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Primary care pediatrics

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https://www.readbyqxmd.com/read/28935428/predictive-factors-for-the-outcome-of-high-flow-nasal-cannula-therapy-in-a-pediatric-intensive-care-unit-is-the-spo2-fio2-ratio-useful
#1
Fulya Kamit Can, Ayşe Berna Anil, Murat Anil, Neslihan Zengin, Fatih Durak, Caner Alparslan, Zeynep Goc
OBJECTIVES: To determine the predictive factors for the outcome of high-flow nasal cannula (HFNC) therapy in a pediatric intensive care unit (PICU). MATERIALS AND METHODS: We prospectively included all patients with acute respiratory distress/failure aged 1month to 18years who were admitted to the PICU between January 2015 and May 2016 and treated with HFNC as a primary support and for postextubation according to our pre-established protocol. HFNC failure was defined as the need for escalation to non-invasive ventilation (NIV) or invasive mechanical ventilation (MV)...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28935390/ask-the-question-screening-for-postpartum-mood-and-anxiety-disorders-in-pediatric-primary-care
#2
Stacy Kurtz, Jack Levine, Marcy Safyer
Postpartum mood and anxiety disorders (PMADs) are a significant source of toxic stress for young children and can disrupt developing brain architecture resulting in long-lasting deleterious effects. Thus, screening for PMADs must be considered as an essential task of a pediatric primary care provider (PCP) and the pediatric medical home. Problems in parenting capacity in mothers with PMADs can lead to disorders in attachment and a range of other emotional and developmental challenges for a young child. Therefore, all PCP office visits with mothers should include surveillance as well as formal screening at regular, pre-determined intervals...
September 18, 2017: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/28932917/the-met-needs-for-pediatric-surgical-conditions-in-sierra-leone-estimating-the-gap
#3
Carmen Mesas Burgos, Håkon Angell Bolkan, Donald Bash-Taqi, Lars Hagander, Johan Von Screeb
BACKGROUND: In low- and middle-income countries, there is a gap between the need for surgery and its equitable provision, and a lack of proxy indicators to estimate this gap. Sierra Leone is a West African country with close to three million children. It is unknown to what extent the surgical needs of these children are met. AIM: To describe a nationwide provision of pediatric surgical procedures and to assess pediatric hernia repair as a proxy indicator for the shortage of surgical care in the pediatric population in Sierra Leone...
September 20, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28932575/pediatric-lung-transplantation
#4
REVIEW
Christian Benden
Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28929269/behavioral-health-integration-in-health-care-settings-lessons-learned-from-a-pediatric-hospital-primary-care-system
#5
Leandra Godoy, Melissa Long, Donna Marschall, Stacy Hodgkinson, Brooke Bokor, Hope Rhodes, Howard Crumpton, Mark Weissman, Lee Beers
Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists...
September 19, 2017: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/28928043/treating-postpartum-mood-and-anxiety-disorders-in-primary-care-pediatrics
#6
Polina Umylny, Miguelina German, Alexa Lantiere
Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers...
September 16, 2017: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/28928039/vaccination-coverage-of-adolescents-with-chronic-medical-conditions
#7
Annika M Hofstetter, Stewin Camargo, Karthik Natarajan, Susan L Rosenthal, Melissa S Stockwell
INTRODUCTION: Adolescents with chronic medical conditions (CMCs) are at increased risk of vaccine-preventable infections. Little is known about their vaccine uptake. METHODS: This retrospective cohort study included 3,989 adolescents aged 11-17 years receiving care at academically affiliated pediatric clinics between August 2011 and June 2013. Data were abstracted from the medical center's electronic health record and immunization registry in 2014. Vaccination coverage, timeliness, and missed opportunities were evaluated and analyzed in 2015-2016...
September 16, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28927681/adapting-an-evidence-based-pediatric-acute-asthma-exacerbation-severity-assessment-tool-for-pediatric-primary-care
#8
Anne T Magpuri, Jane K Dixon, Ruth McCorkle, Angela A Crowley
INTRODUCTION: The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care. METHOD: The three stages of the project included (a) identification of criteria in a literature review, (b) validation of the criteria by an expert panel, and (c) adaptation of the criteria in the design of an assessment tool...
