A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.
80 and over; Adolescent; Adult; Aged; Ambulatory Care/*statistics & numerical data; Bias; Child; Family Practice/*statistics & numerical data; Female; Health Care Surveys/*methods/standards; Humans; Infant; Male; Middle Aged; Observation/*methods; Office Visits/*statistics & numerical data; Ohio; Preschool; Research Design/standards; Sensitivity and Specificity; Time Factors
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by direct observation was compared with data reported by physicians using the 1993 NAMCS form. RESULTS: Outpatient visit physician reports of procedures and examinations using the NAMCS method showed generally good concordance with direct observation measures, with kappas ranging from 0.39 for ordering a chest x-ray to 0.86 for performance of Pap smears. Concordance was generally lower for health behavior counseling, with kappas ranging from 0.21 for alcohol counseling to 0.60 for smoking cessation advice. The NAMCS form had high specificity (range, 0.90-0.99) but variable (range, 0.12-.84) sensitivity compared with direct observation, with the lowest sensitivities for health behavior counseling. The NAMCS physician report method overestimated visit duration in comparison with direct observation (16.5 vs. 12.8 minutes). CONCLUSIONS: Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.
Gilchrist Valerie J; Stange Kurt C; Flocke Susan A; McCord Gary; Bourguet Claire C
Medical care
2004
2004-03
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/10.1097/01.mlr.0000114916.95639.af" target="_blank" rel="noreferrer noopener">10.1097/01.mlr.0000114916.95639.af</a>
Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
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/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
Aeroallergen sensitization in healthy children: racial and socioeconomic correlates.
Female; Male; Socioeconomic Factors; Incidence; Child; Risk Factors; Sensitivity and Specificity; Odds Ratio; Health Status; Probability; Confidence Intervals; Human; Adolescence; Logistic Regression; Case Control Studies; Immunization; Preschool; Population; Air Pollutants – Immunology; Allergens – Immunology; Hypersensitivity – Diagnosis; Hypersensitivity – Epidemiology; Hypersensitivity – Immunology; Respiratory Hypersensitivity – Diagnosis; Respiratory Hypersensitivity – Ethnology; Respiratory Hypersensitivity – Immunology; Skin Tests – Methods
Objective: Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy children with no family history of atopy.Study Design: Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels. The Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) was used to examine the impact of sensitization on quality of life.Results: Thirty-nine percent of healthy children were sensitized to 1 or more allergen panels. Multivariate logistic regression showed increased risk among African-American children for any sensitization (OR, 2.17; [95% CI: 1.23, 3.84]) and sensitization to any outdoor allergen (OR, 2.96 [95% CI: 1.52, 5.74]). Eighty-six percent of children had PADQLQ scores of 1 or less (0 to 6 scale).Conclusions: Allergic sensitization is prevalent even among children who do not have a personal or family history of asthma, allergic rhinitis, or atopic dermatitis and who have no evidence of current, even subtle effects from this sensitization on allergic disease-related quality of life. African-American children are at greater risk for presence of sensitization, especially to outdoor allergens.
Stevenson MD; Sellins S; Grube E; Schroer K; Gupta J; Wang N; Khurana Hershey GK; Stevenson Michelle D; Sellins Stacey; Grube Emilie; Schroer Kathy; Gupta Jayanta; Wang Ning; Khurana Hershey Gurjit K
Journal of Pediatrics
2007
2007-08
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/10.1016/j.jpeds.2007.03.001" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2007.03.001</a>
Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records.
*Algorithms; *Medical Order Entry Systems; Adolescence; Adolescent; adverse drug event; Adverse Drug Event – Prevention and Control; Age Distribution; Algorithms; Anti-Bacterial Agents/*administration & dosage/adverse effects; Antibiotics – Administration and Dosage; Antibiotics – Adverse Effects; Child; clinical; Clinical; Computer Assisted; Computer-Assisted; CPOE; decision support systems; Decision Support Systems; Demography; Drug Overdose/diagnosis/*prevention & control; Drug Therapy; Drug-Related Side Effects and Adverse Reactions/*prevention & control; electronic health record; Electronic Health Records; electronic medical record; Electronic Order Entry; Female; Funding Source; Hospitals; Humans; Infant; Male; medical order entry system; Medication Errors – Prevention and Control; Medication Errors – Statistics and Numerical Data; Medication Errors/*prevention & control/statistics & numerical data; Newborn; Overdose – Diagnosis; Overdose – Prevention and Control; patient safety; Pediatric; Preschool; risk management; Young Adult
Objectives: Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications. Materials and Methods: We created an order and alert analysis system that identified antibiotic medication orders and evaluated user response to dosing alerts. Orders associated with overridden alerts were examined for evidence of administration and the delivered dose was compared to pharmacy-derived dosing rules to confirm true overdoses. True overdose cases were reviewed for association with known ADEs. Results: Of 55 546 orders reviewed, 539 were true overdose orders, which lead to 1965 known overdose administrations. Documentation of loose stools and diarrhea was significantly increased following drug administration in the overdose group. Dosing rule thresholds were altered to reflect clinically accurate dosing. These rule changes decreased overall alert burden and improved the salience of alerts. Discussion: Electronic algorithm-based detection systems can identify antibiotic overdoses that are clinically relevant and are associated with known ADEs. The system also serves as a platform for evaluating the effects of modifying electronic dosing rules. These modifications lead to decreased alert burden and improvements in response to decision support alerts. Conclusion: The success of this test case suggests that gains are possible in reducing medication errors and improving patient safety with automated algorithm-based detection systems. Follow-up studies will determine if the positive effects of the system persist and if these changes lead to improved safety outcomes.
Kirkendall Eric S; Kouril Michal; Dexheimer Judith W; Courter Joshua D; Hagedorn Philip; Szczesniak Rhonda; Li Dan; Damania Rahul; Minich Thomas; Spooner S Andrew
Journal of the American Medical Informatics Association : JAMIA
2017
2017-03
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/10.1093/jamia/ocw086" target="_blank" rel="noreferrer noopener">10.1093/jamia/ocw086</a>
Benzodiazepine-associated atrioventricular block.
