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Pediatric overuse

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https://www.readbyqxmd.com/read/29340791/treatment-of-disabling-headache-with-greater-occipital-nerve-injections-in-a-large-population-of-childhood-and-adolescent-patients-a-service-evaluation
#1
Francesca Puledda, Peter J Goadsby, Prab Prabhakar
BACKGROUND: Pediatric headache disorders can be extremely disabling, with marked reduction in the quality of life of children and their carers. Evidenced-based options for the treatment of primary headache disorders with preventive medication is limited and clinical outcomes are often unsatisfactory. Greater occipital nerve injections represent a rapid and well-tolerated therapeutic option, which is widely used in clinical practice in adults, and has previously shown a good outcome in a pediatric population...
January 16, 2018: Journal of Headache and Pain
https://www.readbyqxmd.com/read/29319496/geographic-variations-in-antibiotic-prescription-for-pediatric-acute-upper-respiratory-tract-infections-in-south-korea
#2
Youn Jung, Hyemin Cho, Eunhee Ji, Eun-Ji Park, Sunmee Jang
OBJECTIVE: This study aimed to investigate the factors affecting the geographic differences in antibiotic prescription rates in pediatric upper respiratory tract infections (URI) patients in South Korea. MATERIALS AND METHODS: We performed a nationwide cross-sectional study using 228 administrative districts of Korea, which are the unit of analysis. Prescription rate of antibiotics, the outcome variable, was measured as the proportion of antibiotic prescription days out of total visit days for the treatment of acute URIs using National Health Insurance Service (NHIS) claims data for 2012...
January 10, 2018: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29273482/a-novel-host-protein-assay-outperforms-routine-parameters-for-distinguishing-between-bacterial-and-viral-lower-respiratory-tract-infections
#3
Michal Stein, Shelly Lipman-Arens, Kfir Oved, Asi Cohen, Ellen Bamberger, Roy Navon, Olga Boico, Tom Friedman, Liat Etshtein, Meital Paz, Tanya M Gottlieb, Or Kriger, Yura Fonar, Ester Pri-Or, Renata Yacobov, Yaniv Dotan, Amit Hochberg, Moti Grupper, Irina Chistyakov, Israel Potasman, Isaac Srugo, Eran Eden, Adi Klein
Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines 3 host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs)...
November 24, 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/29215711/triage-tools-for-detecting-cervical-spine-injury-in-pediatric-trauma-patients
#4
REVIEW
Annelie Slaar, M M Fockens, Junfeng Wang, Mario Maas, David J Wilson, J Carel Goslings, Niels Wl Schep, Rick R van Rijn
BACKGROUND: Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule (CCR). Both tools are proven to be accurate in deciding whether or not diagnostic imaging is needed in adults presenting for blunt trauma screening at the emergency department...
December 7, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29168013/clinical-features-and-treatment-of-pediatric-patients-with-drug-induced-anaphylaxis-a-study-based-on-pharmacovigilance-data
#5
Yan Xing, Hua Zhang, Shusen Sun, Xiang Ma, Roy A Pleasants, Huilin Tang, Hangci Zheng, Suodi Zhai, Tiansheng Wang
We assessed the clinical features and treatment of pediatric patients with drug-induced anaphylaxis in clinical settings. Pediatric drug-induced anaphylaxis cases collected by the Beijing Pharmacovigilance Database from 2004 to 2014 were analyzed. A total of 91 cases were identified. Drug-induced anaphylaxis was primarily caused by antibiotics (53%). Children of 0-5 years were more likely to develop cyanosis symptoms than children of 13-17 years (OR = 5.14, 95%CI [1.74, 15.20], P = 0.002). Children of 13-17 years were more likely to develop hypotension than children of 6-12 years (OR = 11...
November 22, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29153252/antimicrobial-stewardship-in-pediatric-post-acute-care-facilities
#6
Candace L Johnson, Meaghan Jain, Lisa Saiman, Natalie Neu
Providers in pediatric post-acute care facilities were surveyed about knowledge of and resources for antimicrobial stewardship. All agreed that antibiotics were overused in such pediatric facilities, but 60% had not implemented stewardship strategies. Lack of treatment guidelines (47%) was identified as the most common barrier to antimicrobial stewardship.
