John D. Mark

All Publications

• Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents CHILDREN-BASEL McClafferty, H., Brooks, A. J., Chen, M., Brenner, M., Brown, M., Esparham, A., Gerstbacher, D., Golianu, B., Mark, J., Weydert, J., Yeh, A., Maizes, V. 2018; 5 (4)

  Abstract

  It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

  View details for PubMedID 29690631

• Pediatric Integrative Medicine in Academia: Stanford Children's Experience. Children (Basel, Switzerland) Ramesh, G. n., Gerstbacher, D. n., Arruda, J. n., Golianu, B. n., Mark, J. n., Yeh, A. M. 2018; 5 (12)

  Abstract

  Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient's overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success.

  View details for PubMedID 30545081

• Complementary and alternative medicine in pulmonology CURRENT OPINION IN PEDIATRICS Mark, J. D., Chung, Y. 2015; 27 (3): 334-340

  Abstract

  To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children.The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders.This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.

  View details for DOI 10.1097/MOP.0000000000000217

  View details for Web of Science ID 000354214800012

  View details for PubMedID 25888149

• Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum. Children (Basel, Switzerland) McClafferty, H., Dodds, S., Brooks, A. J., Brenner, M. G., Brown, M. L., Frazer, P., Mark, J. D., Weydert, J. A., Wilcox, G. M., Lebensohn, P., Maizes, V. 2015; 2 (1): 98-107

  Abstract

  Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents' self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1-8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

  View details for DOI 10.3390/children2010098

  View details for PubMedID 27417353

  View details for PubMedCentralID PMC4928751

• Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum Children McClafferty, H., Dodds, H., Mark, J., et al 2015; 2: 98-107

  View details for DOI 10.3390/children2010098

• Pediatric plastic bronchitis: case report and retrospective comparative analysis of epidemiology and pathology. Case reports in pulmonology Kunder, R., Kunder, C., Sun, H. Y., Berry, G., Messner, A., Frankovich, J., Roth, S., Mark, J. 2013; 2013: 649365-?

  Abstract

  Plastic bronchitis (PB) is a pathologic condition in which airway casts develop in the tracheobronchial tree causing airway obstruction. There is no standard treatment strategy for this uncommon condition. We report an index patient treated using an emerging multimodal strategy of directly instilled and inhaled tissue plasminogen activator (t-PA) as well as 13 other cases of PB at our institution between 2000 and 2012. The majority of cases (n = 8) occurred in patients with congenital heart disease. Clinical presentations, treatments used, histopathology of the casts, and patient outcomes are reviewed. Further discussion is focused on the epidemiology of plastic bronchitis and a systematic approach to the histologic classification of casts. Comorbid conditions identified in this study included congenital heart disease (8), pneumonia (3), and asthma (2). Our institutional prevalence rate was 6.8 per 100,000 patients, and our case fatality rate was 7%.

  View details for DOI 10.1155/2013/649365

  View details for PubMedID 23662235

• Integrating the home management plan of care for children with asthma into an electronic medical record. Joint Commission journal on quality and patient safety / Joint Commission Resources Patel, S. J., Longhurst, C. A., Lin, A., Garrett, L., Gillette-Arroyo, J., Mark, J. D., Wood, M. S., Sharek, P. J. 2012; 38 (8): 359-365

  Abstract

  Asthma exacerbation is one of the most common causes for pediatric hospitalization. One of the three Joint Commission quality measures--which has proven the most challenging--addresses the provision of a home management plan of care (HMPC) for discharge of pediatric inpatients with a primary diagnosis of asthma. A user-friendly electronic medical record (EMR)-generated HMPC was developed and implemented at Lucile Packard Children's Hospital (LPCH) Palo Alto, California, an HPMC needed to be completed before entry of an inpatient discharge order.A cohort study using historical controls was conducted in 2010-2011. Patients were eligible to receive an HMPC if they were between the ages of 2 and 17 years old at discharge, had a length of stay < 120 days, were not enrolled in clinical trials, and had the primary discharge diagnosis of asthma. These patients were identified by the EMR if this diagnosis was listed in the diagnosis list or problem list or if the asthma admit/discharge order set was initiated.Compliance with the HMPC increased from 65.3% for the 39 months (April 1, 2007-June 30, 2010) before integration of the HMPC into EMR to 93.7% for the 18 months after integration (July 1, 2010, through December 31, 2011); p < .0001. Users of the EMR-integrated HMPC found it to be significantly easier to complete, less time-consuming, and less prone to potential errors or omission.Lessons learned at LPCH included the need for a continuous surveillance and improvement model, which resulted in several iterations of the HMPC; the importance of soliciting user input, which resulted in improvements in work flow; and consistent support from the quality management and information technology departments, which are crucial to eliminating barriers and facilitating improvement.

