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https://www.readbyqxmd.com/read/28812473/implementation-of-a-pathway-for-the-treatment-of-fever-and-neutropenia-in-pediatric-patients-with-cancer
#1
Joy Vanderway, Catherine Vincent, Susan M Walsh, Jennifer Obrecht
Fever and neutropenia is an oncologic emergency. Time-to-antibiotics (TTA) refers to the amount of time from initial provider evaluation for fever and neutropenia to intravenous antibiotic administration. Research supports that rapid time-to-antibiotics (RTTA) is associated with improved patient outcomes. This quality improvement project evaluated the success of implementing an RTTA pathway in pediatric oncology patients with fever and neutropenia. The setting was an advanced practice nurse-managed pediatric ambulatory infusion center where patients with fever and neutropenia were often evaluated and treated...
September 2017: Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses
https://www.readbyqxmd.com/read/28812056/initiating-a-standardized-regional-referral-and-counter-referral-system-in-guatemala-a-mixed-methods-study
#2
Rupa Kapoor, Leslie Avendaño, Maria Antonieta Sandoval, Andrea T Cruz, Esther M Sampayo, Miguel A Soto, Elizabeth A Camp, Heather L Crouse
Background:Few data exist for referral processes in resource-limited settings. We utilized mixed-methods to evaluate the impact of a standardized algorithm and training module developed for locally identified needs in referral/counter-referral procedures between primary health centers (PHCs) and a Guatemalan referral hospital. Methods: PHC personnel and hospital physicians participated in surveys and focus groups pre-implementation and 3, 6, and 12 months post-implementation to evaluate providers' experience with the system...
2017: Global Pediatric Health
https://www.readbyqxmd.com/read/28812053/emergency-medical-service-personnel-recognize-pediatric-concussions
#3
Joshua N Speirs, Matthew I Lyons, Bert E Johansson
Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed...
2017: Global Pediatric Health
https://www.readbyqxmd.com/read/28811042/understanding-readmissions-in-children-undergoing-surgery-a-pediatric-nsqip-analysis
#4
Afif N Kulaylat, Dorothy V Rocourt, Anthony Y Tsai, Kathryn L Martin, Brett W Engbrecht, Mary C Santos, Robert E Cilley, Christopher S Hollenbeak, Peter W Dillon
BACKGROUND: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. MATERIALS AND METHODS: Retrospective review of pediatric patients (n=130,274) undergoing surgery (2013-2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission...
July 31, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28810649/effect-of-dexmedetomidine-combined-with-sufentanil-on-preventing-emergence-agitation-in-children-receiving-sevoflurane-anesthesia-for-cleft-palate-repair-surgery
#5
Ke Luo, Jun-Mei Xu, Lin Cao, Ju Gao
The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28808990/onychomadesis-in-a-9-month-old-boy-with-hand-foot-mouth-disease
#6
Ibrahim Mortada, Rola Mortada, Mohamad Al Bazzal
BACKGROUND: Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis is described as a rare, late complication of hand-foot-mouth disease, which is a viral illness commonly seen in the pediatric age group. It is therefore important to elucidate the presentation of this entity, especially in the context of the hand-foot-mouth disease. CASE PRESENTATION: We report a case of onychomadesis in a 9-month old Lebanese boy who presented to the emergency department with rapidly progressing nail changes involving all four extremities...
August 14, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28808794/thiol-disulfide-homeostasis-as-a-novel-indicator-of-oxidative-stress-in-children-with-simple-febrile-seizures
#7
Bahri Elmas, Özcan Erel, Dilek Ersavaş, Yusuf Yürümez
Simple febrile seizures are generally benign, but during the seizure, elevated levels of glutamate and high levels of oxygen use due to the high metabolic brain activity result in oxidative stress. However, the relationship between febrile seizures and oxidative stress remains unclear. In this study, we investigated thiol/disulfide homeostasis as a new oxidative stress parameter in patients with simple febrile seizures. This study was performed between February 2016 and May 2016 at the Pediatric Emergency Unit...
August 14, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28808787/malignant-transformation-of-a-conservatively-managed-incidental-childhood-cerebral-mass-lesion-controversy-regarding-management-paradigm
#8
Jehuda Soleman, Jonathan Roth, Zvi Ram, Michal Yalon, Shlomi Constantini
BACKGROUND: Incidental findings on neuroimaging in the pediatric population are an emerging treatment challenge. Treatment options for these incidental childhood brain mass lesions, which radiologically may be assumed to be low-grade gliomas (LGG), vary, ranging from careful conservative "wait and scan" treatment to surgical biopsy, gross total resection, and upfront radiation and/or chemotherapy. As malignant transformation of LGG in children is extremely rare, some series advocate careful conservative management of these lesions; however, universal treatment protocols are not totally agreed upon...
