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Guideline pediatric emergency

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https://www.readbyqxmd.com/read/28813753/pre-guideline-trends-associated-with-chest-radiograph-usage-for-pediatric-community-acquired-pneumonia-in-emergency-department-settings
#1
Eric W Jones, Benjamin Meyer, Aaron M Berg, Benson S Hsu
BACKGROUND: Health care spending in the U.S. totaled $3 trillion in 2014 and continues to increase rapidly. Minimizing waste through clinical guidelines is a promising strategy to reduce spending without compromising patient care. In 2011, clinical guidelines recommended against the use of chest X-ray (CXR) for diagnosis of community-acquired pneumonia (CAP) in pediatric ambulatory settings. However, use of CXR has not changed post-guideline. Thus, understanding the drivers of CXR utilization prior to guideline implementation could improve guideline adherence...
May 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28807611/initial-treatment-for-nonsyndromic-early-life-epilepsy-an-unexpected-consensus
#2
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/28781150/2016-guidelines-for-the-use-of-antifungal-agents-in-patients-with-invasive-fungal-diseases-in-taiwan
#3
REVIEW
Hsiang-Chi Kung, Po-Yen Huang, Wei-Ting Chen, Bor-Sheng Ko, Yee-Chun Chen, Shan-Chwen Chang, Yin-Ching Chuang
The Infectious Diseases Society of Taiwan, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines have updated the guidelines for the use of antifungal agents in adult patients with invasive fungal diseases in Taiwan. This guideline replaces the 2009 version. Recommendations are provided for Candida, Cryptococcus, Aspergillus and Mucormycetes. The focus is based on up-to-date evidence on indications for treatment or prophylaxis of the most common clinical problems...
July 25, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28774767/variation-in-the-evaluation-of-testicular-conditions-across-united-states-pediatric-emergency-departments
#4
Lois K Lee, Michael C Monuteaux, Joel D Hudgins, John J Porter, Susan C Lipsett, Florence Bourgeois, Bartley G Cilento, Mark I Neuman
OBJECTIVES: To explore the variation in diagnostic testing and management for males diagnosed with three testicular conditions (testicular torsion, appendix testis torsion, epididymitis/orchitis) using a large pediatric health care database. Diagnostic testing is frequently used in evaluation of the acute scrotum; however, there is likely variability in the use of these tests in the emergency department setting. METHODS: We conducted a cross-sectional study of males with the diagnoses of testicular torsion, appendix testis torsion, and epididymitis/orchitis...
July 26, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28763405/suspected-pediatric-influenza-risk-stratification-algorithm-a-clinical-decision-tool
#5
Patrick D Evers, Michelle Starr, Michael J McNeil, Laura OʼNeill, Andrea Posa, Timothy Savage, Russell Migita
BACKGROUND AND OBJECTIVES: Influenza causes significant annual burden among children. Current guidelines recommend empiric treatment for a broadly defined group of children at high risk for influenza complications, resulting in overtreatment or costly viral testing. This study creates an algorithm for clinicians to risk stratify children with influenza-like illness (ILI) according to likelihood of influenza infection. METHODS: A retrospective analysis was performed on 818 children seen in the emergency department from November 2012 to April 2013 for ILI...
August 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28754601/magnesium-sulfate-infusion-for-acute-asthma-in-the-emergency-department
#6
REVIEW
Jose Enrique Irazuzta, Nicolas Chiriboga
OBJECTIVES: To describe the role of intravenous magnesium sulfate (MgSO4) as therapy for acute severe asthma in the pediatric emergency department (ED). SOURCE: Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma...
July 26, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28751095/a-comprehensive-review-of-immunization-practices-in-solid-organ-transplant-and-hematopoietic-stem-cell-transplant-recipients
#7
REVIEW
Pearlie P Chong, Robin K Avery
BACKGROUND: Vaccine-preventable diseases, especially influenza, varicella, herpes zoster, and invasive pneumococcal infections, continue to lead to significant morbidity and mortality in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. METHODS: We highlight guideline recommendations for the use of key vaccines in SOT and HSCT recipients and to review the latest evidence and developments in the field. RESULTS: Physicians should vaccinate individuals with end-stage organ disease, as vaccine seroresponse rates are higher pretransplantation...
July 24, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28747930/parental-involvement-and-child-and-adolescent-eating-disorders-perspectives-from-residents-in-psychiatry-pediatrics-and-family-medicine
#8
Tamara Davidson Marcon, Laura Girz, Amanda Stillar, Carole Tessier, Adele Lafrance
OBJECTIVES: Best practice guidelines encourage the involvement of parents in the assessment and treatment of child/adolescent eating disorders (ED). This study investigated medical residents' perspectives regarding parental involvement as well as their expectations for future practice in the assessment and treatment of ED. METHOD: Five hundred and eighty-four medical residents from 17 Canadian residency programs specializing in family medicine, pediatrics, and psychiatry completed a web-based survey...
July 2017: Journal of the Canadian Academy of Child and Adolescent Psychiatry
https://www.readbyqxmd.com/read/28745853/pneumothorax-in-pediatric-patients-management-strategies-to-improve-patient-outcomes-digest
#9
Matthew Harris, Joshua Rocker, Kathryn H Pade
The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base...
