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https://www.readbyqxmd.com/read/28526220/lumbar-puncture-for-all-febrile-infants-29-56-days-old-a-retrospective-cohort-reassessment-study
#1
Richard Scarfone, Ashlee Murray, Payal Gala, Fran Balamuth
OBJECTIVES: To determine the incidence of bacterial meningitis (BM) among all febrile infants 29-56 days old undergoing a lumbar puncture (LP) in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with BM to reassess the need for routine LP in these infants. STUDY DESIGN: Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29-56 days old with fever and who had an LP in the emergency department...
May 16, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28523862/transatlantic-medical-consultation-and-second-opinion-in-pediatric-cardiology-has-benefit-past-patient-care-a-case-study-in-videoconferencing
#2
Lubica Kovacikova, Martin Zahorec, Peter Skrak, Brian D Hanna, R Lee Vogel
BACKGROUND: Telemedicine is a rapidly evolving form of modern information and communication technology used to deliver clinical services and educational activities. OBJECTIVE: The aim of this article is to report and analyze our experience with transatlantic consultation via videoconferencing in pediatric cardiology. METHODS: In February, 2013, videoconferencing project was launched between a medium-volume pediatric cardiac center in Bratislava, Slovakia and subspecialty experts from a high-volume pediatric cardiac program at The Children's Hospital of Philadelphia (CHOP), USA...
May 19, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28472239/association-between-ibuprofen-use-and-severity-of-surgically-managed-posttonsillectomy-hemorrhage
#3
Pamela A Mudd, Princy Thottathil, Terri Giordano, Ralph F Wetmore, Lisa Elden, Abbas F Jawad, Luis Ahumada, Jorge A Gálvez
Importance: Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure. Objective: To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity. Design, Setting, and Participants: This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia...
May 4, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28468790/genome-wide-association-studies-and-meta-analyses-for-congenital-heart-defects
#4
A J Agopian, Elizabeth Goldmuntz, Hakon Hakonarson, Anshuman Sewda, Deanne Taylor, Laura E Mitchell
BACKGROUND: Maternal and inherited (ie, case) genetic factors likely contribute to the pathogenesis of congenital heart defects, but it is unclear whether individual common variants confer a large risk. METHODS AND RESULTS: To evaluate the relationship between individual common maternal/inherited genotypes and risk for heart defects, we conducted genome-wide association studies in 5 cohorts. Three cohorts were recruited at the Children's Hospital of Philadelphia: 670 conotruncal heart defect (CTD) case-parent trios, 317 left ventricular obstructive tract defect (LVOTD) case-parent trios, and 406 CTD cases (n=406) and 2976 pediatric controls...
June 2017: Circulation. Cardiovascular Genetics
https://www.readbyqxmd.com/read/28456065/improving-hiv-post-exposure-prophylaxis-rates-after-pediatric-acute-sexual-assault
#5
Samantha Schilling, Stephanie A Deutsch, Rebecca Gieseker, Jennifer Molnar, Jane M Lavelle, Philip V Scribano
The purpose of our study was to increase the rate of children with appropriate HIV-PEP regimens among those diagnosed with sexual assault in The Children's Hospital of Philadelphia Emergency Department (ED). The outcome measure was the percent of patients receiving correct HIV-PEP. We retrospectively reviewed 97 charts over 31 months to define the baseline rate of children receiving appropriate HIV-PEP regimens (pre QI-implementation period: 2/2012-8/2014). Among children in which HIV-PEP was indicated following sexual assault, 40% received the recommended 28-day course...
April 26, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28451918/risk-factors-for-poor-bone-health-in-primary-mitochondrial-disease
#6
Shifa S Gandhi, Colleen Muraresku, Elizabeth M McCormick, Marni J Falk, Shana E McCormack
INTRODUCTION: Primary mitochondrial disease is caused by either mitochondrial or nuclear DNA mutations that impact the function of the mitochondrial respiratory chain. Individuals with mitochondrial disorders have comorbid conditions that may increase their risk for poor bone health. The objective of this retrospective electronic medical record (EMR) review was to examine risk factors for poor bone health in children and adults with primary mitochondrial disease. METHODS: Eighty individuals with confirmed clinical and genetic diagnoses of primary mitochondrial disease at the Children's Hospital of Philadelphia (CHOP) were included in this study...
April 27, 2017: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/28394779/evaluating-new-skill-sets-for-performance-improvement-human-factors-as-a-case-study
#7
T Eugene Day, Sarah Henrickson Parker, Virginia Lederman, Debbie McKetta, Anna Spraycar
New skill sets and improvement disciplines are constantly arising across the vast industrial and academic landscape of modern economies. Prescient hospital administrators are routinely searching for new and innovative ways to improve care, care delivery, safety, quality, and access. But, it can be challenging to identify those emerging skill sets, which will likely have lasting effect and will provide strong return on investment, from passing fads with little capacity to move performance benchmarks for a hospital...
