#Pediatricintegrativemedicine: hashtag#pediatrics' newest hashtag#subspecialty?

Background Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. Methods Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. Results Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income PS: https://rdcu.be/bKFWL

#Antimicrobial stewardship in hashtag#pediatrics: focusing on the challenges hashtag#clinicians face

Background Antimicrobial use is very common in hospitalized children. An assessment of clinician’s prevailing knowledge and clinical approach to prescribing antimicrobials is helpful in order to develop the best strategies for successful stewardship programs. The objectives of the study were to determine fundamental knowledge of principles, approach to antimicrobial use through the clinical vignettes and to identify perceived challenges in decreasing antimicrobial use. Methods A questionnaire was developed by subject matter experts and pretested to ensure validity. Using a cross-sectional prospective design, the questionnaire was completed anonymously by staff and trainee physicians at a single tertiary care pediatric hospital between late November 2011 and February 2012. Results Of 159 eligible physicians, 86 (54.1%) responded, of which 77 (46 staff and 31 trainees) reported regularly prescribing antimicrobials. The majority of physicians had modest knowledge of factors that would increase risk of resistance however, less than 20% had correct knowledge of local resistance patterns for common bacteria. Almost half of physicians correctly answered the clinical vignettes. Over half of trainees and one third of staff relied most on online manuals for information regarding antimicrobials to assist prescription decision-making. Overall, physicians perceived that discontinuing empiric antimicrobials was the most difficult to achieve to decrease antibiotic use. PS: https://lnkd.in/fZMjE7Y

Hypnosis in pediatrics: applications at a pediatric pulmonary center

Hypnosis in hashtag#pediatrics: applications at a hashtag#pediatricpulmonary center
Background This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period. Methods Hypnotherapy was offered to 303 patients from May 1, 1998 – October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients' subjective evaluations. Results Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients' symptoms worsened and no new symptoms emerged following hypnotherapy
PS: https://lnkd.in/fmeHYm2

A prognostic analysis of pediatrics central nervous system small cell tumors: evaluation of EGFR family gene amplification and overexpression

A prognostic hashtag#analysis of hashtag#pediatrics hashtag#centralnervoussystem small hashtag#celltumors: evaluation of EGFR family hashtag#gene amplification and overexpression PS: https://rdcu.be/bKFW4

Biennial Scientific Meeting of the Asia Pacific Paediatric Endocrine Society (APPES) and the 50th Annual Meeting of the Japanese Society for Pediatric Endocrinology (JSPE)

PS: https://ijpeonline.biomedcentral.com/articles/10.1186/s13633-017-0054-x

Accessibility of pediatric inpatient services in Japan

In Japan, all citizens are covered by the national insurance system. Children’s medical expenses are subsidized by local government co-payments. This removed most economic barriers to visiting medical facilities, geographical obstacles to pediatric medical services remain, including distance to medical facilities and transportation time. However, information on geographic accessibility of pediatric inpatient services is scarce. In this study, I calculated the proportion of children resident in areas accessible to pediatric inpatient service providers within 30 and 60 minutes by automobile. Calculations were based on addresses of hospitals that met criteria for high reimbursement for secondary and tertiary pediatric inpatient services, data for residential blocks, and data for the average velocity of an automobile. In total, 88.0% of children lived within 30 minutes of these hospitals and 95.2% of children lived within 60 minutes. The percentage of children with such access was higher in regions with high population density (e.g., Kanto and Kinki) compared with regions with low population density (e.g., Hokkaido, Tohoku, and Shikoku). Furthermore, regions with high population density also had high rates of children that lived within reach of hospitals with at least five full-time pediatricians.

Defining pediatric polypharmacy: A scoping review

Objectives

Lack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy.

Methods

Medline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of “polypharmacy” and “children”. Data were extracted about study characteristics, polypharmacy terms and definitions from qualifying studies, and were synthesized by disease conditions.

Results

Out of 4,398 titles, we included 363 studies: 324 (89%) provided numeric definitions, 131 (36%) specified duration of polypharmacy, and 162 (45%) explicitly defined it. Over 81% (n = 295) of the studies defined polypharmacy as two or more medications or therapeutic classes. The most common comprehensive definitions of pediatric polypharmacy included: two or more concurrent medications for ≥1 day (n = 41), two or more concurrent medications for ≥31 days (n = 15), and two or more sequential medications over one year (n = 12). Commonly used terms included polypharmacy, polytherapy, combination pharmacotherapy, average number, and concomitant medications. The term polypharmacy was more common in psychiatry literature while epilepsy literature favored the term polytherapy.

Pediatric AIDS in the Elimination Agenda

The Global Plan for Elimination of Pediatric HIV

In 2011, Ambassador Eric Goosby of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and Michel Sidibe, Executive Director of Joint United Nations Programme on HIV and AIDS (UNAIDS), formally announced a plan for eliminating new HIV infections in children and keeping their mothers alive [1]. The elimination of pediatric HIV agenda, or the Global Plan, calls for decreasing new pediatric infections by 90% and halving maternal deaths from HIV and AIDS by 2015 [1]. This newest call to action strengthens previous global commitments to reduce the number of vertical HIV infections with concomitant decreases in mortality from HIV and AIDS and mortality in children under age 5 [2]. While high-level rhetoric is necessary to mobilize resources, the strategy to end mother-to-child transmission of HIV (eMTCT) has thus far focused primarily on the expansion of prevention of mother-to-child transmission (PMTCT) [1]–[3] with little attention focused on infected children or those missed by current programming. This strategy places at risk a whole generation of children who despite our best efforts are missed by current PMTCT programming and continue to become infected with HIV.

Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

Abstract

Background

There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia.

Methods

Using an established database, a retrospective cohort study was conducted of children aged 0–15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records.

Results

Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23–0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05–2.58).

Simulation and debriefing in neonatology 2016: Mission incomplete

Abstract
Simulation can be an effective tool to facilitate the acquisition and maintenance of the cognitive, technical and behavioral skills necessary to carry out our mission in neonatology: the delivery of safe, effective and efficient care to our patients. Prominent examples of successful implementation of simulation within neonatology include the Neonatal Resuscitation Program, the International Pediatric Simulation Society, and the International Network for Simulation-Based Pediatric Innovation, Research and Education. Despite these successes much remains to be accomplished. Expanding simulation beyond technical skill acquisition, using simulated environments to conduct research into human and system performance, incorporating simulation into high-stakes skill assessments, embracing the expertise of the more extensive modeling and simulation community and, in general, applying simulation to healthcare with the same degree of gravitas with which it is deployed in other high-risk industries are all tasks that must be completed in order to achieve our mission.

Caffeine citrate – Is it a silver bullet in neonatology?

Caffeine citrate is one of the most prescribed drug in the present day NICU for apnea. Its efficacy, tolerability, wide therapeutic index and safety margin has made it the drug of choice among the methylxanthines. Its therapeutic uses in apnea of prematurity, mechanical ventilation, bronchopulmonary dysplasia has made it a “silver bullet” in neonatology. However, there are still controversies surrounding this drug. This review is aimed to update the reader about the basic pharmacology, current therapeutic uses, adverse effects, controversies as well as present and future research of caffeine.

How to find and how to read articles in neonatology

Summary

Staying abreast of the neonatal literature is an important task. Being aware of new information and knowing how to evaluate its reliability remain essential to be able to provide the most appropriate, evidence-based, therapy to our patients. This article discusses methods for being informed of, and critically reviewing, published research in order to fulfill these tasks without being overwhelmed by the number or complexity of publications

Neonatology faculty development using simulation

Abstract

The goal of faculty development activities is to supply the public with knowledgeable, skilled, and competent physicians who are prepared for high performance in the dynamic and complex healthcare environment. Current faculty development programs lack evidence-based support and are not sufficient to meet the professional needs of practicing physicians. Simulation activities for faculty development offer an alternative to traditional, teacher-centric educational offerings. Grounded in adult learning theory, simulation is a learner-centric, interactive, efficient, and effective method to train busy professionals. Many of the faculty development needs of clinical neonatologists can be met by participating in simulation-based activities that focus on technical skills, teamwork, leadership, communication, and patient safety.

Approaches in rare diseases and pediatrics across international boundaries

Rare diseases are designated as affecting less than 200,000 individuals (US) and of the approximately 7000 designated rare diseases, the majority of these occur in pediatric patients, and across international boundaries. An example is pediatric ARDS (Acute Respiratory Distress Syndrome) which is not diagnosed until a previously healthy child presents in the pICU with severe symptoms and in which more children die each year than from cystic fibrosis and leukemia, combined. The Nathaniel Adamczyk Foundation (NAF) is focused on identifying risk factors and opportunities for prevention of this devastating disease. Boththe diagnosis and patient management are challenged by having to deal with a syndrome in a critical care situation in a heterogeneous patient population.

NAF has undertaken the development of an (inter) national tissue and data repository to support both clinical research and enhanced clinical decision support for patient management. Creation of an analytical platform to integrate, access and analyze temporal clinical data ranging from the pICU to also incorporate neo-natal ICU and pregnancy history is underway with a prototype already in testing. Analytical methods are being evaluated in collaboration with Dr. Mike Quasney (Medical College of Wisconsin) and the Virtual Pediatric ICU and PALISI (Pediatric Acute Lung Injury and Sepsis Investigators). This effort is exploring expanded international partnerships in both Europe and China to increase the accessible data for analysis and to further participate in the development of better diagnostic standards.

We will present the initial state of both the analytics and platform development to encourage extension of this international effort to interested clinicians and clinical researchers. We believe that this unique approach, which focuses first on addressing the critical need to improve patient management through disease stratification, will not only benefit pARDS but be extensible to many other pediatric rare disorders.

Potency of integrating three-dimensional cardiac magnetic resonance imaging into electroanatomic mapping to perform catheter ablation in pediatrics

PS: https://rdcu.be/bJduh

Epidemiology of sepsis in #pediatrics: first #Colombian multicenter pilot survey

Epidemiology of sepsis in #pediatrics: first #Colombian multicenter pilot survey

PS: https://rdcu.be/bJdus

Isolated #enophthalmos: an uncommon gateway to orbital #tumorsin #pediatrics: 9 month-old female presenting with isolated enophthalmos as the unique sign of a metastatic orbital #tumor: a case report

Isolated #enophthalmos: an uncommon gateway to orbital #tumorsin #pediatrics: 9 month-old female presenting with isolated enophthalmos as the unique sign of a metastatic orbital #tumor: a case report

PS: https://rdcu.be/bJdux