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Evidence based practics pediatrics

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https://www.readbyqxmd.com/read/28323667/central-venous-access-in-children-indications-devices-and-risks
#1
Guillermo Ares, Catherine J Hunter
PURPOSE OF REVIEW: Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation...
March 18, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28315898/modifiable-risk-factors-and-interventions-for-childhood-obesity-prevention-within-the-first-1-000-days
#2
Anne M Dattilo
Worldwide, the prevalence of childhood obesity has increased, amounting to 42 million overweight or obese children, and there is increasing evidence that the origins are within the first 1,000 days: the period of conception through 2 years. Antecedents of early childhood obesity are multifactorial, and associations of varying strength have been documented for genetic/epigenetic, biologic, dietary, environmental, social, and behavioral influences. Modifiable factors in pregnancy and early infancy associated with childhood obesity include maternal overweight/obesity, maternal smoking, gestational weight gain, infant and young child feeding, caregiver responsive feeding practices, as well as sleep duration, and physical activity...
2017: Nestlé Nutrition Institute Workshop Series
https://www.readbyqxmd.com/read/28306741/pre-hospital-midazolam-for-benzodiazepine-treated-seizures-before-and-after-the-rapid-anticonvulsant-medication-prior-to-arrival-trial-a-national-observational-cohort-study
#3
Eytan Shtull-Leber, Robert Silbergleit, William J Meurer
BACKGROUND: Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. METHODS AND FINDINGS: This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28302281/the-art-and-science-of-pediatric-damage-control
#4
Anthony Tran, Brendan T Campbell
Damage control is a surgical strategy that has evolved and expanded considerably over the past 25 years. The approach was initially developed as a "bail out" procedure to control bleeding with severe abdominal injuries in the setting of unmitigated hemorrhagic shock. Damage control is now more broadly applied as a comprehensive management plan for the resuscitation and surgical treatment of injured patients with exhausted physiologic and metabolic reserve. This article reviews the most current concepts in damage control that are important and relevant to the practicing pediatric surgeon...
February 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28301843/specialty-based-variation-in-applying-maternal-fetal-surgery-trial-evidence
#5
Ryan M Antiel, Alan W Flake, Mark P Johnson, Nahla Khalek, Natalie E Rintoul, John D Lantos, Farr A Curlin, Jon C Tilburt, Chris Feudtner
INTRODUCTION: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. MATERIALS AND METHODS: Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. RESULTS: Of 1,176 eligible physicians, 670 (57%) responded...
March 17, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28300761/incorporating-hypnosis-into-pediatric-clinical-encounters
#6
Robert A Pendergrast
Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen...
March 16, 2017: Children
https://www.readbyqxmd.com/read/28290063/behavioral-health-integration-in-large-multi-group-pediatric-practice
#7
REVIEW
Abigail Boden Schlesinger
There is increasing interest in methods to improve access to behavioral health services for children and adolescents. Children's Community Pediatric Behavioral Health Service (CCPBHS) is an integrated behavioral health service whose method of (a) creating a leadership team with empowered administrative and clinical stakeholders who can act on a commitment to change and (b) having a clear mission statement with integrated administrative and clinical care processes can serve as a model for implementing integration efforts within the medical home...
March 2017: Current Psychiatry Reports
https://www.readbyqxmd.com/read/28288601/babies-living-safe-smokefree-randomized-controlled-trial-of-a-multilevel-multimodal-behavioral-intervention-to-reduce-low-income-children-s-tobacco-smoke-exposure
#8
Bradley N Collins, Stephen J Lepore
BACKGROUND: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations...
March 14, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28288079/evidence-based-pediatric-orthopaedics-how-safe-is-safe
#9
G Alexander Augustithis, Hannah Margaret Ensor, James S Huntley
BACKGROUND: The aim of minimizing the risks of complications and adverse events is at the center of surgical practice.This study aimed to assess the evidence on which pediatric orthopaedic surgical procedures are described as "safe." In particular, the objective was to ascertain the proportion of studies describing a procedure as "safe," which achieved a 95% upper limit confidence interval of risk of 5% or less for major adverse events. METHOD: A primary search of Journal of Paediatric Orthopaedics 2009 to 2014 for the single term "safe" returned 71 papers appropriate for analysis...
