Showing posts with label guidelines. Show all posts
Showing posts with label guidelines. Show all posts

Monday, April 14, 2014

Two Studies on Media Exposure in Young Children Provide Concerning Results

Photo by normanack via Flickr
The AAP has made media awareness a priority issue for pediatricians and patients and policies to limit media exposure in infants, children and teens have come forth over the past few years in our journal (doi: 10.1542/ peds.2013-2656).

Despite the policies, children seem to be spending more and more time engaged in media usage so this week we are releasing two studies you can share with your patients that might make more of a dent in reducing the amount of television or other media children are often routinely exposed to at home.

The first study by Cespedes et al. (doi: 10.1542/peds.2013-3998) looked at sleep duration differences between infancy and mid-childhood when there was a television in the bedroom as the child got older, as well as whether sleep duration was influenced negatively by the amount of television watched overall. Given the studies we have published on the association of inadequate sleep with general mental and physical health, having sleep duration potentially influenced, or at least associated with, prolonged television exposure and/or television in the bedroom is a message that is well-worth sharing with your patients.

Similarly, a second study by Radesky et al. (doi: 10.1542/peds.2013-2367) looked at parental report of infant behavioral self-regulation and its association with early childhood media exposure. The authors’ study hypothesis was that poor-self regulation would result in parents placing their child in front of television and videos more than those parents who did not perceive their children having self-regulation problems. Again—alerting families that there are better solutions to perceived behavioral issues with their children than simply putting them in front of a television or video screen is also some guidance we might provide to parents in our quest to reduce media exposure in our youngest patients.

Channel your energy into reading these two studies so you can in turn channel your media-reduction messages even more to your patients.

Related Reading:

Thursday, February 20, 2014

Quality Improvement: Reducing Utilization for Inpatients with Bronchiolitis

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our March issue:

We all know that the mainstay of treatment for bronchiolitis is time. Still, some children require hospitalization for respiratory support. Once in the hospital, it is all too easy to order tests and unnecessary treatment. Is it possible to change that?
Photo by Lumax Art via Flickr

Dr. Mittal and colleagues (doi: 10.1542/peds.2013-2881) share their experience in decreasing utilization without worsening care. Though implementing clinical practice guidelines can be a complex process, Dr. Mittal’s team successfully developed and implemented guidelines for management of bronchiolitis in children less than 2 years old. Their implementation not only involved teamwork and collaboration (including monthly team meetings), but provider education, online access to the clinical practice guidelines, order sets and data sharing. Read more of the quality report to learn what impact this had on resource utilization and length of stay.

Spend some time that you would otherwise use ordering tests to let us know how you can decrease unnecessary utilization. Leave a comment below, submit an eLetter on our journal site, or join the conversation on Facebook or Twitter.

Tuesday, February 11, 2014

Just When You Thought The AAP Guidelines Had Solved How to Evaluate a UTI…

Photo by Aseev Artem via Wikimedia Commons
In 2011, the AAP via our journal published revised evidence-based guidelines for diagnosis and treatment of urinary tract infections in children (doi: 10.1542/peds.2011-1330) that received much attention and resulted in various commentaries, letters to the editor, and subsequent studies to further confirm or not confirm these guidelines.

One recommendation was that a renal and bladder ultrasound should be performed after an initial febrile UTI, and a voiding cystourethrogram should follow if the ultrasound shows an abnormality—and this has been accepted as the standard of practice—at least until Nelson et al. (doi: 10.1542/peds.2013-2109) published their early release study this week looking at almost 4,000 cases where both an ultrasound and VCUG were both performed. The sensitivity, specificity, and predictive values of ultrasound for an abnormal VCUG were determined.

Sadly, in this study, ultrasound proved to be a poor predictor of genitourinary abnormalities and a VCUG was needed even in the setting of a negative ultrasound.

Has this been the case for you? Do you agree with the findings in this study? Share your thoughts below or via an eLetter, Facebook or Twitter, or go with the flow and read an accompanying commentary by Downs et al. (doi: 10.1542/peds.2013-4158) that presents a different take on what we should do for follow-up if we identify a UTI. Read this study and commentary and learn more.

Related Reading:

Wednesday, December 4, 2013

AAP Guidelines for Bronchiolitis: Are We Using Them? How Do We Know?

In 2006, the AAP published a set of evidence-based Clinical Practice Guidelines for diagnostic testing and treatment of bronchiolitis (doi: 10.1542/peds.2006-2223). Once published, did anyone use them, and if so, can that be reflected in less diagnostic testing and certain- types of treatments?

Parikh et al. (doi: 10.1542/peds.2013-2005) decided to examine this by looking at inpatients with bronchiolitis before and after the Guidelines were published using a large administrative billing database. In a representative cohort of 41 pediatric hospitals involving more than 130,000 patients over an 8 year period, it appears the guidelines are making a difference in reducing inappropriate non-evidence-based tests and some treatments.

To find out just how utilization is reduced and in what way, take a deep breath and read this article for yourself. If you haven’t been adhering to these Guidelines, you likely will after you read this interesting study.