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https://www.readbyqxmd.com/read/28918202/implementation-of-a-risk-stratified-opioid-weaning-protocol-in-a-pediatric-intensive-care-unit
#1
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/28911874/childhood-adversity-predicts-reduced-physiological-flexibility-during-the-processing-of-negative-affect-among-adolescents-with-major-depression-histories
#2
Shimrit Daches, Maria Kovacs, Charles George, Ilya Yaroslavsky, Eniko Kiss, Agnes Vetro, Roberta Dochnal, István Benak, Ildikó Baji, Kitti Halas, Attila Makai, Krisztina Kapornai, Jonathan Rottenberg
BACKGROUND: Adversity during early development has been shown to have enduring negative physiological consequences. In turn, atypical physiological functioning has been associated with maladaptive processing of negative affect, including its regulation. The present study therefore explored whether exposure to adverse life events in childhood predicted maladaptive (less flexible) parasympathetic nervous system functioning during the processing of negative affect among adolescents with depression histories...
September 11, 2017: International Journal of Psychophysiology
https://www.readbyqxmd.com/read/28891099/opioid-and-benzodiazepine-weaning-in-pediatric-patients-review-of-current-literature
#3
Norman E Fenn, Kimberly S Plake
Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly employ a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purpose of this review is to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28887267/patterns-and-outcomes-of-care-in-children-with-advanced-heart-disease-receiving-palliative-care-consultation
#4
Katherine L Marcus, Emily M Balkin, Hasan Al-Sayegh, Elyssa Guslits, Elizabeth D Blume, Clement Ma, Joanne Wolfe
CONTEXT: While access to subspecialty pediatric palliative care (PPC) is increasing, little is known about the role of PPC for children with advanced heart disease (AHD). OBJECTIVES: To examine features of subspecialty PPC involvement for children with AHD. METHODS: Retrospective single-institution medical record review of patients with a primary diagnosis of AHD for whom the PPC team was initially consulted between 2011 and 2016. RESULTS: Among 201 patients, 87% had congenital/structural heart disease, the remainder having acquired/non-structural heart disease...
September 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28866754/opioid-associated-iatrogenic-withdrawal-in-critically-ill-adult-patients-a-multicenter-prospective-observational-study
#5
Pan Pan Wang, Elaine Huang, Xue Feng, Charles-André Bray, Marc M Perreault, Philippe Rico, Patrick Bellemare, Paul Murgoi, Céline Gélinas, Annie Lecavalier, Dev Jayaraman, Anne Julie Frenette, David Williamson
BACKGROUND: Opioids and benzodiazepines are frequently used in the intensive care unit (ICU). Regular use and prolonged exposure to opioids in ICU patients followed by abrupt tapering or cessation may lead to iatrogenic withdrawal syndrome (IWS). IWS is well described in pediatrics, but no prospective study has evaluated this syndrome in adult ICU patients. The objective of this study was to determine the incidence of IWS caused by opioids in a critically ill adult population. This multicenter prospective cohort study was conducted at two level-1 trauma ICUs between February 2015 and September 2015 and included 54 critically ill patients...
September 2, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28841275/neuropsychiatric-manifestations-of-pediatric-nmda-receptor-autoimmune-encephalitis-a-case-series-from-a-tertiary-care-center-in-india
#6
Salah Basheer, Madhu Nagappa, Anita Mahadevan, Parayil Sankaran Bindu, Arun B Taly, Satish Chandra Girimaji
Objective: Although psychiatric manifestations are one of the most common presentations of pediatric N-methyl-D-aspartate receptor (NMDAR) encephalitis, there is a lack of studies that characterize psychiatric aspects of this disorder. This study was designed to address this gap. Methods: Initial clinical presentations including psychiatric symptoms, treatment details, and outcome with respect to psychiatric symptoms were collected from medical case records of children aged less than 18 years with seropositive NMDAR encephalitis from a single tertiary care center (May 2010-November 2016)...
August 17, 2017: Primary Care Companion to CNS Disorders
https://www.readbyqxmd.com/read/28831924/management-of-antiepileptic-treatment-after-epilepsy-surgery-practices-and-problems
#7
Guido Rubboli, Anne Sabers, Peter Uldall, Kristina Malmgren
BACKGROUND: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic controlled trials have been specifically conducted so far and no consensus or standardized guidelines regarding postsurgical drug discontinuation policy and procedures are available. METHODS: In this paper, we aim to provide an updated overview on the the present knowledge on this topic, which is based mainly on retrospective studies reporting practices used in individual centers...
