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Send us a textActive Treatment vs Expectant Management of Patent Ductus Arteriosus in Preterm Infants: A Meta-Analysis.Buvaneswarran S, Wong YL, Liang S, Quek SC, Lee J.JAMA Pediatr. 2025 May 27:e251025. doi: 10.1001/jamapediatrics.2025.1025. Online ahead of print.PMID: 40423988 Free PMC As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textPrenatal Cannabis Use and Neonatal Outcomes: A Systematic Review and Meta-Analysis.Lo JO, Ayers CK, Yeddala S, Shaw B, Robalino S, Ward R, Kansagara D.JAMA Pediatr. 2025 May 5:e250689. doi: 10.1001/jamapediatrics.2025.0689. Online ahead of print.PMID: 40323610As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Avec Dre Julie Autmizguine, pédiatre-infectiologue, et Stéphanie Tremblay, pharmacienne en pédiatrie générale et en maladies infectieuses, nous allons:définir l'ostéomyélite et l'arthrite septique (définition, physiopathologie, agents pathogènes, diagnostic, complications possibles);décrire les différentes options de traitements (chirurgical, médical);illustrer les notions abordées via des cas patients afin de répondre à des questions pratiques.Références:Société canadienne de pédiatrie. Le diagnostic et la prise en charge des infections ostéoarticulaires aiguës chez les enfants. 2018. Reconduit en janvier 2024. The Royal Children's Hospital Melbourne. Clinical Practice Guideline: Bone and joint infection. Mis à jour en 2021. Peltola H et al. Osteomyelitis-Septic Arthritis Study Group. Short- versus long-term antimicrobial treatment for acute hematogenous osteomyelitis of childhood: prospective, randomized trial on 131 culture-positive cases. Pediatr Infect Dis J. 2010 Ballock RT et al. A comparison of early versus late conversion from intravenous to oral therapy in the treatment of septic arthritis. J Pediatr Orthop. 2009 Autmizguine J et al. Pharmacokinetics and pharmacodynamics of oral cephalexin in children with osteoarticular infections. Pediatr Infect Dis J. 2013Nielsen AB et al. Oral versus intravenous empirical antibiotics in children and adolescents with uncomplicated bone and joint infections: a nationwide, randomised, controlled, non-inferiority trial in Denmark. Lancet Child Adolesc Health. 2024 Alcobendas Rueda RM et al. Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom? Pediatr Infect Dis J. 2022 Keren R et al. Pediatric Research in Inpatient Settings Network. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015 AntibioPed. (2025) Messil inc. (Version 1.5.0) [Application mobile] Disponible sur l'AppStore et Google Play. Également disponible en version web.Captation et montage: Philippe Lacroix, spécialiste en audiovisuelIdée originale, réalisation et animation: Émilie Roy-St-PierreConseillères en communication: Katrine Louis-Seize et Pascale ChatagnierLogo: Équipe des communications et du graphisme du CHU Sainte-JustineMusique: Samuel Ross Collègues, ami(e)s et famille, merci pour votre précieux soutien. © mgparkilo 2025Merci pour l'écoute! Allez mettre une réaction sur vos épisodes préférés, partagez la bonne nouvelle sur Facebook/Instagram et abonnez-vous pour ne rien manquer
Los artículos que se tratan en el episodio de hoy están listados aquí:Stalter, E. J., Verhofste, S. L., Dagle, J. M., Steinbach, E. J., Ten Eyck, P., Wendt, L., Segar, J. L., & Harshman, L. A. (2025). Somatic growth outcomes in response to an individualized neonatal sodium supplementation protocol. Journal of perinatology : official journal of the California Perinatal Association, 45(3), 305–311. https://doi.org/10.1038/s41372-024-02141-9Oikonomopoulou, N., Rodriguez-Castaño, M. J., Corredera, A., Cortés-Ledesma, C., Vierge, E., Martinez-Orgado, J., & Arruza, L. (2025). Extremely preterm infants with adverse neurological outcome present more frequently impaired right ventricular performance. Pediatric research, 10.1038/s41390-025-03959-5. Advance online publication. https://doi.org/10.1038/s41390-025-03959-5Jeanne, Emilya; Alvaro, Rubenb; Shalish, Wissamc. Reimagining apnea monitoring in the neonatal ICU. Current Opinion in Pediatrics 37(2):p 173-181, April 2025. | DOI: 10.1097/MOP.0000000000001432 Faix RG, Laptook AR, Shankaran S, et al. Whole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial. JAMA Pediatr. Published online February 24, 2025. doi:10.1001/jamapediatrics.2024.6613 Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal. Soy tu host, Maria Flores Cordova, MD. Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos. No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comSíguenos en nuestras redes:Twitter: @incubadorapodInstagram: @laincubadorapodcast Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org
Send us a textWhole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial.Faix RG, Laptook AR, Shankaran S, Eggleston B, Chowdhury D, Heyne RJ, Das A, Pedroza C, Tyson JE, Wusthoff C, Bonifacio SL, Sánchez PJ, Yoder BA, Laughon MM, Vasil DM, Van Meurs KP, Crawford MM, Higgins RD, Poindexter BB, Colaizy TT, Hamrick SEG, Chalak LF, Ohls RK, Hartley-McAndrew ME, Dysart K, D'Angio CT, Guillet R, Kicklighter SD, Carlo WA, Sokol GM, DeMauro SB, Hibbs AM, Cotten CM, Merhar SL, Bapat RV, Harmon HM, Sewell E, Winter S, Natarajan G, Mosquera R, Hintz SR, Maitre NL, Benninger KL, Peralta-Carcelen M, Hines AC, Duncan AF, Wilson-Costello DE, Trembath A, Malcolm WF, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA Pediatr. 2025 Feb 24:e246613. doi: 10.1001/jamapediatrics.2024.6613. Online ahead of print.PMID: 39992674As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-419 Overview: Water fluoridation has been an area of periodic controversy since it was first introduced in the 1950s. This episode dives into recent reports on the benefits and potential impacts of water fluoridation on children's IQ. Gain valuable insights and feel prepared when addressing patient questions about this topic. Episode resource links: Taylor KW, Eftim SE, Sibrizzi CA, et al. Fluoride Exposure and Children's IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online January 06, 2025. Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny AM, O'Malley L. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2024 Oct 4;10(10):CD010856. Schluter PJ, Hobbs M, Atkins H, Mattingley B, Lee M. Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children. JAMA Pediatr. 2020 Oct 1;174(10):969-976 Guest: Alan M. Ehrlich, MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-419 Overview: Water fluoridation has been an area of periodic controversy since it was first introduced in the 1950s. This episode dives into recent reports on the benefits and potential impacts of water fluoridation on children's IQ. Gain valuable insights and feel prepared when addressing patient questions about this topic. Episode resource links: Taylor KW, Eftim SE, Sibrizzi CA, et al. Fluoride Exposure and Children's IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online January 06, 2025. Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny AM, O'Malley L. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2024 Oct 4;10(10):CD010856. Schluter PJ, Hobbs M, Atkins H, Mattingley B, Lee M. Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children. JAMA Pediatr. 2020 Oct 1;174(10):969-976 Guest: Alan M. Ehrlich, MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Send us a textApnea After 2-Month Vaccinations in Hospitalized Preterm Infants: A Randomized Clinical Trial. Greenberg RG, Rountree W, Staat MA, Schlaudecker EP, Poindexter B, Trembath A, Laughon M, Poniewierski MS, Spreng RL, Broder KR, Wodi AP, Museru O, Anyalechi EG, Marquez PL, Randolph EA, Aleem S, Kilpatrick R, Walter EB.JAMA Pediatr. 