Acetaminophen/adverse effects; Alprazolam/*adverse effects; Anti-Anxiety Agents/adverse effects; Anticonvulsants/poisoning; Antidotes/adverse effects/therapeutic use; Atrioventricular Block/*chemically induced/physiopathology; Child; Clonazepam/*poisoning; Drug Combinations; Electrocardiography; Flumazenil/adverse effects/therapeutic use; Humans; Hydrocodone/adverse effects; Male; Preschool; Risperidone/adverse effects; Young Adult
Dysrhythmias, although common in overdose situations, are not often seen after benzodiazepine exposures. We report two cases of transient atrioventricular block after benzodiazepine misuse. Case 1 is a 4-year-old boy who was found unresponsive after an ingestion of clonazepam. An electrocardiogram (EKG) performed on emergency department presentation demonstrated first-degree atrioventricular block (PR 206 ms). After flumazenil administration, he developed second-degree atrioventricular block (Mobitz Type 1). EKG abnormalities resolved by morning. Serum clonazepam was 478 ng/mL (laboratory clonazepam reference range, 10-75 ng/mL with a dose of up to 6 mg/day) 5 hours after being found unresponsive. Case 2 is a 23-year-old man who presented to the emergency department after ingesting risperidone, combination hydrocodone/acetaminophen, and alprazolam. On arrival, his EKG demonstrated sinus bradycardia with a PR interval of 182 msec. He subsequently developed second-degree atrioventricular block (Mobitz Type I). Sinus bradycardia with resolution of his atrioventricular block (PR 200 ms) was seen on a third EKG performed 5 hours after presentation. These two patients demonstrated transient first- and second-degree atrioventricular block after benzodiazepine exposure. Benzodiazepines have been shown to alter L-type Ca2+ channel function. This alteration in function may account for the dysrhythmias seen in our patients. Together, these cases serve to remind clinicians of this rare but potentially serious complication associated with benzodiazepine exposure.
Arroyo Plasencia Anna M; Ballentine Lynn M; Mowry James B; Kao Louise W
American Journal of Therapeutics
2012
2012-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181dcf572" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181dcf572</a>
Binaural interaction of bone-conducted auditory brainstem responses in children with congenital atresia of the external auditory canal.
Adolescent; Audiometry; Auditory; Bilateral/congenital/physiopathology; Bone Conduction/*physiology; Brain Stem/*physiology; Child; Conductive/congenital/physiopathology; Ear; Ear Canal/*abnormalities/physiopathology; Evoked Potentials; Evoked Response; Hearing Loss; Humans; Middle/abnormalities; Preschool; Pure-Tone; Temporal Bone/abnormalities
Bilateral bone-conducted auditory brainstem responses (BC-ABRs) were recorded in children with atresia of the external auditory canal bilaterally (AECB) in order to compare the response characteristics to normal hearing adults. The binaural interaction component (BIC) of the ABR occurs when the sum of the monaural-evoked ABR amplitudes are different in amplitude when compared to the binaural-evoked ABR amplitude. Previous electrophysiological work from our lab has shown that children with AECB lateralize bone-conducted (BC) sound. Furthermore, we have found in normal-hearing adults that BICs exist using BC clicks. In adults, BC-BIC occurred in the latency region corresponding to waves IV-VI, whereas for children with AECB corresponding peak latencies occurred earlier. Same as normal-hearing adults, BC-ABR IV-V complex peak amplitudes for sum of the BC-monaural right and
Sheykholeslami Kianoush; Habiby Kermany Mohammad; Sebastein Schmerber; Kaga Kimitaka
International journal of pediatric otorhinolaryngology
2003
2003-10
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/10.1016/s0165-5876(03)00197-6" target="_blank" rel="noreferrer noopener">10.1016/s0165-5876(03)00197-6</a>
Black-dot tinea capitis. Patchy hair loss is common in pediatric patients.
Humans; Male; Child; Alopecia/*etiology; Antifungal Agents/administration & dosage; Griseofulvin/administration & dosage; Ketoconazole/administration & dosage; Tinea Capitis/*complications/*diagnosis/drug therapy; Preschool; Alopecia – Etiology; Tinea – Diagnosis; Tinea – Drug Therapy
Brodell Robert T; Vescera Giorgio
Postgraduate medicine
2002
2002-04
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/10.3810/pgm.2002.04.1182" target="_blank" rel="noreferrer noopener">10.3810/pgm.2002.04.1182</a>
Botulin therapy in pediatric ophthalmology.
Adult; Humans; Child; Infant; Cooperative Behavior; Botulinum Toxins/administration & dosage/*therapeutic use; Eye Movements; Informed Consent; Ketamine; Preanesthetic Medication; Strabismus/*therapy; Preschool
Magoon E H
International ophthalmology clinics
1989
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).
<a href="http://doi.org/10.1097/00004397-198902910-00011" target="_blank" rel="noreferrer noopener">10.1097/00004397-198902910-00011</a>
Buprenorphine Exposures Among Children and Adolescents Reported to US Poison Control Centers.
Young Adult; Child; Infant; United States; Odds Ratio; Patient Admission; Human; Adolescence; Preschool; BUPRENORPHINE; HOSPITAL admission & discharge; ODDS ratio; PATIENTS; POISON control centers; SUBSTANCE abuse; UNITED States; Buprenorphine – Poisoning – United States; Buprenorphine – Therapeutic Use; BUPRENORPHINE – Therapeutic use; Poison Control Centers – United States; Substance Use Disorders – Drug Therapy
OBJECTIVE: To investigate buprenorphine exposures among children and adolescents
Post Sara; Spiller Henry A; Casavant Marcel J; Chounthirath Thitphalak; Smith Gary A
Pediatrics
2018
2018-07
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/10.1542/peds.2017-3652" target="_blank" rel="noreferrer noopener">10.1542/peds.2017-3652</a>
Calcium channel blocker toxicity.
Adult; Assisted Circulation; Calcium Channel Blockers/classification/pharmacokinetics/*poisoning; Calcium Channels; Calcium Chloride/therapeutic use; Cardiovascular Agents/therapeutic use; Cardiovascular Diseases/*chemically induced/drug therapy; Charcoal/therapeutic use; Child; Combined Modality Therapy; Drug Overdose/drug therapy/therapy; Enema; Extracorporeal Circulation; Fat Emulsions; Fluid Therapy; Glucagon/therapeutic use; Heart/drug effects; Humans; Hyperglycemia/*chemically induced/drug therapy; Infant; Intravenous/therapeutic use; L-Type/physiology; Muscle; Plasmapheresis; Poisoning/drug therapy/physiopathology/therapy; Practice Guidelines as Topic; Preschool; Smooth; Vascular/drug effects
Calcium channel blockers continue to be used for the management of a wide variety of adult and pediatric conditions including hypertension, angina pectoris, atrial arrhythmias, Raynaud phenomenon, and migraine headaches. With increased use comes increased potential for misuse and abuse. This article serves as a review of calcium channel blocker physiology with emphasis on presentation and management of the pediatric patient with calcium channel blocker toxicity.
Arroyo Anna Maria; Kao Louise W
Pediatric emergency care
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/10.1097/PEC.0b013e3181b0a504" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e3181b0a504</a>
CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009-2013.
