Pediatric Annals

A Pediatrician's View

Milton I Levine, MD

Abstract

More and more in specialty circles today one hears the term "recertification." This would imply that those physicians who claim specialty status would be re-examined from time to time to assure that they had maintained a high level of knowledge in their particular field.

The origin of these rumors is not the American Academy of Pediatrics or any other medical organization but official sources in Washington, D. C., where a great deal of attention is being focused today on medical care.

The idea of continuing medical education is not new, and such organizations as the American Academy of Pediatrics not only devote a large portion of their conventions to seminars and roundtables but also sponsor seminars throughout the country on various subjects of general pediatrie interest. Magazines are published containing the latest scientific advances and reports of interesting cases. Textbooks are revised every few years, and texts on the various subspecialties appear from time to time. In other words, the opportunity for continuing education exists- but one cannot force a physician to take advantage of it.

At the recent annual convention of the American Academy of Pediatrics in San Francisco, it was generally agreed that recertification examinations would probably be mandatory within a few years whether the practicing pediafrician approves or not. The question naturally followed as to how these pediatricians could best keep informed of current advances in pediatrics as well as review general information that may have become somewhat hazy.

One important suggestion made was that pediatricians regularly read a magazine dedicated to continuing pediatrie education, and one working on this problem mentioned that, in his opinion, PEDIATRIC ANNALS best fitted the type of magazine that could fulfill this function.

We have written in previous editorials that from the very outset our primary aim has been to present to the practicing pediatrician not only material that will keep him up to date but also articles containing information necessary for maintaining a high level of pediatrie care.

We are happy about the reception and approval of this magazine by the pediatrie world - and if we can continue to aid substantially in the postgraduate education of pediatricians throughout the country, our efforts will have been fully rewarded.

This is the third and final issue of PEDIATRIC ANNALS devoted to cancer in infancy and childhood. The first and second were published in May and June of 1974. In the June issue we noted that there were important subjects yet to be covered. These are presented in this current issue.

Once again Dr. Carl Pochedly is the Guest Editor, and once again he has brought together a group of distinguished contributors.

All pediatricians realize the comparative rarity of cancer during childhood; but, as Dr. Pochedly emphasizes in his introduction, the urgency of immediately diagnosing the disease makes it imperative that pediatricians be aware and always on the alert for signs .and symptoms that might give evidence of cancer. Optimal results of treatment are to be gained only if diagnosis is made in the early stages.

The article "Malignant Bone Tumors," by Dr. Norman Jaffe, presents an excellent review of this important subject; although these tumors are comparatively uncommon, mortality is exceedingly high. Dr. Jaffe emphasizes the importance oí a careful and painstaking evaluation and not only presents a differential diagnosis of bone tumors, benign and malignant, but also details the principles of treatment of each of these pathologic types.

"The Histiocytoses" are discussed by Dr. Sanford Leikin. These are among the most difficult tumors to diagnose, in which to differentiate benign and malignant, and for which to select the most effective…

More and more in specialty circles today one hears the term "recertification." This would imply that those physicians who claim specialty status would be re-examined from time to time to assure that they had maintained a high level of knowledge in their particular field.

The origin of these rumors is not the American Academy of Pediatrics or any other medical organization but official sources in Washington, D. C., where a great deal of attention is being focused today on medical care.

The idea of continuing medical education is not new, and such organizations as the American Academy of Pediatrics not only devote a large portion of their conventions to seminars and roundtables but also sponsor seminars throughout the country on various subjects of general pediatrie interest. Magazines are published containing the latest scientific advances and reports of interesting cases. Textbooks are revised every few years, and texts on the various subspecialties appear from time to time. In other words, the opportunity for continuing education exists- but one cannot force a physician to take advantage of it.