November 15, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/29117014/what-s-new-in-pediatric-upper-extremity-sports-injuries
#7
Jennifer J Beck, Connor G Richmond, Marc A Tompkins, Ann Heyer, Kevin G Shea, Aristides I Cruz
BACKGROUND: Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to provide a comprehensive appraisal of the most recent literature, highlighting updates on sports-related upper extremity injuries in pediatric patients. METHODS: An electronic search of the PubMed, EMBASE, and Google Scholar databases was performed for keywords related to pediatric overhead athletes, osteochondritis dissecans (OCD) of the capitellum, medial epicondyle fractures, shoulder instability, and clavicle fractures...
November 7, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28992328/what-parents-think-about-the-risks-and-benefits-of-antibiotics-for-their-child-s-acute-respiratory-tract-infection
#8
Julia E Szymczak, Sarah B Klieger, Matthew Miller, Alexander G Fiks, Jeffrey S Gerber
Background: Parental pressure is often cited as a reason for why pediatricians overuse antibiotics for children with acute respiratory tract infection (ARTI). We sought to capture parent perceptions of antibiotics at the time of their child's presentation with an ARTI. Methods: We conducted semistructured interviews with parents of children who presented with ARTI symptoms to 1 of 4 diverse practices in a large hospital-affiliated network of pediatric primary care practices...
September 14, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28974521/update-to-practice-standards-for-electrocardiographic-monitoring-in-hospital-settings-a-scientific-statement-from-the-american-heart-association
#9
REVIEW
Kristin E Sandau, Marjorie Funk, Andrew Auerbach, Gregory W Barsness, Kay Blum, Maria Cvach, Rachel Lampert, Jeanine L May, George M McDaniel, Marco V Perez, Sue Sendelbach, Claire E Sommargren, Paul J Wang
BACKGROUND AND PURPOSE: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records...
November 7, 2017: Circulation
https://www.readbyqxmd.com/read/28894729/procalcitonin-for-diagnostics-and-treatment-decisions-in-pediatric-lower-respiratory-tract-infections
#10
Philipp Baumann, Gurli Baer, Jessica Bonhoeffer, Aline Fuchs, Verena Gotta, Ulrich Heininger, Nicole Ritz, Gabor Szinnai, Jan Bonhoeffer
Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28828471/why-it-is-so-hard-to-talk-about-overuse-in-pediatrics-and-why-it-matters
#11
Shawn L Ralston, Alan R Schroeder
No abstract text is available yet for this article.
October 1, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28763554/does-this-child-have-pneumonia-the-rational-clinical-examination-systematic-review
#12
REVIEW
Sonal N Shah, Richard G Bachur, David L Simel, Mark I Neuman
Importance: Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse. Objective: To systematically review the accuracy of symptoms and physical examination findings in identifying children with radiographic pneumonia. Data Sources and Study Selection: MEDLINE and Embase (1956 to May 2017) were searched, along with reference lists from retrieved articles, to identify diagnostic studies of pediatric pneumonia across a broad age range that had to include children younger than age 5 years (although some studies enrolled children up to age 19 years); 3644 unique articles were identified, of which 23 met inclusion criteria...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28746259/variations-in-antibiotic-and-azithromycin-prescribing-for-children-by-geography-and-specialty-united-states-2013
#13
Katherine E Fleming-Dutra, Alicia Demirjian, Monina Bartoces, Rebecca M Roberts, Thomas H Taylor, Lauri A Hicks
BACKGROUND: Using antibiotics appropriately is critical to slow spread of antibiotic resistance, a major public health problem. Children, especially young children, receive more antibiotics than other age groups. Our objective was to describe antibiotic use in children in the United States (US) and use of azithromycin, which is recommended infrequently for pediatric conditions. METHODS: We used QuintilesIMS Xponent 2013 data to calculate the number and rate of oral antibiotic prescriptions for children by age (0-2, 3-9 and 10-19 years) and agent...
July 19, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28728423/changing-antibiotic-prescribing-in-a-primary-care-network-the-role-of-readiness-to-change-and-group-dynamics-in-success
#14
Suratha Elango, Julia E Szymczak, Ian M Bennett, Rinad S Beidas, Rachel M Werner
Overuse of broad-spectrum antibiotics in outpatient pediatrics remains a significant issue and there is limited evidence on how to effectively implement outpatient stewardship interventions. This study examines the relationship between readiness to change and modifiable factors affecting success of a primary care network antibiotic stewardship intervention. A survey designed to measure readiness to accept a health care innovation was administered to 209 clinicians. Practices were split in half into "high" versus "low" readiness to change...
