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Goal directed therapy in children

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https://www.readbyqxmd.com/read/29101938/practical-considerations-for-the-diagnosis-and-management-of-asthma-in-older-adults
#1
REVIEW
Barbara P Yawn, MeiLan K Han
Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset...
November 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29065156/motor-skill-delays-in-pre-school-children-with-leukemia-one-year-after-treatment-hematopoietic-stem-cell-transplantation-therapy-as-an-important-risk-factor
#2
Livia Taverna, Marta Tremolada, Sabrina Bonichini, Barbara Tosetto, Giuseppe Basso, Chiara Messina, Marta Pillon
CNS-directed therapies for the treatment of leukemia can adversely affect the acquisition of new skills, such as reading/writing and math. Two years after the end of treatments, children show gross and fine motor skill delays that may persist even when patients are considered healed. The goal of the present study was to assess motor skills difficulties in pre-school children with leukemia one year after treatment. Particular attention has been paid to those patients who had undergone Hematopoietic Stem Cell Transplantation (HSCT) and to the relationship between motor delays and age bands...
2017: PloS One
https://www.readbyqxmd.com/read/28958737/changes-in-spectroscopic-biomarkers-after-transcranial-direct-current-stimulation-in-children-with-perinatal-stroke
#3
Helen L Carlson, Patrick Ciechanski, Ashley D Harris, Frank P MacMaster, Adam Kirton
BACKGROUND: Perinatal stroke causes lifelong motor disability, affecting independence and quality of life. Non-invasive neuromodulation interventions such as transcranial direct current stimulation (tDCS) combined with intensive therapy may improve motor function in adult stroke hemiparesis but is under-explored in children. Measuring cortical metabolites with proton magnetic resonance spectroscopy (MRS) can inform cortical neurobiology in perinatal stroke but how these change with neuromodulation is yet to be explored...
September 13, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/28932979/tuberculous-meningitis-in-children-and-adults-new-insights-for-an-ancient-foe
#4
REVIEW
Alyssa Mezochow, Kiran Thakur, Christopher Vinnard
PURPOSE OF REVIEW: Tuberculous meningitis is the most devastating manifestation of infection with Mycobacterium tuberculosis and represents a medical emergency. Approximately one half of tuberculous meningitis patients die or suffer severe neurologic disability. The goal of this review will be to review the pathogenic, clinical, and radiologic features of tuberculous meningitis and to highlight recent advancements in translational and clinical science. RECENT FINDINGS: Pharmacologic therapy includes combination anti-tuberculosis drug regimens and adjunctive corticosteroids...
September 20, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28891406/clinical-practice-guideline-evaluation-of-the-neck-mass-in-adults
#5
Melissa A Pynnonen, M Boyd Gillespie, Benjamin Roman, Richard M Rosenfeld, David E Tunkel, Laura Bontempo, Itzhak Brook, Davoren Ann Chick, Maria Colandrea, Sandra A Finestone, Jason C Fowler, Christopher C Griffith, Zeb Henson, Corinna Levine, Vikas Mehta, Andrew Salama, Joseph Scharpf, Deborah R Shatzkes, Wendy B Stern, Jay S Youngerman, Maureen D Corrigan
Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise...
September 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28863857/revised-consensus-statement-on-the-preventive-and-symptomatic-care-of-patients-with-leukodystrophies
#6
REVIEW
Laura A Adang, Omar Sherbini, Laura Ball, Miriam Bloom, Anil Darbari, Hernan Amartino, Donna DiVito, Florian Eichler, Maria Escolar, Sarah H Evans, Ali Fatemi, Jamie Fraser, Leslie Hollowell, Nicole Jaffe, Christopher Joseph, Mary Karpinski, Stephanie Keller, Ryan Maddock, Edna Mancilla, Bruce McClary, Jana Mertz, Kiley Morgart, Thomas Langan, Richard Leventer, Sumit Parikh, Amy Pizzino, Erin Prange, Deborah L Renaud, William Rizzo, Jay Shapiro, Dean Suhr, Teryn Suhr, Davide Tonduti, Jacque Waggoner, Amy Waldman, Nicole I Wolf, Ayelet Zerem, Joshua L Bonkowsky, Genevieve Bernard, Keith van Haren, Adeline Vanderver
Leukodystrophies are a broad class of genetic disorders that result in disruption or destruction of central myelination. Although the mechanisms underlying these disorders are heterogeneous, there are many common symptoms that affect patients irrespective of the genetic diagnosis. The comfort and quality of life of these children is a primary goal that can complement efforts directed at curative therapies. Contained within this report is a systems-based approach to management of complications that result from leukodystrophies...
September 2017: Molecular Genetics and Metabolism
https://www.readbyqxmd.com/read/28861407/alterations-in-cerebral-blood-flow-after-resuscitation-from-cardiac-arrest
#7
REVIEW
Bistra Iordanova, Lingjue Li, Robert S B Clark, Mioara D Manole
Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28836264/development-of-molecularly-targeted-therapies-to-treat-pediatric-malignancies
#8
REVIEW
Clinton F Stewart, Giles W Robinson
Drugs and biologics developed to treat children with cancer have been historically developed in adults for adult indications. Although leading to many useful drugs and biologics to treat pediatric cancer, future development of molecularly targeted therapies (MTTs) should be directed toward pediatric tumors more specifically to maximize antitumor efficacy while minimizing acute morbidity and long-term disability. This will put pediatric clinicians closer to the goal of cure for all children diagnosed with cancer...
November 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28790038/participate-cp-a-protocol-of-a-randomised-waitlist-controlled-trial-of-a-motivational-and-behaviour-change-therapy-intervention-to-increase-physical-activity-through-meaningful-participation-in-children-with-cerebral-palsy
#9
Sarah Elizabeth Reedman, Roslyn N Boyd, Catherine Elliott, Leanne Sakzewski
INTRODUCTION: Children with cerebral palsy (CP) participate in leisure-time physical activities (PA) less often, with less intensity and reduced diversity than their typically developing peers. Participation in leisure-time physical activities may be an important source of habitual physical activity (HPA) for children with CP, who as a group have lower levels of HPA and increased sedentary time compared with their typically developing peers. The proposed study aims to compare the efficacy of a participation focused therapy (ParticiPAte CP) to usual care in a pragmatic, randomised waitlist controlled trial...
August 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28726532/local-to-global-working-together-to-meet-the-needs-of-vulnerable-communities
#10
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
#11
REVIEW
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...
June 2017: Pediatrics
https://www.readbyqxmd.com/read/28552449/safety-and-efficacy-of-warfarin-therapy-in-kawasaki-disease
#12
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...
October 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
#13
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...
August 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28383324/cerebral-autoregulation-oriented-therapy-at-the-bedside-a-comprehensive-review
#14
REVIEW
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
#15
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
#16
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
#17
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
#18
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
#19
REVIEW
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
#20
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
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