth, but suggesting that they eatless calories and exercise more didnot seem to be getting anywhere.“The kids were not buying thehealth monologues I was selling so Idecided to go out into the communi-ty and ask them,” she said. At localhealth advisory meetings the atten-dees suggested she do something“that changes people’s lives,” notjust another health fair.

Dr. Anderson-Willis’ church groupchose walking for wellness as theirfirst ministry project in January2009. “We prayed, walked, andprayed again. Over time, we addedhealth talks, recognition of mini vic-tories – like exercising during theweek , and then we moved out to thepark. After a few weeks, I recog-nized that my fellow church mem-bers and I were losing weight,” Dr. Anderson-Willis said.

She also began to notice otherhealth improvements in her fellowwalker’s lives. Cholesterol levelsand elevated blood pressures weredropping. Some were able to discon-tinue their blood pressure medica-tions. Others were able to stopsmoking with the support of thegroup.

It was about six months into thisjourney when the church walkinggroup connected with Walk with aDoc. “I was so excited to have theenergy and enthusiasm of physiciansfrom different specialties who werefighting the same battles of gettingwalkers out each week,” Dr. Ander-son-Willis said.

“Each Walk with a Doc group en-courages and empowers individualsto do what they’ve always wanted todo with their health. People fromdifferent backgrounds and ethnicitiescreate a potpourri of conversationtopics. From the physicians whovolunteer to speak, to people whobring someone, or come to supportsomeone, it is all about giving.”

The First Lady’s “Let’s Move”

Ohio Pediatrics

Ohio Pediatrics • Summer 2010www.ohioaap.org 21

Are you tired of getting nowhere inthe fight against obesity and for bet-ter health? You may want to considergetting involved with a program likeWalk with a Doc.

Walk with a Doc is an organizationcreated by David Sabgir, MD, a Co-lumbus cardiologist. He saw what amarked difference regular exercisemakes in his patients. He began toorganize regular walks that include ateam of supporting physicians, nurs-es, and community members. Theymeet in a park or a mall, they listento walkers questions, provide coffee,water bottles, and food. The healthproviders share medical news thatcould affect patient’s lifestyles, checkblood pressures, stretch, and thenwalk.

On May 8, central Ohio hosted“Come Out and Walk, Garden, andPlay” at the Franklin Park Conserva-tory. This was an expanded versionof the Walk with a Doc program. Theevent physician organizers were pe-diatricians Wendy Anderson-Willis,

MD, and Mary Lynn Niland, MD.With the support of multiple commu-nity organizations, including Nation-wide Children’s Hospital, the eventbrought out nearly 100 communityphysicians and hundreds of citizens.The morning started with a healthybreakfast. This was followed by in-troductions, music and pre-walkstretching, before participants walkedin the park. Post-walk activities in-cluded gardening for the kids, moremusic, and multiple health informa-tion booths.

Dr. Anderson-Willis leads a walkin the park every Saturday.

“I never actually had the courageto launch a walking group. I thoughtthat this idea would end up on myback burner which is, by the way,

Walk with a Doc is changing lives

See Walk...on page 23

Central Ohio hosted “Come Out and Walk, Garden, and Play” in May at the

Franklin Park Conservatory. Nearly 100 community physicians and hundreds of

Columbus residents participated.

Ohio Pediatrics

Ohio Pediatrics • Summer 2010 www.ohioaap.org22

Pertussis... from page 20

sults other than positive culture forBordetella pertussis. While the sen-sitivity of culture can reach 80% to90% under optimal conditions, inpractice, sensitivity typically rangesfrom 30% to 60%. The ACIP statesthat research is needed to evaluateand define improved diagnostic testsfor pertussis.

Additionally, vaccination rates re-main low. According to the CDC, in2008, only 41% of adolescents 13-17 years of age were vaccinatedwith Tdap. Among adults, only 2%report vaccination with Tdap.

The ACIP recommends: • A single dose of Tdap for adults

19-64 years of age instead of a Tdbooster; the Tdap dose is recom-

mended if it has been more than 10years since the last Td booster. Aninterval of two years between Tdand Tdap has been used, but shorterintervals after Td vaccine may beused.

• A single dose of Tdap for ado-lescents 11-18 years of age insteadof Td for those who have yet to re-ceive a Td booster.

With the availability of Tdap vac-cine, health-care professionals needto uphold the standard of care forinfant pertussis by: 1) vaccinatingthe child with DTaP, and 2) vacci-nating those adults and adolescentswho come in close contact with thechild with Tdap vaccine.

Raising awareness

One way to help reduce the spreadof pertussis to vulnerable infants, isby developing campaigns to raiseawareness among new mothers andfamilies about the importance ofTdap vaccination.

Providers can use existing officevisits as an opportunity to increaseTdap vaccination among adults andadolescents.

Through the commitment of phy-sicians, plus the availability of Tdapvaccines, the standard of care forproviding protection against pertus-sis in the U.S. is being redefined.

