Showing posts with label respiration. Show all posts
Showing posts with label respiration. Show all posts

Wednesday, March 18, 2015

To Air Is Human: New Tools In At Home Asthma Treatment


By: Kathleen Walsh  MD, MS; Editorial Board Memeber
 
      When I ask my adolescent daughter about her asthma care goals, she replies “I don’t have any,” with a sarcastic tone and a charming, braces-filled grin.  However, I know her goals include placing well in cross country races, passing her taekwondo tests, and getting good grades in school.
       All of these require excellent control of her asthma.  When she was a baby, my goals for her asthma were to minimize exacerbation frequency and duration both for her happiness and so I could finish residency.  While achieving my goals for my daughter’s asthma care has always been my primary motivation for adhering to her treatment, only recently have our goals become a part of our discussions with her clinicians.
       In this week’s Pediatrics, the MyAsthma intervention described by Fiks et al. (doi: 10.1542/peds.2014-3167) takes an important early step toward parent and physician shared decision making regarding asthma treatment at home.  MyAsthma is a portal-based intervention, where parents enter information about their child’s asthma, including their goals and their child’s current symptoms, several times a month.  The portal uses evidence-based protocols to support decisions by the family and clinician about when they need to communicate further and when to change the home treatment plan.
      Although the study was relatively small, with twenty-six children in the treatment arm and a 57% participation rate, the authors found statistically significant improvements in some outcomes.  Specifically, children in the treatment group had significantly larger improvements in ACT scores over the study period compared to controls.  In addition, parents in the treatment group reported significantly less missed work than controls.  While other portal-based asthma interventions exist, this is the first to ask parents about their asthma management goals.
      The identification of family care goals is a key step in the parent and clinician co-management of chronic disease.  The portal-based intervention described by Fiks provides decision support for asthma management when and where the patient needs it- at the family’s convenience and at home.  It also enables a partnership between families and clinicians through goal setting, enhanced communication, and early identification and mitigation of changes in health status.  The spread of promising interventions such as this one will provide the necessary support so that families and clinicians can collaborate to improve chronic disease outcomes.  For pediatricians, this is the kind of collaborative care we would like to provide to all of our patients and their families.  

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Monday, July 14, 2014

Two Studies on the Benefits of Delayed Cord Clamping

By: Lewis First, MD, MS; Editor-in-Chief 

Early (less than 30 seconds) versus delayed (greater than 30-60 seconds) cord clamping has been the subject of a number of recent studies in our journal and others, and this week, we share two more that are worth your attention.

Photo by Mamma Loves via Flickr
The first by Diaz-Castro et al. (doi: 10.1542/ peds.2013-3798) looks at the influence of early versus late cord clamping relative to oxidative stress and inflammation signaling. The delay in clamping may reduce the amount of oxidative stress and inflammation and improve outcomes without other adverse complications—at least according to data shared by these authors.

To lend further support to delayed clamping, Ersdal et al. (doi: 10.1542/peds.2014-0467) looked at the timing of cord clamping relative to spontaneous respiration. The authors studied more than 15,500 infants born in Tanzania and looked at neonatal outcomes and found benefit in reducing risk of death when spontaneous respirations preceded cord clamping.

To better understand the pathophysiologic mechanisms that result in beneficial outcomes to newborns by delayed cord clamping, read both studies and you’re likely to be in accord if you aren't already in seeing even more benefit to this practice when a baby is born.

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