At the recent annual convention of the American Academy of Pediatrics in San Francisco, it was generally agreed that recertification examinations would probably be mandatory within a few years whether the practicing pediafrician approves or not. The question naturally followed as to how these pediatricians could best keep informed of current advances in pediatrics as well as review general information that may have become somewhat hazy.

One important suggestion made was that pediatricians regularly read a magazine dedicated to continuing pediatrie education, and one working on this problem mentioned that, in his opinion, PEDIATRIC ANNALS best fitted the type of magazine that could fulfill this function.

We have written in previous editorials that from the very outset our primary aim has been to present to the practicing pediatrician not only material that will keep him up to date but also articles containing information necessary for maintaining a high level of pediatrie care.

We are happy about the reception and approval of this magazine by the pediatrie world - and if we can continue to aid substantially in the postgraduate education of pediatricians throughout the country, our efforts will have been fully rewarded.

This is the third and final issue of PEDIATRIC ANNALS devoted to cancer in infancy and childhood. The first and second were published in May and June of 1974. In the June issue we noted that there were important subjects yet to be covered. These are presented in this current issue.

Once again Dr. Carl Pochedly is the Guest Editor, and once again he has brought together a group of distinguished contributors.

All pediatricians realize the comparative rarity of cancer during childhood; but, as Dr. Pochedly emphasizes in his introduction, the urgency of immediately diagnosing the disease makes it imperative that pediatricians be aware and always on the alert for signs .and symptoms that might give evidence of cancer. Optimal results of treatment are to be gained only if diagnosis is made in the early stages.

The article "Malignant Bone Tumors," by Dr. Norman Jaffe, presents an excellent review of this important subject; although these tumors are comparatively uncommon, mortality is exceedingly high. Dr. Jaffe emphasizes the importance oí a careful and painstaking evaluation and not only presents a differential diagnosis of bone tumors, benign and malignant, but also details the principles of treatment of each of these pathologic types.

"The Histiocytoses" are discussed by Dr. Sanford Leikin. These are among the most difficult tumors to diagnose, in which to differentiate benign and malignant, and for which to select the most effective treatment regimens. Dr. Leikin reports the results of the Children's Cancer Study Group. It is evident here that the age of onset of the disease is the main factor in determining the prognosis, and that the results of treatment regimens differ with the age at which patients are treated. This contribution is a clear, well-organized summary of the present-day knowledge of a complex disease.

"Burkitt's Lymphoma," a malignant disease, was first described in Uganda in 1961. It is found primarily in children of ,tropical countries but is occasionally found in the United States as well. This malignancy is reviewed by Dr. John L. Ziegler of the National Cancer Institute. It is of particular importance, for it is not only the most rapidly growing human neoplasm but also the most responsive to chemotherapy. Dr. Ziegler reports that, of the patients who have small or localized tumors, who have small métastases, or who have had extensive surgical excision, one-third achieve first remissions and do not relapse when treated by chemotherapy and radiation. The prognosis is dependent on the initial response to chemotherapy.

Following this is a most important commentary by Dr. Jerome M. Vaeth warning of the potential permanent damage caused by radiation therapy of tissues in very young children. He stresses the need not only to keep radiation at the lowest therapeutic level but also to eliminate it when chemotherapy is adequate by itself.

The article on "Pediatrie Chemotherapy," by Drs. Teresa J.Vietti and Mark B. Edelstein, presents a clear and beautiful review of a rapidly advancing science of interest to all pediatricians. In this discussion the authors review the most commonly used agents with proved effectiveness as well as certain new and promising drugs. The action, toxicity, and method of administration of these agents are detailed.

The final paper of this symposium"Group Therapy Sessions as Part of Treatment of Children With Cancer," by Dr. Warren A. Hef fron- covers a new and important aspect in the emotional care of children with cancer. Staff members are included as part of the group, and there are group meetings of parents as well. In addition, there are staff meetings of all concerned with the treatment of these children at which the emotional care of the patient is discussed.

10.3928/0090-4481-19750201-03

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