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https://www.readbyqxmd.com/read/28339409/practice-based-evidence-from-a-clinical-cohort-that-received-pediatric-constraint-induced-movement-therapy
#1
Stephanie C DeLuca, Mary Rebekah Trucks, Dorian A Wallace, Sharon L Ramey
PURPOSE: Constraint-Induced Movement Therapy (CIMT) is now designated a highly efficacious treatment for children with cerebral palsy, based on rigorous clinical trials. Yet virtually no evidence confirms that these moderate to large size effects can be replicated in clinical practice for a more heterogeneous clinical population. Thus there is a need to collect and report treatment outcome data based on actual clinical practice as a critical next step for implementation. METHODS: This study presents results from a prospective study conducted on a clinical cohort of 88 children, 18 months to 12 years old (M = 55 months, SD = 5 months), who received high-intensity CIMT known as ACQUIREc...
2017: Journal of Pediatric Rehabilitation Medicine
https://www.readbyqxmd.com/read/28338594/the-association-of-non-accidental-trauma-with-historical-factors-exam-findings-and-diagnostic-testing-during-the-initial-trauma-evaluation
#2
Mauricio A Escobar, Marc Auerbach, Katherine Flynn-O'Brien, Gunjan Tiyyagura, Matthew A Borgman, Susan J Duffy, Kelly Falcone, Rita Burke, John M Cox, Sabine Maguire
Early identification of non-accidental trauma (NAT) is a critical component of pediatric trauma care. Literature searches were conducted related to the association of NAT with seven key areas: history, exam findings (burns, oral trauma, bruising) and imaging (fractures, abdominal and brain injuries). When available, odds ratios (OR) with 95% confidence intervals (CI) for associations with NAT are presented. Systematic reviews have been published in six of the seven key areas and are described. The operational definition of NAT was widely variable across studies, prohibiting meta-analysis...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338416/impact-of-a-complex-care-management-model-on-cost-and-utilization-among-adolescents-and-young-adults-with-special-care-and-health-needs
#3
Daniel D Maeng, Susan R Snyder, Thomas W Davis, Janet F Tomcavage
Adolescents and young adults with special care and health needs in the United States-many of whom have Medicaid coverage-at the transition phase between pediatric and adult care often experience critical care gaps. To address this challenge, a new model-referred to as Comprehensive Care Clinic (CCC)-has been developed and implemented by Geisinger Health System since 2012. CCC comprises a care team, consisting of a generalist physician, advanced practitioner, pharmacist, and a nurse case manager, that develops and closely follows a coordinated care plan...
March 24, 2017: Population Health Management
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#4
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28336579/implementation-of-a-modified-who-pediatric-procedural-sedation-safety-checklist-and-its-impact-on-risk-reduction
#5
Lindsay Kahlenberg, Lindsay Harsey, Mary Patterson, Don Wachsberger, Dave Gothard, Michael Holder, Michael Forbes, Urmila Tirodker
BACKGROUND AND OBJECTIVES: Major adverse events (AEs) related to pediatric deep sedation occur at a low frequency but can be of high acuity. The high volume of deep sedations performed by 3 departments at our institution provided an opportunity to reduce variability and increase safety through implementation of a procedural sedation safety checklist. We hypothesized that implementation of a checklist would improve compliance of critical safety elements (CSEs) (primary outcome variable) and reduce the sedation-related AE rate (secondary outcome variable)...
March 23, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28336302/-vasopressors-and-inotropes-use-in-pediatrics
#6
Adrián García-Canales, Rocío Alejandra Peña-Juárez, Luz de María Sandoval-Franco
The cardiovascular system is a dynamic system whose function is to ensure adequate delivery of oxygen, nutrients and hormones to the tissues, necessary for cell metabolism, also synthesizes and modifies vasoactive components to regulate vascular tone and myocardial function. These components have become critical in the management of pediatric patients in critical condition with heart failure and shock which has proven its beneficial effects, however its use and abuse brings harmful effects, increase mortality, associated with arrhythmias and increase myocardial oxygen consumption favoring the presence of ischemia, therefore is necessary to know the mechanism of action and indications of these drugs to minimize the harmful effects...
