To Refer or Not to Refer: Managing Febrile UTI in Children

Program Description:

Given the amount of conflicting evidence that currently exists about how and when to treat febrile UTIs, primary care providers for children can find themselves in a quandary about how to manage these children. This Webinar focuses on providing details to help clarify some of the questions to enable the viewer to provide individualized treatment options for their patients.

Target Audience:

Activity Objectives:

After completing this activity, participants should be better able to:

• List the risks and benefits of watchful waiting


• Decide when to initiate prophylaxis, with which antimicrobials and for how long


• Choose the appropriate screening after a first febrile UTI


• Determine when to refer a patient to a urologist



Credits	Type	Accreditation Statement	Designation Statement
2.50	AMA PRA Category 1 Credit(s)TM	Hemedicus, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.	Hemedicus designates this enduring material for a maximum of 2.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty:

Martin A. Koyle, MD
Professor of Surgery
University of Toronto
Program Director
Hospital for Sick Children
Toronto, Ontario
Canada

Christopher S. Cooper, MD
Professor and Vice Chair
Department of Urology
University of Iowa Hospitals and Clinics
Iowa City, Iowa

Andrew J. Kirsch, MD
Chief, Division of Pediatric Urology
Clinical Professor of Urology
Emory University School of Medicine
Georgia Urology, PA
Children’s Healthcare of Atlanta
Atlanta, Georgia

Donald L. Shifrin, MD
Clinical Professor of Pediatrics
University of Washington School of Medicine
Seattle, Washington

Disclosures:

Accreditor Disclosure Of Conflicts Of Interest Policy:
To resolve identified conflicts of interest, the educational content was fully reviewed by Hemedicus. The resulting certified activity was found to provide educational content that is current, evidence-based and commercially balanced.

Review Committee Disclosure
In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Hemedicus, Inc requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly the staff of Hemedicus, as planners and reviewers, disclose as follows:

Jonathan Wood: No relevant financial relationships with any commercial interest.
Robin Simak: No relevant financial relationships with any commercial interest.
Erilyn Riley: No relevant financial relationships with any commercial interest.

Faculty Disclosures
As an ACCME accredited provider of continuing medical education, Hemedicus requires that faculty participating in a CME activity disclose any relevant financial relationship they may have with a pharmaceutical or medical equipment company, product, or service within the preceding 12 months, including any relationship with the commercial supporter of this activity. The faculty reported the following:

Martin A. Koyle, MD; Fees for non-CME services: Oceana Therapeutics, Inc.

Christopher S. Cooper, MD; No relevant financial relationships with any commercial interest.

Andrew J. Kirsch, MD; Research Support: Oceana Therapeutics, Inc.; Consultant: Oceana Therapeutics, Inc., Fees for non-CME services: Oceana Therapeutics, Inc. Royalty: Cook Urological

Donald L. Shifrin, MD, Consultant: American Academy of Pediatrics

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in this educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. Further, participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Disclaimer
The content and views presented in this educational activity are those of the presenters and do not necessarily reflect those of Hemedicus or the supporter. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

This activity is accredited by Hemedicus, Inc.



If you have any questions relating to the accreditation of this activity, please contact Robin Simak, Managing Director, CME Compliance, Hemedicus, rsimak@hemedicus.com.

This educational activity is made possible by an educational grant from Oceana Therapeutics, Inc.



If you have any questions relating to your certificate or technical issues with this activity, please contact myCME.Support@haymarketmedical.com.

Permissions
Shifrin presentation
Slide: Comparison of caregiver worry about fever by past health care practices
Reproduced with permission from Pediatrics, Vol. 107, Pages 1241-1246, Copyright © 2001 by the AAP.

Slide: Predictive value of laboratory tests in the diagnosis of UTI in young children
Reproduced with permission from Pediatrics, Vol. 104, Page e54, Copyright © 1999 by the AAP.

Slide: Clinical practice guideline for the diagnosis and management of initial UTI in FWS 2-24 mos
Reproduced with permission from Pediatrics, Vol. 128, Pages 595 – 610 (e749-e770), Copyright © 2011 by the AAP.

Slide: Probability of UTI among febrile infant girls and infant boys according to number of findings present
Reproduced with permission from Pediatrics, Vol. 128, Pages 595 – 610 (e749-e770), Copyright © 2011 by the AAP.

Koyle presentation
Slide: Algorithms lack “tailoring” options to an individual patient!
Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011;365:239 © Massachusetts Medical Society

Cooper presentation
Slide: Renal scarring
Reproduced with permission from Pediatrics, Vol. 103, Page e54, Copyright © 1999 by the AAP.

Slide: Preventing UTIs: Incontinence
Reproduced with permission from: Nepple KG, Cooper CS. Management of voiding dysfunction in children. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011. Copyright © 2011 UpToDate, Inc. For more information visit www.uptodate.com.

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Instructions:

In order for you to obtain CME credit and receive your certificate, you must complete both the post-test and evaluation form. Participants who receive a successful online grade of 70% or higher will be issued a certificate online. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

I have read and understand the required CME information.


SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.