Challenges and unique considerations of adolescents with chronic kidney disease
Chronic kidney disease (CKD) is an increasingly prevalent disease that burdens patients of all ages significantly. While much data have been gathered on adult and paediatric populations, there is a lack of data on the effects of CKD on young adults and adolescents. The aim of this review was to look at the prevalence and comorbidities of this patient population, considering the rapid biological growth and development during this time frame. We present this review to illustrate the need for further research into this special patient group.
Nikhil Nair
Saurav Prashant Kadatane
Rita Marie Yaacoub
Jazlyn M Sandhu
Shreeyans Bhavaraju
Rupesh Raina
Acta Paediatr
. 2023 Mar 13. doi: 10.1111/apa.16752.
2023
English
End of Life Therapeutic Videography in Pediatrics: Feasibility and Acceptability
Purpose: This study aimed to determine the feasibility and acceptability of using videography to alleviate the stress of anticipatory mourning in pediatric palliative care patients. A secondary aim was to expand palliative/end of life care research by performing a more comprehensive examination of children's experiences with life-shortening illness. Methods: Eligible patients ages eight and older made a legacy video with the assistance of investigative staff and completed a questionnaire to evaluate their emotional states before and after making the video. Bereaved parents also received a questionnaire to assess the impact of the legacy. Results: Nine patients enrolled and eight completed the study through the therapeutic exit interview. Most reported decreased anxiety and a positive experience. Conclusion: Therapeutic videography is feasible and acceptable to accomplish and can improve the emotional state of participants. Conducting research requiring active participation of patients very near the end of life proved to be challenging.
Cassandra D Hirsh
Daniel H Grossoehme
Haralambos Tsirambidis
Gwendolyn Richner
Sarah Friebert
Omega (Westport)
. 2022 Feb 1;302228211046793. doi: 10.1177/00302228211046793. Online ahead of print.
2022
English
Acute Tramadol Ingestion With Transient Acute Kidney Injury in an Adolescent Female.
Tramadol is a centrally acting synthetic analgesic medication with both opioid and non-opioid affects, and it inhibits the re-uptake inhibitor of norepinephrine and serotonin. It is hepatically metabolized via CYP2D6 to its active metabolite, O-desmethyltramadol, which has greater pharmacologic activity than the parent compound. Both are excreted in the urine. Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure, and/or mortality.1–3 We describe an adolescent who developed transient intrinsic renal injury, not associated with rhabdomyolysis, following an intentional overdose of tramadol.
Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure and/or mortality. Our patient was a 16-year-old female who was evaluated following an intentional tramadol ingestion, estimated 27.8 to 37 mg/kg, and had a seizure prior to arriving at our health care facility. Her symptoms were consistent with a tramadol ingestion; however, she developed transient acute renal impairment (peak serum creatinine, 4.04 mg/dL), which improved over 6 days with minimal intervention. No other causes were identified to explain her acute renal impairment thus it was attributed to the tramadol overdose. Providers should be aware that transient acute renal impairment could occur with an intentional tramadol ingestion and may not require aggressive intervention.
Mike TB; DeVault H; Blackford MG
Journal Of Pediatric Pharmacology & Therapeutics
2021
2021-05-19
Pediatric Pharmacy Association. All rights reserved.
Journal Article
<a href="https://doi.org/10.5863/1551-6776-26.4.411" target="_blank" rel="noreferrer noopener">https://doi.org/10.5863/1551-6776-26.4.411</a>
Acute Tramadol Ingestion With Transient Acute Kidney Injury in an Adolescent Female.
acute kidney injury; DRUG side effects; adolescent; tramadol; ACUTE kidney failure; case report; adverse drug effect; analgesics; drug overdose; RHABDOMYOLYSIS; STRIATED muscle necrosis; TRAMADOL
Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure and/or mortality. Our patient was a 16-year-old female who was evaluated following an intentional tramadol ingestion, estimated 27.8 to 37 mg/kg, and had a seizure prior to arriving at our health care facility. Her symptoms were consistent with a tramadol ingestion; however, she developed transient acute renal impairment (peak serum creatinine, 4.04 mg/dL), which improved over 6 days with minimal intervention. No other causes were identified to explain her acute renal impairment thus it was attributed to the tramadol overdose. Providers should be aware that transient acute renal impairment could occur with an intentional tramadol ingestion and may not require aggressive intervention. [ABSTRACT FROM AUTHOR]
Mike TB; DeVault H; Blackford MG
Journal Of Pediatric Pharmacology & Therapeutics
2021
2021-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.5863/1551-6776-26.4.411" target="_blank" rel="noreferrer noopener">10.5863/1551-6776-26.4.411</a>
Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.
Humans; Male; Female; Unnecessary Procedures; Infant; Adolescent; Child; Sensitivity and Specificity; Child Preschool; Retrospective Studies; Tomography X-Ray Computed; Observer Variation; Bronchoscopy; Bronchoscopy; Computed tomography; Foreign Bodies/diagnostic imaging/therapy; Foreign body aspiration; Respiratory System/diagnostic imaging
BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA
Journal of Pediatric Surgery
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jpedsurg.2019.09.045" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2019.09.045</a>
Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis.
Aged; Humans; Male; Adult; Female; Aged 80 and over; Middle Aged; Infant; Adolescent; Child; Emergency Medical Services; Young Adult; Child Preschool; Quality Improvement; Aircraft; Healthcare Failure Mode and Effect Analysis/methods; Triage/standards; Air Ambulances
OBJECTIVE: Overtriage (OT) of helicopter emergency medical services (HEMS) poses significant burden to multiple stakeholders. The project aims were to identify the following: 1) associated factors, 2) downstream effects, and 3) focus areas for change. METHODS: We undertook a failure mode and effects analysis (FMEA) to evaluate our HEMS interfacility transport process. Data were collected from organizational finances and 3 key stakeholder groups: 1) interfacility patients transferred by HEMS in 2017 who were discharged from the receiving facility within 24 hours (n = 149), 2) flight registered nurses (n = 19), and 3) referring emergency medicine providers (EMPs) (n = 30) from the top HEMS users of 2017. The completed FMEA identified failure modes, the frequency and severity of effects, and unique risk profile numbers (RPNs). RESULTS: Twelve failure modes were identified with 30 potential causes. Leading failure modes included inappropriate HEMS requests by EMPs (RPN = 343), inappropriate activation by EMS for interfacility transport (RPN = 343), and minimizing patient/family involvement in decision making (RPN = 315). Significant burdens to organizational finances and flight registered nurse satisfaction were identified. CONCLUSION: Associated factors for interfacility HEMS OT, downstream effects, and areas for change were identified. EMP and emergency medical services practices, HEMS processes, and shared decision making may affect regional OT rates.
