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https://www.readbyqxmd.com/read/29679141/ethical-considerations-of-researchers-conducting-pediatric-clinical-drug-trials-a-qualitative-survey-in-two-belgian-university-children-s-hospitals
#1
Wannes Van Hoof, Kevin Meesters, Lien Dossche, Daphné Christiaens, Pauline De Bruyne, Johan Vande Walle
There is a general consensus about the underlying theoretical ethical principles that ground the practice of pediatric clinical trials: scientific necessity, good risk/benefit ratio, minimized burden, and parental consent/child assent. However, these principles are so broadly construed that it is not always clear how they should be applied in clinical practice. We conducted a qualitative study at Ghent University Hospital and the hospital of the Dutch-speaking university of Brussels on how researchers weigh ethical principles, assess the risk/benefit balance, estimate patient experience, and experience informed consent procedures in pediatric drug studies...
April 21, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29677085/surgical-antimicrobial-prophylaxis-among-pediatric-patients-in-south-africa-comparing-two-healthcare-settings
#2
Nicolene van der Sandt, Natalie Schellack, Lindi A Mabope, Mothahadini Pb Mawela, Danie Kruger, Brian Godman
BACKGROUND: Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa. OBJECTIVE: Assess compliance to SAP guidelines for pediatric patients undergoing surgery in one of four surgical sub-specialties among hospitals in South Africa. METHODS: Eight month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015...
April 19, 2018: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/29672887/young-age-is-associated-with-increased-rates-of-residual-recurrent-pediatric-differentiated-thyroid-carcinoma
#3
Sarah Hampson, Derek Stephens, Jonathan D Wasserman
OBJECTIVE: Differentiated thyroid carcinoma is rare in young children. There are conflicting data as to whether disease in this age group differs from that in adolescents and specifically, if it is more aggressive. Current practice guidelines do not differentiate treatment between these groups, but speculate that differences may exist. We sought to compare clinical features, treatment and outcomes between children (<12 years) and adolescents (12-18 years) with thyroid nodules and thyroid malignancy over a 20 year period...
April 19, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29672616/adherence-to-hyperbilirubinemia-guidelines-by-midwives-general-practitioners-and-pediatricians-in-indonesia
#4
Mahendra T A Sampurna, Kinanti A Ratnasari, Risa Etika, Christian V Hulzebos, Peter H Dijk, Arend F Bos, Pieter J J Sauer
Severe hyperbilirubinemia, which may result in kernicterus, is seen more frequently in low and middle-income countries, such as Indonesia, than in high-income countries. In Indonesia midwives, general practitioners (GPs), and pediatricians are involved in the care of jaundiced newborn infants. It is unknown whether the high incidence of severe hyperbilirubinemia in this country is related to a lack of awareness of existing hyperbilirubinemia guidelines issued by, for example, the World Health Organization, the American Academy of Pediatrics, or the Indonesian Health Ministry, or to a lack of adherence to such guidelines...
2018: PloS One
https://www.readbyqxmd.com/read/29667919/assessment-of-community-pediatric-providers-approach-to-a-child-with-celiac-disease-and-available-serological-testing-associated-with-a-large-tertiary-care-center
#5
Leina S Alrabadi, Anthony F Porto
An evidence-practice gap for use of celiac disease testing can lead to poor resource utilization. False positive tests may lead to unnecessary diet changes, gastroenterology consults, parental/patient concern, and additional testing and expenses complicated by varied available celiac bundles. An understanding of pediatric provider practices according to guideline recommendations further improves this gap.
April 1, 2018: Clinical Pediatrics
https://www.readbyqxmd.com/read/29667860/educational-needs-in-the-diagnosis-and-management-of-pediatric-functional-constipation-a-us-survey-of-specialist-and-primary-care-clinicians
#6
Justin Barnes, Brandon Coleman, Sharon Hwang, Aleksandra Stolic, Athos Bousvaros, Samuel Nurko, Gregory D Salinas
OBJECTIVES: The goal of this study was to identify opportunities among gastroenterologists and gastroenterology nurse practitioners (NPs)/physician assistants (PAs) for continuing medical education (CME) related to functional constipation. METHODS: An online, case-vignette survey was designed to identify and quantify practice patterns of pediatric gastroenterology clinicians. Case vignettes are a validated method for assessing clinician practice patterns. The survey consisted of three patient cases: a 3-year-old female with a 6-month history of constipation; a 6-year-old male with a 1-year history of constipation refractory to treatment and a sacral dimple with nearby tuft of hair; and a 16-year-old male with a 10-year history of constipation, and a sullen, depressed mood...