August 22, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28818584/-neonatal-intoxication-to-vitamin-d-in-premature-babies-a-series-of-16%C3%A2-cases
#8
M Vierge, S Laborie, A Bertholet-Thomas, M-C Carlier, J-C Picaud, O Claris, J Bacchetta
INTRODUCTION: Preterm neonates are particularly at risk of vitamin D (25-D) deficiency. To prevent rickets and osteopenia in this population, international guidelines vary between 800 and 1000IU per day of vitamin D in Europe and recommend 400IU per day in the USA. Target levels of circulating 25-D are not well identified, with the lower target level 50-75nmol/L and the upper target level probably 120nmol/L. METHODS: Between 2013 and 2015, 16 premature infants (born<35WG) were referred to pediatric nephrology clinics because of symptoms secondary to 25-D overdose during the neonatal period...
August 14, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28817499/nurse-practitioner-lead-pediatric-baclofen-pump-program-impact-on-safety-and-quality-of-care
#9
Kristin Buxton, Ann Morgan, Jayne Rogers
Children with cerebral palsy experience spasticity that can be debilitating and cause significant pain and contractures. Intrathecal baclofen (ITB) therapy can help relieve this spasticity and improve the quality of life for these patients, but it comes with risk. Withdrawal from the medication in case of abrupt discontinuation of delivery can be life-threatening. Regular maintenance of the system is mandatory. Having a program in place to manage the device and support patients helps to ensure their safety...
August 16, 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28815713/clinical-winnicott-traveling-a-revolutionary-road
#10
Vincenzo Bonaminio
The author contends that, contrary to the usual perception that Winnicott followed a linear progression "through pediatrics to psychoanalysis," Winnicott's vision was always a psychoanalytic one, even during his early pediatric work. His place in the development of psychoanalytic theory is highlighted, and the author discusses such key Winnicottian concepts as transitional space, the false self, and the use of the object. Winnicott's unique approach to the form and value of analytic interpretation is particularly emphasized, and his thoughts on the treatment of depression are also addressed, as well as his distinction between regression and withdrawal...
July 2017: Psychoanalytic Quarterly
https://www.readbyqxmd.com/read/28797539/risk-factors-for-poor-prognosis-in-children-with-refractory-purulent-meningitis-and-the-discharge-criteria
#11
Hai-Lun Peng, Yue Hu, Hong-Jia Chen, Pan-Pan Song, Li Jiang
This study was undertaken to investigate the relationship between cerebrospinal fluid abnormalities and prognosis in pediatric refractory purulent meningitis. Ninety cases of pediatric refractory purulent meningitis were stratified into "good" (n=33) or "poor" (n=57) prognosis groups according to the Glasgow clinical outcome scores. The symptoms, laboratory results, and prognosis were compared by using univariate and multivariate logistic regression analyses. Univariate analysis showed that poor prognosis was associated with: unequal pupil size in both eyes; positive Babinski sign; CSF-WBC >500×10(6)/L, CSF protein concentration >1...
August 7, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28793780/iatrogenic-opioid-withdrawal-in-critically-ill-patients-a-review-of-assessment-tools-and-management
#12
Ada W Chiu, Sofia Contreras, Sangeeta Mehta, Jennifer Korman, Marc M Perreault, David R Williamson, Lisa D Burry
OBJECTIVE: To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. DATA SOURCES: We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management...
August 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28790849/immunotargeting-relapsed-or-refractory-precursor-b-cell-acute-lymphoblastic-leukemia-role-of-blinatumomab
#13
REVIEW
Manon Queudeville, Rupert Handgretinger, Martin Ebinger
Patients with refractory or relapsed (R/R) acute lymphoblastic leukemia (ALL) have a dismal prognosis of around 5% long-term survival when treated with cytotoxic chemotherapy and allogenic stem cell transplantation. T-cell immunobased strategies open up new therapeutic perspectives. Blinatumomab is the first of a new class of antibody constructs that was labeled bispecific T-cell engager (BiTE): it consists of two single chain variable fragment connected with a flexible linker, one side binding CD3, the other CD19...
2017: OncoTargets and Therapy
https://www.readbyqxmd.com/read/28780657/combination-therapy-of-rituximab-and-mycophenolate-mofetil-in-childhood-lupus-nephritis
#14
Julien Hogan, Astrid Godron, Véronique Baudouin, Theresa Kwon, Jérôme Harambat, Georges Deschênes, Olivier Niel
BACKGROUND: In clinical trials, the addition of rituximab (RTX) to the combination therapeutic regimen of mycophenolate mofetil (MMF) and corticosteroids failed to improve outcome in lupus nephritis (LN). However, recent data suggest that RTX may have steroid-sparing beneficial effects with an efficacy similar to that of conventional regimens. We report our experience with RTX in the treatment of children with LN. METHODS: Patients treated with RTX for first occurrence of LN class III to V were enrolled in the study...