Grabowski RL; McNett M; Ackerman MH; Schubert C; Mion LC
Air Medical Journal
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.amj.2019.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2019.07.012</a>
Theory of Mind and Parental Nurturance as Predictors of Peer Relationships After Childhood Traumatic Brain Injury: A Test of Moderated Mediation.
Humans; Male; Female; Adolescent; Child; Interpersonal Relations; Trauma Severity Indices; Parent-Child Relations; Pediatrics; Friends; Child Rearing; Parenting; Peer Group; Peer rejection/victimization; Reciprocated friendships; Social outcomes; Theory of mind; Traumatic brain injury; Brain Injuries Traumatic/physiopathology; Crime Victims; Social Distance; Theory of Mind/physiology
OBJECTIVE: Traumatic brain injury (TBI) sustained in childhood is associated with poor social outcomes. This study investigated the role of theory of mind (ToM) as a mediator of the relation between TBI and peer rejection/victimization and reciprocated friendships, as well as the moderating effect of parental nurturance on those relationships. METHOD: Participants were children of 8-13 years old (M = 10.45, SD = 1.47), including 13 with severe TBI, 39 with complicated mild/moderate TBI, and 32 children with orthopedic injuries. Data on peer rejection/victimization and friendship were collected in school classrooms using the Extended Class Play and friendship nominations. Parents rated parental nurturance using the Child-Rearing Practices Report. Finally, ToM was measured based on children's average performance across three tasks measuring different aspects of ToM. RESULTS: Severe TBI was associated with poorer ToM, greater peer rejection/victimization, and fewer reciprocated friendships. ToM mediated the relation between severe TBI and peer rejection/victimization (i.e., severe TBI predicted poorer ToM, which in turn predicted greater rejection/victimization). Parental nurturance significantly moderated this relation, such that the mediating effect of ToM was significant only at low and average levels of parental nurturance, for both severe and complicated mild/moderate TBI groups. Neither the mediating effect of ToM nor the moderating effect of parental nurturance was significant for reciprocated friendships. CONCLUSION: High parental nurturance may mitigate the negative effects of ToM deficits on risk of peer rejection/victimization among children with TBI. Interventions designed to increase parental nurturance or ToM may promote better social outcomes among children with TBI.
Deighton S; Durish CL; Taylor HG; Rubin K; Dennis M; Bigler ED; Vannatta K; Gerhardt CA; Stancin T; Yeates KO
Journal of the International Neuropsychological Society
2019
2019-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1017/s135561771900064x" target="_blank" rel="noreferrer noopener">10.1017/s135561771900064x</a>
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis.
Aged; Humans; Male; Adult; Female; Hospitalization; Middle Aged; Adolescent; Young Adult; Length of Stay; Retrospective Studies; Prevalence; Health Resources; Opioid-Related Disorders/epidemiology; Pancreatitis Chronic/drug therapy
OBJECTIVES: We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients. METHODS: A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients. RESULTS: A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness. CONCLUSIONS: Opioid use disorder-related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Bilal M; Chatila A; Siddiqui MT; Al-Hanayneh M; Shah AR; Desai M; Wadhwa V; Parupudi S; Casey BW; Krishnan K; Hernandez-Barco YG
Pancreas
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/mpa.0000000000001430" target="_blank" rel="noreferrer noopener">10.1097/mpa.0000000000001430</a>
"Living life as if i never had cancer": A study of the meaning of living well in adolescents and young adults who have experienced cancer
childhood; definition; quality of life; advance care planning; cancer; adolescent; advance care
Background Cancer diagnoses pose challenges to adolescents' and young adults' (AYA) physical, mental, and emotional health, and developmental tasks. In order for AYAs, caregivers, clinicians, and other collaborators to optimize health outcomes (coproduction of health), understanding what living well means for AYAs who have experienced cancer is necessary. The objective was to develop an empirical definition of "living well" for AYAs who have experienced cancer to broadly understand AYA values and priorities. This definition may ultimately guide future conversations between caregivers and AYAs, eliciting thorough, personal definitions of living well from individual AYAs. Such conversations may enhance AYA participation in coproducing their health. Procedure Qualitative analysis using a phenomenological approach of N = 30 structuredRespecting Choicesinterviews conducted with AYAs (14-21 years; mean 84.2 [SD 69] months postcancer diagnosis with 21% on active treatment) from four tertiary pediatric hospitals in the context of a primary study of a pediatric advance care planning intervention trial. Results AYAs who have experienced cancer conceptualized "living well" as maintaining physical, mental, and emotional health, as well as engaging in purposeful, age-appropriate activities with people important to them. Living well had three components: living mindfully, living an identity as a healthy AYA, and spending time with friends and family. Conclusions Conversations with AYAs who have experienced cancer elicited rich, complex concepts of "living well." Provider initiation of discussions about living well may facilitate personalized goals of care conversations. This study may serve as the basis to design and prototype future clinical interventions to enhance AYA engagement.
Schreiner K; Grossoehme DH; Friebert S; Baker JN; Needle J; Lyon ME
Pediatric Blood & Cancer
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/pbc.28599" target="_blank" rel="noreferrer noopener">10.1002/pbc.28599</a>
Moderation and mediation of the relationships between masculinity ideology and health status.
Adolescent; Female; Humans; Male; Adult; Aged; Middle Aged; Young Adult; Surveys and Questionnaires; Health Status; Masculinity; Health Behavior/physiology
OBJECTIVE: The purpose of this study was to assess the direct and indirect relationships between the endorsement of traditional masculinity ideology (TMI) and self-reported health status through potential mediating variables of expectations of benefits from health risk behaviors and actual health risk behaviors. In addition, the objective was to test the moderating effect of gender identity, broadly defined (including cisgender and transgender men and women and nonbinary persons). METHOD: Participants (N = 1233; 34.3% transgender) participated in an online survey, responding to measures of TMI, expectations of benefits, health behaviors, health status, and demographics. Data were analyzed using conditional process modeling. RESULTS: TMI was positively and directly associated with general health status for self-identified men (regardless of their sex assigned at birth), and with mental health for both men and women, but was not associated with physical health for persons of any gender identity. TMI was positively and directly associated with expectations of benefits for both men and women. Expectations of benefits from engaging in health risk behaviors was positively associated with health risk behaviors, and health risk behaviors had a large negative association with health status, for people of all gender identities. CONCLUSIONS: TMI may be a general and mental health protective factor for self-identified men, and a mental health protective factor for women, regardless of assigned sex at birth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Levant RF; Jadaszewski S; Alto K; Richmond K; Pardo S; Keo-Meier C; Gerdes Z
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1037/hea0000709" target="_blank" rel="noreferrer noopener">10.1037/hea0000709</a>
PMID: 30652914
The changing landscape of aortic valve replacement in the usa.