April 2017: Health Care Manager
https://www.readbyqxmd.com/read/28390597/association-of-airway-abnormalities-with-22q11-2-deletion-syndrome
#8
Rosalba Sacca, Karen B Zur, T Blaine Crowley, Elaine H Zackai, Kathleen D Valverde, Donna M McDonald-McGinn
INTRODUCTION: 22q11.2 deletion syndrome (22q11.2DS) presents with complex but variable symptoms, including cardiac, immune, palatal, endocrine, cognitive, and psychiatric issues. However, an association of 22q11.2DS with structural airway abnormalities has not been formally described. The aim of this study was to document the frequency of this association. METHODS: We retrospectively reviewed medical records of patients with 22q11.2DS evaluated in the 22q and You Center at the Children's Hospital of Philadelphia between 1999 and 2015 referred to otolaryngology for an airway assessment...
May 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28374599/longitudinal-study-of-driver-licensing-rates-among-adolescents-and-young-adults-with-autism-spectrum-disorder
#9
Allison E Curry, Benjamin E Yerys, Patty Huang, Kristi B Metzger
Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner's permit and driver's license, as well as the rate at which they progress through the licensing system, we conducted a retrospective cohort study of 52,172 New Jersey residents born in the years 1987-1995 who were patients of the Children's Hospital of Philadelphia healthcare network ⩾12 years of age; 609 (1...
April 1, 2017: Autism: the International Journal of Research and Practice
https://www.readbyqxmd.com/read/28347975/automated-adherence-reminders-for-high-risk-children-with-asthma-a-research-protocol
#10
Sarah A Adams, Michelle Chan Leach, Chris Feudtner, Victoria A Miller, Chén Collin Kenyon
BACKGROUND: The use of inhaled corticosteroid (ICS) medications has been shown to improve asthma control and reduce asthma-related morbidity and mortality. Two recent randomized trials demonstrated dramatic improvements in ICS adherence by monitoring adherence with electronic sensors and providing automated reminders to participants to take their ICS medications. Given their lower levels of adherence and higher levels of asthma-related emergency department (ED) visits, hospitalizations, and death, urban minority populations could potentially benefit greatly from these types of interventions...
March 27, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28314702/short-term-outcomes-of-the-multi-institutional-bladder-exstrophy-consortium-successes-and-complications-in-the-first-two-years-of-collaboration
#11
J G Borer, E Vasquez, D A Canning, J V Kryger, A Bellows, D Weiss, T Groth, A Shukla, M P Kurtz, M E Mitchell
INTRODUCTION/BACKGROUND: Bladder exstrophy is a rare diagnosis that presents major reconstructive challenges. To increase experience and proficiency in the care of bladder exstrophy (BE), the Multi-Institutional BE Consortium (MIBEC) was formed, with a focus on refining technical aspects of complete primary repair of bladder exstrophy (CPRE) and subsequent care. OBJECTIVE: Outcome measures included successful CPRE (absence of dehiscence), complications, and integrated points of technique and care over the short-term...
February 20, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28241909/reducing-unnecessary-postoperative-complete-blood-count-testing-in-the-pediatric-intensive-care-unit
#12
Maya Dewan, Jorge Galvez, Tracey Polsky, Genna Kreher, Blair Kraus, Luis Ahumada, John Mccloskey, Heather Wolfe
CONTEXT: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine." OBJECTIVE: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months. DESIGN: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior quality-improvement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241164/evaluation-of-optical-coherence-tomography-to-detect-elevated-intracranial-pressure-in-children
#13
Jordan W Swanson, Tomas S Aleman, Wen Xu, Gui-Shuang Ying, Wei Pan, Grant T Liu, Shih-Shan Lang, Gregory G Heuer, Phillip B Storm, Scott P Bartlett, William R Katowitz, Jesse A Taylor
Importance: Detecting elevated intracranial pressure in children with subacute conditions, such as craniosynostosis or tumor, may enable timely intervention and prevent neurocognitive impairment, but conventional techniques are invasive and often equivocal. Elevated intracranial pressure leads to structural changes in the peripapillary retina. Spectral-domain (SD) optical coherence tomography (OCT) can noninvasively quantify retinal layers to a micron-level resolution. Objective: To evaluate whether retinal measurements from OCT can serve as an effective surrogate for invasive intracranial pressure measurement...