March 20, 2017: Archivos de Cardiología de México
https://www.readbyqxmd.com/read/28336016/review-of-issues-and-challenges-of-practicing-emergency-medicine-above-30-000-feet-altitude-2-anonymized-cases
#7
Kam Lun Hon, Karen Ka Yan Leung
We present 2 anonymized cases to identify issues and challenges associated with long-haul in-flight medical emergencies. The first case involved a middle-aged man with a history of carditis on a systemic steroid who developed vomiting and rigor. Four physicians, including a pediatric intensivist, responded to the emergency call. In the second case, a pediatric trainee who was the only onboard medical personnel was summoned for help when a middle-aged man developed acute shortness of breath while traveling on a commercial flight...
March 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28335910/management-strategies-for-cln2-disease
#8
REVIEW
Ruth E Williams, Heather R Adams, Martin Blohm, Jessica L Cohen-Pfeffer, Emily de Los Reyes, Jonas Denecke, Kristen Drago, Charlie Fairhurst, Margie Frazier, Norberto Guelbert, Szilárd Kiss, Annamaria Kofler, John A Lawson, Lenora Lehwald, Mary-Anne Leung, Svetlana Mikhaylova, Jonathan W Mink, Miriam Nickel, Renée Shediac, Katherine Sims, Nicola Specchio, Meral Topcu, Ina von Löbbecke, Andrea West, Boris Zernikow, Angela Schulz
CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability...
April 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28333519/-doctor-are-you-listening-communication-about-children-s-mental-health-and-psychosocial-concerns
#9
Anne E Pidano, Madhavi M Padukkavidana, Lisa Honigfeld
Effective communication is critical, including in the pediatric primary care setting. Pediatric primary care providers (PPCPs) are in a unique position to address psychosocial and mental health concerns during office visits, and effective communication skills play a crucial role in providing an opportunity for parents and patients to disclose and discuss such concerns. In this article, the authors encourage two relatively simple strategies that have shown potential for enhancing effective communication in pediatric primary care regarding mental health and psychosocial issues: (a) ensure that pediatric residents and practicing providers have access to brief, targeted communications training and (b) strongly promote the use of screening tools both to encourage discussion and to assist in identifying children who may benefit from further assessment and/or treatment...
March 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28329463/current-practices-in-the-timing-of-stage-2-palliation
#10
James M Meza, Robert D B Jaquiss, Brett R Anderson, Michael-Alice Moga, James K Kirklin, George Sarris, William G Williams, Brian W McCrindle
BACKGROUND: Mortality through single-ventricle palliation remains high and the effect of the timing of stage 2 palliation (S2P) is not well understood. We investigated current practice patterns in the timing of S2P across two professional societies and compared them to actual practice patterns from two databases of patients who underwent S2P. METHODS: A ten-question survey was distributed to the members of the Congenital Heart Surgeons' Society (CHSS) and the European Congenital Heart Surgeons' Association (ECHSA)...
March 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28329120/sleep-wake-disturbances-after-traumatic-brain-injury-synthesis-of-human-and-animal-studies
#11
Danielle K Sandsmark, Jonathan E Elliott, Miranda M Lim
Sleep-wake disturbances following traumatic brain injury (TBI) are increasingly recognized as a serious consequence following injury and as a barrier to recovery. Injury-induced sleep-wake disturbances can persist for years, often impairing quality of life. Recently, there has been a nearly exponential increase in the number of primary research articles published on the pathophysiology and mechanisms underlying sleep-wake disturbances after TBI, both in animal models and human subjects, including in the pediatric population...
March 17, 2017: Sleep
https://www.readbyqxmd.com/read/28328786/high-quality-randomized-controlled-trials-in-pediatric-critical-care-a-survey-of-barriers-and-facilitators
#12
Mark Duffett, Karen Choong, Jennifer Foster, Maureen Meade, Kusum Menon, Melissa Parker, Deborah J Cook
OBJECTIVES: High-quality, adequately powered, randomized controlled trials are needed to inform the care of critically ill children. Unfortunately, such evidence is not always available. Our objective was to identify barriers and facilitators of conducting high-quality randomized controlled trials in pediatric critical care, from the perspective of trialists in this field. DESIGN: Self-administered online survey. Respondents rated the importance of barriers and effectiveness of facilitators on seven-point scales...
March 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28328691/factors-associated-with-discharge-home-after-transfer-to-a-pediatric-emergency-department
#13
Erin R Peebles, Michael R Miller, Tim P Lynch, Janice A Tijssen
OBJECTIVES: The transfer of children from community emergency departments (EDs) to tertiary care pediatric EDs for investigations, interventions, or a second opinion is common. In order to improve health care system efficiency, we must have a better understanding of this population and identify areas for education and capacity building. METHODS: We conducted a retrospective chart review of all patients (aged 0-17 years) who were transferred from community ED to a pediatric ED from November 2013 to November 2014...