Adolescent; Female; Humans; Male; Adult; Aged; Treatment Outcome; Risk Factors; United States; Aged 80 and over; Aortic Valve; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement
AIMS: The aim of this study was to analyse the real-world national data on parallel utilisation of transcatheter (TAVR) and surgical (SAVR) aortic valve replacement. METHODS AND RESULTS: We queried an all-payer, administrative United States in-patient database to identify all AVR hospitalisations in patients aged ≥18 years from January 2012 to December 2016 and examined the temporal changes in the number of AVR procedures and in-hospital mortality. A total of 463,675 AVRs were performed - 363,275 (78.4%) SAVR and 100,400 (21.6%) TAVR. AVR linearly increased (from 78,985 in 2012 to 103,415 in 2016; +30.9%; ptrend<0.001) largely due to a marked increase in TAVR (from 7,655 to 33,545; +338%; ptrend<0.001), whereas the absolute number of SAVRs remained relatively stable (from 71,330 to 69,870; -1%; ptrend<0.001). The number of TAVRs increased in all pre-specified age groups (<75, 75-79, 80-85, and ≥85 years; ptrend<0.001 for all). In contrast, the number of SAVRs increased modestly in patients aged <75 years (ptrend<0.001) and declined in those aged 75-79 years, 80-84 years, or ≥85 years (ptrend<0.001 for all). Age- and sex-adjusted in-hospital mortality after isolated (aOR 1.00 [0.95-1.05]; ptrend=0.96) or combined SAVR (aOR 1.01 [0.97-1.05]; ptrend=0.66) remained unchanged during the study period, whereas in-hospital mortality after TAVR declined (aOR 0.75 [0.70-0.79]; ptrend<0.001). Similar trends in in-hospital mortality were seen in the age subgroups. CONCLUSIONS: The number of AVRs markedly increased in the USA from 2012 to 2016, mainly due to the widespread adoption of TAVR, whereas the number of SAVRs remained relatively stable. In-hospital mortality after TAVR declined, whereas that after SAVR has remained unchanged.
Gupta T; Kolte D; Khera S; Goel K; Villablanca PA; Kalra A; Abbott JD; Elmariah S; Fonarow GC; Rihal CS; Garcia MJ; Weisz G; Bhatt DL
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
2019
2019-12-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4244/EIJ-D-19-00381" target="_blank" rel="noreferrer noopener">10.4244/EIJ-D-19-00381</a>
PMID: 31403460
Pediatric airway management in COVID-19 patients: consensus guidelines from the society for pediatric anesthesia's pediatric difficult intubation collaborative and the Canadian Pediatric Anesthesia Society.
Adolescent; Humans; Child; Preschool; Infant; Newborn; Guidelines as Topic; Pneumonia; Intubation; Infection Control; Infectious Disease Transmission; Consensus; Pandemics; Airway Management/ methods; Anesthesia/methods; Anesthesiology/ methods/standards; Coronavirus Infections/ therapy; Pediatrics/ methods/standards; Intratracheal/ methods/standards; Patient-to-Professional/prevention & control; Viral/ therapy
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the
Matava CT; Kovatsis PG; Lee JK; Castro P; Denning S; Yu J; Park R; Lockman JL; Von Ungern-Sternberg B; Sabato S; Lee LK; Ayad I; Mireles S; Lardner D; Whyte S; Szolnoki J; Jagannathan N; Thompson N; Stein ML; Dalesio N; Greenberg R; McCloskey J; Peyton J; Evans F; Haydar B; Reynolds P; Chiao F; Taicher B; Templeton T; Bhalla T; Raman VT; Garcia-Marcinkiewicz A; Gálvez J; Tan J; Rehman M; Crockett C; Olomu P; Szmuk P; Glover C; Matuszczak M; Galvez I; Hunyady A; Polaner D; Gooden C; Hsu G; Gumaney H; Pérez-Pradilla C; Kiss EE; Theroux MC; Lau J; Asaf S; Ingelmo P; Engelhardt T; Hervías M; Greenwood E; Javia L; Disma N; Yaster M; Fiadjoe JE
Anesthesia and Analgesia
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1213/ANE.0000000000004872" target="_blank" rel="noreferrer noopener">10.1213/ANE.0000000000004872</a>
Results through skeletal maturity of planned fibular nonunion for the treatment of genu varum in achondroplasia: An observational retrospective study
Female; Humans; Male; Adolescent; Retrospective Studies; Child; Treatment Outcome; Radiography; Tibia; Osteotomy; Periosteum; Achondroplasia; Age Determination by Skeleton; Fibula; Genu Varum
Current surgical options for treating genu varum in achondroplasia include tibial and fibular osteotomy and growth modulation using plates and screws. However, a single surgeon consistently treated genu varum using a planned fibular nonunion (PFN). The purpose of this study is to describe his surgical technique and report radiographic and clinical outcomes for the cohort studied.This is an observational retrospective review. The cohort studied included patients with achondroplasia who had PFN surgery for the treatment of genu varum at a young age (<13 years) and was followed through to skeletal maturity. The surgery included meticulous closure of the periosteum over the remaining fibula. The surgery was considered a success if the patient did not require subsequent surgery and had acceptable or improved clinical alignment. Radiographic measures used to determine change in genu varum included the anatomic tibio-femoral angle (aTFA), tibia varus, and tibia-fibula ratio. Clinically, changes in lower limb alignment were defined using a plumb line and 6 categories of alignment ranging from extreme varus to valgus. Statistics were used to validate the plumb line categorization to available radiographic measures. Other appropriate statistical methods were used with P < .05 considered significant.Of the 53 PFN cases (27 patients) included in the study, 34 (64%) did not require subsequent surgery and had acceptable or improved alignment. The average age at surgery and follow-up was 6.1 and 17.0 years, respectively. For the 37 limbs (19 patients) with available radiographs, pre- and post-surgery radiographic measures significantly improved including aTFA (3° varus to 2° valgus, P = .003), tibia varus (2° varus to 3° valgus, P = .004), and the tibia-fibula ratio (0.977 to 1.013, P < .001). Clinically, 32 cases (60%) demonstrated significant improvement by translating into an improved alignment and 9 (17%) remained the same (P < .01). Complications were minimal and insignificant. Failures were readily managed by tibia-fibular osteotomies in adolescence and at maturity.PFN for the treatment of genu varum in young achondroplasia patients significantly improved radiographic and clinical measures of lower limb alignment through skeletal maturity with relatively few complications.