March 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28277380/update-on-developmental-anesthesia-neurotoxicity
#10
Laszlo Vutskits, Andrew Davidson
PURPOSE OF REVIEW: Adverse long-term impact of general anesthesia on the developing brain is a widely discussed and controversial issue with potential public health relevance. The goal of this article is to give insights into the most recent experimental and clinical observations aimed to advance our understanding in this field. RECENT FINDINGS: Recent investigations demonstrate long-term behavioral consequences of early-life anesthesia exposure in nonhuman primates under experimental conditions that are translationally relevant to human clinical practice...
March 8, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28277214/pediatric-minimum-speech-test-battery
#11
Kristin Uhler, Andrea Warner-Czyz, Rene Gifford, Pmstb Working Group
BACKGROUND: Assessment of patient outcomes and documentation of treatment efficacy serves as an essential component of (re)habilitative audiology; however, no standardized protocol exists for the assessment of speech perception abilities for children with hearing loss. This presents a significant challenge in tracking performance of children who utilize various hearing technologies for within-subjects assessment, between-subjects assessment, and even across different facilities. PURPOSE: The adoption and adherence to a standardized assessment protocol could help facilitate continuity of care, assist in clinical decision making, allow clinicians and researchers to define benchmarks for an aggregate clinical population, and in time, aid with patient counseling regarding expectations and predictions regarding longitudinal outcomes...
March 2017: Journal of the American Academy of Audiology
https://www.readbyqxmd.com/read/28271812/elite-youth-sports-from-best-pediatric-science-practice-to-sports-practice-2016
#12
Craig A Williams
In my 2015 editorial, I selected two research publications with a focus on an applied sports sciences perspective. This year I have chosen to focus on two publications from a methodological viewpoint, highlighting the importance of laboratory procedures and extraction of data through a systematic review respectively. The first publication by Leites and colleagues (J Appl Physiol) addresses questions in relation to thermoregulation and carbohydrate metabolism in young people. This topic is difficult to conduct due to additional ethical and safety concerns due to exercising in the heat...
February 2017: Pediatric Exercise Science
https://www.readbyqxmd.com/read/28270384/a-mobile-clinical-decision-support-tool-for-pediatric-cardiovascular-risk-reduction-clinical-practice-guidelines-development-and-description
#13
Robert D Furberg, Pamela Williams, Jacqueline Bagwell, Kenneth LaBresh
BACKGROUND: Widespread application of research findings to improve patient outcomes remains inadequate, and failure to routinely translate research findings into daily clinical practice is a major barrier for the implementation of any evidence-based guideline. Strategies to increase guideline uptake in primary care pediatric practices and to facilitate adherence to recommendations are required. OBJECTIVE: Our objective was to operationalize the US National Heart, Lung, and Blood Institute's Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents into a mobile clinical decision support (CDS) system for healthcare providers, and to describe the process development and outcomes...
March 7, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28267670/selective-digestive-decontamination-in-critically-ill-children-a-survey-of-canadian-providers
#14
Srinivas Murthy, Nazima Pathan, Brian H Cuthbertson
BACKGROUND: Selective digestive decontamination of the digestive tract involves the routine administration of oral, gastric, and intravenous antibiotics to mechanically ventilated children to prevent hospital-acquired infections. It has a strong evidence base in adults, with limited pediatric evidence. Current utilization of this intervention among pediatric physicians in North America is unknown. METHODS: An electronic survey administered to pediatric critical care and pediatric infectious disease providers in Canada...
February 20, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28265128/how-we-manage-pediatric-deep-venous-thrombosis
#15
REVIEW
Marisol Betensky, Mark A Bittles, Paul Colombani, Neil A Goldenberg
Over the past two decades, the incidence and recognition of venous thromboembolism (VTE) in children has significantly increased, likely as a result of improvements in the medical care of critically ill patients and increased awareness of thrombotic complications among medical providers. Current recommendations for the management of VTE in children are largely based on data from pediatric registries and observational studies, or extrapolated from adult data. The scarcity of high-quality evidence-based recommendations has resulted in marked variations in the management of pediatric VTE among providers...
