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Goal directed therapy in children

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
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
Heidi Kempert, Ethan Benore, Rachel Heines
OBJECTIVE: To discuss whether patient reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting. Children and adolescents' perception of their abilities is a natural target of rehabilitation therapies. Perceived functioning is often impaired when experiencing chronic pain and is a meaningful goal of rehabilitation therapy. This study examines two patient reported measures administered as part of physical therapy for chronic pain...
September 14, 2016: Archives of Physical Medicine and Rehabilitation
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...
June 2016: Seminars in Cutaneous Medicine and Surgery
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
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
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
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
Sarita Eisenberg, Ling-Yu Guo
This article reviews the existing literature on the diagnostic accuracy of two grammatical accuracy measures for differentiating children with and without language impairment (LI) at preschool and early school age based on language samples. The first measure, the finite verb morphology composite (FVMC), is a narrow grammatical measure that computes children's overall accuracy of four verb tense morphemes. The second measure, percent grammatical utterances (PGU), is a broader grammatical measure that computes children's accuracy in producing grammatical utterances...
May 2016: Seminars in Speech and Language
Adam Kirton, John Andersen, Mia Herrero, Alberto Nettel-Aguirre, Lisa Carsolio, Omar Damji, Jamie Keess, Aleksandra Mineyko, Jacquie Hodge, Michael D Hill
OBJECTIVE: To determine whether the addition of repetitive transcranial magnetic stimulation (rTMS) and/or constraint-induced movement therapy (CIMT) to intensive therapy increases motor function in children with perinatal stroke and hemiparesis. METHODS: A factorial-design, blinded, randomized controlled trial ( assessed rTMS and CIMT effects in hemiparetic children (aged 6-19 years) with MRI-confirmed perinatal stroke. All completed a 2-week, goal-directed, peer-supported motor learning camp randomized to daily rTMS, CIMT, both, or neither...
May 3, 2016: Neurology
Philippa Easterbrook, Cheryl Johnson, Carmen Figueroa, Rachel Baggaley
HIV infection and viral hepatitis due to HBV and HCV infection are major causes of chronic disease worldwide, and share some common routes of transmission, epidemiology, initial barriers faced in treatment access, and in strategies for a global public health response. Testing and diagnosis of HIV, HBV, and HCV infection is the gateway for access to both care and treatment and prevention services, and crucial for an effective HIV and hepatitis epidemic response. In this review article, we first summarize the common goals and guiding principles in a public health approach to HIV and hepatitis testing...
January 2016: AIDS Reviews
Naotaka Usui
This article reviews the current topics in the field of epilepsy surgery. Each type of epilepsy is associated with a different set of questions and goals. In mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS), postoperative seizure outcome is satisfactory. A recent meta-analysis revealed superior seizure outcome after anterior temporal lobectomy compared with selective amygdalohippocampectomy; in terms of cognitive outcome; however, amygdalohippocampectomy may be beneficial. In temporal lobe epilepsy with normal magnetic resonance imaging (MRI), postoperative seizure outcome is not as favorable as it is in MTLE with HS; further improvement of seizure outcome in these cases is necessary...
May 15, 2016: Neurologia Medico-chirurgica
M Patricia George, Vikas Singh, Mark T Gladwin
The goal of this review is to describe evolving epidemiology of noninfectious, nonneoplastic pulmonary complications of HIV infection, including HIV-associated pulmonary arterial hypertension (HIV-PAH) and interstitial lung disease (ILD). The development of antiretroviral therapy has rendered HIV a chronic illness in treated patients, and the landscape of HIV-associated medical conditions continues to evolve. Although there has been a shift away from AIDS-defining infectious diseases and malignancies, HIV-PAH continues to affect survival adversely when compared with HIV-infected patients without PAH...
April 2016: Seminars in Respiratory and Critical Care Medicine
Suresh K Sankhla, Narayan Jayashankar, Ghulam M Khan
OBJECTIVE: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm...
October 2015: Journal of Pediatric Neurosciences
Kai Chen, Yi-Ning Wu, Yupeng Ren, Lin Liu, Deborah Gaebler-Spira, Kelly Tankard, Julia Lee, Weiqun Song, Maobin Wang, Li-Qun Zhang
OBJECTIVE: To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. DESIGN: A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. SETTING: Home versus laboratory within a research hospital. PARTICIPANTS: Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups...
August 2016: Archives of Physical Medicine and Rehabilitation
Caroline Demily, Caroline Rigard, Elodie Peyroux, Gabrielle Chesnoy-Servanin, Aurore Morel, Nicolas Franck
Attentional, visuospatial, and social cognition deficits have a negative impact on children's adaptative and social competences and, as a result, on their ability to achieve a normal functioning and behavior. Until now and despite the frequency of those deficits, there is a lack of children's specific cognitive remediation tools specifically dedicated to attentional and visuospatial areas. The «Cognitus & Moi» program involves a variety of exercises in a paper and/or pencil (n = 30) or a computerized format (n = 29) and a strategy coaching approach...
2016: Frontiers in Psychiatry
O V Trunova, A E Mashkov, M A Khan, V F Prikuls, N N Nazarenko, M V Supova, S N Smirnova, K S Larionov
The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years...
September 2015: Voprosy Kurortologii, Fizioterapii, i Lechebnoĭ Fizicheskoĭ Kultury
Christine Mrakotsky, Rajsavi Anand, Christopher Watson, Catherine Vu, Alana Matos, Shelby Friel, Michael Rivkin, Scott Snapper
BACKGROUND: Structural brain changes in gray matter volume, cortical thickness, and white matter density have been recently found in adults with Crohn's disease (CD), with the potential to affect cognitive and emotional functions. Intestinal and systemic inflammation during active disease as well as anti-inflammatory steroid therapy have been considered as possible underlying mechanisms, however to date there is little data for other disease factors, particularly in pediatric CD. We previously demonstrated decreased white matter density, cortical thickness and subcortical volume in a small sample of children with CD compared to healthy controls with independent effects of inflammation and steroids (Mrakotsky et al...
March 2016: Inflammatory Bowel Diseases
Mary Saliski, Sapna R Kudchadkar
Achieving successful early mobilization for the intubated, critically ill child is dependent on optimizing sedation and analgesia. Finding the fine balance between oversedation and undersedation can be challenging. The ideal is for a child to be lucid and interactive during the daytime and demonstrate normal circadian rhythm for sleep with rest at night. Being alert during the day facilitates active participation in therapy including potential ambulation, while decreasing the risk of delirium during mechanical ventilation...
2015: Journal of Pediatric Intensive Care
Volkan Yumuk, Constantine Tsigos, Martin Fried, Karin Schindler, Luca Busetto, Dragan Micic, Hermann Toplak
Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores...
2015: Obesity Facts
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