Weiner Dennis S; Mirhaidari Gabriel J M; Morscher Melanie A; Gothard M David; Adamczyk Mark J
Medicine
2019
2019-11
Journal Article
<a href="http://doi.org/10.1097/MD.0000000000017723" target="_blank" rel="noreferrer noopener">10.1097/MD.0000000000017723</a>
PMID: 31689811
Benefits Of Stimulus Exposure: Developmental Learning Independent Of Task Performance
acoustic startle response; adolescent; adult; auditory perception; critical period; development; ear muscle-reflex; experience; gap detection; inferior colliculus; learning; maternal separation; Neurosciences & Neurology; perceptual deterioration; prepulse inhibition; primary auditory-cortex; voice onset time
Perceptual learning (training-induced performance improvement) can be elicited by task-irrelevant stimulus exposure in humans. In contrast, task-irrelevant stimulus exposure in animals typically disrupts perception in juveniles while causing little to no effect in adults. This may be due to the extent of exposure, which is brief in humans while chronic in animals. Here we assessed the effects of short bouts of passive stimulus exposure on learning during development in gerbils, compared with non-passive stimulus exposure (i.e., during testing). We used prepulse inhibition of the acoustic startle response, a method that can be applied at any age, to measure gap detection thresholds across four age groups, spanning development. First, we showed that both gap detection thresholds and gap detection learning across sessions displayed a long developmental trajectory, improving throughout the juvenile period. Additionally, we demonstrated larger within- and across-animal performance variability in younger animals. These results are generally consistent with results in humans, where there are extended developmental trajectories for both the perception of temporally-varying signals, and the effects of perceptual training, as well as increased variability and poorer performance consistency in children. We then chose an age (mid-juveniles) that displayed clear learning over sessions in order to assess effects of brief passive stimulus exposure on this learning. We compared learning in mid-juveniles exposed to either gap detection testing (gaps paired with startles) or equivalent gap exposure without testing (gaps alone) for three sessions. Learning was equivalent in both these groups and better than both naive age-matched animals and controls receiving no gap exposure but only startle testing. Thus, short bouts of exposure to gaps independent of task performance is sufficient to induce learning at this age, and is as effective as gap detection testing.
Green D B; Ohlemacher J; Rosen M J
Frontiers in Neuroscience
2016
2016-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3339/fnins.2016.00263" target="_blank" rel="noreferrer noopener">10.3339/fnins.2016.00263</a>
Assessment of serum creatine kinase among adolescent patients following jimsonweed (Datura stramonium) and moonflower (Datura inoxia) ingestions: a review of 11 cases
Adolescent; Toxicology; Intoxication; Anticholinergics; induced rhabdomyolysis; Intoxication; presentations; Rhabdomyolysis; Toxic plants
Introduction. Datura stramonium (DS) (jimsonweed) is well known for its abuse potential for hallucinogenic effects and Datura inoxia (DI) (moonflower) has been abused for similar effects. To our knowledge, only one case report describes rhabdomyolysis in association with DS or DI ingestion. Case identification and details. Patient hospital charts were retrospectively screened from January 1, 2002 to December 31, 2007 to identify patients with qualifying ICD-9 codes for toxic plant ingestions. We report on 11 patient cases of DS/DI ingestions in which serum creatine kinase (CK) concentrations were monitored. These admissions occurred at our hospital over a 6-year period. Serum CK concentrations ranged from 72 to 70,230 U/L. Only three patients had serum CK concentrations greater than 1,000 U/L. One patient with a peak concentration of 70,230 U/L and a positive myoglobinuria was diagnosed with rhabdomyolysis. Discussion. Based on our review of the literature and these cases, it is possible that serum CK concentrations may be elevated more frequently than previously realized. The clinical significance of this abnormal laboratory value is uncertain with the majority of patients remaining asymptomatic without any clinical evidence of rhabdomyolysis.
Blackford M G; Fitzgibbon J J; Reed M D
Clinical Toxicology
2010
2010-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3109/15563651003772946" target="_blank" rel="noreferrer noopener">10.3109/15563651003772946</a>
Let's help keep kids from abusing medication.
Humans; Adolescent; *Physician-Patient Relations; Patient Education as Topic; *Adolescent Behavior; Parent-Child Relations; Substance-Related Disorders/*prevention & control
Weinstock Frank J; Stutman Robert
Medical economics
2008
2008-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Retrotendinous calcification of the infrapatellar tendon: unusual cause of anterior knee pain syndrome.
Female; Humans; Adolescent; *Knee Joint; Pain/etiology; Arthroscopy; Calcinosis/*complications/pathology/surgery; Tendons/*pathology; Diagnosis; Differential
Bilateral anterior knee pain is a common presentation to the orthopaedist. Correct diagnosis is based on careful history and physical examination aided by proper radiographs. Erroneous diagnosis may lead to improper treatment. This report describes a case of bilateral anterior knee pain syndrome of 3 years' duration. The teenaged patient was believed to be suffering from seronegative rheumatoid arthritis. Her pain persisted despite numerous antirheumatoid medications as well as a single injection of steroids into each infrapatellar tendon. The management of her case by means of arthroscopic surgical intervention is described.
Voto S J; Ewing J W
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
1988
1905-6
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0749-8063(88)80068-9" target="_blank" rel="noreferrer noopener">10.1016/s0749-8063(88)80068-9</a>
Pruritic rash.
Female; Humans; Middle Aged; Adolescent; Treatment Outcome; Severity of Illness Index; Prognosis; Risk Assessment; Allergens; Eczema/*diagnosis; Family Practice/methods; Nickel/*adverse effects/immunology; Patch Tests; Pruritus/*diagnosis/drug therapy/etiology; Steroids/therapeutic use; Diagnosis; Differential; Administration; Topical; Dermatitis; Allergic Contact/*diagnosis/drug therapy/etiology
Uhlenhake Elizabeth; Brodell Robert T; Nedorost Susan
The Journal of Family Practice
2009
2009-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Can sun protection knowledge change behavior in a resistant population?
Female; Humans; Male; Adolescent; *Health Education; *Adolescent Behavior; *Health Behavior; Attitude to Health; Radiation Protection; Skin Neoplasms/*prevention & control/psychology; Sunlight/adverse effects; Sunscreening Agents/administration & dosage; Psychology
The future skin cancer statistics for the youth of the United States are staggering. Traditional educational programs are currently the mainstay to foster sun protective awareness for this high-risk, sun-worshipping population. This study was designed to monitor high school students for both short-term and long-term changes in knowledge and attitude, as well as for any change in behavior, following a standard sun protection intervention. Our results demonstrated that although students had an increase in knowledge, it was insufficient to change their behavior.
Swindler Julie E; Lloyd Jenifer R; Gil Karen M
Cutis
2007
2007-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jaad.2003.10.657" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2003.10.657</a>
Gamekeeper's thumb: ulnar collateral ligament injury.
Humans; Male; Adolescent; *Athletic Injuries/diagnosis/physiopathology/therapy; *Ulna; Collateral Ligaments/*injuries
Injury to the ulnar collateral ligament of the thumb, once a common chronic occupational injury occurring in British gamekeepers, is now most frequently an acute sports-related injury in skiers, football players and other athletes. Differentiation of complete versus partial tears of the ligament is crucial because the treatment for complete tears is surgical. Radiographic evaluation, while important, has a limited role. Partial ligamentous tears, or those associated with uncomplicated avulsion fractures of the proximal phalanx, can be adequately treated by the family physician using simple shortarm thumb spica casting.