AdolescentJAMES FITZGIBBON, MD(330) 543-8038 jfitzgibbon@chmca.org

Child Abuse & NeglectKATHI MAKOROFF, MD(513) 636-0037kathi.makoroff@cchmc.org

Children With Disabilities JAMES BRYANT, MD(614) 644-1106 James.Bryant@odh.ohio.gov

ROBERTA BAUER, MDbauerr@ccf.org

Pediatric Care Council JON PRICE, MD(614) 722-4385 pricej3@columbus.rr.com

Early Education & Child CareJUDITH ROMANO, MD(740) 633-6480/6482drjudithromano.1@comcast.net

Fetus and NewbornRICHARD McCLEAD, MD(614) 722-4529richard.mcclead@nationwidechildrens.org

Health EquityMARK REDDING, MD(419) 774-9077 reddingz@worldnet.att.net

JONNA MCRURY, MD, FAAP jmcrury@aol.com

Home & School HealthROBERT MURRAY, MD(614) 722-4958 robert.murray@nationwidechildrens.org

Injury, Violence & Poison PreventionMIKE GITTELMAN, MD(513) 636-7288 mike.gittelman@cchmc.org

Vice-chair: SARAH DENNY, MDsarah.denny@nationwidechildrens.org

Nominating Committee KATHERINE KREUCK, MD, FAAP (614) 895-2426KKrueck@insight.rr.com

DEANNA DAHL-GROVE, MD (216) 844-8716deanna.dahl-grove@case.edu

KAREN MONTGOMERY-REAGAN, DO(740) 593-2444montgomk@ohio.edu

Pediatric AdvocacyWILLIAM COTTON, MD(614) 722-4950william.cotton@nationwidechildrens.org

Pediatric Emergency Medicine WENDY POMERANTZ, MD(513) 636-7966 wendy.pomerantz@cchmc.org

Practice ManagementDIANE LEMAY, MD, FAAP(740) 348-1981drdlemay@aol.com

Social and Emotional ANDREW GARNER, MD, PhD, FAAP(440) 808-9228 Andrew.garner@uhhs.com

Senior VACANT*

Young Physicians and ResidentsALLISON BRINDLE, MD(216) 444-2733brindla@ccf.org

EMILY DECKER, MD, Vice Chairemilydeckerosu@aol.com

NORAH LEDYARD, DO, Vice ChairNorah.Ledyard@utoledo.edu

Liaisons/Representatives

State CATCH CoordinatorsMARK REDDING, MD(419) 774-9077reddingz@worldnet.att.net

JONNA MCRURY, MD, FAAP jmcrury@aol.com

If you are interested in getting involved inan Ohio AAP committee, please contactthe committee chair.

Ohio AAP Committees

Ohio Pediatrics

Ohio Pediatrics • Summer 2010 23

Walk...from page 21

campaign has helped bring attentionto childhood obesity.

Dr. Anderson-Willis gets excitedwhen she receives healthy updatesfrom Columbus City Schools aboutchanges in vending machines, schoolmeals, and active transportation toschool in lieu of busing. “I havefound my way into the Leave NoChild INSIDE Central Ohio Collab-orative where I have the opportunityto lean on others who are paving theway to better health for childrenthrough contact with nature,” shesaid. With the increased media focuson wellness, kids and families nowunderstand when she brings up nutri-tion and exercise during their check-ups. “The community is collaborat-ing. Organizations that once viewedthemselves as competitors are nowworking together against the obesitytidal wave,” she said.

Physicians can combat the coun-try’s obesity epidemic by organizinga Walk with a Doc program out theirown practice or hospital, or by mak-ing it a community-wide collabora-tive. Visit the walkwithadoc.org web-site for more information..

Dr. Anderson-Willis can be reachedat wendy.anderson@ nationwidechil-drens.org.

– Wendy Anderson-Willis, MD

Nationwide Children’s

Hospital

The Ohio AAP announces the following meetings and events.

Aug. 31 – Ohio AAP Foundation Golf OutingRattlesnake Ridge Golf Club, Sunbury, OH

Aug.-Oct. – Ounce of Prevention Trainings &Webinars See Page 8 for dates and locations

Sept. 10 – Breakfast for BooksOhio Union, The Ohio State University Campus

Sept. 29 – Reach Out and Read Ohio Annual MeetingState Library of Ohio, Columbus

Nov. 5-6 – 2010 Ohio AAP Annual MeetingColumbus

Calendar of Events

Dues remitted to the OhioChapter are not deductible asa charitable contribution, butmay be deducted as an ordi-nary and necessary businessexpense. However, $40 ofthe dues is not deductible asa business expense becauseof the chapter’s lobbyingactivity. Please consult yourtax adviser for specific infor-mation.

This statement is in refer-ence to fellows, associatefellows and subspecialty fel-lows.

No portion of the candidatefellows nor post residencyfellows dues is used for lob-bying activity.

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd. Suite 215Worthington, OH 43085

PRESORTED

STANDARD

Permit No. 156

U.S. Postage

PAID

DUBLIN, OH

Dues disclosure

statement