Thursday, July 12, 2007
In case you wonder what I do By Anthony Policastro, M.D

I will be starting my developmental and behavioral pediatrics practice at the Nemours Seaford office on July 13th. Up to this point in time, most of the patients that I have seen have had ADHD or learning problems. That has resulted in a three-month wait for appointments. It has also resulted in a waiting list for appointments. Now that I will be seeing more patients, there should be little if any wait to get in to see me. Therefore, I felt it made sense to share what a developmental and behavioral pediatrician does. Childhood development is complex. There are a variety of different theories explaining it. The good news is that most children develop just fine. They do well from a learning standpoint. They do well from a behavioral standpoint. Those individuals with minor issues can easily be taken care of by their primary care physician. There are some children whose problems are more complex. They may benefit from consultation with a specialist. Many of the children I currently see for learning issues have a combination of problems. They may have both ADHD and a learning problem. Deciding how much of the issue belongs to each of these is sometimes complicated. It affects the course of treatment. Similar issues occur with other developmental problems. For example, autism requires a lot of educational intervention. There are medical issues that need to be handled. However, the school plays a big role. Occasional input from a developmentalist may help with that balance. Some children have a combination of motor delays and mental delays. This is often related to premature birth. Again they need a combination of medical therapy, rehabilitation therapy and education. Working out a plan for the combination of those three can benefit from a developmental referral. Some inherited genetic and chromosomal disorders have a combination of problems. These may also include educational issues. They may include rehabilitation issues. They may include medical issues. Consultation with a developmental pediatrician may help work out the plan for the mix of services needed. Many behavioral issues are mild. They just need advice from the primary care physician. Some are a little more complex. A behavior modification plan can be worked out with a behavioral pediatrician to try and get things back on course. Severe behavioral problems will be even beyond the behavioral pediatrician and need counseling. The behavioral pediatrician can provide assistance with making the decision about ongoing counseling.

Public Health issues rabies reminder
Delaware Health and Social Services' (DHSS) Division of Public Health (DPH) reminds the public that rabies continues to be present in Delaware and outdoor activities may put residents in proximity to infected animals. Raccoons, skunks and foxes remain the most frequent carriers of the disease in Delaware, and these animals are active in areas where people live. This also brings these wild animals in close contact with pet dogs and cats, which can also become infected. For that reason, Tom Postell, DPH rabies program manager, advises residents to avoid all contact with unknown animals, including unfamiliar dogs and cats. "If it is not your family's pet, do not touch or approach the animal," Postell said. David Wolfe, MPH, DPH epidemiologist, said rabies affects different animals in different ways. Some animals become aggressive, and others are passive. Pet owners should update their animals' rabies vaccination and not allow pets to wander. Adults should encourage children to refrain from touching unfamiliar animals and immediately tell them if they have been bitten or scratched. Anyone who believes they or a loved one have had contact with a rabid animal should call DPH.

New Facilities at Nemours
For parents, having a sick child can be a nerve-wracking experience. Even when a child gets an earache, fever, or a minor injury that they know isn't life threatening, most parents would like to have them examined by a healthcare professional. Nemours/Alfred I. duPont Hospital for Children has a brand new facility to help treat children with minor illnesses and injuries quickly and efficiently. The newly expanded Urgent Care Center is now located next to the Emergency Department at Alfred I. duPont Hospital for Children. Parents can bring their child into the Emergency Department entrance where a nurse will evaluate symptoms. About 30 percent of children entering the ED will go to Urgent Care Center. Children who do not require intensive treatment will be taken to the new state-of-the-art center with six private treatment rooms staffed by board-certified pediatricians. To help reduce a family's anxiety, the waiting area is attractively designed with soothing colors, comfortable chairs, and a courtyard. This unit benefits families in two ways. Because they do not have to wait behind other more critical patients, it provides quick treatment for minor injuries and illnesses. This allows the main ER to concentrate on patients that require more intensive care that requires longer treatment times. The Urgent Care Center is open from 10 a.m. to midnight, Monday through Friday and 1 p.m. to midnight on weekends and holidays.