Richard J R
American Family Physician
1996
1996-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Limitations of the obstetric group B Streptococcus protocol.
Adult; Female; Humans; Adolescent; Infant; Pregnancy; Follow-Up Studies; Anti-Bacterial Agents/*therapeutic use; Guideline Adherence; Antibiotic Prophylaxis; *Pregnancy Outcome; Obstetrics/methods; Primary Prevention/methods; Streptococcal Infections/diagnosis/*drug therapy/*prevention & control; Streptococcus agalactiae/*drug effects/*isolation & purification; Pregnancy Complications; Newborn; Infectious/diagnosis/*drug therapy
OBJECTIVE: To assess compliance with the Centers for Disease Control and Prevention (CDC) screening-based protocol for obstetric group B Streptococcus (GBS) and to determine an acceptable threshold for protocol failure. STUDY DESIGN: A retrospective chart review was carried out for all deliveries performed through the resident-run community clinic from January through June 1999. Compliance with the CDC protocol was assessed by reviewing collected data from patient charts and comparing it to CDC requirements. Data were collected regarding patient demographics, antenatal GBS status, gestational age at screening, time of rupture of the membranes, time the antibiotic was given and time of delivery. RESULTS: A total of 248 charts were reviewed. Elective cesarean deliveries were excluded (25 charts). Unknown culture status was found for 22 (9.9%) patients. Cultures were collected before 35 weeks' gestation in 39 (17.5%) patients and at \textgreater 37 weeks' gestation in 28 (12.6%) patients. Of those with known positive GBS status, 4 (7.0%) were not treated, and antibiotics were given less than four hours before delivery in 13 (24.5%) patients. Of those with unknown status, six (27.2%) were not treated. Overall, there was 70% compliance with the culture collection arm of the protocol and 87% compliance with the treatment arm. CONCLUSION: Fulfillment of CDC guidelines in this community setting is imperfect. There are several areas beyond physician control, including precipitous delivery and patient non-compliance. However, perhaps an acceptable threshold for limitations of adherence to the protocol can be reached.
Nemunaitis-Keller Jennifer; Gill Prabacharan
The Journal of reproductive medicine
2003
2003-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Expressed attitudes of adolescents toward marriage and family life.
Humans; Adolescent; Texas; *Attitude; Sexual Behavior; Family/*psychology; Divorce; Marriage/*psychology
In the U.S., modifications in family structure and in attitudes concerning marriage and family life have been numerous. Areas such as sexual behavior and alternative living arrangements have become highly varied and nontraditional compared to past generations. This study examined the attitudes of adolescents toward aspects of marriage and family life. The majority of adolescents expressed negative attitudes toward divorce and viewed marriage as a lifelong commitment. While only about a third of the adolescents expressed positive attitudes toward premarital sex, a majority indicated they would engage in sexual intercourse before marriage, or already have. Interestingly, about half of the adolescents held positive attitudes toward cohabitation. Lastly, the adolescents demonstrated a growing acceptance of premarital counseling and psychoeducational interventions regarding marriage and family life.
Martin Paige D; Specter Gerald; Martin Don; Martin Maggie
Adolescence
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Adolescent premarital sexual activity, cohabitation, and attitudes toward marriage.
Female; Humans; Male; Adolescent; Prevalence; *Attitude; Interpersonal Relations; Family/psychology; Sexual Behavior/*psychology/statistics & numerical data
Societal trends indicate ambivalent attitudes about marriage. Specifically, there is greater acceptance of divorce and nontraditional living arrangements such as cohabitation, as well as acceptance and prevalence of premarital sex, than in the past. The authors examine adolescent attitudes toward marriage and their association with premarital sexual activity and cohabitation. Recommendations for helping adolescents understand the realities of marriage and family life are shared.
Martin P D; Martin D; Martin M
Adolescence
2001
1905-6
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The use of radioisotope scans in the evaluation of primary lymphoma of bone.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Neoplasm Staging; Radionuclide Imaging; Bone Neoplasms/*diagnostic imaging; Diagnosis; Differential; Lymphoma; Large B-Cell; Diffuse/*diagnostic imaging
Primary lymphoma of bone is a rare lesion comprising less than 5% of all malignant primary bone tumors. Because of this rarity, the diagnosis of this lesion based on clinical findings and standard radiographic evaluations is extremely difficult and may not be entertained until after a biopsy has been performed. We retrospectively reviewed the cases of 22 consecutive patients with a diagnosis of primary lymphoma of bone (appendicular and axial skeleton) who along with standard radiographic evaluations had a technetium 99 bone scan performed as part of the preoperative staging process. A characteristic pattern demonstrating an increased uptake of intense tracer concentration peripherally and a relatively cold central area was seen consistently in all cases. This uptake pattern is then reversed with use of a gallium 67 scan. Because of the ambiguity of plain radiographs in the evaluation of adult bone lesions, radioisotope bone scans should be used as a diagnostic aid in an attempt to obtain as much information as possible about the biologic behavior of the bony lesion prior to any surgical intervention.
Leeson M C; Makely J T; Carter J R; Krupco T
Orthopaedic review
1989
1989-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Side effects of the use of botulinum toxin for treatment of benign essential blepharospasm and hemifacial spasm.
Female; Humans; Male; Adolescent; Prognosis; Blepharoptosis/chemically induced; Blepharospasm/*drug therapy; Botulinum Toxins/*adverse effects/therapeutic use; Diplopia/chemically induced; Dry Eye Syndromes/chemically induced; Eyelid Diseases/*drug therapy; Facial Muscles/*drug effects; Spasm/*drug therapy; Vision Disorders/chemically induced
From April 1983 to April 1988, 381 botulinum toxin injections for lid spasms were administered to 106 patients. Sixty-nine had bilateral blepharospasm and 37 had hemifacial spasm. Of the 381 injections, 308 had been given to patients who returned for follow-up examinations. No systemic effects were noted at any of these visits; all side effects were temporary; there were no serious complications. Ptosis, the most frequently encountered problem, occurred after 26 (8.4%) of the injections. Other complications included: corneal exposure (after eight injections, 2.59%); face droop (after 11 injections, 3.57%); diplopia (after five injections, 1.62%); and subtle visual blurring (after eight injections, 2.59%). One patient noted jaw tenseness, another mentioned tearing, one reported brow droop, and another complained of crossed eyes. Ten injections had minimal effect; in these cases a repeat injection usually was effective. Only four patients chose surgery after beginning injections. We conclude that botulinum toxin injections are a safe, effective means of treating lid spasms.