April 1, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/28219061/establishing-prenatal-surgery-for-myelomeningocele-in-asia-the-singapore-consensus
#14
Tuangsit Wataganara, Suresh Seshadri, Tak Yeung Leung, Citra Matter, Monawat Ngerncham, Namtip Triyasunant, Padmakar Vidyadhar Mali, Agnhitori Biswas, Katika Nawapun, Nisarat Phithakwatchara, Alan W Flake, Mark P Johnson, Arijit Biswas, Mahesh Choolani
OBJECTIVES: The Management of Myelomeningocele Study (MOMS Trial) has inspired many fetal therapy centers (FTCs) to offer open fetal surgery for myelomeningocele (MMC). This is an initial effort to create a candidate model that can be applicable to many parts of Asia. MATERIAL AND METHODS: A limited selection of specialists from 4 established FTCs in Thailand, Hong Kong, India, and Singapore met for a round table discussion. Experts from Children's Hospital of Philadelphia (CHOP) involved in the Trial moderated the session...
2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28148316/design-and-initial-results-of-a-programme-for-routine-standardised-longitudinal-follow-up-after-congenital-heart-surgery
#15
Sara K Pasquali, Chitra Ravishankar, Jennifer C Romano, Kristin Kane, Suzanne Viers, Andrea Kennedy, Nancy Burnham, Ray Lowery, Karen Uzark, Lauren Retzloff, Jonathon J Rome, Joseph W Rossano, John R Charpie, Thomas L Spray, Michael G Gaies, Richard G Ohye, J William Gaynor
BACKGROUND: With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children's Hospital of Philadelphia (CHOP) and University of Michigan (UM). METHODS: We included children undergoing benchmark operations of the Society of Thoracic Surgeons...
December 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/28140383/pavlik-harness-disease-revisited-does-prolonged-treatment-of-a-dislocated-hip-in-a-harness-adversely-affect-the-%C3%AE-angle
#16
Alex L Gornitzky, Emily K Schaeffer, Charles T Price, Wudbhav N Sankar
BACKGROUND: Current dogma contends that prolonged treatment of a dislocated hip in Pavlik harness beyond 3 weeks will cause "Pavlik harness disease." To our knowledge, however, no previous studies have documented objective morphologic changes to the acetabulum from continued treatment of a persistently dislocated hip. METHODS: We retrospectively reviewed a consecutive series of infants with developmental dysplasia of the hip, below 6 months old, who failed Pavlik treatment from a single, tertiary-care pediatric hospital and a multicenter, international study group...
June 27, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28114639/incidence-of-recurrence-in-posterior-circulation-childhood-arterial-ischemic-stroke
#17
Michael Y Uohara, Lauren A Beslow, Lori Billinghurst, Brianna M Jones, Sudha K Kessler, Daniel J Licht, Rebecca N Ichord
Importance: Childhood arterial ischemic stroke (CAIS) affects approximately 1.6 per 100 000 children per year, while stroke recurs in up to 20% of patients at 5 years. Factors determining the risk of recurrence are incompletely understood. Objective: To investigate the incidence of the recurrence of CAIS in the posterior and anterior circulations to determine if the risk differs between the 2 locations. Design, Setting, and Participants: A retrospective analysis of CAIS was conducted among children enrolled in a single-center prospective consecutive cohort at The Children's Hospital of Philadelphia between January 1, 2006, and January 1, 2015...
March 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28112025/validation-of-the-use-of-electronic-health-records-for-classification-of-adhd-status
#18
Siobhan M Gruschow, Benjamin E Yerys, Thomas J Power, Dennis R Durbin, Allison E Curry
OBJECTIVE: To validate an electronic health record (EHR)-based algorithm to classify ADHD status of pediatric patients. METHOD: As part of an applied study, we identified all primary care patients of The Children's Hospital of Philadelphia [CHOP] health care network who were born 1987-1995 and residents of New Jersey. Patients were classified with ADHD if their EHR indicated an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "314...
October 1, 2016: Journal of Attention Disorders
https://www.readbyqxmd.com/read/28056115/a-tiered-approach-to-retinopathy-of-prematurity-screening-tarp-using-a-weight-gain-predictive-model-and-a-telemedicine-system
#19
Jaclyn Gurwin, Lauren A Tomlinson, Graham E Quinn, Gui-Shuang Ying, Agnieshka Baumritter, Gil Binenbaum
Importance: The Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study telemedicine system of remote fundus image grading and The Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP-ROP) postnatal weight gain predictive model are 2 approaches for improving ROP screening efficiency. Current screening has low specificity for severe ROP. Objective: To describe a tiered approach to ROP screening (TARP) for identifying children who develop severe ROP using telemedicine and a predictive model synergistically...
January 5, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/28045769/diverting-ileostomy-for-the-treatment-of-severe-refractory-pediatric-inflammatory-bowel-disease
#20
Elizabeth C Maxwell, Noor Dawany, Robert N Baldassano, Petar Mamula, Peter Mattei, Lindsey Albenberg, Judith R Kelsen
OBJECTIVES: Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population. METHODS: Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD...
December 30, 2016: Journal of Pediatric Gastroenterology and Nutrition
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