  View details for PubMedID 22946253

• Pediatric Asthma: An Integrative Approach to Care NUTRITION IN CLINICAL PRACTICE Mark, J. D. 2009; 24 (5): 578-588

  Abstract

  Asthma in children and young adults is a complex disease with many different phenotypic expressions. Diagnosis is often made based on history and lung function including measuring airway reversibility. However, in children younger than 6 years of age, the diagnosis is more difficult because many children wheeze in the first 4-6 years of life, especially with viral infections. For those children, asthma treatment is often started empirically. Those who go on to develop chronic asthma most likely have a genetic predisposition and exposure to various environmental factors resulting in chronic inflammation of the lower respiratory tract. There are established national guidelines for diagnosing and treating asthma in children and adults. For persistent asthma, it is recommended that medications be taken on a regular basis after identifying and avoiding environmental triggers. Because many factors play a role in developing asthma in children, many nonmedical approaches to asthma and asthma-like conditions have been promoted even when the diagnosis is at times uncertain. The nonmedical approaches and therapies are often referred to as complementary and alternative medicine (CAM). This review will discuss the conventional therapies recommended for children with asthma in addition to CAM therapies, some of which have supporting scientific evidence. Integrating conventional and CAM therapies can prove to be an effective way to treat pediatric asthma, a common and chronic childhood lung disorder. A case is provided to illustrate how such an integrative approach was used in the successful treatment of a child with moderate persistent asthma.

  View details for DOI 10.1177/0884533609342446

  View details for Web of Science ID 000270636400006

  View details for PubMedID 19841246

• Integrative medicine and asthma PEDIATRIC CLINICS OF NORTH AMERICA Mark, J. D. 2007; 54 (6): 1007-?

  Abstract

  Childhood asthma is a spectrum of symptoms and clinical presentations. The treatment begins with developing goals of therapy for a child by the health care provider, the family, and the child as a team. The primary objective is to reduce symptoms and exacerbations using therapies that include conventional medications, environmental controls, and lifestyle modification while reducing the potential for adverse effects of medications and the disease. Complementary and alternative medicine (CAM) may play a role in meeting these objectives, and through the integration of conventional and CAM therapies, an integrative medicine approach may facilitate reaching these objectives in a more effective manner.

  View details for DOI 10.1016/j.pcl.2007.09.005

  View details for PubMedID 18061788

• Integrating complementary and alternative medicine with allopathic care in the neonatal intensive care unit ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE Mark, J. D., Barton, L. L. 2001; 7 (4): 136-?

  View details for Web of Science ID 000172536500024

  View details for PubMedID 11452557

• The use of dietary supplements in pediatrics: A study of echinacea CLINICAL PEDIATRICS Mark, J. D., Grant, K. L., Barton, L. L. 2001; 40 (5): 265-269

  Abstract

  Alternative medical therapies are commonly used and have increased in popularity. Although patients may not always disclose the use of alternative therapies, they may seek advice regarding their use, especially for children. Regulation and standardization of these modalities, especially botanicals, is incomplete. The University of Arizona has initiated a study of the use of echinacea in the prevention of recurrent otitis media. A review of echinacea preparations was undertaken, and this report discusses the complexities surrounding the use of this dietary supplement. The number and diversity of echinacea preparations are detailed; the role of the physician as "botanical" advisor to patients and families is examined.