Adolescent; Adult; Brain Neoplasms/*epidemiology; Central Nervous System Neoplasms/*epidemiology; Child; Epidemiological Monitoring; Female; Humans; Infant; Male; Newborn; Preschool; Registries; Societies; United States/epidemiology; Young Adult
Ostrom Quinn T; Gittleman Haley; Xu Jordan; Kromer Courtney; Wolinsky Yingli; Kruchko Carol; Barnholtz-Sloan Jill S
Neuro-oncology
2016
2016-10
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/10.1093/neuonc/now207" target="_blank" rel="noreferrer noopener">10.1093/neuonc/now207</a>
Characterizing Children Presenting to Three Freestanding EDs.
Adolescence; Adolescent; Age Factors; Child; Emergency Service; Emergency Service – Statistics and Numerical Data; Female; Hospital/*statistics & numerical data; Humans; Infant; Male; Newborn; Preschool; Retrospective Design; Retrospective Studies; Severity of Illness Index; Severity of Illness Indices; Sex Factors; United States
Simon Erin L; Kovacs Mitch; Hayslip Dave; Jouriles Nicholas
The American journal of emergency medicine
2016
2016-10
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/10.1016/j.ajem.2016.07.060" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2016.07.060</a>
Cocooning: Influenza Vaccine for Parents and Caregivers in an Urban, Pediatric Medical Home.
Adult; Female; Male; Aged; Child; Infant; Caregivers; Parents; Nurse Practitioners; Human; Chi Square Test; Funding Source; Middle Age; Fisher's Exact Test; Adolescence; Pearson's Correlation Coefficient; Preschool; McNemar's Test; Pediatricians; Wilcoxon Rank Sum Test; Influenza – Prevention and Control – In Infancy and Childhood; Influenza – Risk Factors; Influenza Vaccine – Administration and Dosage
White PC; Baum DL; Ross H; Falletta L; Reed MD
Clinical pediatrics
2010
2010
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/10.1177/0009922810374353" target="_blank" rel="noreferrer noopener">10.1177/0009922810374353</a>
Congenital syphilis: early- and late-stage findings of rhagades and dental anomalies.
Child; Cicatrix/microbiology; Congenital/*complications/diagnosis; Fluorescent Treponemal Antibody-Absorption Test; Hearing Disorders/microbiology; Humans; Male; Preschool; Syphilis; Tooth Abnormalities/*microbiology
Congenital syphilis occurs via vertical transmission when Treponema pallidum crosses the placenta after the 16th week of gestation. Manifestations of congenital syphilis vary from asymptomatic infection to stillbirth. We present a case of congenital syphilis in a Vietnamese orphan who presented with rhagades, hearing deficit, and abnormal dentition after adoption in the United States. He demonstrated both early- and late-stage findings of congenital syphilis. He is presumed to be 5 years old, and it is uncertain if he received treatment. Upon arrival to the United States, his rapid plasma reagin test was negative, but his fluorescent treponemal antibody-absorption test was positive, so no further treatment was recommended. It is possible that other late congenital syphilis stigmata may develop in his later years. The Centers for Disease Control recommends screening all pregnant women for syphilis at the beginning of prenatal care. Clinicians should be made aware of the manifestations of congenital syphilis, especially when caring for international orphans and children born to mothers who lacked prenatal care.
Khetarpal Shilpi; Kempf Ellen; Mostow Eliot
Pediatric dermatology
2011
2011-08
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/10.1111/j.1525-1470.2010.01288.x" target="_blank" rel="noreferrer noopener">10.1111/j.1525-1470.2010.01288.x</a>
Cutaneous abscesses in children: epidemiology in the era of methicillin-resistant Staphylococcus aureus in a pediatric emergency department.
*Methicillin-Resistant Staphylococcus aureus; Abscess – Epidemiology; Abscess – Microbiology; Abscess/*epidemiology/microbiology; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Child; Emergency Service; Female; Hospital; Human; Humans; Infant; Infectious – Epidemiology; Infectious – Microbiology; Male; Methicillin-Resistant Staphylococcus Aureus; Pediatrics; Preschool; Recurrence; Retrospective Design; Retrospective Studies; Skin Diseases; Soft Tissue Infections – Epidemiology; Soft Tissue Infections – Microbiology; Soft Tissue Infections/*epidemiology/microbiology; Staphylococcal Skin Infections/*epidemiology/microbiology
OBJECTIVE: Skin and soft tissue infections are a major public health issue. Previous literature suggests a recurrence rate of 4% in children. The purpose of this study was to examine the epidemiology, body location, and history of previous infections among children in the emergency department setting. METHODS: A retrospective study was performed using electronic medical records from all subjects treated in a large pediatric emergency department with attending physician diagnosis and billing codes indicative of a cutaneous abscess from July 1, 2007, to December 31, 2007. Descriptive statistics were used to evaluate abscess location, prior history of infection, bacterial etiology, and patient disposition. RESULTS: Three hundred eighteen abscess visits occurred in 308 individual subjects; 79% were due to methicillin-resistant Staphylococcus aureus. Approximately 14% of subjects presented with more than 1 abscess. Those 2 years or younger were more likely to have buttock abscesses (P \textless 0.001). Of the 192 subjects for whom responses were documented, 82 (43%) had a history of a prior abscess. Children 2 years or younger were significantly more likely to be hospitalized or go to the operating room: 49% versus 15% (P \textless 0.001). CONCLUSIONS: Many children with a cutaneous abscess have a prior history of infection. Multiple abscesses are common. Young children are more likely to have abscesses in the diaper area or be hospitalized. Studies of effective hygiene practices and interventions to reduce recurrence are urgently needed.
Holsenback Heather; Smith Lisa; Stevenson Michelle D
Pediatric emergency care
2012
2012-07
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/10.1097/PEC.0b013e31825d20e1" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31825d20e1</a>
Defining Success in Pediatric Palliative Care While Tackling the Quadruple Aim.
*Attitude of Health Personnel; Adolescence; American Academy of Pediatrics; Child; Health Personnel/*psychology; Hospice and Palliative Care Nursing/*organization & administration; Humans; Infant; Newborn; Organizational Objectives; Palliative Care – In Infancy and Childhood; Pediatric Nursing/*organization & administration; Preschool; Success
Bogetz Jori F; Friebert Sarah
Journal of palliative medicine
2017
2017-02
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/10.1089/jpm.2016.0389" target="_blank" rel="noreferrer noopener">10.1089/jpm.2016.0389</a>
Diagnosis at a glance.
Male; Aged; Child; Preschool; Acne Rosacea – Complications; Ankyloglossia – Diagnosis; Sebaceous Gland Diseases – Diagnosis
Park Y W; Matthews M; Coleman P
Emergency Medicine (00136654)
2004
2004-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Direct care staff and parents'/legal guardians' perspectives on end-of-life care in a long-term care facility for medically fragile and intellectually disabled pediatric and young adult residents.