2025 Jan 6. doi: 10.1001/jamapediatrics.2024.5311. Online ahead of print.PMID: 39761016As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Language delays are one of the most common concerns brought up in pediatric well visits. Dr. Jennifer Poon, a pediatric specialist in Development and Behavior, joins Dr. Sarah Straka and medical student Alisha Patel to discuss how to recognize and manage language delays. Specifically, they will: Define and understand language delay. Recognize the initial signs and symptoms of language delays. Identify and explain clinical pearls of potential etiologies of language delays. Recognize the developmental milestones for language based on age. Discuss the prevalence of language delays as well as identify the risk factors and patient demographics that have an increased susceptibility. Understand the initial diagnostic approach to the child with suspected language delay. Review the most common interventions when a child has language delay. Understand how to best discuss the prognosis for language delays and counsel the families and caregivers CME Credit (requires free sign up): link coming soon! References: Karani NF, Sher J, Mophosho M. The influence of screen time on children's language development: A scoping review. S Afr J Commun Disord. 2022 Feb 9;69(1):e1-e7. doi: 10.4102/sajcd.v69i1.825. PMID: 35144436; PMCID: PMC8905397. Law, James et al. “Speech and language therapy interventions for children with primary speech and/or language disorders.” The Cochrane Database of Systematic Reviews 2017,1 CD012490. 9 Jan. 2017, doi:10.1002/14651858.CD012490 Sices, Laura, and Marilyn Augustyn. “Expressive Language Delay (‘Late Talking') in Young Children.” Edited by Robert G Voigt and Mary Torchia, UptoDate, Wolters Kluwer, UpToDate, Inc., 25 Jan. 2022, https://www.uptodate.com/contents/expressive-language-delay-late-talking-in-young-children. Spratt, Eve G et al. “The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood.” Psychology (Irvine, Calif.) 3,2 (2012): 175-182. doi:10.4236/psych.2012.32026 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652241/ Sunderajan, Trisha, and Sujata V Kanhere. “Speech and language delay in children: Prevalence and risk factors.” Journal of family medicine and primary care 8,5 (2019): 1642-1646. doi:10.4103/jfmpc.jfmpc_162_19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559061/ Takahashi I, Obara T, Ishikuro M, et al. Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years. JAMA Pediatr.Published online August 21, 2023. doi:10.1001/jamapediatrics.2023.3057 Young, Allen. and Matthew Ng. “Genetic Hearing Loss.” StatPearls, StatPearls Publishing, 17 April 2023. https://www.ncbi.nlm.nih.gov/books/NBK580517/ Zuckerman B, Khandekar A. Reach Out and Read: evidence based approach to promoting early child development. Curr Opin Pediatr. 2010 Aug;22(4):539-44. doi: 10.1097/MOP.0b013e32833a4673. PMID: 20601887.
Send us a textOccurrence and Time of Onset of Intraventricular Hemorrhage in Preterm Neonates: A Systematic Review and Meta-Analysis of Individual Patient Data.Nagy Z, Obeidat M, Máté V, et al. JAMA Pediatr. 2024 Dec. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textSystemic Postnatal Corticosteroids, Bronchopulmonary Dysplasia, and Survival Free of Cerebral Palsy. Doyle LW, Mainzer R, Cheong JLY.JAMA Pediatr. 2024 Nov 18:e244575. doi: 10.1001/jamapediatrics.2024.4575. Online ahead of print.PMID: 39556404 Systemic Corticosteroids to Prevent Bronchopulmonary Dysplasia: Balancing Risk and Reward. Jensen EA.JAMA Pediatr. 2024 Nov 18. doi: 10.1001/jamapediatrics.2024.4572. Online ahead of print.PMID: 39556388 No abstract available.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textNational Trends in Infant Mortality in the US After Dobbs.Singh P, Gallo MF.JAMA Pediatr. 