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Pediatric Practice (pediatric + practice)
Selected AbstractsBalloon Debanding the Pulmonary Artery: In Vitro Studies and Early Clinical ExperienceCONGENITAL HEART DISEASE, Issue 4 2009Gareth J. Morgan MPhil ABSTRACT Despite increasing corrective procedures for children with congenital heart disease, there remains a place for surgical banding of the main pulmonary artery (PA). In the vast majority of cases, these bands eventually need to be removed. We examined three cases of percutaneous disruption of PA bands using balloon catheters at our institution. We also performed an in vitro study of PA band disruption mechanism and disruption pressure. Our in vitro study suggested a predictable burst pressure for PA bands over the range of diameters routinely used in pediatric practice. Of three patients who underwent interventional debanding, two patients had successful disruption of their PA bands with no reintervention at 19 months and 23 months follow up. Balloon disruption of surgical PA bands may offer a less invasive alternative to surgical band removal. In vitro analysis suggests that the burst pressure required and mechanism of disruption are predictable. [source] Novel treatments for autistic spectrum disordersDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2005Susan E. Levy Abstract In no area of developmental pediatric practice is there more controversy regarding the choice of treatment than related to children with autistic spectrum disorders (ASD). Complementary and alternative medical therapies (CAM) are often elected because they are perceived as treating the cause of symptoms rather than the symptoms themselves. CAM used for autism can be divided by proposed mechanism: immune modulation, gastrointestinal, supplements that affect neurotransmitter function, and nonbiologic intervention. Secretin as a therapy for autism is discussed as an example of how a clinical observation rapidly grew to a widespread treatment before well-designed studies demonstrated absence of effect. The plausibility for behavioral effect was not substantiated by clinical studies. CAM used for treatment of autism is examined in terms of rationale, evidence of efficacy, side effects, and additional commentary. Families and clinicians need access to well-designed clinical evidence to assist them in choice of therapies. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:131,142. [source] Erythroderma/generalized exfoliative dermatitis in pediatric practice: An overviewINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2006Virendra N. Sehgal MD First page of article [source] Pro,con debate: is codeine a drug that still has a useful role in pediatric practice?PEDIATRIC ANESTHESIA, Issue 2 2010DCHRCP, FRCA, MICHAEL TREMLETT BM First page of article [source] The place of premedication in pediatric practicePEDIATRIC ANESTHESIA, Issue 9 2009ABRAHAM ROSENBAUM MD Summary Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro,con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective. [source] The Management of difficult intubation in childrenPEDIATRIC ANESTHESIA, Issue 2009ROBERT W.M. WALKER FRCA Summary This article looks at the current techniques and equipment recommended for the management of the difficult intubation scenario in pediatric practice. We discuss the general considerations including preoperative preparation, the preferred anesthetic technique and the use of both rigid laryngoscopic and fiberoptic techniques for intubation. The unanticipated scenario is also discussed. [source] Laryngospasm in pediatric practicePEDIATRIC ANESTHESIA, Issue 4 2008ANN E. BLACK FRCA No abstract is available for this article. [source] Ultrasonographic guidance in pediatric regional anesthesia.PEDIATRIC ANESTHESIA, Issue 11 2006Part 2: techniques Summary The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially ,blind' techniques. The development of high-resolution portable ultrasound (US) has made the use of US for regional anesthesia possible. Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks. [source] Acanthosis Nigricans: A Common Finding in Overweight YouthPEDIATRIC DERMATOLOGY, Issue 6 2007Wendy J. Brickman M.D. Youth (7,17 years) at nine pediatric practices completed surveys on demographics and family history of diabetes and had weight and height measured. Acanthosis nigricans was scored and digital photography of the neck performed. A total of 618 youth were included in the analysis: mean age 11.5 years; 51% female; 61% African American, 27% Hispanic, 12% Caucasian, and 32% with body mass index ,95th percentile. Acanthosis was found in 19%, 23%, and 4% of the African American, Hispanic, and Caucasian youth, respectively, and in 62% of youth with a body mass index ,98th percentile. Using multiple logistic regression, we found increasing body mass index z -score, presence of maternal gestational diabetes, female gender, and not being Caucasian each were independently associated with acanthosis nigricans. Acanthosis was common among overweight youth and was associated with risk factors for glucose homeostasis abnormalities. Acanthosis nigricans can be a trigger to counsel families on its causes and consequences; and thus motivate them to make healthy lifestyle changes that can decrease the risk of developing cardiovascular disease or diabetes. [source] Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trialCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2009Richard Reading Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial . BarrR. G., RivaraF. P., BarrM., CummingsP., TaylorJ., LenguaL. J. & Meredith-BenitzE. ( 2009 ) Pediatrics , 123 , 972 , 980 . DOI: 10.1542/peds.2008-0908 . Background Infant crying is an important precipitant for shaken-infant syndrome. Objective To determine if parent education materials [The Period of PURPLE Crying (PURPLE)] change maternal knowledge and behaviour relevant to infant shaking. Methods This study was a randomized, controlled trial conducted in prenatal classes, maternity wards and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included two knowledge scales about crying and the dangers of shaking; three scales about behavioural responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and three questions concerning the behaviours of sharing of information with others about crying, walking away if frustrated and the dangers of shaking. Results The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioural responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviours of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. Conclusions Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviours considered to be important for the prevention of shaking. [source] | |||||||||||||