July 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28628411/sports-and-the-growing-musculoskeletal-system-sports-imaging-series
#15
Jie C Nguyen, Scott E Sheehan, Kirkland W Davis, Kara G Gill
Increased youth participation in sports has resulted in increased injury tolls due to shifts toward participation in competitive sports at earlier ages, increased training intensity and competition schedules, as well as specialization into one sport. The physiology of the growing musculoskeletal system makes the growing athlete particularly vulnerable to specific types of injuries. Radiologists must understand the differences between pediatric and adult athletes to recognize the particular injuries to which these young athletes are prone...
July 2017: Radiology
https://www.readbyqxmd.com/read/28495389/clinical-trainees-responses-to-parents-who-question-evidence-based-recommendations
#16
Sydney E Philpott, Holly O Witteman, Katherine M Jones, David S Sonderman, Anne-Sophie Julien, Mary C Politi
OBJECTIVE: We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS: We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions...
May 2, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28458416/a-study-of-antimicrobial-use-in-children-admitted-to-pediatric-medicine-ward-of-a-tertiary-care-hospital
#17
Sandip Baidya, Avijit Hazra, Supratim Datta, Amal Kanti Das
OBJECTIVES: Antimicrobials are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in Eastern India, to generate a profile of antimicrobial use and suspected adverse drug reactions (ADRs) attributable to them. MATERIALS AND METHODS: Hospitalized children of either sex, aged between 1 month and 12 years, were studied. Baseline demographic and clinical features, duration of hospital stay, antimicrobials received in hospital along with dosing and indications and details of suspected ADRs attributable to their use were recorded...
January 2017: Indian Journal of Pharmacology
https://www.readbyqxmd.com/read/28377653/clinical-and-radiological-evaluation-of-turmeric-powder-as-a-pulpotomy-medicament-in-primary-teeth-an-in-vivo-study
#18
Rajiv N Purohit, Manohar Bhatt, Kanchan Purohit, Jitendra Acharya, Rajesh Kumar, Rakesh Garg
Many plants with biological and antimicrobiological properties have been studied since there has been a relevant increase in the incidence of antibiotic overuse and misuse. In dentistry, phytomedicines have been used as anti-inflammatory, antibiotic, analgesic, and sedative agents. Turmeric is used extensively in foods for its flavor and color, as well as having a long tradition of use in the Chinese and Ayurvedic systems of medicine, particularly as an anti-inflammatory and for the treatment of flatulence, jaundice, menstrual difficulties, hematuria, hemorrhage, and colic...
January 2017: International Journal of Clinical Pediatric Dentistry
https://www.readbyqxmd.com/read/28298481/categorization-of-national-pediatric-quality-measures
#19
Samantha A House, Eric R Coon, Alan R Schroeder, Shawn L Ralston
BACKGROUND AND OBJECTIVE: The number of quality measures has grown dramatically in recent years. This growth has outpaced research characterizing content and impact of these metrics. Our study aimed to identify and classify nationally promoted quality metrics applicable to children, both by type and by content, and to analyze the representation of common pediatric issues among available measures. METHODS: We identified nationally applicable quality measure collections from organizational databases or clearinghouses, federal Web sites, and key informant interviews and then screened each measure for pediatric applicability...
April 2017: Pediatrics
https://www.readbyqxmd.com/read/28287685/care-of-shoulder-pain-in-the-overhead-athlete
#20
REVIEW
Joseph Chorley, Richard E Eccles, Armand Scurfield
Shoulder complaints are common in the overhead athlete. Understanding the biomechanics of throwing and swimming requires understanding the importance of maintaining the glenohumeral relationship of the shoulder. Capsular laxity, humeral retrotorsion, glenoid retroversion, glenohumeral internal rotation deficit, and scapular dyskinesis can all contribute to shoulder dysfunction and pain. Injuries are more likely during peak height velocity, especially when coupled with overuse, previous injuries not adequately treated, or change in the demands on the shoulder such as a new technique, bigger field, or longer race...
March 1, 2017: Pediatric Annals
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