March 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28735118/giant-meckel-s-diverticulum-compressing-root-of-mesentery-a-rare-cause-of-ileal-gangrene-case-report-and-review-of-literature
#10
Mohammed Farooq, Aashish Rajesh
INTRODUCTION: Meckel's diverticulum (MD) commonly presents as gastrointestinal bleeding in the pediatric population and intestinal obstruction in adults. There is no consensus for surgical excision of an incidentally diagnosed MD. We present a hitherto unreported vascular cause of intestinal gangrene due to MD. CASE PRESENTATION: A 16year old boy was referred as an acute abdomen for tertiary hospital management. Clinical examination and CT suggested small bowel obstruction and emergency laparotomy was performed...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28734656/patterns-of-emergency-department-care-for-newly-diagnosed-immune-thrombocytopenia-in-united-states-children-s-hospitals
#11
LaQuita Jones, Terah Koch, Joseph Stanek, Sarah H O'Brien
We used the Pediatric Health Information Systems database to ascertain treatment patterns of immune thrombocytopenia across the US. Despite the recently published guidelines by the American Society of Hematology, most patients are still being hospitalized for immune thrombocytopenia, even in the absence of documented bleeding symptoms.
July 19, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28729186/-tuberculosis-treatment-for-children-an-update
#12
María José Mellado Peña, Begoña Santiago García, Fernando Baquero-Artigao, David Moreno Pérez, Roi Piñeiro Pérez, Ana Méndez Echevarría, José Tomás Ramos Amador, David Gómez-Pastrana Durán, Antoni Noguera Julian
Tuberculosis (TB) is the most important infectious disease all over the world, with a high morbidity and mortality. Pediatric tuberculosis has been a neglected epidemic, due to the difficulties in assessing its global impact, reduced incidence and lower infectivity compared to adults. In 2015, the WHO reported 1 million cases of paediatric TB and 169,000 deaths. In Europe, the emergence of MDR TB is a major concern, representing 16% of the new diagnosis in Eastern Europe. In 2014, it was estimated that about 219,000 children were infected by MDR-TB-strains in Europe, and 2,120 developed the disease...
July 17, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28719479/a-simulation-based-quality-improvement-initiative-improves-pediatric-readiness-in-community-hospitals
#13
Travis Whitfill, Marcie Gawel, Marc Auerbach
BACKGROUND: The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100)...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28708813/application-and-interpretation-of-histocompatibility-data-in-liver-transplantation
#14
Russell N Wesson, Eric W Etchill, Jacqueline Garonzik-Wang
PURPOSE OF REVIEW: There has been a resurgence of interest in histocompatibility as it applies to liver transplantation. The association of persistent and de-novo donor specific antibody (DSA) and outcomes after liver transplantation continues to be investigated. RECENT FINDINGS: Consensus continues to evolve regarding the existence of acute and chronic antibody-mediated rejection (AMR) and pathogenicity of DSA and associated pathologic findings after liver transplantation...
July 13, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28701360/multicentre-randomised-clinical-trial-of-paediatric-concussion-assessment-of-rest-and-exertion-pedcare-a-study-to-determine-when-to-resume-physical-activities-following-concussion-in-children
#15
Andrée-Anne Ledoux, Nicholas J Barrowman, Kathy Boutis, Adrienne Davis, Sarah Reid, Gurinder Sangha, Ken J Farion, Kevin Belanger, Mark S Tremblay, Keith Owen Yeates, Carol DeMatteo, Nick Reed, Roger Zemek
INTRODUCTION: Rest until symptom-free, followed by a progressive stepwise return to activities, is often prescribed in the management of paediatric concussions. Recent evidence suggests prolonged rest may hinder recovery, and early resumption of physical activity may be associated with more rapid recovery postconcussion. The primary objective is to determine whether the early reintroduction of non-contact physical activity beginning 72 hours postinjury reduces postconcussive symptoms at 2 weeks in children following an acute concussion as compared with a rest until asymptomatic protocol...
July 12, 2017: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/28697268/the-cost-of-hospital-admission-brief-resolved-unexplained-events
#16
Justin Triemstra
The modern health care system continues to expand at a meteoric rate with ever-increasing technological advancements. However, with these advancements come unsustainably rising costs and occasionally unintended, avoidable harm. In this article, we use a brief resolved unexplained event (BRUE) to illustrate how recent guidelines can help physicians practice value in this modern health care system. A BRUE is a common pediatric problem that is seen in ambulatory and emergency department settings. Infants presenting with a BRUE can be separated into low- and high-risk groups per recent guidelines...
July 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28697266/less-is-more-evidence-based-management-of-bronchiolitis
#17
Elisa Hampton, Erika Abramson
Bronchiolitis is a common cause of outpatient visits and hospitalization in children younger than age 2 years. Despite the frequency with which pediatricians manage this diagnosis, there is significant variability in care in both the inpatient and outpatient setting. This may be due in part to changing guidelines set forth by leading pediatric organizations such as the American Academy of Pediatrics, as increasing evidence emerges that traditional therapies are not effective. This article reviews current evidence-based practices for diagnosis and treatment of bronchiolitis, and provides an overview of inpatient management...
July 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28697156/transitions-of-care-the-presence-of-written-interfacility-transfer-guidelines-and-agreements-for-pediatric-patients
#18
Andrea Lynn Genovesi, Lenora M Olson, Russell Telford, Diana Fendya, Ellen Schenk, Theresa Morrison-Quinata, Elizabeth A Edgerton
OBJECTIVE: Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28691958/guidelines-for-the-provision-and-assessment-of-nutrition-support-therapy-in-the-pediatric-critically-ill-patient-society-of-critical-care-medicine-and-american-society-for-parenteral-and-enteral-nutrition
#19
Nilesh M Mehta, Heather E Skillman, Sharon Y Irving, Jorge A Coss-Bu, Sarah Vermilyea, Elizabeth Anne Farrington, Liam McKeever, Amber M Hall, Praveen S Goday, Carol Braunschweig
This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance...
July 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28688998/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#20
Alain Cariou, Jean-Francois Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
July 5, 2017: Anaesthesia, Critical Care & Pain Medicine
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