Adolescence; Adolescent; Adult; Aged; Caregivers – Psychosocial Factors; Caregivers/*psychology; Child; Clinical Assessment Tools; Disabled – Psychosocial Factors; Disabled Children/*psychology; Female; Hospital – Psychosocial Factors; Hospital/*psychology; Human; Humans; Impact of Events Scale; Infant; Long Term Care – Psychosocial Factors; Long-Term Care/*psychology; Male; Middle Age; Middle Aged; Newborn; Nursing Staff; Ohio; Parents – Psychosocial Factors; Parents/*psychology; Pediatric Nursing; Preschool; Scales; Terminal Care – Psychosocial Factors; Terminal Care/*psychology; Young Adult
OBJECTIVE: Children and young adults with severe disabilities and their families are faced with enormous challenges throughout the lifespan, including admitting the child to a long-term care facility (LTCF) and making end-of-life (EOL) care decisions. While children are residents of these specialized LTCF, the majority of their daily care, even up until death, is provided by nursing aides or habilitation aides (HAs) with limited training and educational backgrounds compared with other licensed healthcare providers. The purpose of this study was to determine the impact of a resident's EOL experience on the primary HAs and parents/guardians. METHOD: Thirty-five resident deaths occurred at Hattie Larlham Center for Children with Disabilities (HLCCD) between January 1, 2006 and February 28, 2009. The HAs and parents/legal guardians were identified for each death and invited to complete three surveys per resident (FAMCARE, Impact of Events Scale (IES)-revised, and Perspective on End-of-Life Care) to assess their experience. There were 112 surveys mailed to 62 HAs and 47 surveys mailed to 47 parents. RESULTS: Forty-two surveys were returned from 18/62 HAs (response rate 29%) and 11/47 parents/legal guardians completed the surveys (response rate 23%). The FAMCARE survey found that parents were more satisfied with the EOL care than were the HAs. The IES-revised found no difference in traumatic responses from either group. Comments from the Perspective on End-of-Life Care survey were analyzed qualitatively for common themes including pain control, respect, decision making, environmental needs, resources, and support. SIGNIFICANCE OF RESULTS: Because of a low response rate, it was difficult to draw significant conclusions; however, several interesting trends were noted regarding the number of deaths HAs experienced, satisfaction with care, and distress. The special needs of this population and their caregivers can provide crucial insights into interventions (e.g. chaplaincy support, debriefings, anticipatory counseling, environmental changes) that might be of benefit for any caregiver or parent of a child with a long-term, chronic condition, particularly involving developmental disability.
Grossberg Richard I; Blackford Martha; Friebert Sarah; Benore Ethan; Reed Michael D
Palliative & supportive care
2013
2013-08
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/10.1017/S1478951512000326" target="_blank" rel="noreferrer noopener">10.1017/S1478951512000326</a>
Duplicated pelvic floor musculature and diastematomyelia in a cloacal exstrophy patient.
Female; Humans; Magnetic Resonance Imaging; Child; Radiography; Cloaca/*abnormalities; Cloacal Exstrophy; Diastematomyelia; Duplicated Pelvic Floor; Etiology; Exstrophy-Epispadias Complex; Neural Tube Defects/*complications/diagnosis/diagnostic imaging; Pelvic Bones/abnormalities; Pelvic Floor/*abnormalities/diagnostic imaging; Spinal Dysraphism; Preschool
Cloacal exstrophy is the most severe and rare form of the exstrophy-epispadias complex, presenting with exposed bladder halves extruding through an abdominal wall defect and variable genitourinary, gastrointestinal, musculoskeletal, and neurological defects. The authors report magnetic resonance imaging findings of a neurologically-intact, 24-month-old female with cloacal exstrophy who presented with anterior spinal dysraphism and diastematomyelia and duplicate pelvic floor musculature. The constellation of defects suggests a common genetic, biochemical, and embryological origin for duplication of the bladder, spinal cord, and pelvic floor muscles occurring in the fourth week of gestation.
Inouye Brian M; Tourchi Ali; Massanyi Eric Z; Gearhart John P; Tekes Aylin
Journal of radiology case reports
2014
2014-10
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/10.3941/jrcr.v8i10.2088" target="_blank" rel="noreferrer noopener">10.3941/jrcr.v8i10.2088</a>
Editorial comment.
Child; Urodynamics; Preschool; Electrotherapy; Pelvic Floor Muscles; Bladder; Neurogenic – Etiology; Spina Bifida – Complications; Neurogenic – Physiopathology; Neurogenic – Therapy; Overactive Bladder – Etiology; Overactive Bladder – Physiopathology; Overactive Bladder – Therapy
Bologna R
Urology
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/10.1016/j.urology.2009.02.038" target="_blank" rel="noreferrer noopener">10.1016/j.urology.2009.02.038</a>
Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
*Emergency Service; *Practice Guidelines as Topic; Adolescent; Adult; Anti-Bacterial Agents/*therapeutic use; Child; Cohort Studies; Dose-Response Relationship; Drug; Drug Administration Schedule; Evidence-Based Medicine; Female; Follow-Up Studies; Hospital; Hospitals; Humans; Male; Pediatric; Pharyngitis/*drug therapy/*microbiology; Preschool; Streptococcal Infections/*drug therapy/microbiology; Treatment Outcome
BACKGROUND: Pharyngitis is a common complaint in pediatric patients. If clinical parameters are used alone, bacterial pathogens will be wrongly implicated in many cases. A nonstandardized approach to the treatment of children with pharyngitis in an emergency department setting may lead to inappropriate empirical therapy, contribute to increased bacterial resistance, and result in adverse events related to the treatment provided. OBJECTIVE: To implement evidence-based guidelines for the diagnosis and treatment of children with pharyngitis in an emergency department setting and thereby influence practices of prescribing antibiotics. DESIGN AND METHODS: An evidence-based guideline for the evaluation and treatment of patients with pharyngitis was developed and implemented in our emergency department. Preintervention and postintervention patient cohorts were identified by a search of the emergency department's clinical repository. A medical record review was performed using a standardized data abstraction form (history and examination data, diagnostic testing, and therapy provided). Treatment decisions were judged as appropriate if the diagnosis of pharyngitis caused by group A beta-hemolytic streptococci was based on confirmatory microbiological testing rather than on the history and physical examination findings alone. RESULTS: We included 443 patients for study (219 preintervention and 224 postintervention). In the preintervention group, 97 (44%) of 214 received appropriate treatment. In the postintervention group, 204 (91%) of 224 received appropriate treatment. CONCLUSION: An evidence-based clinical guideline can influence and improve practices of prescribing antibiotics by pediatric emergency physicians in a teaching hospital setting.