Kalra H K; Magoon E H
Ophthalmic surgery
1990
1990-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Variation in heart disease mortality across census tracts as a function of overdispersion and social class mixture.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Ohio/epidemiology; *Demography; *Social Class; Heart Diseases/*mortality; Statistical; *Models
Variation in heart disease (HD) mortality rates across census tracts is greater than expected given binomial error and available explanatory variables. We extended an extra-binomial variation model for rates standardized by the direct method. The overdispersion parameter accounted for 36 per cent of the observed variation in standardized rates. Ignoring overdispersion resulted in a change in an estimate of the effect of social class on HD mortality and substantial underestimation of the error of the estimates of such effects. Ecologic regression on the proportional mixture of social classes within tracts provided an appealing approach to the problem of estimating fixed effects with aggregated data.
Jarjoura D; Logue EE
Statistics in medicine
1990
1990-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/sim.4780091009" target="_blank" rel="noreferrer noopener">10.1002/sim.4780091009</a>
Preventive health care for adolescents.
Humans; Adolescent; Physician-Patient Relations; Physicians; Physician's Role; Family; *Adolescent Health Services; *Preventive Health Services; Psychology
Physicians, parents or guardians, and the community all have an important role in preventive care for adolescents. Adolescents desire more interaction with their primary care providers. Physicians can influence the health care of adolescents by developing a collaboration with them that augments protective factors and allows a reduction in risk behaviors.
Gilchrist V; Alexander E
Primary Care
1994
1994-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Anorexia and bulimia.
Adult; Female; Humans; Male; Adolescent; Combined Modality Therapy; Anorexia Nervosa/complications/diagnosis/*therapy; Bulimia/complications/diagnosis/*therapy; Diagnosis; Differential
Anorexia nervosa and bulimia nervosa are eating disorders with distinct clinical presentations. Reduced caloric intake, a hallmark of both disorders, is manifested by self-induced starvation in anorexia and by binge eating and gastrointestinal purging in bulimia. Treatment includes nutritional intervention, psychotherapy and pharmacotherapy in either the ambulatory or the hospital setting.
Giannini A J; Newman M; Gold M
American Family Physician
1990
1990-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4135/9781412972031.n20" target="_blank" rel="noreferrer noopener">10.4135/9781412972031.n20</a>
Recognition of subarachnoid hemorrhage.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Neurologic Examination; Tomography; Headache/etiology; Central Nervous System Diseases/etiology; Nausea/etiology; Subarachnoid Hemorrhage/complications/*diagnosis; Vomiting/etiology; Emergency Service; Hospital; 80 and over; X-Ray Computed
The medical records of 109 patients who presented to the emergency department during a five-year period with proven nontraumatic, spontaneous subarachnoid hemorrhage (SAH) were retrospectively reviewed. The clinical presentation, diagnostic modalities used, and accuracy of diagnosis by emergency physicians were analyzed. The most common historical features were headache (81 patients, or 74%), nausea or vomiting (85 patients, or 77%), and loss of consciousness (58 patients, or 53%). Nonexertional activities preceding SAH were more frequent than exertional events (57% vs 21%). Neurologic findings were present in 70 patients (64%) and consisted primarily of altered levels of consciousness. Thirty-eight patients (35%) had nuchal rigidity. Ninety-six emergency cranial computed tomography scans were performed, of which 91 were diagnostic for SAH (sensitivity, 95%). Lumbar puncture was performed on two patients with normal computed tomography scans and revealed bloody spinal fluid. The overall diagnostic accuracy by emergency physicians was 85%. The correct diagnosis was delayed in 16 patients (15%), the majority of whom had headaches and normal neurologic examinations. Atypical symptoms, the warning leak syndrome, and the need for prompt diagnosis and therapy are reviewed.
Fontanarosa P B
Annals of emergency medicine
1989
1989-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(89)80059-9" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(89)80059-9</a>
Adult epiglottitis.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; *Epiglottitis/diagnosis/therapy; *Laryngitis/diagnosis/therapy; Haemophilus Infections/diagnosis/therapy; Haemophilus influenzae
Adult epiglottitis (or "supraglottitis") is an uncommon but increasingly recognized entity. Though prior studies emphasized the fulminant nature of the disease, recent evidence suggests that epiglottitis in adults may follow a relatively less severe clinical course, especially if Hemophilus influenza is not isolated. The records of 28 patients with adult epiglottitis were retrospectively analyzed to characterize the presenting features and clinical course of the disease. The diagnosis was established by laryngoscopy, lateral cervical radiographs, or both. Laryngoscopy did not precipitate airway obstruction in any patient. The majority of patients experienced a relatively benign clinical course and improved with medical management that consisted of ICU admission, intravenous antibiotics, hydration, inhaled mist, and corticosteroids. Only two patients (7%) required airway support with orotracheal intubation because of respiratory difficulty. There were no instances of respiratory arrest or airway obstruction. No tracheostomies were performed, and there were no deaths. It was concluded that adult epiglottitis can follow a less severe course than classically described.
Fontanarosa P B; Polsky S S; Goldman G E
The Journal of emergency medicine
1989
1989-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0736-4679(89)90350-8" target="_blank" rel="noreferrer noopener">10.1016/0736-4679(89)90350-8</a>
The consultation and referral process. A report from NEON. Northeastern Ohio Network Research Group.
Adult; Female; Humans; Male; Middle Aged; Ohio; Adolescent; Aged; Child; Cross-Sectional Studies; United States; Prospective Studies; *Medicine; Physicians; *Communication; Interprofessional Relations; *Specialization; Family; *Family Practice/statistics & numerical data; *Referral and Consultation/statistics & numerical data; Ambulatory Care; Preschool
BACKGROUND: Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS: The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS: Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS: Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process.
Bourguet C C; Gilchrist V; McCord G
The Journal of Family Practice
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Evaluation of venous distension device: phase II: cannulation of nonemergent patients.
Adult; Humans; Middle Aged; Adolescent; Catheterization; Evaluation Studies as Topic; Obesity/physiopathology; Punctures/*methods; Tourniquets; Peripheral/instrumentation/*methods
A device designed to augment venous filling by applying a vacuum to the arm during tourniquet application was evaluated in adult patients considered to have difficult peripheral venous access and in need of nonemergent venipuncture or intravenous cannulation. Patients taking medications that affected platelet activity or who had venipuncture attempts within 1 week in the same extremity were excluded. A total of 21 patients (age, 38.8 +/- 15 years; weight, 77.3 +/- 22.5 kg) were studied. The majority were obese (62%) and/or did not have prominent veins even when a standard tourniquet cuff was placed (71%). Use of the device was successful in 19 patients (90%), with a mean time to venipuncture after vacuum removal of 38 +/- 30 seconds. In the 2 patients in whom the device was unsuccessful, both patients were intravenous drug users and subsequently required either external jugular or central venous line placement. Seven patients had unsuccessful attempts at venipuncture or intravenous cannulation on the opposite extremity immediately before use of the device. In these 7 patients, subsequent use of the device was 100% successful (p = 0.0003, Fisher's exact test, assuming all attempts using standard techniques would have been unsuccessful). When conventional tourniquets are unsuccessful for venipuncture, the use of the venous distension device may obviate the need for more invasive forms of venous access.
