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Children with medical complexity

J E Dietrich, D L Yee, X M Santos, J L Bercaw-Pratt, J Kurkowski, H Soni, Y J Lee-Kim, M D Shah, D Mahoney, L V Srivaths
BACKGROUND: Bleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to healthcare providers given the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. SPECIFIC AIMS: To use an electronic approach to enhance patient compliance with medications used to treat their HMB...
October 14, 2016: Journal of Pediatric and Adolescent Gynecology
Karen Spruyt, Wiebe Braam, Marcel Smits, Leopold Mg Curfs
AIMS: Individuals with Smith-Magenis syndrome (SMS) are reported to have a disrupted circadian rhythm. Our aim was to examine problematic sleeping in those attending our sleep clinic for the first time. METHODS: At intake, caregivers of 50 children and nine adults with SMS were surveyed about the sleep pattern and potential melatonin administration. Sampling of salivary melatonin levels was performed. RESULTS: At intake, exogenous melatonin was used by 16 children (27...
October 14, 2016: CNS Neuroscience & Therapeutics
B Dal Pupo, M Zanon, A W Tech, L V Cruz, M Cornelli, C do Valle Pereira, J Bertoglio, C Acosta, P Perusato, A J C Monteiro, G Marinho, A P S Souza, C D Garcia
BACKGROUND: Today, Brazil is the second country of the world in number of transplants. Nonetheless, waiting lists are getting longer. This lack of organs occurs mostly because of people's reduced knowledge about the donation process. With the aim of changing this scenario, in 2013 and 2014, "Organ Donation Week" events were held at the Federal University of Health Sciences of Porto Alegre. METHODS: During the 2 years, documentaries followed by a cycle of debates with experts in this area were exhibited...
September 2016: Transplantation Proceedings
Jennifer Jao, Rohan Hazra, Claude A Mellins, Robert H Remien, Elaine J Abrams
INTRODUCTION: The tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV-infected children on the one hand and a mounting number of HIV-exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status. DISCUSSION: Disclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status...
2016: Journal of the International AIDS Society
Eszter Szilassy, Jess Drinkwater, Marianne Hester, Cath Larkins, Nicky Stanley, William Turner, Gene Feder
We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group...
October 14, 2016: Health & Social Care in the Community
Sophie Thiemann, Nathiana Smit, Till Strowig
The intestinal microbiota is a diverse ecosystem containing thousands of microbial species, whose metabolic activity affects many aspects of human physiology. Large-scale surveys have demonstrated that an individual's microbiota composition is shaped by factors such as diet and the use of medications, including antibiotics. Loss of overall diversity and in some cases loss of single groups of bacteria as a consequence of antibiotic treatment in humans has been associated with enhanced susceptibility toward gastrointestinal infections and with enhanced weight gain and obesity in young children...
October 15, 2016: Current Topics in Microbiology and Immunology
Paola Friedrich, Catherine G Lam, Geetinder Kaur, Elena Itriago, Raul C Ribeiro, Ramandeep S Arora
BACKGROUND: Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject...
2016: PloS One
Yair Shachar, Allan Billig, Katya Chapchay, Jhonatan Elia, Neta Adler, Alexander Margulis
BACKGROUND: Large congenital melanocytic nevi entail significant medical and cosmetic ramifications for patients and families. Reconstruction is a challenging endeavor, especially when the lesion is present on the limbs. The literature describes various methods by which a plastic surgeon can address reconstruction; yet, to date, there has been no series describing a method that provides consistent results with low complication rates. In this study, we describe our surgical technique for reconstruction of the upper extremity after excision of large circumferential CNM with a pre-expanded bi-pedicled flap, namely the "sleeve" flap...
October 5, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Evhen Y Strashko, Аnna A Kapustianska, Lyudmyla E Bobyreva
Matters of physical and medical rehabilitation of children with organic lesions of the nervous system, in particular, with cerebral palsy, are actual in countries around the world. Hippotherapy is neurophysiologically oriented therapy using horses. Determine whether a combination of hippotherapy as a method of rehabilitation in the aftermath of outpatient comprehensive impact on MS on a stationary phase; Study of the effect of hippotherapy as securing and preparation method for learning new postures and movements in children with spastic cerebral palsy forms; The study of the possible optimization of psychophysical state, activation motivations of patients; Determination of the optimal timing of hippotherapy sessions, the number of procedures, the study of possible fatigue factor children...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Anna M Follent, Anna F Rumbach, Elizabeth C Ward, Jeanne Marshall, Pamela Dodrill, Peter Lewindon
PURPOSE: There is limited information regarding the nature of dysphagia and feeding difficulties following alkali ingestion injury to inform multidisciplinary intervention. The aim was to describe the history and nature of chronic dysphagia and feeding difficulties in two children following severe alkali ingestion injury. METHODS: Medical records, primary caregiver report, and clinical assessment were used to compile detailed case histories and assess current dysphagia and feeding skills...