Diaz Maria Carmen G; Symons Nadine; Ramundo Maria L; Christopher Norman C
Archives of Pediatrics & Adolescent Medicine
2004
2004-10
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/10.1001/archpedi.158.10.977" target="_blank" rel="noreferrer noopener">10.1001/archpedi.158.10.977</a>
Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
Female; Male; Ohio; Child; Infant; Human; Descriptive Statistics; Adolescence; Retrospective Design; Random Sample; Preschool; Record Review; Antibiotics – Administration and Dosage – In Infancy and Childhood; Emergency Care – Standards – In Infancy and Childhood; Penicillins – Administration and Dosage; Pharyngitis – Drug Therapy – In Infancy and Childhood; Practice Guidelines – Utilization
Diaz MCG; Symons N; Ramundo ML; Christopher NC
Archives of Pediatrics & Adolescent Medicine
2004
2004-10
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/10.1001/archpedi.158.10.977" target="_blank" rel="noreferrer noopener">10.1001/archpedi.158.10.977</a>
Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Female; Male; Child; Infant; Prospective Studies; Pain Measurement; Analysis of Variance; Placebos; Injections; Human; Chi Square Test; Preschool; Intravenous; Anesthetics; Treatment Outcomes; Double-Blind Studies; Hypnotics and Sedatives – Administration and Dosage; Lidocaine – Administration and Dosage; Local – Administration and Dosage; Propofol – Administration and Dosage
BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated Face, Legs, Activity, Cry, Consolability Pain Assessment Scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD
Pediatric emergency care
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0b013e31827b227e" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31827b227e</a>
Evaluation of the patient with seizures: an evidence based approach.
*Emergencies; *Evidence-Based Medicine; 80 and over; Adolescent; Adult; Aged; Child; Diagnosis; Differential; Humans; Infant; Preschool; Risk Factors; Seizures/diagnosis/*etiology/therapy
Statistics tell us that as many as 1 in 20 members of the population will suffer a seizure at some point in their lifetime, a figure which becomes even more likely if one lives to the age of 80. Thus, a careful evidence based approach to the patient with seizure is immensely useful to the emergency physician. The authors evaluate current studies on the subject, discuss seizures as they relate to specific patient groups, and, ultimately, make recommendations on this important subject.
Bradford J C; Kyriakedes C G
Emergency medicine clinics of North America
1999
1999-02
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/10.1016/s0733-8627(05)70053-5" target="_blank" rel="noreferrer noopener">10.1016/s0733-8627(05)70053-5</a>
Exome sequence identified a c.320A \textgreater G ALG13 variant in a female with infantile epileptic encephalopathy with normal glycosylation and random X inactivation: Review of the literature.
*Mutation; *X Chromosome Inactivation; ALG13; CDG Is; Child; Congenital disorder of glycosylation; Congenital Disorders of Glycosylation/diagnosis/*genetics; Exome; Female; Glycosylation; Heterozygote; Humans; Infant; Infantile/diagnosis/*genetics; Mental Retardation; Missense; N-Acetylglucosaminyltransferases/*genetics; Post-Translational; Preschool; Protein Processing; Spasms; Syndrome; Transferrin/metabolism; X-inactivation; X-Linked/diagnosis/*genetics
Congenital Disorders of Glycosylation (CDG) are new and rapidly expanding neurometabolic disorders with multisystem involvements, broad phenotypic manifestations, and variable severity. The majority results from a defect of one of the steps involved with protein or lipid N-glycosylation pathway. Almost all are inherited in autosomal recessive patterns with a few exceptions such as the
Hamici Sana; Bastaki Fatma; Khalifa Mohamed
European journal of medical genetics
2017
2017-10
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/10.1016/j.ejmg.2017.07.014" target="_blank" rel="noreferrer noopener">10.1016/j.ejmg.2017.07.014</a>
Heparin free dialysis in critically sick children using sustained low efficiency dialysis (SLEDD-f): A new hybrid therapy for dialysis in developing world.
Humans; Adolescent; Retrospective Studies; Child; Infant; *Critical Care/methods; Acute Kidney Injury/blood/mortality/*therapy; Critical Illness/*therapy; Developing Countries; Feasibility Studies; Follow-Up Studies; Length of Stay; Renal Dialysis/adverse effects/instrumentation/*methods; Treatment Outcome; Preschool
BACKGROUND: In critically sick adults, sustained low efficiency dialysis [SLED] appears to be better tolerated hemodynamically and outcomes seem to be comparable to CRRT. However, there is paucity of data in critically sick children. In children, two recent studies from Taiwan (n = 11) and India (n = 68) showed benefits of SLED in critically sick children. AIMS AND OBJECTIVES: The objective of the study was to look at the feasibility and tolerability of sustained low efficiency daily dialysis-filtration [SLEDD-f] in critically sick pediatric patients. MATERIAL AND METHODS: Design: Retrospective study Inclusion criteria: All pediatric patients who had undergone heparin free SLEDD-f from January 2012 to October 2017. Measurements: Data collected included demographic details, vital signs, PRISM III at admission, ventilator parameters (where applicable), number of inotropes, blood gas and electrolytes before, during, and on conclusion of SLED therapy. Technical information was gathered regarding SLEDD-f prescription and complications. RESULTS: Between 2012-2017, a total of 242 sessions of SLEDD-f were performed on 70 patients, out of which 40 children survived. The median age of patients in years was 12 (range 0.8-17 years), and the median weight was 39 kg (range 8.5-66 kg). The mean PRISM score at admission was 8.77+/-7.22. SLEDD-f sessions were well tolerated, with marked improvement in fluid status and acidosis. Premature terminations had to be done in 23 (9.5%) of the sessions. There were 21 sessions (8.6%) terminated due to hypotension and 2 sessions (0.8%) terminated due to circuit clotting. Post- SLEDD-f hypocalcemia occurred in 15 sessions (6.2%), post- SLEDD-f hypophosphatemia occurred in 1 session (0.4%), and post- SLEDD-f hypokalemia occurred in 17 sessions (7.0%). CONCLUSIONS: This study is the largest compiled data on pediatric SLEDD-f use in critically ill patients. Our study confirms the feasibility of heparin free SLEDD-f in a larger pediatric population, and even in children weighing \textless20 kg on inotropic support.
Sethi Sidharth Kumar; Bansal Shyam B; Khare Anshika; Dhaliwal Maninder; Raghunathan Veena; Wadhwani Nikita; Nandwani Ashish; Yadav Dinesh Kumar; Mahapatra Amit Kumar; Raina Rupesh
PloS one
2018
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/10.1371/journal.pone.0195536" target="_blank" rel="noreferrer noopener">10.1371/journal.pone.0195536</a>
High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood.