August 14, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28808073/unintentional-cannabis-intoxication-in-toddlers
#9
Isabelle Claudet, Sébastien Mouvier, Magali Labadie, Cécile Manin, Anne-Pascale Michard-Lenoir, Didier Eyer, Damien Dufour
BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004-2014). METHODS: A retrospective, national, multicenter, observational study of a pediatric cohort...
August 14, 2017: Pediatrics
https://www.readbyqxmd.com/read/28807611/initial-treatment-for-nonsyndromic-early-life-epilepsy-an-unexpected-consensus
#10
Renée A Shellhaas, Anne T Berg, Zachary M Grinspan, Courtney J Wusthoff, John J Millichap, Tobias Loddenkemper, Jason Coryell, Russell P Saneto, Catherine J Chu, Sucheta M Joshi, Joseph E Sullivan, Kelly G Knupp, Eric H Kossoff, Cynthia Keator, Elaine C Wirrell, John R Mytinger, Ignacio Valencia, Shavonne Massey, William D Gaillard
OBJECTIVE: There are no evidence-based guidelines on the preferred approach to treating early-life epilepsy. We examined initial therapy selection in a contemporary US cohort of children with newly diagnosed, nonsyndromic, early-life epilepsy (onset before age three years). METHODS: Seventeen pediatric epilepsy centers participated in a prospective cohort study of children with newly diagnosed epilepsy with onset under 36 months of age. Details regarding demographics, seizure types, and initial medication selections were obtained from medical records...
June 27, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28807480/opportunities-and-challenges-in-screening-for-childhood-sexual-abuse
#11
Deepa L Sekhar, Jennifer L Kraschnewski, Heather L Stuckey, Pamela D Witt, Erica B Francis, Ginger A Moore, Paul L Morgan, Jennie G Noll
Retrospective studies suggest 1 in 4 girls and 1 in 6 boys will experience sexual abuse before 18 years of age, resulting in future morbidity. Successful interventions exist, however, victims are reluctant to disclose. Screening for childhood sexual abuse (CSA) may provide an opportunity to overcome this barrier, yet no current model for universal CSA screening exists. We sought to understand the perspective of key stakeholders on CSA screening through qualitative research. Eight focus groups of 7-10 participants each (n=62) were conducted from April-September 2016...
August 11, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28807192/does-compliance-with-antibiotic-prophylaxis-in-pediatric-simple-appendicitis-matter
#12
Krislynn M Mueck, Luke R Putnam, Kathryn T Anderson, Kevin P Lally, KuoJen Tsao, Lillian S Kao
BACKGROUND: Institutional protocols for preincisional antibiotic prophylaxis can standardize care and improve outcomes. However, challenges remain in compliance with such protocols for urgent or emergent operations. We hypothesized that compliance with an institutional protocol for antibiotic prophylaxis for appendectomy for appendicitis in pediatric patients results in reduced surgical site infections (SSIs) after simple appendectomy. METHODS: This retrospective study assessed all pediatric patients (≤18 y) who underwent appendectomy for confirmed simple appendicitis at a tertiary children's hospital between 2012 and 2015...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28806978/transcriptome-sequencing-in-pediatric-acute-lymphoblastic-leukemia-identifies-fusion-genes-associated-with-distinct-dna-methylation-profiles
#13
Yanara Marincevic-Zuniga, Johan Dahlberg, Sara Nilsson, Amanda Raine, Sara Nystedt, Carl Mårten Lindqvist, Eva C Berglund, Jonas Abrahamsson, Lucia Cavelier, Erik Forestier, Mats Heyman, Gudmar Lönnerholm, Jessica Nordlund, Ann-Christine Syvänen
BACKGROUND: Structural chromosomal rearrangements that lead to expressed fusion genes are a hallmark of acute lymphoblastic leukemia (ALL). In this study, we performed transcriptome sequencing of 134 primary ALL patient samples to comprehensively detect fusion transcripts. METHODS: We combined fusion gene detection with genome-wide DNA methylation analysis, gene expression profiling, and targeted sequencing to determine molecular signatures of emerging ALL subtypes...
August 14, 2017: Journal of Hematology & Oncology
https://www.readbyqxmd.com/read/28806579/access-to-emergency-care-services-a-transversal-ecological-study-about-brazilian-emergency-health-care-network
#14
T A H Rocha, N C da Silva, P V Amaral, A C Q Barbosa, J V M Rocha, V Alvares, D G de Almeida, E Thumé, E B A F Thomaz, R C de Sousa Queiroz, M R de Souza, A Lein, N Toomey, C A Staton, J R N Vissoci, L A Facchini
OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs)...
