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Goal directed therapy in children

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https://www.readbyqxmd.com/read/28726532/local-to-global-working-together-to-meet-the-needs-of-vulnerable-communities
#1
Anne Dressel, Lucy Mkandawire-Valhmu, Ann Dietrich, Ellen Chirwa, Florence Mgawadere, Sylvia Kambalametore, Peninnah Kako
Since 2012, the University of Wisconsin-Milwaukee (UWM) faculty from nursing and physical therapy (PT) have been working together towards a common goal: to meet the healthcare needs of vulnerable populations in Malawi and Milwaukee. Sharing valuable knowledge and understanding one another's professions have allowed us to develop interprofessional education (IPE) learning experiences for students to help identify how quality of life could be improved or enhanced for children and their families across two different geographic spaces, one in rural Malawi and the other in urban Milwaukee...
July 20, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28562301/pain-assessment-and-treatment-in-children-with-significant-impairment-of-the-central-nervous-system
#2
Julie Hauer, Amy J Houtrow
Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention...
May 22, 2017: Pediatrics
https://www.readbyqxmd.com/read/28552449/safety-and-efficacy-of-warfarin-therapy-in-kawasaki-disease
#3
Annette L Baker, Christina Vanderpluym, Kimberly A Gauvreau, David R Fulton, Sarah D de Ferranti, Kevin G Friedman, Jenna M Murray, Loren D Brown, Christopher S Almond, Margaret Evans-Langhorst, Jane W Newburger
OBJECTIVE: To describe the safety and efficacy of warfarin for patients with Kawasaki disease and giant coronary artery aneurysms (CAAs, ≥8 mm). Giant aneurysms are managed with combined anticoagulation and antiplatelet therapies, heightening risk of bleeding complications. STUDY DESIGN: We reviewed the time in therapeutic range; percentage of international normalization ratios (INRs) in range (%); bleeding events, clotting events; INRs ≥6; INRs ≥5 and <6; and INRs <1...
May 25, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28434913/development-of-school-based-asthma-management-programs-in-rochester-new-york-presented-in-honor-of-dr-robert-haggerty
#4
REVIEW
Jill S Halterman, Reynaldo Tajon, Paul Tremblay, Maria Fagnano, Arlene Butz, Tamara T Perry, Kenneth M McConnochie
In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned: 1) the importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) the need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) the need to expand beyond the local community and take a broad perspective on improving health on a national level...
April 18, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28383324/cerebral-autoregulation-oriented-therapy-at-the-bedside-a-comprehensive-review
#5
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Romergryko G Geocadin, Ryan J Healy, Wendy Ziai, Marek A Mirski
This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes...
June 2017: Anesthesiology
https://www.readbyqxmd.com/read/28339410/unimanual-versus-bimanual-therapy-in-children-with-unilateral-cerebral-palsy-same-same-but-different
#6
Brian Hoare, Susan Greaves
BACKGROUND: There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS: Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy...
2017: Journal of Pediatric Rehabilitation Medicine
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#7
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
June 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28303625/eradication-rate-of-helicobacter-pylori-infection-is-directly-influenced-by-adherence-to-therapy-in-children
#8
Kallirroi Kotilea, Joyce Mekhael, Assaad Salame, Tania Mahler, Veronique Yvette Miendje-Deyi, Samy Cadranel, Patrick Bontems
BACKGROUND: Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended...
March 17, 2017: Helicobacter
https://www.readbyqxmd.com/read/28251511/herpes-simplex-encephalitis-an-update
#9
REVIEW
John W Gnann, Richard J Whitley
PURPOSE OF REVIEW: The goal of this review is to provide an update on current thinking regarding herpes simplex encephalitis (HSE), emphasizing new information about pathogenesis, diagnosis, and immune responses. Specific questions to be addressed are the following: (1) Is there a genetic predisposition to HSE? (2) What clinical approaches have the greatest impact on improving the long-term outcomes in patients with HSE? And (3) are there immune-mediated mechanisms that may account for relapsing HSE? RECENT FINDINGS: Toll-like receptor 3 (TLR 3) plays an important role in innate immune responses, including generation of interferons...