*BMI percentile; *Body Mass Index; *infant growth; *obese; *weight for length; Age Factors; Body Mass Index; Case Control Studies; Case-Control Studies; Child; Comparative Studies; Evaluation Research; Female; Human; Humans; Incidence; Infant; Logistic Models; Logistic Regression; Male; Morbid – Diagnosis; Morbid – Epidemiology; Morbid/*diagnosis/*epidemiology; Multicenter Studies; Newborn; Obesity; Obesity – Diagnosis; Obesity – Epidemiology; Obesity/diagnosis/epidemiology; Predictive Value of Tests; Preschool; Reference Values; Reproducibility of Results; Risk Assessment; Scales; Sex Factors; Validation Studies; Weight Gain
OBJECTIVE: To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity. STUDY DESIGN: Two lean (body mass index [BMI] 5th to /=99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds. Repeated-measures mixed modeling and logistic regression were used for analysis. RESULTS: A total of 783 participants of normal weight and 480 participants with severe obesity were included in the initial study. BMI differed significantly between the severely obese and normal-weight cohorts by age 4 months (P \textless .001), at 1 year before the median age at onset of obesity. A cutoff of the World Health Organization (WHO) 85th percentile for BMI at 6, 12, and 18 months was a strong predictor of severe obesity by age 6 years (sensitivity, 51%-95%; specificity, 95%). This BMI threshold was validated in a second independent cohort (n = 2649), with a sensitivity of 33%-77% and a specificity of 74%-87%. A BMI \textgreater/=85th percentile in infancy increases the risk of severe obesity by age 6 years by 2.5-fold and the risk of clinical obesity by age 6 years by 3-fold. CONCLUSIONS: BMI trajectories in children who develop severe obesity by age 6 years differ from those in children who remain at normal weight by age 4-6 months, before the onset of obesity. Infants with a WHO BMI \textgreater/=85th percentile are at increased risk for developing severe obesity by age 6 years.
Smego Allison; Woo Jessica G; Klein Jillian; Suh Christina; Bansal Danesh; Bliss Sherri; Daniels Stephen R; Bolling Christopher; Crimmins Nancy A
The Journal of pediatrics
2017
2017-04
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<a href="http://doi.org/10.1016/j.jpeds.2016.11.020" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2016.11.020</a>
Homozygosity for a mutation affecting the catalytic domain of tyrosyl-tRNA synthetase (YARS) causes multisystem disease
Adult; Biochemistry & Molecular Biology; Catalytic Domain; Child; Female; gene; Genetic Diseases; Genetic Predisposition to Disease; Genetics & Heredity; Hearing Loss; Heterozygote; Homozygote; Humans; impairment; Inborn; Infant; lactic-acidosis; Loss of Function Mutation; Male; mechanisms; Mutation; myopathy; Newborn; onset; Pedigree; Phenotype; phenotypic variability; Preschool; recessive mutations; Sensorineural; Severity of Illness Index; swiss-model; Tyrosine-tRNA Ligase; variant; Whole Exome Sequencing; Yeasts
Aminoacyl-tRNA synthetases (ARSs) are critical for protein translation. Pathogenic variants of ARSs have been previously associated with peripheral neuropathy and multisystem disease in heterozygotes and homozygotes, respectively. We report seven related children homozygous for a novel mutation in tyrosyl-tRNA synthetase (YARS, c.499C > A, p.Pro167Thr) identified by whole exome sequencing. This variant lies within a highly conserved interface required for protein homodimerization, an essential step in YARS catalytic function. Affected children expressed a more severe phenotype than previously reported, including poor growth, developmental delay, brain dysmyelination, sensorineural hearing loss, nystagmus, progressive cholestatic liver disease, pancreatic insufficiency, hypoglycemia, anemia, intermittent proteinuria, recurrent bloodstream infections and chronic pulmonary disease. Related adults heterozygous for YARS p.Pro167Thr showed no evidence of peripheral neuropathy on electromyography, in contrast to previous reports for other YARS variants. Analysis of YARS p.Pro167Thr in yeast complementation assays revealed a loss-of-function, hypomorphic allele that significantly impaired growth. Recombinant YARS p.Pro167Thr demonstrated normal subcellular localization, but greatly diminished ability to homodimerize in human embryonic kidney cells. This work adds to a rapidly growing body of research emphasizing the importance of ARSs in multisystem disease and significantly expands the allelic and clinical heterogeneity of YARS-associated human disease. A deeper understanding of the role of YARS in human disease may inspire innovative therapies and improve care of affected patients.
Williams Katie B; Brigatti Karlla W; Puffenberger Erik G; Gonzaga-Jauregui Claudia; Griffin Laurie B; Martinez Erick D; Wenger Olivia K; Yoder Mark A; Kandula Vinay V R; Fox Michael D; Demczko Matthew M; Poskitt Laura; Furuya Katryn N; Reid Jeffrey G; Overton John D; Baras Aris; Miles Lili; Radhakrishnan Kadakkal; Carson Vincent J; Antonellis Anthony; Jinks Robert N; Strauss Kevin A
Human Molecular Genetics
2019
1905-7
<a href="http://doi.org/10.1093/hmg/ddy344" target="_blank" rel="noreferrer noopener">10.1093/hmg/ddy344</a>
Improved auscultation skills in paramedic students using a modified stethoscope.