April 18, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29663585/perioperative-anticoagulation-practices-for-pediatric-liver-transplantation
#7
Stylianos Voulgarelis, Bernadette Vitola, Stacee M Lerret, Johnny C Hong, John P Scott
Despite continued advancements in perioperative care for pediatric liver transplant (LT), graft-threatening vascular occlusion events including hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) remain a source of significant morbidity and mortality. Perioperative anticoagulation is commonly used for the prevention of HAT and PVT, but evidence-based guidelines are lacking. The goals of this survey were to determine the frequency of use of an anticoagulation protocol and to describe variation in anticoagulation practices among pediatric LT centers...
April 16, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29659856/integration-of-physical-abuse-clinical-decision-support-into-the-electronic-health-record-at-a-tertiary-care-children-s-hospital
#8
Srinivasan Suresh, Richard A Saladino, Janet Fromkin, Emily Heineman, Tom McGinn, Rudolph Richichi, Rachel P Berger
Objective: To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse. Methods: A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects' providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects' providers had no alerts, but could manually search for the order set...
April 12, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29655374/surveying-cystic-fibrosis-care-centers-to-assess-adoption-of-infection-prevention-and-control-recommendations
#9
Lisa Saiman, Juyan J Zhou, Xiaotong Jiang, Michael R Kosorok, Marianne S Muhlebach
OBJECTIVEIn 2013, the Cystic Fibrosis (CF) Foundation developed an updated guideline for infection prevention and control (IP&C) practices for CF. We sought to assess the adoption of specific recommendations by CF care centers.METHODSDirectors of the 277 CF care centers in the United States were asked to complete a confidential online survey regarding the adoption of selected IP&C recommendations. Selected recommendations were those we considered less likely to be incorporated into a center's written IP&C policies...
April 15, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29653238/the-pediatric-asthma-yardstick-practical-recommendations-for-a-sustained-step-up-in-asthma-therapy-for-children-with-inadequately-controlled-asthma
#10
Bradley E Chipps, Leonard B Bacharier, Judith R Farrar, Daniel J Jackson, Kevin R Murphy, Wanda Phipatanakul, Stanley J Szefler, W Gerald Teague, Robert S Zeiger
Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. While tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the three age groups of childhood - adolescence (12-18 years old), school age (6-11 years old), and young children (≤ 5 years old), and what works for one age group may not be the best approach for another...
April 10, 2018: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#11
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652179/associations-between-maternal-nutrition-knowledge-attitude-and-practice-and-25-hydroxyvitamin-d-levels-and-rickets-in-children-in-xinjiang-province-people-s-republic-of-china
#12
Yu Liang, Hai-Yan Ren, Peng-Xiang Zuo
We explored the association between maternal nutrition knowledge, attitude, and practice (KAP) and 25-hydroxyvitamin D (25(OH)D) values in children with rickets in Xinjiang, People's Republic of China. We recruited 514 mothers with children (<2 years) from pediatric outpatient departments. We determined general status of families, maternal nutrition KAP, and 25(OH)D values in 212 children with rickets, with doctors using "Prevention and Treatment Program for Infant and Young Children Rickets" and "Application Guideline for Vitamin D and Bone Health in Adult Chinese (2014 Standard Edition)" to identify...
April 1, 2018: Asia-Pacific Journal of Public Health
https://www.readbyqxmd.com/read/29650310/electronic-health-record-with-computerized-decision-support-tools-for-the-purposes-of-a-pediatric-cardiovascular-heart-disease-screening-program-in-crete
#13
Ilias Chatzakis, Kostas Vassilakis, Christos Lionis, Ioannis Germanakis
BACKGROUND AND OBJECTIVE: Early detection of cardiovascular (CV) disease or associated risk factors during childhood is of paramount importance, allowing for early treatment or lifestyle modifications, respectively. The objective of this study was to describe the development of an electronic health record (EHR), with integrated computerized decision support system (CDSS), specifically designed for supporting the needs of a pilot pediatric CV disease screening program applied on primary school students of a Mediterranean island...
June 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29622322/bronchiolitis-from-practice-guideline-to-clinical-practice
#14
REVIEW
Maybelle Kou, Vivian Hwang, Nadira Ramkellawan
The American Academy of Pediatrics' clinical practice guideline in bronchiolitis was last updated in 2014 with recommendations to improve care for pediatric patients with bronchiolitis. As most treatments of bronchiolitis are supportive, the guideline minimizes the breadth of treatments previously used and cautions the use of tests and therapies that have a limited evidence base. Emergency physicians must be familiar with the guidelines in order to apply best practices appropriately.