September 16, 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28927200/epidemiology-of-invasive-fungal-disease-in-children
#9
Zoi Dorothea Pana, Emmanuel Roilides, Adilia Warris, Andreas H Groll, Theoklis Zaoutis
Considerable progress has been made in the prevention, diagnosis, and management of pediatric patients with invasive fungal disease (IFD). The reported decreasing trend in the incidence of invasive candidiasis (IC) over the past 15 years in both neonates and children has been encouraging. Nevertheless, due to the growing number of immunocompromised children at risk for IFD, this disease continues to be associated with significant morbidity and death and with increased financial burden to the health care system...
September 1, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28926505/do-all-clavicle-fractures-in-children-need-to-be-managed-by-orthopedic-surgeons
#10
John Adamich, Andrew Howard, Mark Camp
OBJECTIVES: Although many uncomplicated pediatric fractures do not require routine long-term follow-up with an orthopedic surgeon, practitioners with limited experience dealing with pediatric fractures will often defer to a strategy of frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system. METHODS: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of clavicle fractures was performed...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28922571/interprofessional-oral-health-initiative-in-a-nondental-american-indian-setting
#11
Kate L Murphy, Laura S Larsson
BACKGROUND AND PURPOSE: Tooth decay is the most common chronic childhood disease and American Indian (AI) children are at increased risk. Pediatric primary care providers are in an opportune position to reduce tooth decay. The purpose of this study was to integrate and evaluate a pediatric oral health project in an AI, pediatric primary care setting. METHODS: The intervention set included caregiver education, caries risk assessment, and a same-day dental home referral...
September 18, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28922233/endoscopic-versus-open-repair-for-craniosynostosis-in-infants-using-propensity-score-matching-to-compare-outcomes-a-multicenter-study-from-the-pediatric-craniofacial-collaborative-group
#12
Douglas R Thompson, David Zurakowski, Charles M Haberkern, Paul A Stricker, Petra M Meier
BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis...
September 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28921890/phase-ii-study-of-dabigatran-in-children-with-venous-thrombosis-pharmacokinetics-safety-and-tolerabilty
#13
J M L Halton, M Albisetti, B Biss, L Bomgaars, M Brueckmann, S Gropper, R Harper, F Huang, M Luciani, H Maas, I Tartakovsky, L G Mitchell
BACKGROUND: The current standard-of-care treatments for pediatric venous thromboembolism (VTE) have limitations. Dabigatran etexilate (DE), a direct thrombin inhibitor, may offer an alternative therapeutic option. OBJECTIVES: To assess the pharmacokinetics (PK), pharmacodynamics (PD), safety and tolerability of DE oral liquid formulation (OLF) in pediatric patients with VTE. PATIENTS/METHODS: Patients who had completed planned treatment with low-molecular-weight heparin or oral anticoagulants for VTE were enrolled in two age groups (2-<12 and 1-<2 years) and received DE OLF based on an age- and weight-adjusted nomogram...
September 16, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28918202/implementation-of-a-risk-stratified-opioid-weaning-protocol-in-a-pediatric-intensive-care-unit
#14
L Nelson Sanchez-Pinto, Lara P Nelson, Phuong Lieu, Joyce Y Koh, John W Rodgers, Krichelle A Larson, Jennifer M Huson, Rambod Amirnovin
PURPOSE: Opioids are important in the care of critically ill children. However, their use is associated with complications including delirium, dependence, withdrawal, and bowel dysfunction. Our aim was to implement a risk-stratified opioid weaning protocol to reduce the duration of opioids without increasing the incidence of withdrawal. METHODS: A pre- and post-interventional prospective study was undertaken in a large children's hospital pediatric ICU where we implemented a risk-stratified opioid weaning protocol...