Adult; Aged; Child; Students; Clinical Competence; Computer Simulation; Emergency Medical Services; Education; Educational Status; Human; Questionnaires; Competency Assessment; Qualitative Studies; Middle Age; Pretest-Posttest Design; Education Research; Quantitative Studies; Preschool; Stethoscopes; Gastrointestinal Motility; Heart Auscultation; Heart Sounds; Respiratory Sounds; Allied Health; Auscultation – Education
Simon EL; Lecat PJ; Haller NA; Williams CJ; Martin SW; Carney JA; Pakiela JA
Journal of Emergency Medicine (0736-4679)
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jemermed.2012.01.048" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2012.01.048</a>
Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Administration; Adolescent; Adrenal Cortex Hormones/administration & dosage/*therapeutic use; African Americans/statistics & numerical data; Ambulatory Care/statistics & numerical data; Asthma/diagnosis/*drug therapy/ethnology; Child; Cross-Sectional Studies; Drug Utilization/statistics & numerical data/trends; Emergency Service; European Continental Ancestry Group/statistics & numerical data; Female; Hospital/statistics & numerical data; Hospitalization/statistics & numerical data; Humans; Infant; Inhalation; Male; Medicaid/*statistics & numerical data; Newborn; Ohio; Preschool; Regression Analysis; Retrospective Studies; Sex Factors; United States
BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P \textless .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
Stevenson Michelle D; Heaton Pamela C; Moomaw Charles J; Bean Judy A; Ruddy Richard M
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
2008
2008-06
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/S1081-1206(10)60049-X" target="_blank" rel="noreferrer noopener">10.1016/S1081-1206(10)60049-X</a>
Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Female; Male; Ohio; Child; Infant; United States; Sex Factors; Human; Cross Sectional Studies; Adolescence; Retrospective Design; Regression; Preschool; Newborn; Administration; Inhalation; Ambulatory Care – Statistics and Numerical Data; Emergency Service – Statistics and Numerical Data; Blacks – Statistics and Numerical Data; Whites – Statistics and Numerical Data; Medicaid – Statistics and Numerical Data; Hospitalization – Statistics and Numerical Data; Adrenal Cortex Hormones – Therapeutic Use; Adrenal Cortex Hormones – Administration and Dosage; Asthma – Diagnosis; Asthma – Drug Therapy; Asthma – Ethnology; Drug Utilization – Statistics and Numerical Data; Drug Utilization – Trends
BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P \textless .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
Stevenson MD; Heaton PC; Moomaw CJ; Bean JA; Ruddy RM
Annals of Allergy, Asthma & Immunology
2008
2008-06
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/s1081-1206(10)60049-x" target="_blank" rel="noreferrer noopener">10.1016/s1081-1206(10)60049-x</a>
Insulin regulation of cholesterol 7alpha-hydroxylase expression in human hepatocytes: roles of forkhead box O1 and sterol regulatory element-binding protein 1c.
*Gene Expression Regulation; *Transcriptional Activation; Adolescent; Adult; Animals; Child; Cholesterol 7-alpha-Hydroxylase/*biosynthesis/genetics; Enzymologic; Female; Forkhead Box Protein O1; Forkhead Transcription Factors/*physiology; Hepatocytes/*enzymology; Humans; Insulin/metabolism/*physiology; Male; Middle Aged; Preschool; Rats; Sterol Regulatory Element Binding Protein 1/*physiology; Transcription Factors/*physiology
Bile acid synthesis and pool size increases in diabetes, whereas insulin inhibits bile acid synthesis. The objective of this study is to elucidate the mechanism of insulin regulation of cholesterol 7alpha-hydroxylase gene expression in human hepatocytes. Real-time PCR assays showed that physiological concentrations of insulin rapidly stimulated cholesterol 7alpha-hydroxylase (CYP7A1) mRNA expression in primary human hepatocytes but inhibited CYP7A1 expression after extended treatment. The insulin-regulated forkhead box O1 (FoxO1) and steroid regulatory element-binding protein-1c (SREBP-1c) strongly inhibited hepatocyte nuclear factor 4alpha and peroxisome proliferator-activated receptor gamma coactivator-1alpha trans-activation of the CYP7A1 gene. FoxO1 binds to an insulin response element in the rat CYP7A1 promoter, which is not present in the human CYP7A1 gene. Insulin rapidly phosphorylates and inactivates FoxO1, whereas insulin induces nuclear SREBP-1c expression in human primary hepatocytes. Chromatin immunoprecipitation assay shows that insulin reduced FoxO1 and peroxisome proliferators-activated receptor gamma-coactivator-1alpha but increased SREBP-1c recruitment to CYP7A1 chromatin. We conclude that insulin has dual effects on human CYP7A1 gene transcription; physiological concentrations of insulin rapidly inhibit FoxO1 activity leading to stimulation of the human CYP7A1 gene, whereas prolonged insulin treatment induces SREBP-1c, which inhibits human CYP7A1 gene transcription. Insulin may play a major role in the regulation of bile acid synthesis and dyslipidemia in diabetes.
Li Tiangang; Kong Xiaoying; Owsley Erika; Ellis Ewa; Strom Stephen; Chiang John Y L
The Journal of biological chemistry
2006
2006-09
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/10.1074/jbc.M605815200" target="_blank" rel="noreferrer noopener">10.1074/jbc.M605815200</a>
Lichen striatus.
Adolescent; Age Factors; Child; Diagnosis; Differential; Female; Humans; Inflammation/*diagnosis/pathology; Lichenoid Eruptions/*diagnosis/epidemiology/pathology; Male; Preschool; Sex Factors
Graham Jacqueline N; Hossler Eric W
Cutis
2016
2016-02
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/10.1007/978-3-540-29676-8_3241" target="_blank" rel="noreferrer noopener">10.1007/978-3-540-29676-8_3241</a>
Longitudinal assessment of bone growth and development in a facility-based population of young adults with cerebral palsy.
Absorptiometry; Adolescence; Adolescent; Adult; Bone Density – Physiology; Bone Density/*physiology; Cerebral Palsy – Physiopathology; Cerebral Palsy/*physiopathology; Child; Cross Sectional Studies; Cross-Sectional Studies; Female; Human; Humans; Long Term Care – Statistics and Numerical Data; Long-Term Care/*statistics & numerical data; Longitudinal Studies; Male; Photon; Preschool; Prospective Studies; Risk Factors; Young Adult
AIM: Osteoporosis is a significant clinical problem in persons with moderate to severe cerebral palsy (CP), causing fractures with minimal trauma. Over the past decade, most studies examining osteoporosis and CP have been cross-sectional in nature, focused exclusively on children and adolescents and only involving one evaluation of bone mineral density (BMD). The purpose of this study was to assess BMD in a group including adults with CP, and changes in each individual's BMD over a 5- to 6-year period. METHOD: The study group included 40 residents of a long-term care facility aged 6 to 26 years at the time of their initial evaluation. Twenty-one patients (52.5%) were male, 35 (88%) were white, and 38 (95%) were in Gross Motor Function Classification System level V. BMD was assessed by dual-energy X-ray absorptiometry on the right and left distal femurs for three distinct regions of interest. RESULTS: Five residents had a fracture that occurred during the study period; this represented a fracture rate of 2.1% per year in the study group. Longitudinally, annualized change in the median BMD was 0.7% to 1.0% per year in the different regions of the distal femur, but ranged widely among the study group, with both increases and decreases in BMD. Increase in BMD over time was negatively correlated with age and positively correlated with change in weight. INTERPRETATION: Changes in BMD over time in profoundly involved persons with CP can range widely, which is important to recognize when evaluating potential interventions to improve BMD. Age and changes in body weight appear the most relevant factors.
Grossberg Richard; Blackford Martha G; Kecskemethy Heidi H; Henderson Richard; Reed Michael D
Developmental medicine and child neurology
2015
2015-11
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/10.1111/dmcn.12790" target="_blank" rel="noreferrer noopener">10.1111/dmcn.12790</a>
Neonatal glycine encephalopathy: biochemical and neuropathologic findings.