Diabetes screenings
Blood Bank of Delmarva will offer blood donors the opportunity to be screened for diabetes beginning in October. It will be the first blood banking organization in the country to launch this type of program. Up to 50,000 blood donors are expected to be screened annually, helping identify many people on the Delmarva Peninsula who do not know they have or are at risk for developing diabetes. Confidential results will be posted on a secure server accessed through the Blood Bank's website. Robert L. Travis, president and CEO of the Blood Bank of Delmarva, conceived the idea for a screening program after hearing a presentation on the diabetes epidemic. Travis formed a committee of experts from Christiana Care Health System, Blue Cross Blue Shield of Delaware, the American Diabetes Association (ADA), and the Delaware Division of Public Health to help advance the project. According to the ADA, more than 75,000 people locally have diabetes. About one-third of them are "hidden diabetics" (more than 6 million nationwide) and are unaware they have the disease. "Once we understood the magnitude of the diabetes problem and how tens of thousands of people could be screened, our board voted to move ahead with this important project," said Travis. The non-fasting blood glucose test will be completely voluntary and will be offered to donors at no charge. Donors with an elevated blood glucose level will be urged to consult their physician. Diabetes is the fifth leading cause of death by disease, with more than 400,000 Americans dying from its complications each year. Those can include problems related to the heart, kidneys, eyes, feet, nerves, teeth, and gums. If detected early, diabetes is treatable.

Food health inspections online
Finding out about a food establishment's latest inspection is as easy as going online. Visitors can view inspection reports for restaurants, fast food operations, delis, cafeterias, and other types of food service establishments at Visitors can view establishments by name, county, or date of inspection. Both minor and major violations of state standards are included. This new service makes it easier for the public to check on eating establishments and allows people to quickly find out whether restaurants are meeting food safety standards. In Delaware, there are over 3,500 permitted food establishments that prepare and serve food to the public. Most of these are inspected twice a year using the State of Delaware Food Code, a science-based regulation similar to the national model from the US Food and Drug Administration. Inspections assure the food is being handled properly from preparation through serving. Inspectors observe kitchen worker's food handling practices, make sure equipment is working properly, take food temperatures, inspect refrigerators and storage areas, and measure water temperatures and sanitizer levels. If a problem is found, the manager is shown the correct procedure. The online report listing shows the date of the most recent food safety inspection and which Food Code "critical" requirements, if any, were out-of-compliance at the time of the inspection. Non-critical violations - which are not displayed, involve important retail practices such as facilities maintenance and general sanitation, but are less likely to contribute to food borne illness. "None" when entered in the Food Code Critical Violations column indicates that there were no critical violations observed during the inspection on the date listed.

EMSC Award Nemours employee
Marie Renzi, MSN, RN, CEN, EMSC, Program Manager for Nemours/Alfred I. duPont Hospital for Children and the Delaware Division of Public Health was one of six individuals who received the 2007 Emergency Medical Services for Children (EMSC) National Heroes Award on June 19 in Washington, D.C. EMSC awards are given to individuals for their commitment, creativity, and resourcefulness in successfully addressing one or more challenging EMSC issues. Renzi was named the recipient of this year's EMSC Project Coordinator of Distinction Award for her comprehensive understanding of Delaware's pediatric emergency medical care issues and for successfully integrated EMSC into state EMS programs. In 1997, Renzi became a "founding member" of the Delaware EMSC program after the state received its first EMSC grant. Under her leadership, Delaware conducted two comprehensive pediatric emergency care needs assessments, then implemented and completed a five-year plan based on the findings. One of Renzi's greatest assets is her ability to bring several organizations together for a common cause. She has initiated and sustained relationships with a number of pediatric-related organizations, including her most recent collaboration with Alfred I. duPont Hospital for Children. With this partnership in place, paramedic students are now guaranteed a significant amount of clinical time in the pediatric emergency department. She has also diligently served on many committees and task forces over the years. She is currently a member of the State Coordinating Council for Children With Disabilities, the Delaware Safe Kids Coalition Board, and the State School Health Services Commission. More recently, she was appointed by Gov. Ruth Ann Minner to serve on the State's Child Death and Stillborn Commission.