September 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28917392/description-of-a-multi-university-education-and-collaborative-care-child-psychiatry-access-program-new-york-state-s-cap-pc
#15
D L Kaye, V Fornari, M Scharf, W Fremont, R Zuckerbrot, C Foley, T Hargrave, B A Smith, J Wallace, G Blakeslee, J Petras, S Sengupta, J Singarayer, A Cogswell, I Bhatia, P Jensen
OBJECTIVE: Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION: CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010...
September 2017: General Hospital Psychiatry
https://www.readbyqxmd.com/read/28916453/making-the-legal-and-ethical-case-for-universal-screening-for-postpartum-mood-and-anxiety-disorders-in-pediatric-primary-care
#16
Amy Lewis Gilbert, Casey Balio, Nerissa S Bauer
Postpartum depression (PPD), part of a larger spectrum of perinatal mood and anxiety disorders, affects up to 15% of women following the birth of an infant. Fathers may also be affected. PPD not only affects caregivers, but also impacts infants through mechanisms such as inadequate caregiver-infant interactions and non-adherence to safety practices. The negative impact on infants may extend across the life course through adulthood. This article seeks to move the needle toward universal screening for PPD using validated tools in pediatric primary care settings for new caregivers by making the legal and ethical case for this course of action in a manner that is both compelling and accessible for clinicians...
September 12, 2017: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/28916250/successful-integration-of-pediatrics-into-state-health-care-reform-efforts
#17
Judith S Shaw, Susan E Varni, Elizabeth Cheng Tolmie, Mary Kate Mohlman, Valerie S Harder
Health care reform in Vermont promotes patient-centered medical homes (PCMH) and multi-disciplinary community health teams to support population health. This qualitative study describes the expansion of Vermont's health care reform efforts, initially focused on adult primary care, to pediatrics through interviews with project managers and facilitators, CHT members, pediatric practitioners and care coordinators, and community-based providers. Analyses used grounded theory, identifying themes confirmed by repeat occurrence across respondents...
September 12, 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28916249/diagnostic-errors-impact-of-an-educational-intervention-on-pediatric-primary-care
#18
Julianne Nemes Walsh, Margaret Knight, A James Lee
INTRODUCTION: The purpose of our study was to determine the impact of an educational program on a provider's knowledge related to diagnostic errors and diagnostic reasoning strategies. METHODS: A quasi-experimental interventional study with a multimedia approach, case study discussion, and trigger-generated medical record review at two time points was conducted. Measurement tools included a test developed by the National Patient Safety Foundation, Reducing Diagnostic Errors: Strategies for Solutions Quiz, additional diagnostic reasoning questions, and a trigger-generated process to analyze medical records...
September 12, 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28916019/the-basic-science-of-behavior-change-and-its-application-to-pediatric-providers
#19
REVIEW
Allison R Love, Peter S Jensen, Lisa Khan, Tiffany West Brandt, James Jaccard
Pediatric primary care providers (PPCPs) are increasingly expected to know how to assess, diagnose, and treat a wide range of mental health problems in children and adolescents. For many PPCPs, this means learning and performing new practice behaviors that were not taught in their residency training. Typical continuing education approaches to engage PPCPs in new practices have not yielded the desired changes in provider behavior. This article summarizes behavior change principles identified through basic behavior science, adult education, and communication research, and discusses their application to a patient-centered pediatric primary care mental health curriculum...
October 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28916016/comparing-two-models-of-integrated-behavioral-health-programs-in-pediatric-primary-care
#20
REVIEW
Miguelina Germán, Michael L Rinke, Brittany A Gurney, Rachel S Gross, Diane E Bloomfield, Lauren A Haliczer, Silvie Colman, Andrew D Racine, Rahil D Briggs
This study examined how to design, staff, and evaluate the feasibility of 2 different models of integrated behavioral health programs in pediatric primary care across primary care sites in the Bronx, NY. Results suggest that the Behavioral Health Integration Program model of pediatric integrated care is feasible and that hiring behavioral health staff with specific training in pediatric, evidence-informed behavioral health treatments may be a critical variable in increasing outcomes such as referral rates, self-reported competency, and satisfaction...
October 2017: Child and Adolescent Psychiatric Clinics of North America
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