March 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28328688/prioritizing-the-care-of-critically-ill-children-in-south-africa-how-does-screen-perform-against-other-triage-tools
#14
Bhakti Hansoti, Peter Hodkinson, Lee Wallis
OBJECTIVE: Childhood mortality remains unacceptably high. In low-resource settings, children with critical illness often present for care. Current triage strategies are time consuming and require trained health care workers. To address this limitation, our team developed a simple subjective tool, SCREEN (Sick Children Require Emergency Evaluation Now), which is easy to administer, to identify critically ill children. This article presents the development of the SCREEN program and evaluates its performance when compared with other commonly implemented triage tools in low-resource settings...
March 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28328654/outcomes-for-children-receiving-noninvasive-ventilation-as-the-first-line-mode-of-mechanical-ventilation-at-intensive-care-admission-a-propensity-score-matched-cohort-study
#15
Jenny V Morris, Padmanabhan Ramnarayan, Roger C Parslow, Sarah J Fleming
OBJECTIVES: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. DESIGN: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007-2014). SETTING: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28328609/evaluation-of-dentoalveolar-trauma-in-children-and-adolescents-a-modified-classification-system-and-surgical-treatment-strategies-for-its-management
#16
Nadia Theologie-Lygidakis, Ourania K Schoinohoriti, Minas Leventis, Ioannis Iatrou
OBJECTIVE: To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective. PATIENTS AND METHODS: Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed. RESULTS: A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department...
March 21, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28328243/factors-associated-with-bleeding-and-thrombosis-in-children-receiving-extracorporeal-membrane-oxygenation-ecmo
#17
Heidi J Dalton, Ron Reeder, Pamela Garcia-Filion, Richard Holubkov, Robert A Berg, Athena Zuppa, Frank W Moler, Thomas Shanley, Murray M Pollack, Christopher Newth, John Berger, David Wessel, Joseph Carcillo, Michael Bell, Sabrina Heidemann, Kathleen L Meert, Richard Harrison, Allan Doctor, Robert F Tamburro, J Michael Dean, Tammara Jenkins, Carol Nicholson
RATIONALE: Extracorporeal membrane oxygenation (ECMO) is employed for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. OBJECTIVES: (1) Measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) identify factors associated with these complications; and (3) determine the impact of these complications on patient outcome. METHODS: Prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals from December 2012 to September 2014...
March 22, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28326084/hiv-infection-and-compromised-mucosal-immunity-oral-manifestations-and-systemic-inflammation
#18
REVIEW
Samantha E Heron, Shokrollah Elahi
Mucosal surfaces account for the vast majority of HIV transmission. In adults, HIV transmission occurs mainly by vaginal and rectal routes but rarely via oral route. By contrast, pediatric HIV infections could be as the result of oral route by breastfeeding. As such mucosal surfaces play a crucial role in HIV acquisition, and spread of the virus depends on its ability to cross a mucosal barrier. HIV selectively infects, depletes, and/or dysregulates multiple arms of the human immune system particularly at the mucosal sites and causes substantial irreversible damage to the mucosal barriers...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28325567/microvascular-surgery-in-the-congenital-cardiac-patient-a-case-series-exploring-feasibility-and-practical-applications
#19
John A LoGiudice, Karri Adamson, Nancy Ghanayem, Ronald K Woods, Michael E Mitchell
BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015...
February 17, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28324239/mtdna-maintenance-defects-syndromes-and-genes
#20
Carlo Viscomi, Massimo Zeviani
A large group of mitochondrial disorders, ranging from early-onset pediatric encephalopathic syndromes to late-onset myopathy with chronic progressive external ophthalmoplegia (CPEOs), are inherited as Mendelian disorders characterized by disturbed mitochondrial DNA (mtDNA) maintenance. These errors of nuclear-mitochondrial intergenomic signaling may lead to mtDNA depletion, accumulation of mtDNA multiple deletions, or both, in critical tissues. The genes involved encode proteins belonging to at least three pathways: mtDNA replication and maintenance, nucleotide supply and balance, and mitochondrial dynamics and quality control...
March 21, 2017: Journal of Inherited Metabolic Disease
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