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Clinical Pediatrics

Jack Stevens, Deborah Splaingard, Stephanie Webster-Cheng, Joseph Rausch, Mark Splaingard
Self-administered treatments may overcome access barriers to evidence-based care for pediatric sleep problems. Two hundred thirty-nine families participated in a randomized controlled trial with 3 study arms: a DVD intervention condition (the Sleep Easy Solution), a Website comparison condition, and a Wait-List comparison condition. The primary outcome was trichotomous-Do you consider your child's sleep a problem? (not a problem at all, a small problem, a very serious problem). DVD was superior to Wait-List in terms of the primary outcome ( P = ...
February 19, 2019: Clinical Pediatrics
Zachary Willis, Delesha Miller Carpenter, Robyn Sayner, Betsy L Sleath
Children with asthma are exposed to antibiotics more frequently than their peers. The quality of provider-patient discussion about antibiotics is unknown. In this secondary data analysis, we reviewed existing transcripts of audiotaped adolescent asthma visits using a standardized coding sheet to analyze the quality of communication about antibiotics. Of 539 transcripts, we identified 12 discussions about antibiotics. No patient or parent requested antibiotics. In most cases, discussion was limited to assessment of drug allergies and preferred formulation...
February 19, 2019: Clinical Pediatrics
Louis Vernacchio, Emily K Trudell, Sarah R McLaughlin, Vijeta Bhambhani
Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices...
February 19, 2019: Clinical Pediatrics
Lakshmanan Sivasundaram, Nikunj N Trivedi, Julian Gatta, Anne Y Ning, Chang-Yeon Kim, R Justin Mistovich
Childhood non-accidental trauma (NAT) is the second most common cause of death in children. Despite its prevalence, NAT is frequently unreported due to provider misdiagnosis or unawareness. The purpose of this study was to determine current risk factors and injury patterns associated with NAT. A retrospective review of the Kids' Inpatient Database was performed for the years 2009 and 2012. Univariate and multivariate analyses were used to determine the statistically significant risk factors for NAT. In 2009 and 2012, 174 442 children were hospitalized for fractures...
February 16, 2019: Clinical Pediatrics
(no author information available yet)
No abstract text is available yet for this article.
February 14, 2019: Clinical Pediatrics
Brandon S Allport, Barry S Solomon, Sara B Johnson
Although father engagement in pediatric care is associated with positive child health outcomes, pediatric primary care providers (PCPs) often focus on the mother-child dyad. This study sought to characterize pediatric PCPs' engagement of fathers in care. Pediatric PCPs affiliated with an academic health system were invited to complete an online survey. The primary outcome was the proportion of providers who routinely implement American Academy of Pediatrics recommendations for father engagement. There were 100 respondents...
February 14, 2019: Clinical Pediatrics
Meike Lo Re, Margaret Chaplin, Benjamin Aronow, Vania Modesto-Lowe
The escalation of the opioid crisis has led to an increase in the treatment of opioid use disorder. In particular, recent legislation has allowed for office-based treatment with buprenorphine, a partial µ-opioid agonist that is believed to be safer than methadone due to a ceiling effect on respiratory depression in adults. An increasing number of children are being exposed to buprenorphine as more adults in US households receive take-home prescriptions. The ceiling effect seen in adults does not seem to apply to young children, and intoxication with severe symptoms including fatalities can occur...
February 10, 2019: Clinical Pediatrics
Patrick T Reeves, Jayasree Krishnamurthy, Eric A Pasman, Cade M Nylund
During the observance of Christmas, many families display decorations, which increases the risk of unfettered access and subsequent ingestion of small objects by children in the home. Our aim was to characterize the epidemiology of Christmas foreign body ingestion (CFBI) by children. National Electronic Injury Surveillance System data from 1997 to 2015 were obtained for children aged 0 to 17 years who presented to United States Emergency Departments matching "ingested" for "artificial Christmas trees"; "Christmas tree lights"; "Christmas tree stands or supports"; "Christmas decorations, nonelectric"; and "Christmas decorations, electric" (excluding tree lights)...
February 8, 2019: Clinical Pediatrics
Shamim Islam, Nora Biary, Brian Wrotniak
No abstract text is available yet for this article.
February 8, 2019: Clinical Pediatrics
Ladan Davallow Ghajar, Lauren K Wood Heickman, Mark Conaway, Alan D Rogol
Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of ≤18.0 µg/dL (~500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2...