March 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/28259315/clinical-practice-guidelines-proposed-the-use-of-pit-and-fissure-sealants-to-prevent-and-arrest-noncavitated-carious-lesions
#16
Chris Deery
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry. Wright JT, Crall JJ, Fontana M, Gillette EJ, NovĂ˝ BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Tampi MP, Graham L, Estrich C, Carrasco-Labra A. J Am Dent Assoc. 2016;147(8):672-82. SOURCE OF FUNDING: American Dental Association and the American Academy of Pediatric Dentistry...
March 2017: Journal of Evidence-based Dental Practice
https://www.readbyqxmd.com/read/28257631/clinical-practice-recommendations-for-allergen-specific-immunotherapy-in-children-the-italian-consensus-report
#17
REVIEW
Giovanni Battista Pajno, Roberto Bernardini, Diego Peroni, Stefania Arasi, Alberto Martelli, Massimo Landi, Giovanni Passalacqua, Antonella Muraro, Stefania La Grutta, Alessandro Fiocchi, Luciana Indinnimeo, Carlo Caffarelli, Elisabetta Calamelli, Pasquale Comberiati, Marzia Duse
Allergen-specific immunotherapy (AIT) is currently recognized as a clinically effective treatment for allergic diseases, with a unique disease-modifying effect. AIT was introduced in clinical practice one century ago, and performed in the early years with allergenic extracts of poor quality and definition. After the mechanism of allergic reaction were recognized, the practice of AIT was refined, leading to remarkable improvement in the efficacy and safety profile of the treatment. Currently AIT is accepted and routinely prescribed worldwide for respiratory allergies and hymenoptera venom allergy...
January 23, 2017: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/28242859/counseling-parents-and-teens-about-marijuana-use-in-the-era-of-legalization-of-marijuana
#18
Sheryl A Ryan, Seth D Ammerman
Many states have recently made significant changes to their legislation making recreational and/or medical marijuana use by adults legal. Although these laws, for the most part, have not targeted the adolescent population, they have created an environment in which marijuana increasingly is seen as acceptable, safe, and therapeutic. This clinical report offers guidance to the practicing pediatrician based on existing evidence and expert opinion/consensus of the American Academy of Pediatrics regarding anticipatory guidance and counseling to teenagers and their parents about marijuana and its use...
February 27, 2017: Pediatrics
https://www.readbyqxmd.com/read/28230456/off-label-prescribing-for-children-with-migraines-in-u-s-ambulatory-care-settings
#19
L Leanne Lai, Leroy Koh, Jane Ai-Chen Ho, Alexander Ting, Augustine Obi
BACKGROUND: Migraines, Which Affect About 10% Of School-Age Children In The United States, Can Significantly Impair Quality Of Life. Despite Potential Disability, Many Children Do Not Receive Treatment Or Prophylaxis, Since Medications Specifically Approved For Children Are Significantly Less Than For Adults. There Is Also Controversy Surrounding The Apparent Widespread Practice Of Prescribing Off-Label Medications For Children With Migraines. However, Little Research Has Been Done To Identify Physician-Prescribing Patterns Of Migraine Medication For Children...
March 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28209414/barriers-and-facilitators-to-the-implementation-of-evidence-based-practice-by-pediatric-surgeons
#20
Katrina J Sullivan, Carolyn Wayne, Andrea M Patey, Ahmed Nasr
BACKGROUND/PURPOSE: Evidence-based practice (EBP) has been identified as a foundation of mainstream medical practice, yet pediatric surgery has been slow in the acceptance and implementation of EBP. METHODS: Semi-structured interviews of 14 pediatric surgeons were conducted to determine barriers and facilitators to EBP. Resulting data were analyzed using a systematic 3-step approached of coding, generation of specific beliefs, and identification of domains relevant to practice change...
February 8, 2017: Journal of Pediatric Surgery
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