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29619552/using-dynamic-treatment-regimes-to-understand-erythropoietin-stimulating-agent-hyporesponsiveness
#15
Ari H Pollack, Assaf P Oron, Joseph T Flynn, Raj Munshi
BACKGROUND: Erythropoietin-stimulating agent hyporesponsiveness (ESAH) is associated with increased cardiovascular mortality in patients with end-stage renal disease (ESRD) on hemodialysis. Dynamic treatment regimes (DTR), a clinical decision support (CDS) tool that guides the prescription of specific therapies in response to variations in patient states, have been used to guide treatment for chronic illnesses that require frequent monitoring and therapy changes. Our objective is to explore the role of utilizing a DTR to reduce ESAH in pediatric hemodialysis patients...
April 4, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29616203/non-invasive-brain-stimulation-in-children-with-unilateral-cerebral-palsy-a-protocol-and-risk-mitigation-guide
#16
Bernadette T Gillick, Andrew M Gordon, Tim Feyma, Linda E Krach, Jason Carmel, Tonya L Rich, Yannick Bleyenheuft, Kathleen Friel
Non-invasive brain stimulation has been increasingly investigated, mainly in adults, with the aims of influencing motor recovery after stroke. However, a consensus on safety and optimal study design has not been established in pediatrics. The low incidence of reported major adverse events in adults with and without clinical conditions has expedited the exploration of NIBS in children with paralleled purposes to influence motor skill development after neurological injury. Considering developmental variability in children, with or without a neurologic diagnosis, adult dosing and protocols may not be appropriate...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29615134/improving-outcomes-after-pediatric-cardiac-arrest-the-icu-resuscitation-project-study-protocol-for-a-randomized-controlled-trial
#17
Ron W Reeder, Alan Girling, Heather Wolfe, Richard Holubkov, Robert A Berg, Maryam Y Naim, Kathleen L Meert, Bradley Tilford, Joseph A Carcillo, Melinda Hamilton, Matthew Bochkoris, Mark Hall, Tensing Maa, Andrew R Yates, Anil Sapru, Robert Kelly, Myke Federman, J Michael Dean, Patrick S McQuillen, Deborah Franzon, Murray M Pollack, Ashley Siems, John Diddle, David L Wessel, Peter M Mourani, Carleen Zebuhr, Robert Bishop, Stuart Friess, Candice Burns, Shirley Viteri, David A Hehir, R Whitney Coleman, Tammara L Jenkins, Daniel A Notterman, Robert F Tamburro, Robert M Sutton
BACKGROUND: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology...
April 3, 2018: Trials
https://www.readbyqxmd.com/read/29605354/trends-in-the-management-of-secondary-post-tonsillectomy-hemorrhage-in-children
#18
Christine M Clark, Jane R Schubart, Michele M Carr
OBJECTIVE: To define current practices in management of secondary post-tonsillectomy hemorrhage (PTH) in children by pediatric and general otolaryngologists. INTRODUCTION: Bleeding after tonsillectomy is common. Our goal was to describe management methods across the U.S. METHODS: Questions regarding perioperative management and treatment in response to three hypothetical cases featuring secondary post-tonsillectomy bleeding were posed via REDCap survey...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29605347/diagnosis-and-management-of-pediatric-sinusitis-a-survey-of-primary-care-otolaryngology-and-urgent-care-providers
#19
Laurie Newton, Amanda Kotowski, Melissa Grinker, Robert Chun
OBJECTIVES: The aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolaryngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) in children 1-18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS)...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29605191/a-quality-improvement-intervention-to-reduce-emergency-department-radiography-for-bronchiolitis
#20
Joel Reiter, Adin Breuer, Oded Breuer, Saar Hashavya, David Rekhtman, Eitan Kerem, Malena Cohen-Cymberknoh
INTRODUCTION: Bronchiolitis is one of the most common infectious diseases in children and the most frequent cause of hospitalization in infants. Clinical practice guidelines recommend that a chest X-ray (CXR) should not be routinely obtained in the diagnosis of bronchiolitis, as studies have shown that they do not affect clinical outcomes, but rather lead to overuse of pharmacological agents and a longer length of hospital stay. OBJECTIVE: To determine whether active institution of bronchiolitis practice guidelines as part of a quality improvement project decreased the use of CXRs in the Pediatric Emergency Department (ED)...
April 2018: Respiratory Medicine
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