2024 Oct 21. doi: 10.1001/jamapediatrics.2024.4276. Online ahead of print.PMID: 39432283As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Hello everyone and welcome to another episode of the Performance Psychcast. Today we are very fortunate to be speaking with David Durand. David Durand is a sports performance and psychology coach. His background and training is in clinical psychology, while he also has a strength and conditioning certification from the NSCA and a mental performance consultant certification from the AASP. His business, Real Development LLC, offers sports training services that combine mental, physical, and skill development for athletes. David focuses on helping individuals develop through a holistic perspective that increases their long-term potential rather than over emphasizing short-term success. His new book, B.E.T. On It: A Psychological Approach to Coaching Gen Z and Beyond, is a guide for coaches looking to make a difference in modern athletes' lives by understanding their brains and bodies on a deeper level and equipping them with tools to increase their health, well-being, and performance. https://www.amazon.com/B-T-Psychological-Approach-Coaching/dp/B0DB6SFDRK/ref=sr_1_1?crid=3NUQJJCKPWGMG&dib=eyJ2IjoiMSJ9.eoaf9FTSjdtYtTMZE78B8ettggUH6hP5Xd8Et6UOi1MWliBOfilpx9uhNBwUz7zBRIiEpSUgzh01s4g_h5U7d856oXNi6J2FDDpUqgGwHfA.nHVlSaU_r8iqkSfsGvpBJyUcFFkTms88aCfs6sJfjqM&dib_tag=se&keywords=bet+on+it+a+psychological+approach&qid=1722423966&sprefix=%2Caps%2C112&sr=8-1 And here's the study referenced in the podcast: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2799812#:~:text=Motivated%20by%20the%20anticipation%20of,brain%20responds%20to%20its%20environment. Citation: Maza MT, Fox KA, Kwon S, et al. Association of Habitual Checking Behaviors on Social Media With Longitudinal Functional Brain Development. JAMA Pediatr. 2023;177(2):160–167. doi:10.1001/jamapediatrics.2022.4924 www.sportingbounce.com The online directory of sport performance specialists. Sportingbounce helps connect specialists in sport psychology, nutrition, sports massage, injury rehabilitation, coaching, and fitness training s with clients. With a daily spend on Google Adwords, social media advertising, and excellent organic rankings on search engines your business will get found on sporting bounce. Visit sportingbounce.com to find out how sporting bounce can help you. Don't forget that listeners of this podcast can get 50% off the Premium membership package by entering the code performance, that's “PERFORMANCE” meaning you get the best possible coverage for less than 20 pence a day!
Send us a textInitial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks' Gestation: A Systematic Review and Individual Participant Data Network Meta-Analysis.Sotiropoulos JX, Oei JL, Schmölzer GM, Libesman S, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, Dekker J, Vermeulen MJ, Sundaram V, Kumar P, Kaban RK, Rohsiswatmo R, Saugstad OD, Seidler AL.JAMA Pediatr. 2024 Aug 1;178(8):774-783. doi: 10.1001/jamapediatrics.2024.1848.PMID: 38913382As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textWhat I Have Learned in the Last 24 Years Being Editor-in-Chief.Rivara FP.JAMA Pediatr. 2024 Sep 3. doi: 10.1001/jamapediatrics.2024.3288. Online ahead of print.PMID: 39226042 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Natalie Lister is a Senior Research Fellow at The Children's Hospital at Westmead Clinical School at The University of Sydney. She is an Accredited Practicing Dietitian and has a PhD in Nutritional Science from the University of South Australia. Natalie's research interests include investigating dietary interventions that will prevent and manage obesity, diabetes, and cardiovascular risk in children and adolescents. Other interests include investigating the role of eating behaviours, dietary components, and diet quality in improving health.Follow Dr Natalie on LinkedInMake Natalies recipe HEREFast Track trial KEY research papers: Lister, et al. Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial. JAMA Pediatr. 2024 Aug 26. doi: 10.1001/jamapediatrics.2024.2869. Jebeile, et al. Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial. JAMA Pediatr. 2024 Aug 26. doi: 10.1001/jamapediatrics.2024.2851. Hosted on Acast. See acast.com/privacy for more information.