August 5, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28753044/severe-bark-scorpion-envenomation-in-adults
#15
Ayrn D O'Connor, Angela Padilla-Jones, Anne-Michelle Ruha
INTRODUCTION: The preponderance of medical literature regarding severe bark scorpion envenomation describes pediatric patients; however, the majority (>66%) of annual poison center calls pertain to adults. This retrospective review sought to evaluate the clinical manifestations of adults with severe Centruroides sculpturatus envenomation and determine if significant morbidity occurred. METHODS: This is a retrospective review of adults presenting to a single tertiary referral center with Grade-III or Grade-IV scorpion envenomation from 1 January 2007 to 3 March 2013...
July 28, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28744628/infection-related-hospitalizations-after-kidney-transplantation-in-children-incidence-risk-factors-and-cost
#16
Julien Hogan, Christine Pietrement, Anne-Laure Sellier-Leclerc, Ferielle Louillet, Rémi Salomon, Marie-Alice Macher, Etienne Berard, Cécile Couchoud
BACKGROUND: Infection is the leading cause of death and hospitalization in renal transplant recipients. We describe posttransplant infections requiring hospitalization, their risk factors and cost in a national pediatric kidney transplantation cohort. METHODS: Data on renal transplant recipients <20 years were extracted from the French National Medicoadministrative Hospital Discharge database between 2008 and 2013 and matched with the Renal Transplant Database...
July 25, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28731649/opinions-of-members-of-the-national-civil-family-proceedings-and-criminal-courts-in-withholding-or-withdrawing-of-life-support-situations-in-pediatrics
#17
Jorge O Selandari, María S Ciruzzi, Adriel J Roitman, Fernanda Ledesma, Célica Menéndez, Hernán O García
INTRODUCTION: The possibility of sustaining life functions makes it difficult to distinguish between a dying patient and a patient with chances of survival, raising a dilemma for everyone around them. On the one side, continuing with life support techniques that would only extend an irreversible process and result in physical and psychological damage and harm their dignity. On the other side, withholding or withdrawing life support without an adequate reflection and diagnostic-therapeutic effort which may lead to the death of a potentially recoverable child...
August 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28722694/early-life-vincristine-exposure-evokes-mechanical-pain-hypersensitivity-in-the-developing-rat
#18
Katie A Schappacher, Lauren Styczynski, Mark L Baccei
Vincristine (VNC) is commonly used to treat pediatric cancers, including the most prevalent childhood malignancy, acute lymphoblastic leukemia. Although clinical evidence suggests that VNC causes peripheral neuropathy in children, the degree to which pediatric chemotherapeutic regimens influence pain sensitivity throughout life remains unclear, in part because of the lack of an established animal model of chemotherapy-induced neuropathic pain during early life. Therefore, this study investigated the effects of VNC exposure between postnatal days (P) 11 and 21 on mechanical and thermal pain sensitivity in the developing rat...
May 30, 2017: Pain
https://www.readbyqxmd.com/read/28688548/eeg-activity-as-an-objective-measure-of-cognitive-load-during-effortful-listening-a-study-on-pediatric-subjects-with-bilateral-asymmetric-sensorineural-hearing-loss
#19
Pasquale Marsella, Alessandro Scorpecci, Giulia Cartocci, Sara Giannantonio, Anton Giulio Maglione, Isotta Venuti, Ambra Brizi, Fabio Babiloni
OBJECTIVES: Deaf subjects with hearing aids or cochlear implants generally find it challenging to understand speech in noisy environments where a great deal of listening effort and cognitive load are invested. In prelingually deaf children, such difficulties may have detrimental consequences on the learning process and, later in life, on academic performance. Despite the importance of such a topic, currently, there is no validated test for the assessment of cognitive load during audiological tasks...
August 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28655785/a-small-molecule-inhibitor-of-wee1-azd1775-synergizes-with-olaparib-by-impairing-homologous-recombination-and-enhancing-dna-damage-and-apoptosis-in-acute-leukemia
#20
Tamara B Garcia, Jonathan C Snedeker, Dmitry Baturin, Lori Gardner, Susan P Fosmire, Chengjing Zhou, Craig T Jordan, Sujatha Venkataraman, Rajeev Vibhakar, Christopher C Porter
Although some patients with acute leukemia have good prognoses, the prognosis of adult and pediatric patients who relapse or cannot tolerate standard chemotherapy is poor. Inhibition of WEE1 with AZD1775 has been shown to sensitize cancer cells to genotoxic chemotherapies including cytarabine in AML and T-ALL. Inhibition of WEE1 impairs homologous recombination by indirectly inhibiting BRCA2. Thus, we sought to determine if AZD1775 could sensitize cells to the PARP1/2 inhibitor olaparib. We found that combined treatment with AZD1775 and olaparib was synergistic in AML and ALL cells, and this combination impaired proliferative capacity upon drug withdrawal...
June 27, 2017: Molecular Cancer Therapeutics
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