January 29, 2019: Clinical Pediatrics
Matthew J Bruehl, Wallace D Brown, Diana Metropulos, James W Antoon
No abstract text is available yet for this article.
January 28, 2019: Clinical Pediatrics
Laura R Kair, Valerie J Flaherman, Tarah T Colaizy
BACKGROUND: Pasteurized donor human milk (DHM) use for healthy newborns is increasing; however, no studies have explored its effect on breastfeeding outcomes. PATIENTS AND METHODS: We enrolled 60 healthy, term breastfeeding newborns with ≥4.5% weight loss in the first 36 hours in a randomized controlled trial. Thirty newborns were randomly assigned to early limited-volume DHM supplementation and 30 newborns to exclusive breastfeeding. Mothers were surveyed at 1 week and 1, 2, and 3 months regarding the mode of infant feeding...
January 28, 2019: Clinical Pediatrics
Karina M Paci, Randall Wink, Julie Blatt, Dean S Morrell, Paul B Googe, Diana B McShane
No abstract text is available yet for this article.
January 23, 2019: Clinical Pediatrics
Jonathan C Routh, Steven Wolf, Rohit Tejwani, Ruiyang Jiang, Gina-Maria Pomann, Benjamin A Goldstein, Matthew L Maciejewski, Alexander C Allori
The impact of the Patient Protection and Affordable Care Act (PPACA) on children's access to surgical care is not well-defined. Our objective was to describe the early impact of PPACA on children's surgical care before and after Medicaid expansion in 2014. We compared pediatric and young adult surgical outcomes in 2013 and 2014 in Medicaid expansion and nonexpansion states; young adults were included as a control group. From 4 states, 1 597 708 encounters met all inclusion criteria. Comparing expansion to nonexpansion states, modest increases were noted in elective instead of urgent/emergent admissions; in ambulatory instead of inpatient surgeries; in inpatient length of stays; in discharges to home instead of other inpatient care facilities; and in charges for inpatient admissions...
January 22, 2019: Clinical Pediatrics
Mafalda Cascais, Sónia Almeida, Carolina Cordinhã, Carmen do Carmo, Clara Gomes, António Jorge Correia
No abstract text is available yet for this article.
January 18, 2019: Clinical Pediatrics
Laurence Boillat, Federica Angelini, Anne Crucis-Armengaud, Sandra A Asner, Isabelle Rochat
No abstract text is available yet for this article.
January 18, 2019: Clinical Pediatrics
Arvin Garg, Yorghos Tripodis, Zephyr D Dworsky, Robert D Sege
No abstract text is available yet for this article.
January 9, 2019: Clinical Pediatrics
Michael L Rinke, Miguelina German, Bridget Azera, Moonseong Heo, Nicole M Brown, Rachel S Gross, David G Bundy, Andrew D Racine, Carmen Duonnolo, Rahil D Briggs
Adolescent depression causes morbidity and is underdiagnosed. It is unclear how mental health screening and integrated mental health practitioners change adolescent depression identification. We conducted a retrospective primary care network natural cohort study where 10 out of 19 practices implemented mental health screening, followed by the remaining 9 practices implementing mental health screening with less coaching and support. Afterward, a different subset of 8 practices implemented integrated mental health practitioners...
January 9, 2019: Clinical Pediatrics
Brian Murray, Matthew J Streitz, Michael Hilliard, Joseph K Maddry
INTRODUCTION: Adverse medication events are a potential source of significant morbidity and mortality in pediatric patients, where dosages frequently rely on weight-based formulas. The most frequent occurrence of medication errors occurs during the ordering phase. METHODS: Through a prospective cohort analysis, we followed medication errors through patient safety reports (PSRs) to determine if the use of a medication dosage calculator would reduce the number of PSRs per patient visits...
January 8, 2019: Clinical Pediatrics
Robert D Needlman, Benard P Dreyer, Perri Klass, Alan L Mendelsohn
Attendance at well-child visits (WCVs) is a sine qua non of preventive care. We hypothesized that Reach Out and Read (ROR) would be associated with better WCV attendance. Parents of children 76 to 72 months at 8 clinics who did not yet have ROR reported how many WCVs their child had attended in the previous year; separate samples at the same clinics were interviewed 16 months after the ROR program was instituted. Comparing 267 parents before ROR and 254 after, the percentage who had attended the minimum number of WCVs required by the American Academy of Pediatrics periodicity schedule rose from 67...
January 7, 2019: Clinical Pediatrics
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