Amsterdam J T; Hedges J R; Weinshenker E; Schwytzer D J
The American journal of emergency medicine
1988
1988-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0735-6757(88)90004-6" target="_blank" rel="noreferrer noopener">10.1016/0735-6757(88)90004-6</a>
Caffeine Awareness in Children: Insights from a Pilot Study.
Female; Humans; Male; Adolescent; Pilot Projects; Incidence; Child; Cross-Sectional Studies; United States; Surveys and Questionnaires; Age Factors; Sex Factors; Risk Assessment; adolescents; Awareness; Beverages/*adverse effects/statistics & numerical data; caffeine; Caffeine/administration & dosage/*adverse effects; Needs Assessment; sleep; Sleep Wake Disorders/*chemically induced/epidemiology; Students/statistics & numerical data; Practice; *Health Knowledge; Attitudes
STUDY OBJECTIVES: Caffeine, a commonly consumed psychoactive substance, can have significant effects on sleep. Caffeine intake among children is increasing, mainly in the form of sodas. However, adolescent caffeine consumers may lack knowledge about the caffeine content in common beverages. If true, this very fact may hamper the assessment of the effects of caffeine consumption on sleep in children if such assessments are a priori dependent on responders being able to reliably distinguish between caffeinated and noncaffeinated beverages. This preliminary study investigated adolescents' caffeine knowledge and intake at a Cleveland-area public middle school. METHODS: Seventh- and eighth-grade students were surveyed using: (1) the Caffeine Literacy and Sleep Study (CLASS), a
Thakre Tushar P; Deoras Ketan; Griffin Catherine; Vemana Aarthi; Podmore Petra; Krishna Jyoti
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
2015
2015-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5664/jcsm.4848" target="_blank" rel="noreferrer noopener">10.5664/jcsm.4848</a>
Benefits of Stimulus Exposure: Developmental Learning Independent of Task Performance.
development; adolescent; adult; auditory perception; experience; gap detection; learning; prepulse inhibition
Perceptual learning (training-induced performance improvement) can be elicited by task-irrelevant stimulus exposure in humans. In contrast, task-irrelevant stimulus exposure in animals typically disrupts perception in juveniles while causing little to no effect in adults. This may be due to the extent of exposure, which is brief in humans while chronic in animals. Here we assessed the effects of short bouts of passive stimulus exposure on learning during development in gerbils, compared with non-passive stimulus exposure (i.e., during testing). We used prepulse inhibition of the acoustic startle response, a method that can be applied at any age, to measure gap detection thresholds across four age groups, spanning development. First, we showed that both gap detection thresholds and gap detection learning across sessions displayed a long developmental trajectory, improving throughout the juvenile period. Additionally, we demonstrated larger within- and across-animal performance variability in younger animals. These results are generally consistent with results in humans, where there are extended developmental trajectories for both the perception of temporally-varying signals, and the effects of perceptual training, as well as increased variability and poorer performance consistency in children. We then chose an age (mid-juveniles) that displayed clear learning over sessions in order to assess effects of brief passive stimulus exposure on this learning. We compared learning in mid-juveniles exposed to either gap detection testing (gaps paired with startles) or equivalent gap exposure without testing (gaps alone) for three sessions. Learning was equivalent in both these groups and better than both naive age-matched animals and controls receiving no gap exposure but only startle testing. Thus, short bouts of exposure to gaps independent of task performance is sufficient to induce learning at this age, and is as effective as gap detection testing.
Green David B; Ohlemacher Jocelyn; Rosen Merri J
Frontiers in neuroscience
2016
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3389/fnins.2016.00263" target="_blank" rel="noreferrer noopener">10.3389/fnins.2016.00263</a>
Assessing the impact on patient-physician interaction when physicians use personal digital assistants: a Northeastern Ohio Network (NEON) study.
Adult; Female; Humans; Male; Middle Aged; Ohio; Adolescent; Aged; Young Adult; Physician-Patient Relations; Health Care Surveys; *Physician-Patient Relations; Health Services Research; Computers; Human; Surveys; Middle Age; Adolescence; 80 and over; Handheld/*statistics & numerical data; 80 and Over; Hand-Held – Utilization
BACKGROUND: The effects of the use of technological devices on dimensions that affect the physician-patient relationship need to be well understood. OBJECTIVES: Determine patients' perceptions of physicians' personal digital assistant (PDA) use, comparing the results across 8 physician-patient dimensions important to clinical interactions. RESULTS: Patients completed anonymous surveys about their perceptions of physician PDA use. Data were collected during 2006 and 2007 at 12 family medicine practices. Survey items included physician sex, patient demographics, if physicians explained why they were using the PDA, and Likert ratings on 8 dimensions of how a PDA can influence physician-patient interactions (surprise, confidence, feelings, comfort, communication, relationship, intelligence, and satisfaction). The survey response rate was 78%. Physicians explained to their patients what they were doing with the PDA 64% of the time. Logistic regression analyses determined that patients of male physicians, patients attending private practices and underserved sites, patients with Medicaid insurance, and patients who observed their physician using a PDA during both the index visit and at least one prior visit were more likely to receive an explanation of PDA use. Most importantly, physician-patient communication was rated significantly more positive if an explanation of PDA use was offered. CONCLUSION: Patients rate interactions with their physicians more positively when physicians explain their PDA use.
McCord Gary; Pendleton Brian F; Schrop Susan Labuda; Weiss Lisa; Stockton LuAnne; Hamrich Lynn M
Journal of the American Board of Family Medicine : JABFM
2009
2009-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3122/jabfm.2009.04.080056" target="_blank" rel="noreferrer noopener">10.3122/jabfm.2009.04.080056</a>
A fixed-dose combination of adapalene 0.1%-BPO 2.5% allows an early and sustained improvement in quality of life and patient treatment satisfaction in severe acne.