Welcome to the (delayed) 10th & SUMMER BOTOX SPECIAL EPISODE of BSCOS Paediatric Orthopaedic Digest (POD)cast with Caroline Edwards, Head of Childrens Surgery at Plymouth hospital who started her consultant career at Southampton Childrens Hospital, she set up and developed the neuromuscular service. She proposes a "hub and spoke" model for learning at busy tertiary centres and shared her research on the surgical vulnerability score, a tool to assess the likelihood of early death in patients with neuromuscular disorders. Caroline highlights the challenges faced by young adults transitioning from clinic care for cerebral palsy and suggested district general hospitals could provide dedicated clinics. Listen in to the episode to learn more! We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. Skeletal Muscle in Cerebral Palsy: From Belly to Myofibril. Howard JJ & Herzog W. Front Neurol. Feb 2021. PMID: 33679586 2. Virtual Reality Distraction Is No Better Than Simple Distraction Techniques for Reducing Pain and Anxiety During Pediatric Orthopaedic Outpatient Procedures: A Randomized Controlled Trial. Fabricant PD et al. Clin Orthop Relat Res. May 2024. PMID: 37939199 3. Effect of parental touch on relieving acute procedural pain in neonates and parental anxiety (Petal): a multicentre, randomised controlled trial in the UK. Hauck AGV et al. Lancet Child Adolesc Health. April 2024. PMID: 38373429. 4. REM Sleep Preserves Affective Response to Social Stress-Experimental Study. Halonen et al. eNeuro. June 2024. PMID: 38802242 5. Functional electrical stimulation during walking in children with unilateral spastic cerebral palsy: A randomized cross-over trial. Moll et al. Dev Med Child Neurol. May 2024. PMID: 37823431. 6. Clinical Effectiveness of Newborn Screening for Spinal Muscular Atrophy: A Nonrandomized Controlled Trial. Schwartz et al. JAMA Pediatr. June 2024. PMID: 38587854 7. Surgical management of proximal femoral unicameral bone cyst in children. Maximen et al + SOFOP. Bone Joint J. May 2024. PMID: 38688504 8. Treatment of Hip Displacement in Children With Cerebral Palsy: A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children. Kiapekos N et al. J Pediatr Orthop. July 2024. PMID: 38477355 9. Impact of Pavlik Harness treatment on motor skills acquisition: A case-control study. Jesus AR et al. J Child Orthop. March 2024. PMID: 39100978 10. Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills. Harari RE et al. JAMA Netw Open. July 2024. PMID: 39083274 11. Single versus double retrograde intramedullary nail technique for treatment of displaced proximal humeral fractures in children: A retrospective cohort study. Samara E et al. J Child Orthop. March 2024. PMID: 38831859 12. Can the Achilles tendon regenerate completely following percutaneous tenotomy in older children with clubfoot? Aroojis A et al. Int Orthop. June 2024. PMID: 38340143. 13. Guided Growth With Minifragment Plates for Angular Deformities in the Distal Radius in Skeletally Immature Patients. Preliminary Results. Soler-Jimenez A et al. J Pediatr Orthop. September 2024. PMID: 38767293. 14. Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. Liang M et al. J Pediatr Orthop. April 2024. PMID: 38312109 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B See as many of you as possible at the BSCOS sessions at the BOA in Birmingham!
Send us a Text Message.Infant Deaths After Texas' 2021 Ban on Abortion in Early Pregnancy.Gemmill A, Margerison CE, Stuart EA, Bell SO.JAMA Pediatr. 2024 Jun 24:e240885. doi: 10.1001/jamapediatrics.2024.0885. Online ahead of print.PMID: 38913344As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal.Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos; y su anfitriona Maria Flores Cordova, médico residente de pediatría.No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comLos artículos que se tratan en el episodio de hoy están listados aquí:Trial of Selective Early Treatment of Patent Ductus Arteriosus with Ibuprofen.Gupta S, Subhedar NV, Bell JL, Field D, Bowler U, Hutchison E, Johnson S, Kelsall W, Pepperell J, Roberts T, Sinha S, Stanbury K, Wyllie J, Hardy P, Juszczak E; Baby-OSCAR Collaborative Group.N Engl J Med. 2024 Jan 25;390(4):314-325. doi: 10.1056/NEJMoa2305582. PMID: 38265644 Clinical Trial.Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-analyses.Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Somanath SH, Shaik NB, Pullattayil AK, Weiner GM.JAMA Pediatr. 2022 May 1;176(5):502-516. doi: 10.1001/jamapediatrics.2021.6619. PMID: 35226067 Review.Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants.Cervera SB, Saeed S, Luu TM, Gorgos A, Beltempo M, Claveau M, Basso O, Lapointe A, Tremblay S, Altit G.J Perinatol. 2024 Jan 26. doi: 10.1038/s41372-024-01877-8. Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal. Soy tu host, Maria Flores Cordova, MD. Presentado por los Neonatólogos Elena Itriago MD, Dani de Luis Rosell MD, Carolina Michel MD, las futuras doctoras Marla Fortoul, Valentina Giraldo, Laura Molina. Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org
