Wednesday, April 23, 2014

Admit It—You Want to Try Home Oxygen for Bronchiolitis via the ED But Aren’t Sure If Benefits Outweigh Risks—Read On!

Photo by Zappy's Technology via Flickr
While hypoxia in the emergency setting usually means an inpatient admission, when there is mild hypoxia and good follow-up, perhaps sending a patients home from the emergency department on home oxygen might be an acceptable option. Yet what happens to those children sent home on extra
oxygen support?

Flett et al. (doi: 10.1542/peds. 2013-1872) studied a retrospective cohort of more than 230 consecutive patients sent home on oxygen rather than initially admitted. How these patients fared, including their need for readmission or other complications, is well-categorized in this interesting article that may change the way you manage your bronchiolitic patients.

Take a deep breath and read this study to learn more. While you’re at it, turn to a commentary by pediatric emergency medicine specialist Dr. Stephen Teach (doi: 10.1542/peds. 2014-0512) who offers his input on this study.

Are your patients with bronchiolitis being followed on home oxygen? Share your thoughts on what you do or about this study via a response to our blog, an eLetter, or our Facebook or Twitter sites.

Related Reading:

Tuesday, April 22, 2014

Codeine Use Despite Two National Guidelines That Say No

Public Domain Photo via Wikimedia Commons
Since 2006, there have been two national guidelines recommending avoidance of codeine in children for cough or upper respiratory symptoms—so how effective have those guidelines been in curtailing use of this drug for this purpose?

Kaiser et al. (doi: 10.1542/peds. 2013-3171) did a cross-sectional ten year look at codeine prescriptions written in emergency facilities as part of the National Ambulatory Care Survey both before and after the guidelines were published. The results may surprise or more likely disappoint those of you who are not using codeine for common cough and cold symptoms. Many still are. Why?

Both the authors and an accompanying commentary by pediatric toxicologists Drs. Alan Woolf and Christine Greco (doi: 10.1542/peds.2013-4057) shed some light on this issue and are worth your consideration. Hopefully publishing this article and commentary will make more of a dent in curtailing codeine usage than efforts have to date—but read both and learn more.

Related Reading:

Monday, April 21, 2014

Pay Attention: Two Studies on ADHD-Associated Language Problems, Anxiety Disorders

Photo by Lars Ploughmann via Flickr
We are always
looking for new findings that can be helpful to clinicians managing children with attention deficit hyperactivity
disorder (ADHD),
and this week we are releasing two such studies.

The first by Sciberras et al. (doi: 10.1542/peds.2013-3355) looked at the prevalence of language problems on the social and academic functioning of ADHD children in a cross-sectional study of children ages 6-8 years with and without this disorder. Even when one controls for socio-demographic factors and comorbidities, language problems appear to have a higher prevalence in those with ADHD. Just why this happens and what it means (or doesn’t mean) for social and academic function makes for interesting reading.

Likewise the role of anxiety or more than one anxiety comorbidity can also potentially hamper the quality of life of a child with ADHD and Dr. Sciberras et al. (doi:10.1542/peds.2013-3686) again study this association by noting the effect of one or more anxiety disorders in these patients. While one anxiety disorder is by itself not a major contributor to reduced quality of life, the same does not hold true when the number of disorders increases—and Dr Sciberras and her colleagues explain their findings in a fascinating discussion section.

Focus on both of these studies with your full attention, and you’ll be in much better shape monitoring your ADHD patients for associated difficulties up the road.

Have you found similar co-morbidities and subsequent worse outcomes in your own patients with ADHD? Share your thoughts with a response below, an eLetter, or via Facebook and Twitter.

Related Reading:

Friday, April 18, 2014

Injury Risk in Children with Epilepsy: New Opportunities for Prevention Strategies

Photo by Amanda Mills via the CDC
Having a seizure disorder is certainly a challenge for our patients, but does having such a disorder further predispose them to accidental fractures, burns, and overdoses of medications?

Prasad et al. (doi: 10.1542/peds. 2013-2554) opted to look into the prevalence of various injuries in
almost 12,000 patients with epilepsy between the ages of 1 to 24 years and compared these patients to a comparison group of more than 46,000 patients without seizures using a large longitudinal data base of primary care records.

Do you counsel your patients with seizures in regard to injury and poison prevention strategies? After reading this study, I suspect you will, based on the results and the discussion of these results by the authors. Check out this early-released study and learn more.

Related Reading:

Thursday, April 17, 2014

Simulation and Pediatrics: Does It Make A Difference?

Photo by LW web2dot0 via Flickr
More and more we are seeing simulation centers springing up in academic medical centers and being
utilized for teaching of students, residents, fellows, and even our peers for enhancement of clinical skills and patient interactions. So when it comes to learning, does the use of simulation for these purposes make a difference compared to teaching the skills without such technology enhancement?

Cheng et al. (doi: 10.1542/peds.2013-2139) share with us a very useful meta-analysis based on 57 studies involving over 3,500 learners to show us what simulation likely can and cannot accomplish—at least as of today. Their research showed that compared with no intervention, simulation training in pediatrics is associated with uniformly favorable results, though some types of simulation training seemed to be more effective than others. How realistic or technology-dependent interventions need to be effective may surprise you.

If you are considering using simulation as a teacher or a learner, center yourself on this review article —the real deal on what we can learn from simulation.

Related Reading:

Wednesday, April 16, 2014

Using Social Media to Recruit Patients with Rare Diseases for Research Studies

When a child has a rare disease and researchers want to study that disease, it is often difficult to recruit enough patients to make the study results valid, reliable, and in turn, generalizable.

Photo by Johan Larsson via Flickr
Schumacher et al. (doi: 10.1542/peds. 2013-2966) reflect on this problem by sharing the results of posting a study for patients with a rare form of protein-losing enteropathy and/or the rare pulmonary disease, plastic bronchitis, and tracking how patients learned of the study –e.g. via the original posting or through social media outlets for families with these rare problems. The results suggest that patient recruitment might be better achieved through social media than through more traditional websites that discuss rare disease research.

There is a lot to think about in reading how parents learned of these rare studies and the power of social media for recruiting subjects for rare disease research. If you have not journeyed into the world of social media—be aware that your patients certainly have—and you can join our world by visiting us on Facebook and Twitter to stay up to date on breaking studies in our journal and others.

Related Reading:

Tuesday, April 15, 2014

The Successful Usage of Pediatric Milestones in Residency Programs: What Will It Take to Happen?

Photo by Stephanie Bryant, via Flickr
The recent requirement of the Accreditation Council for Graduate Medical Education (the ACGME) to implement competency-based
assessment in residency programs is easier said than done. There are a
myriad of issues that one encounters
in trying to use milestones as the assessment currency of the residency realm—and yet as per ACGME—we must.

This week Schumacher et al. (doi:10.1542/peds. 2013-2917) take on this topic in a special article by sharing the components and resources they believe are needed by programs in four critical domains to insure a highly valid and reliable system of assessment using milestone analysis.

Adding clarification to what this article suggests is a commentary (doi: 10.1542/peds. 2013-3827) by Drs. Carol Carracio and David Nichols from the American Board of Pediatrics, who explore the value of changing from the current training and assessment system, the evidence that milestones-based assessment works, and possible ways to increase efficiencies and limit unnecessary costs.

If you are still wondering what milestones are all about—or perhaps need to use these in your office or hospital to assess trainees, then take the time to read these two articles. They will make you far more competent on the topic of milestones than you ever were before.