March 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28166485/neuroimaging-and-occupational-therapy-bridging-the-gap-to-advance-rehabilitation-in-developmental-coordination-disorder
#10
Meisan Brown-Lum, Jill G Zwicker
Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by poor motor skills that interfere with a child's ability to perform everyday activities. Little is known about the neural mechanisms that implicate DCD, making it difficult to understand why children with DCD struggle to learn motor skills and selecting the best intervention to optimize function. Neuroimaging studies that utilize magnetic resonance imaging techniques have the capacity to play a critical role in helping to guide clinicians to optimize functional outcomes of children with DCD using evidence-based rehabilitation interventions...
January 2017: Journal of Motor Behavior
https://www.readbyqxmd.com/read/27927938/transcranial-direct-current-stimulation-for-children-with-perinatal-stroke-and-hemiparesis
#11
RANDOMIZED CONTROLLED TRIAL
Adam Kirton, Patrick Ciechanski, Ephrem Zewdie, John Andersen, Alberto Nettel-Aguirre, Helen Carlson, Lisa Carsolio, Mia Herrero, Jillian Quigley, Aleksandra Mineyko, Jacquie Hodge, Michael Hill
OBJECTIVE: To determine whether the addition of transcranial direct current stimulation (tDCS) to intensive therapy increases motor function in children with perinatal stroke and hemiparetic cerebral palsy. METHODS: This was a randomized, controlled, double-blind clinical trial. Participants were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age of 6 to 18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2-week after-school motor learning camp (32 hours of therapy)...
January 17, 2017: Neurology
https://www.readbyqxmd.com/read/27864822/caregiver-directed-home-based-intensive-bimanual-training-in-young-children-with-unilateral-spastic-cerebral-palsy-a-randomized-trial
#12
RANDOMIZED CONTROLLED TRIAL
Claudio L Ferre, Marina Brandão, Bhavini Surana, Ashley P Dew, Noelle G Moreau, Andrew M Gordon
AIM: To examine the efficacy of caregiver-directed, home-based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial. METHOD: Twenty-four children (ages 2y 6mo-10y 1mo; 10 males, 14 females) performed home-based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age-matched into groups and randomized to receive home-based hand-arm bimanual intensive therapy (H-HABIT; n=12) or lower-limb functional intensive training (LIFT-control; n=12)...
May 2017: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/27697749/enhance-electronic-hydroxyurea-adherence-a-protocol-to-increase-hydroxyurea-adherence-in-patients-with-sickle-cell-disease
#13
Susan Creary, Deena J Chisolm, Sarah H O'Brien
BACKGROUND: Hydroxyurea (HU) is the only disease-modifying medication for patients with sickle cell disease (SCD). HU can reduce SCD-related complications but only 35% to 50% of pediatric patients adhere to HU at the rates achieved in clinical trials and this limits its clinical effectiveness. Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multidimensional, HU adherence intervention that targets many components of the Health Behavior Model. OBJECTIVE: The aim of this study is to evaluate the impact of Mobile DOT on HU adherence in children with SCD...
October 3, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27676257/pre-exposure-prophylaxis-use-by-breastfeeding-hiv-uninfected-women-a-prospective-short-term-study-of-antiretroviral-excretion-in-breast-milk-and-infant-absorption
#14
Kenneth K Mugwanya, Craig W Hendrix, Nelly R Mugo, Mark Marzinke, Elly T Katabira, Kenneth Ngure, Nulu B Semiyaga, Grace John-Stewart, Timothy R Muwonge, Gabriel Muthuri, Andy Stergachis, Connie L Celum, Jared M Baeten
BACKGROUND: As pre-exposure prophylaxis (PrEP) becomes more widely used in heterosexual populations, an important consideration is its safety in infants who are breastfed by women taking PrEP. We investigated whether tenofovir and emtricitabine are excreted into breast milk and then absorbed by the breastfeeding infant in clinically significant concentrations when used as PrEP by lactating women. METHODS AND FINDINGS: We conducted a prospective short-term, open-label study of daily oral emtricitabine-tenofovir disoproxil fumarate PrEP among 50 HIV-uninfected breastfeeding African mother-infant pairs between 1-24 wk postpartum (ClinicalTrials...