  View details for Web of Science ID 000168809600005

  View details for PubMedID 11388676

• POLYMICROBIAL BACTERIAL SEPSIS AND DEFECTIVE NEUTROPHIL CHEMOTAXIS IN AN INFANT WITH CYSTIC-FIBROSIS PEDIATRICS Kurland, G., Mark, J. D., HALSTED, C. C., Miller, M. E. 1986; 78 (6): 1097-1101

  Abstract

  A 4 1/2-month-old, white girl was admitted to the hospital with respiratory distress and persistent polymicrobial bacteremia. Cystic fibrosis associated with malnutrition and a transient defect in peripheral neutrophil chemotaxis was diagnosed. This remarkable combination of presenting features in a patient with cystic fibrosis is the focus of this case report.

  View details for Web of Science ID A1986F094500018

  View details for PubMedID 3786035

• AIRWAY HYPERREACTIVITY AND A HISTORY OF CLINICAL MANIFESTATIONS OF ASTHMA IN CHILDHOOD PEDIATRIC PULMONOLOGY Mark, J. D., McBride, J. T., Brooks, J. G., McConnochie, K. M., Hall, W. J. 1986; 2 (3): 170-174

  Abstract

  The relationship between airway hyperreactivity and a history of the clinical manifestations of asthma was investigated in 54 children between the ages of 8 and 12. Airway reactivity was assessed by measuring the change in pulmonary function following the hyperventilation of subfreezing air. Clinical manifestations of asthma were assessed by a standardized questionnaire regarding lower respiratory symptoms and by medical records review. The subjects were participating in a study of the sequelae of bronchiolitis; 25 had seen a physician for mild bronchiolitis during the first 2 years of life, and the remainder had not. Airway hyperreactivity was demonstrated in 8 of the 54 children and correlated with use of medication for asthma in the 2 years before pulmonary testing and positive parental response to the question, "Does your child wheeze apart from colds?" Airway hyperreactivity did not correlate with a history of other respiratory symptoms or with a history of physician-diagnosed wheezing or asthma. No questionnaire or chart review item identified over 50% of the children with reactive airways, and most subjects identified by each of the items did not demonstrate hyperreactive airways. These data suggest that airway reactivity is only weakly associated with a history of the clinical manifestations of asthma in childhood, in part because children with clinically inactive asthma do not consistently demonstrate airway hyperreactivity and in part because many children with hyperreactive airways have never had respiratory symptoms.

  View details for Web of Science ID A1986C830600008

  View details for PubMedID 3737278

• NORMAL PULMONARY-FUNCTION MEASUREMENTS AND AIRWAY REACTIVITY IN CHILDHOOD AFTER MILD BRONCHIOLITIS JOURNAL OF PEDIATRICS McConnochie, K. M., Mark, J. D., McBride, J. T., Hall, W. J., Brooks, J. G. 1985; 107 (1): 54-58

  Abstract

  Concern about the long-term sequelae of bronchiolitis has been raised through studies of children hospitalized for bronchiolitis, but the long-term sequelae of mild bronchiolitis have not been studied. We assessed the hypothesis that 25 children with mild bronchiolitis (index subjects) were at greater risk for abnormalities of pulmonary function or airway reactivity to cold air between the ages of 8 and 12 years than were randomly selected, matched controls. There were no consistent differences in pulmonary function or airway reactivity between index and control groups. Airway hyperreactivity was found in five control subjects and three index subjects, and all children with symptomatic asthma were identified by cold air challenge. Our data suggest that children with a history of mild bronchiolitis are not at increased risk between ages 8 and 12 years for airway hyperreactivity or for abnormalities in pulmonary function.

  View details for Web of Science ID A1985ALW1700011

  View details for PubMedID 4009340

• SLEEP-ASSOCIATED AIRWAY PROBLEMS IN CHILDREN PEDIATRIC CLINICS OF NORTH AMERICA Mark, J. D., Brooks, J. G. 1984; 31 (4): 907-918

  Abstract

  Several of the most common and most important sleep-associated airway problems are discussed, including obstructive sleep apnea syndrome, gastroesophageal reflux and nocturnal aspiration, spasmodic croup, nocturnal asthma, and sleep hypoxemia in chronic lung disease, and guidelines are offered for the often difficult diagnosis and for treatment.

  View details for Web of Science ID A1984TF30700012

  View details for PubMedID 6379587