Adult; Female; Humans; Male; Adolescent; Young Adult; Child; Severity of Illness Index; Quality of Life/*psychology; Double-Blind Method; *Patient Satisfaction; Drug Combinations; Acne Vulgaris/*drug therapy/*psychology; Adapalene; Benzoyl Peroxide/administration & dosage/*therapeutic use; Dermatologic Agents/administration & dosage/*therapeutic use; Naphthalenes/administration & dosage/*therapeutic use
INTRODUCTION: Acne has a significant negative impact on quality of life (QoL): lack of self-confidence, depressive symptoms and suicidal thoughts. The objective was to assess the impact of an initial and continued therapy in severe acne patients through patient-related outcomes (PRO). METHODS: In two sequential double-blind randomized studies, patients received either adapalene 0.1% and benzoyl peroxide 2.5% (A-BPO) or vehicle, associated with doxycycline 100 mg for 12 weeks. Patients having obtained at least a good improvement according to investigator global assessment were re-randomized for a 24-week therapy with
Brodell Robert T; Schlosser Bethanee J; Rafal Elyse; Toth Darryl; Tyring Stephen; Wertheimer Albert; Kerrouche Nabil; Bucher Delphine
The Journal of dermatological treatment
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/09546634.2011.643221" target="_blank" rel="noreferrer noopener">10.3109/09546634.2011.643221</a>
The ethics of HIV testing and disclosure for healthcare professionals: what do our future doctors think?
Adult; Female; Humans; Male; Adolescent; Young Adult; United States; Focus Groups; Health Personnel; Health Care Surveys; Students; Anonymous Testing/ethics; Disclosure/*ethics; HIV Seropositivity/*diagnosis; Patients; Human; Thematic Analysis; Interviews; Student Attitudes; Truth Disclosure; Audiorecording; Medical; Medical/*psychology; Health Screening; Attitude to Illness; Mandatory Testing; Privacy and Confidentiality; HIV Infections – Diagnosis; HIV Infections – Ethical Issues
AIM: This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure. METHOD: A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author. RESULTS: Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals. CONCLUSION: This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.
Aultman Julie M; Borges Nicole J
Medical teacher
2011
2011
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/0142159X.2011.530311" target="_blank" rel="noreferrer noopener">10.3109/0142159X.2011.530311</a>
The ethical and pedagogical effects of modeling "not-so-universal" precautions.
Female; Humans; Male; Adolescent; Young Adult; United States; Focus Groups; Curriculum; Patient Safety; Students; Education; Professional; Internship and Residency; *Universal Precautions; Self Care; Human; Thematic Analysis; Student Attitudes; Ethics; Audiorecording; Practice; *Ethics; Medical; *Health Knowledge; Attitudes; Practice Patterns; Organizational; *Models; Medical/psychology; Preventive Health Care; Role Models
AIM: We sought to understand current medical students' levels of training and knowledge, and their attitudes regarding universal precautions practices and underlying professional and ethical issues. METHOD: A total of 54 US medical students at two schools were interviewed to determine the level of understanding and training students receive about universal precautions, their feelings about the effectiveness (or ineffectiveness) of universal precautions, the frequency and kinds of universal precautions used by healthcare professionals as observed by medical students, and students' perspectives about the lack of or inconsistent use of universal precautions. RESULTS: Pre-clinical students focused on safe-sex practices among students and professionals, as well as simple, important acts to protect oneself against infection and disease, such as hand-washing. Clinical students, on the other hand, had more exposure to observing and practicing universal precautions, thus presented us with more, in-depth responses pertaining to inconsistent and ineffective use of universal precautions among peers and role models. Several themes were noted from students' responses. CONCLUSION: This study confirms previously acquired data that universal precautions are not consistently or appropriately used by healthcare professionals, it is a significant and novel study in that it reveals a hidden, ethical, and clinical problem in medical education.
Aultman Julie M; Borges Nicole J
Medical teacher
2011
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/0142159X.2011.530310" target="_blank" rel="noreferrer noopener">10.3109/0142159X.2011.530310</a>
Risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients: a case-control study–sucralfate ingestion is not a negative risk factor.
Adult; Female; Humans; Male; Middle Aged; Ohio; Adolescent; Aged; Hospitalization; Case-Control Studies; Feces/microbiology; *Clostridium difficile; Diarrhea/*epidemiology/microbiology; Sucralfate/*administration & dosage; 80 and over; Enterocolitis; Pseudomembranous/*epidemiology/microbiology
OBJECTIVES: To assess risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients, and to test the hypothesis that sucralfate ingestion is associated with nondetection of C difficile cytotoxin in stool specimens. DESIGN: A retrospective case-control study of hospitalized adult patients who had stool specimens assayed for C difficile cytotoxin. For each patient who had positive C difficile cytotoxin, a patient who had negative C difficile cytotoxin was used as a control. The study period was January to December 1993. SETTING: A community teaching hospital affiliated with a medical school in northeastern Ohio. RESULTS: There were 91 case patients and 91 control patients. Cephalosporin exposure was identified as a risk factor in patients with C difficile diarrhea. The number of patients who had sucralfate ingestion was comparable in both groups of patients. CONCLUSIONS: Administration of cephalosporins was identified as a risk factor in patients with C difficile diarrhea. We were not able to confirm a recent report of the association between ingestion of sucralfate and nondetection of C difficile cytotoxin in stool specimens. Our findings suggest that sucralfate ingestion is not associated with nondetection of C difficile cytotoxin in stool specimens. Assay of C difficile cytotoxin in stool specimens remains a valid method of diagnosing C difficile diarrhea, even in patients who ingest sucralfate.
Watanakunakorn P W; Watanakunakorn C; Hazy J
Infection control and hospital epidemiology
1996
1996-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2307/30141026" target="_blank" rel="noreferrer noopener">10.2307/30141026</a>
Incidental findings in the cervical spine at CT for trauma evaluation.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Registries; Incidental Findings; Injury Severity Score; Length of Stay/statistics & numerical data; Data Collection; Tomography; Human; Middle Age; Adolescence; Retrospective Design; Diagnosis; Cervical Vertebrae/*diagnostic imaging/*injuries; Spinal Injuries/*diagnostic imaging; 80 and over; X-Ray Computed/*methods; Nonparametric; Statistics; Nonparametric Statistics; Trauma Severity Indices; 80 and Over; Length of Stay – Statistics and Numerical Data; X-Ray Computed – Methods; Cervical Vertebrae – Injuries; Cervical Vertebrae – Radiography; Spinal Injuries – Radiography
OBJECTIVE: CT is the standard of care for assessment of traumatic injuries. Because of the detail depicted with this technique, findings incidental to the injury are easily detected. We sought to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT. MATERIALS AND METHODS: The trauma registry was accessed to identify the cases of patients evaluated with cervical spine CT at a level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to bodily location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed. RESULTS: We identified incidental CT findings in 230 of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation. We stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age (p \textless 0.0001). The likelihood of trauma-related incidental findings was associated with injury severity score (p \textless 0.0001). CONCLUSION: Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.
Barboza Richard; Fox Jason H; Shaffer Lynn E T; Opalek Judy M; Farooki Shella
AJR. American journal of roentgenology
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.08.1420" target="_blank" rel="noreferrer noopener">10.2214/AJR.08.1420</a>