Adolescent; Amino Acid Metabolism; Amino Acids/blood; Brain Diseases; Brain/pathology; Calcium Oxalate/blood; Child; Crystallization; Follow-Up Studies; Glycine/*blood; Humans; Inborn Errors/genetics/*pathology; Infant; Male; Metabolic/genetics/*pathology; Myelin Sheath/*pathology; Newborn; Preschool; Spinal Cord/pathology
A patient with neonatal glycine encephalopathy who had severe neurologic retardation, spasticity, and seizures died at 17 years of age. Glycine concentration was markedly elevated in brain tissue, especially in the cerebellum. Neuropathologic study revealed spongy myelinopathy throughout the central nervous system and calcium oxalate crystals in the cerebellum, which are probably derived from degradation of glycine. Myelinopathy appeared to be static compared to neonatal patients. The neurologic manifestations of neonatal glycine encephalopathy are probably due to neurotransmitter abnormalities, not to myelin damage.
Agamanolis D P; Potter J L; Lundgren D W
Pediatric neurology
1993
1993-04
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/10.1016/0887-8994(93)90051-d" target="_blank" rel="noreferrer noopener">10.1016/0887-8994(93)90051-d</a>
New recommendations for the treatment of tuberculosis.
Adult; Antitubercular Agents – Administration and Dosage; Antitubercular Agents – Adverse Effects; Antitubercular Agents – Pharmacodynamics; Antitubercular Agents – Therapeutic Use; Antitubercular Agents/adverse effects/pharmacology/*therapeutic use; Bacterial; Chemical and Drug Induced Liver Injury; Child; Drug Resistance; Female; Hepatitis; HIV Infections – Complications; HIV Infections/complications; Humans; Infant; Microbial; Multiple; Practice Guidelines; Practice Guidelines as Topic; Preschool; Prescribing Patterns – Standards; Tuberculin Test; Tuberculosis – Drug Therapy; Tuberculosis – Epidemiology; Tuberculosis – Prevention and Control; Tuberculosis/*drug therapy/epidemiology/prevention & control; United States
PURPOSE OF REVIEW: The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis and to review newer recommendations and common problems encountered in the treatment of patients with tuberculosis. RECENT FINDINGS: Recently published literature documents the increased incidence of multidrug resistant strains of Mycobacterium tuberculosis, the importance of antituberculosis drug toxicities and drug-drug interactions, persistent problems in the correct interpretation of the tuberculin skin test and ongoing problems with treatment compliance and treatment completion. SUMMARY: This article provides a practical approach to the interpretation of the tuberculin skin test, the proper approach to the treatment of latent tuberculosis infection, and a structured approach to the treatment of presumed or documented active tuberculosis infection. Questions about tuberculosis that are often asked of infectious disease and pulmonary specialists are addressed in a very practical manner.
Myers Joseph P
Current Opinion in Infectious Diseases
2005
2005-04
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/10.1097/01.qco.0000160902.48942.31" target="_blank" rel="noreferrer noopener">10.1097/01.qco.0000160902.48942.31</a>
Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States.
80 and over; Adolescent; Adult; Age Distribution; Aged; Child; Databases; Drug-Related Side Effects and Adverse Reactions/diagnosis/*epidemiology/mortality/therapy; Factual; Female; Hormone antagonists; Hormone Antagonists/*adverse effects; Hormones; Hormones/*adverse effects; Humans; Infant; Male; Medication Errors/*statistics & numerical data; Middle Aged; Newborn; Oral hypoglycemic medications; Poison control center; Poison Control Centers; Preschool; Retrospective Studies; Risk Factors; Sex Distribution; Time Factors; Unintentional therapeutic error; United States/epidemiology; Young Adult
INTRODUCTION: Hormones and hormone antagonists are frequently associated with medication errors and may result in important adverse outcomes. The purpose of this study is to investigate non-health care facility (non-HCF) medication errors associated with hormones and hormone antagonists in the United States (US). METHODS: A retrospective analysis of National Poison Data System data was conducted to identify characteristics and trends of unintentional non-HCF therapeutic errors involving hormones and hormone antagonists among individuals of all ages from 2000 to 2012. RESULTS: From 2000 to 2012, US poison control centers received 169,695 calls regarding unintentional non-HCF therapeutic errors associated with hormone therapies, averaging 13,053 medication error calls annually. The rate of reported errors increased significantly by 162.6% (p \textless 0.001), from 2.24 per 100,000 US residents in 2000 to 5.89 per 100,000 in 2012. Two thirds of the errors (65.2%) occurred among females. The medications most commonly associated with errors were thyroid preparations (23.2%), corticosteroids (21.9%), and insulin (20.0%). All nine deaths and 93.2% of major effects were attributed to hypoglycemic agents. Sulfonylureas alone accounted 43.9% of major effects. The number and rate of therapeutic errors increased significantly for all medication categories except estrogen and thiazolidinediones. Most errors were managed at the site of exposure (82.9%) and did not result in serious medical outcomes (95.6%). CONCLUSIONS: This study provides an overview of non-HCF medication errors associated with hormones and hormone antagonists in the US. While most errors did not result in adverse outcomes, their increasing frequency places a greater burden on the health care system.
Magal Pranav; Spiller Henry A; Casavant Marcel J; Chounthirath Thitphalak; Hodges Nichole L; Smith Gary A
Journal of medical toxicology : official journal of the American College of Medical Toxicology
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s13181-017-0630-8" target="_blank" rel="noreferrer noopener">10.1007/s13181-017-0630-8</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Retrospective Studies; Child; Infant; Treatment Outcome; Risk Factors; Age Factors; Sex Factors; Cleft Lip/*surgery; Cleft Palate/*surgery; Pharynx/*surgery; Retreatment/statistics & numerical data; Speech; Velopharyngeal Insufficiency/*surgery; Preschool
OBJECTIVE: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. DESIGN: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. PARTICIPANTS: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. RESULTS: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. CONCLUSIONS: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor Landon S; Lehman James; Parker Michael G; Schmidt Anna; Fox Lynn; Murthy Ananth S
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
2006
2006-03
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/10.1597/04-115.1" target="_blank" rel="noreferrer noopener">10.1597/04-115.1</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
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/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
Painless deformity of a long finger phalanx of a 4-year-old girl.
Acquired/*diagnostic imaging/pathology; Biopsy; Bone Neoplasms/diagnostic imaging/pathology; Child; Chondroma/diagnostic imaging/pathology; Chronic Disease; Diagnosis; Differential; Female; Fingers/diagnostic imaging/pathology; Hand Deformities; Humans; Preschool; Radiography
Weiner S D; Iorio C D
Clinical orthopaedics and related research
1999
1999-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00003086-199912000-00038" target="_blank" rel="noreferrer noopener">10.1097/00003086-199912000-00038</a>