Send us a Text Message.Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks' Gestation: A Systematic Review and Individual Participant Data Network Meta-Analysis.Sotiropoulos JX, Oei JL, Schmölzer GM, Libesman S, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, Dekker J, Vermeulen MJ, Sundaram V, Kumar P, Kaban RK, Rohsiswatmo R, Saugstad OD, Seidler AL.JAMA Pediatr. 2024 Jun 24:e241848. doi: 10.1001/jamapediatrics.2024.1848. Online ahead of print.PMID: 38913382As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Effect of Low-Dose Iron Supplementation on Early Development in Breastfed Infants: A Randomized Clinical Trial.Svensson L, Chmielewski G, Czyzewska E, Domellöf M, Konarska Z, Piescik-Lech M, Späth C, Szajewska H, Chmielewska A.JAMA Pediatr. 2024 Jul 1;178(7):649-656. doi: 10.1001/jamapediatrics.2024.1095.PMID: 38739382 Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
On this episode we were joined virtually by the Tufts DPT student journal club. Factors Associated With Concussion-like Symptom Reporting in High School Athletes Iverson GL, Silverberg ND, Mannix R, et al. JAMA Pediatr. 2015;169(12):1132. doi:10.1001/jamapediatrics.2015.2374 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux
With the rise of social media, there has also been a rise in cyberbullying. Dr. Ruth Osondu, a child and adolescent psychiatry fellow joins Dr. Dale Peeples a child and adolescent psychiatrist and medical student Bailey Allen to discuss what pediatricians, parents, and teens should know about cyberbullying and suicide risks. Specifically, they will: Educate the listener and general community on signs a child/teenager at risk for suicide. Understand the effect of cyberbullying on the mental health of the child and adolescent population. Recognize signs that an adolescent is being cyberbullied. Understand potential preventative measures for cyberbullying. Recognize ways for a child or adolescent to get help if they are being bullied. Recognize the role of the parent of victims of cyberbullying CME Credit (requires free sign up): Link Coming Soon! References: Bauman S. Cyberbullying: What Does Research Tell Us? Theory Into Practice, Emerging Issues in School Bullying Research. 2013;52(4): 249-256. DOI: 10.1080/00405841.2013.829727 Chan T, Cheun C, Lee Z. Cyberbullying on Social Networking Sites: A Literature Review and and Future Research Directions. Information and Management. 2021;58(2):103411. https://doi.org/10.1016/j.im.202.103411. Earls M, Foy J, Green C. “Mental Health Tools for Pediatrics”, Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians. American Academy of Pediatrics. February 2021. https://doi.org/10.1542/9781610024624-2e_s2_02_MH_tools_for_pediatrics Englander E, Donnerstein E, Kowalski R, Lin CA, Parti K. Defining Cyberbullying. Pediatrics. 2017 Nov;140(Suppl 2):S148-S151. doi: 10.1542/peds.2016-1758U. PMID: 29093051. Englander E. Back to the Drawing Board With Cyberbullying. JAMA Pediatr. 2019 Jun 1;173(6):513-514. doi: 10.1001/jamapediatrics.2019.0690. PMID: 31009032. Hamm MP, Newton AS, Chisholm A, Shulhan J, Milne A, Sundar P, Ennis H, Scott SD, Hartling L. Prevalence and Effect of Cyberbullying on Children and Young People: A Scoping Review of Social Media Studies. JAMA Pediatr. 2015 Aug;169(8):770-7. doi: 10.1001/jamapediatrics.2015.0944. PMID: 26098362. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539. Timmons-Mitchell J, Flannery D; What Pediatricians Should Know and Do about Cyberbullying. Pediatr Rev. July 2020; 41 (7): 373–375. https://doi.org/10.1542/pir.2019-0165 Tozzo P, Cuman O, Moratto E, Caenazzo L. Family and Educational Strategies for Cyberbullying Prevention: A Systematic Review. Int J Environ Res Public Health. 2022 Aug 22;19(16):10452. doi: 10.3390/ijerph191610452. PMID: 36012084; PMCID: PMC9408628. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539. Walrave, Michel, and Wannes Heirman. "Cyberbullying: Predicting victimisation and perpetration." Children & Society 25.1 (2011): 59-72.