October 7, 2016: Disability and Rehabilitation
Alison M DaCosta, Courtney B Sweet, Lisa R Garavaglia, Francis L Casey, Jeffrey D Lancaster
OBJECTIVES: This pilot study investigated the feasibility and effect on health care utilization of medically complex children participating in a pharmacist-led model for care coordination. Quality of life and satisfaction with care were secondarily assessed for each patient. METHODS: Four medically complex children were enrolled and contacted by the pharmacist weekly for 5 consecutive months. Time for each encounter with a patient was collected. Each patient's hospital admissions, days of stay, emergency department visits, and clinic visits were recorded...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Cara McComish, Kristen Brackett, Maureen Kelly, Christine Hall, Sharon Wallace, Victoria Powell
Pediatric feeding difficulties are complex and multifactorial in nature. Children who need assessment and individualized treatment for complex feeding problems are best served by an interdisciplinary treatment team. The medical, motor, and behavioral approach to treating pediatric feeding problems is presented as an avenue to treatment. By necessity, this approach requires a well-functioning interdisciplinary team, including nurses, physicians, registered dietitians, and feeding therapists (speech-language pathologists, occupational and physical therapists)...
July 2016: MCN. the American Journal of Maternal Child Nursing
Charles A James, Leah E Braswell, Amir H Pezeshkmehr, Paula K Roberson, James A Parks, Mary B Moore
BACKGROUND: Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay. OBJECTIVE: To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. MATERIALS AND METHODS: We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children's hospital...
October 5, 2016: Pediatric Radiology
Marcio Leyser, Bruno Leonardo Dias, Ana Luiza Coelho, Marcio Vasconcelos, Osvaldo J M Nascimento
BACKGROUND: Autism Spectrum Disorders (ASD) now encompass a broad heterogeneous group of people who present in the early developmental years with a wide range of social and communication deficits, which are typically also associated with complex repetitive behaviors and circumscribed interests. The target goal is to heighten readers' perception into the trend to personalize the distinct autistic and related developmental conditions encompassing the 12p region. CASE PRESENTATION: This is a case-report of a 4-year-old male who presented the core signs of ASD, which were thought to be related to a rare 12p13...
2016: Molecular Cytogenetics
Narelle Borrott, Sharon Kinney, Fiona Newall, Allison Williams, Noel Cranswick, Ian Wong, Elizabeth Manias
AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital...
October 5, 2016: Journal of Clinical Nursing
Kelsey Merison, Howard Jacobs
While the diagnosis of migraine in children is generally straightforward, treatment can seem complex with a number of medication choices, many of which are used "off label." Patients with intermittent migraines can often be managed with ibuprofen or naproxen taken as needed. Unfortunately, by the time that children present to our practice, they have often tried these medications without improvement. Triptans are frequently prescribed to these patients with good success. It is important to make the patient aware of the possible associated serotonergic reactions...
November 2016: Current Treatment Options in Neurology
Ayman E Eskander, Nevine R El Baroudy, Amira S El Refay
BACKGROUND: Moderate sedation for gastrointestinal endoscopy has traditionally been provided by the endoscopist. Controversy has ensued over safe and efficient sedation practice as endoscopy has increased in numbers and complexity. AIM: To evaluate the safety of ketamine sedation given by non-anesthesiologist during gastrointestinal endoscopy in children. METHODS: A prospective study of 100 paediatric patients with gastrointestinal symptoms who were a candidate for upper or lower gastrointestinal endoscopy in paediatric endoscopy unit at Abo El-Reesh Paediatric Hospital, Cairo University...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Antonio Trabacca, Teresa Vespino, Antonella Di Liddo, Luigi Russo
Cerebral palsy (CP) is one of the most frequent causes of child disability in developed countries. Children with CP need lifelong assistance and care. The current prevalence of CP in industrialized countries ranges from 1.5 to 2.5 per 1,000 live births, with one new case every 500 live births. Children with CP have an almost normal life expectancy and mortality is very low. Despite the low mortality rate, 5%-10% of them die during childhood, especially when the severe motor disability is comorbid with epilepsy and severe intellectual disability...
2016: Journal of Multidisciplinary Healthcare
Nabeel Al-Yateem, Charles Docherty, Maria Brenner, Jameela Alhosany, Hanan Altawil, Muna Al-Tamimi
School nurses are challenged with more children having complex conditions, who are now surviving into school age. This is paralleled by a shift in focus of health systems toward primary care, and national efforts to develop the health-care services, especially those offered to vulnerable populations. Being at the forefront of this change, school nurses in United Arab Emirates (UAE) are finding themselves under pressure to adapt to and facilitate these changes both by improving their practice and by contributing to its underpinning evidence...
October 2, 2016: Journal of School Nursing: the Official Publication of the National Association of School Nurses
Domnita O Badarau, Eva De Clercq, Tenzin Wangmo, Monica Dragomir, Ingrid Miron, Thomas Kühne, Bernice S Elger
Communication about diagnosis and medical treatment for children suffering from life-threatening illnesses is complex. It is a primary step in involving underage patients and families in care and lays the foundation for obtaining parental permission and patient assent for treatment. In practice child participation in care is often difficult to obtain due to patients' different and sometimes fluctuating preferences, but also parents' protective strategies. Physicians may be susceptible to parental wishes to limit information and feel uncomfortable discussing issues related to uncertainty of cure with patients...
October 3, 2016: Journal of Medical Ethics
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