Showing posts with label therapies. Show all posts
Showing posts with label therapies. Show all posts

Friday, May 22, 2015

Reducing Healthcare-Related Risks: Parental Reading, Learning, and Understanding Their Children’s Diagnostic and Therapeutic Plans


By: Kathleen Walsh  MD, MSC
 
      An  article by Stockwell et al. (doi: 10.1542/peds.2014-2152) published this month in Pediatrics shows, unfortunately, that harm to hospitalized children caused by healthcare is all too common.  The study used a Pediatric All-Cause Harm Measurement Tool developed by the authors to identify one in four hospitalized children suffer harm due to the care they receive, and that 45% of these harms are preventable. 
      The prevention of healthcare associated harm begins with a good metric- to understand the size of the problem and measure the impact of improvement strategies.  Most hospitals measure harm to their patients using a combination of surveillance methods used to measure different types of harm, and most are manually gathered rather than automated.  The tool developed and used by Stockwell et al. is a single metric which can automatically gather information on many types of harm from existing electronic data from the medical record.
      Children outside of the hospital also experience harm in their healthcare. A recent study published in Pediatrics (doi: 10.1542/peds.2014-0309) found that, nationally, poison control centers receive a call every eight minutes for a pediatric medication error.  In another study published in Pediatrics (doi: 10.1542/peds.2012-2434), my group found that children with cancer experience injuries due to medication errors at home at rates comparable to hospitalized patients.  To eliminate harm to children caused by healthcare, researchers and clinicians need to broaden their focus to include all settings where healthcare is delivered.
      What can we do to reduce the risk of harm to their children caused by healthcare?  Clinicians and hospitals should get involved in improvement networks. Networks, such as the Children’s Hospitals Solutions for Patient Safety Network, have made great strides in reducing healthcare harm to hospitalized children.  Parents should take an active role in their child’s healthcare.  The Agency for Healthcare Research and Quality web site contains a list of 20 steps parents can take to reduce errors in their child’s care (http://archive.ahrq.gov/consumer/20tipkid.htm).  The document recommends that parents ask all health care workers who contact the child if they have washed their hands.   
     Parents should ask questions about their child’s home medications, including understanding what the medicine is for, side effects, and what time to give the medicine, and what to use to measure the medicine.  Parents, clinicians, and hospitals will need to partner together to eliminate harm to children caused by healthcare. 

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Friday, September 5, 2014

ADHD, Stimulant Treatment and Stunted Growth: Just a Tall Tale?

Photo by Woodleywonderworks via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

Do parents of your patients tell you they worry the stimulant medications being used on their child with attention deficit hyperactivity disorder (ADHD) may affect his or her growth—or so they have read on the internet? Well, stand tall and show these families the new study by Harstad et al. (doi: 10.1542/ peds.2014-0428).

The authors looked at a population–based birth cohort from 1976 through 1982 and identified 340 ADHD cases on stimulant medication and 680 controls. They followed these children into adulthood and monitored their height velocities longitudinally as well as their final adult heights.

There is good news: researchers noted no association with differences in adult height or changes in growth velocity, reinforcing the idea that concerns about growth are far more fiction than fact—at least as per this study.

Do you agree? Have you seen other data that suggests there is an effect? Share your thoughts on this growing controversy by leaving a comment, submitting an eLetter to our journal or by joining in the discussion on Facebook or Twitter.

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Tuesday, December 31, 2013

Isotonic or Hypotonic Maintenance IV Fluids?: A Meta-analysis Tells All

Photo by abbamouse via Flickr
It seems like the standard of care for decades has been to resuscitate with isotonic fluids but keep hydrated at maintenance using hypotonic fluids—at least until Wang et al. (doi: 10.1542/peds.2013-2041) sent us their meta-analysis on the safety of isotonic versus hypotonic IV fluids based on 10 published randomized controlled trials that met study criteria. The results will likely surprise you—so go with the flow of information aggregated in this study and find out more!

Related Reading:

Wednesday, December 18, 2013

Hypertonic Versus Normal Saline for Acute Bronchiolitis: Which Is More Effective and Which Is-Not?

Photo by anjanettew via Flickr
With bronchiolitis season here, it is time to bring out the hypertonic saline nebulized solution with the hope of loosening secretions and improving breathing as prior studies have suggested. Yet this week, we release a randomized controlled study by Jacobs et al. (doi: 10.1542/peds.2013-1646) that goes against the grain (of lots of salt) and proves earlier studies may not have been as valid as they implied and that normal saline may be just as effective as hypertonic salt solutions.

Using bronchiolitis severity scores as well as hospitalization rates, ED and inpatient length of stay, the authors have some findings that will make you take a deep breath before you use this therapy for infants to help them take a deeper breath. Dr. David Cornfield, an intensivist and member of our Editorial Board sheds additional light on the findings of this study in a provocative commentary (doi: 10.1542/peds.2013-3250) that accompanies this article.

Are you using hypertonic saline? Does it work for your bronchiolitic patients? Are you going to change as a result of this study? Share your thoughts and comments with us in the response area of this blog, or via social media, or even an eLetter to the journal. We look forward to your comments on this interesting study.