September 2016: PLoS Medicine
https://www.readbyqxmd.com/read/27639440/easily-administered-patient-reported-outcome-measures-adolescents-perceived-functional-changes-after-completing-an-intensive-chronic-pain-rehabilitation-program
#15
Heidi Kempert, Ethan Benore, Rachel Heines
OBJECTIVE: To determine whether patient-reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting by examining 2 patient-reported measures administered as part of physical and occupational therapy for chronic pain. DESIGN: A retrospective data analysis of children and adolescents with chronic pain treated over a single calendar year. Paired t tests evaluated change in perceived function measures and pain over time...
January 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/27526330/the-changing-paradigm-of-atopic-dermatitis-therapy
#16
Sheila F Friedlander, Eric L Simpson, Alan D Irvine, Lawrence F Eichenfield
The pathophysiology of atopic dermatitis (AD) is complex, and future treatment options will likely be incorporated in a multimodal approach to management. The new, directed therapies that have been developed will likely be used in conjunction with concomitant continuous or intermittent use of standard therapies; the goal is to optimize therapeutic outcomes while minimizing adverse impacts on safety and cost. Current data regarding disease course and expression throughout life suggest that treatment strategies also will need to be adjusted as a patient grows...
2016: Seminars in Cutaneous Medicine and Surgery
https://www.readbyqxmd.com/read/27500722/treatment-of-pediatric-septic-shock-with-the-surviving-sepsis-campaign-guidelines-and-picu-patient-outcomes
#17
Jennifer K Workman, Stefanie G Ames, Ron W Reeder, E Kent Korgenski, Susan M Masotti, Susan L Bratton, Gitte Y Larsen
OBJECTIVES: The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly. DESIGN: Single center retrospective cohort study. SETTING: Emergency department and PICU at an academic children's hospital...
October 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27389606/distilling-common-history-and-practice-elements-to-inform-dissemination-hanf-model-bpt-programs-as-an-example
#18
REVIEW
Laura A Kaehler, Mary Jacobs, Deborah J Jones
There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically supported interventions in general and the core components of specific approaches in particular. The evidence base for behavioral parent training (BPT) and the standard of care for early-onset disruptive behavior disorders (oppositional defiant disorder and conduct disorder), which frequently co-occur with attention deficit hyperactivity disorder, are well established, yet an ahistorical, program-specific lens tells little regarding how leaders, University of Oregon Medical School, shaped the common practice elements of contemporary evidence-based BPT...
September 2016: Clinical Child and Family Psychology Review
https://www.readbyqxmd.com/read/27254420/the-longitudinal-effect-of-emotion-regulation-strategies-on-anxiety-levels-in-children-and-adolescents
#19
Rebecca L Schneider, Joanna J Arch, Lauren N Landy, Benjamin L Hankin
There is growing evidence linking emotion dysregulation to anxiety. However, few studies have examined this relationship longitudinally or developmentally. Additionally, no studies have specifically examined the predictive relevance of the emotion regulation skills taught in mindfulness- and acceptance-based therapies. We explore whether specific emotion regulation processes differentially predict specific anxiety symptoms over time among children and adolescents. METHODS: Initial emotion non-awareness, nonacceptance, and difficulties with goal-directed behavior were assessed in a community sample (n = 312, age range = 8-16, mean age = 11...
June 2, 2016: Journal of Clinical Child and Adolescent Psychology
https://www.readbyqxmd.com/read/27247378/t2candida-provides-rapid-and-accurate-species-identification-in-pediatric-cases-of-candidemia
#20
Camille L Hamula, Kenneth Hughes, Brian T Fisher, Theoklis E Zaoutis, Ila R Singh, Aristea Velegraki
OBJECTIVES: The goal of this study is to assess the ability of the T2Candida platform (T2 Biosystems, Lexington, MA) to accurately identify Candida species from pediatric blood specimens with low volumes. METHODS: Whole blood from 15 children with candidemia was collected immediately following blood culture draw. The amount of blood required by the system was reduced by pipetting whole blood directly onto the T2Candida cartridge. Specimens were subsequently run on the T2Dx Instrument (T2 Biosystems)...
June 2016: American Journal of Clinical Pathology
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