August 11, 2017: Public Health
https://www.readbyqxmd.com/read/28806189/the-use-of-optical-coherence-tomography-in-neuro-ophthalmology
#15
Noel C Y Chan, Carmen K M Chan
PURPOSE OF REVIEW: In the last decade, with the advances of optical coherence tomography (OCT) technology, different imaging protocols and analysis algorithms have been introduced to maximize the potential of this diagnostic tool in the evaluation of different eye diseases. This review aims to provide an update on these additional features, with respect to the management of a diverse range of neuro-ophthalmologic conditions. RECENT FINDINGS: Macular ganglion cell complex (mGCC) analysis has been shown to be superior to peripapillary retinal nerve fiber layer (pRNFL) analysis in certain settings, such as differentiating Leber's hereditary optic neuropathy from functional visual loss; monitoring neurodegenerative diseases or multiple sclerosis; and predicting visual loss in nonarteritic ischemic optic neuropathy...
August 12, 2017: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/28806188/tubulointerstitial-nephritis-and-uveitis
#16
Kaivon Pakzad-Vaezi, Kathryn L Pepple
PURPOSE OF REVIEW: Tubulointerstitial nephritis and uveitis (TINU) is an important yet underrecognized ocular inflammatory syndrome. This review summarizes key historical publications that identified and defined the syndrome, and more recent literature that reveal the importance of urinary β2-microglobulin testing and kidney biopsy in the diagnostic evaluation of patients with TINU. Additionally, research studies providing new insights into disease pathogenesis are highlighted. RECENT FINDINGS: In contrast with initial reports of TINU manifesting exclusively as an anterior uveitis in pediatric patients, more recent reports have identified TINU in patients of all ages with a wide range of ocular manifestations...
August 12, 2017: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/28804814/factors-associated-with-cardiovascular-target-organ-damage-in-children-after-renal-transplantation
#17
Bianca Borchert-Mörlins, Daniela Thurn, Bernhard M W Schmidt, Anja K Büscher, Jun Oh, Tanja Kier, Elena Bauer, Sabrina Baig, Nele Kanzelmeyer, Markus J Kemper, Rainer Büscher, Anette Melk
BACKGROUND: Cardiovascular disease is the second-most common cause of death in pediatric renal transplant recipients. The aim of this study was to evaluate subclinical cardiovascular target organ damage defined as the presence of arterio- and atherosclerotic lesions and cardiac remodeling and to analyze contributing risk factors in a large cohort of children after renal transplantation (RT). METHODS: A total of 109 children aged 13.1 ± 3.3 years who had undergone RT at one of three German transplant centers were enrolled in this study...
August 13, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28803593/predictors-of-obtaining-follow-up-care-in-the-province-of-ontario-canada-following-a-new-diagnosis-of-atrial-fibrillation-heart-failure-and-hypertension-in-the-emergency-department
#18
Clare L Atzema, Bing Yu, Noah M Ivers, Paula A Rochon, Douglas S Lee, Michael J Schull, Peter C Austin
OBJECTIVE: Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases. METHODS: We performed a retrospective cohort study of patients with a new diagnosis of heart failure, atrial fibrillation, or hypertension, who were discharged from 157 non-pediatric EDs in Ontario, Canada, between April 2007 and March 2014...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28803574/retrospective-evaluation-of-the-big-score-to-predict-mortality-in-pediatric-blunt-trauma
#19
Charlotte Grandjean-Blanchet, Guillaume Emeriaud, Marianne Beaudin, Jocelyn Gravel
OBJECTIVES: This study's objective was to measure the criterion validity of the BIG score (a new pediatric trauma score composed of the initial base deficit [BD], international normalized ratio [INR], and Glasgow Coma Scale [GCS]) to predict in-hospital mortality among children admitted to the emergency department with blunt trauma requiring an admission to the intensive care unit, knowing that a score <16 identifies children with a high probability of survival. METHODS: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28803186/asthma-exacerbations-and-triggers-in-children-in-tenor-impact-on-quality-of-life
#20
Bradley E Chipps, Tmirah Haselkorn, Karin Rosén, David R Mink, Benjamin L Trzaskoma, Allan T Luskin
BACKGROUND: Data examining associations between asthma exacerbations, triggers, and asthma-related quality of life (QOL) in children with severe/difficult-to-treat asthma are unavailable. OBJECTIVE: To evaluate real-world data on relationships between asthma exacerbations, triggers, and QOL in children using data from TENOR (The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens), a 3-year observational study of patients with severe/difficult-to-treat asthma, including those aged 6 to 12 years...
August 9, 2017: Journal of Allergy and Clinical Immunology in Practice
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