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: May 30, 2019 Since January 1, 2019, there have been nearly 900 confirmed measles cases across 24 states in the United States. This is 10 times greater than the number of cases in the US 3 years ago, and it is the largest outbreak the US has seen since 1994. The month of May also marks the first reported case of measles in the state of Pennsylvania, where BrainWaves is produced. So this week on the program, Jim Siegler speaks with Dr. Erika Mejia (pediatrician) about the medical and sociopolitical triggers for this outbreak, the misconceptions of the measles-mumps-rubella vaccine, and finally, what you can do to keep measles from "going viral."* Produced by James E Siegler and Erika Mejia. Music courtesy of Advent Chamber Orchestra, Coldnoise, Josh Woodward, Kevin McLeod, and Lee Roosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Bester JC. Measles and measles vaccination: a review. JAMA Pediatr 2016;170(12):1209-15. PMID 27695849Bester JC. Not a matter of parental choice but of social justice obligation: children are owed measles vaccination. Bioethics 2018;32(9):611-19. PMID 30229958Campbell H, Andrews N, Brown KE, Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol 2007;36(6):1334-48. PMID 18037676Fournet N, Mollema L, Ruijs WL, et al. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health 2018;18(1):196. PMID 29378545Maglione MA, Das L, Raaen L, et al. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics 2014;134(2):325-37. PMID 25086160Murch SH, Anthony A, Casson DH, et al. Retraction of an interpretation. Lancet 2004;363(9411):750. PMID 15016483Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis 2004;189 Suppl 1:S4-16. PMID 15106083Poland GA, Jacobson RM. The age-old struggle against the antivaccinationists. N Engl J Med 2011;364(2):97-9. PMID 21226573Trump's tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en *Truth be told, measles claims the lives of 100,000 people around the globe every year. It has already gone viral. This was just a figure of speech. We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
Though measles was declared eliminated in the U.S. decades ago, outbreaks do still happen here, and in other places it's much more common. Before vaccines were widely available, it killed an estimated 2.6 million people worldwide each year. Research: "Measles cases rising alarmingly across Europe: WHO." IANS, 24 Jan. 2024, p. NA. Gale OneFile: Health and Medicine, link.gale.com/apps/doc/A780229341/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=624cac48. Accessed 13 Feb. 2024. "The Medical Influence of Rhazes." Science and Its Times, edited by Neil Schlager and Josh Lauer, vol. 2, Gale, 2001. Gale In Context: World History, link.gale.com/apps/doc/CV2643450171/WHIC?u=mlin_n_melpub&sid=bookmark-WHIC&xid=5ed3d18a. Accessed 13 Feb. 2024. Associated Press. “Measles deaths worldwide jumped 40% last year, health agencies say.” 11/16/2023. https://apnews.com/article/measles-epidemic-children-who-cdc-bb62da7Measles%20deaths%20worldwide%20jumped%2040%%20last%20year,%20health%20agencies%20say Berche, Patrick. “History of measles.” La Presse Médicale. Volume 51, Issue 3, September 2022. https://www.sciencedirect.com/science/article/pii/S0755498222000422 Carson-DeWitt, Rosalyn, MD, et al. "Measles." The Gale Encyclopedia of Public Health, edited by Brigham Narins, 2nd ed., vol. 2, Gale, 2020, pp. 675-680. Gale In Context: Environmental Studies, link.gale.com/apps/doc/CX7947900178/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=5cb0c749. Accessed 13 Feb. 2024. Centers for Disease Control. “Measles History.” https://www.cdc.gov/measles/about/history.html Conis E. Measles and the Modern History of Vaccination. Public Health Reports. 2019;134(2):118-125. doi:10.1177/0033354919826558 Düx A, Lequime S, Patrono LV, Vrancken B, Boral S, Gogarten JF, Hilbig A, Horst D, Merkel K, Prepoint B, Santibanez S, Schlotterbeck J, Suchard MA, Ulrich M, Widulin N, Mankertz A, Leendertz FH, Harper K, Schnalke T, Lemey P, Calvignac-Spencer S. Measles virus and rinderpest virus divergence dated to the sixth century BCE. Science. 2020 Jun 19;368(6497):1367-1370. doi: 10.1126/science.aba9411. PMID: 32554594; PMCID: PMC7713999. Home, Francis. “Medical facts and experiments.” London, 1759. https://archive.org/details/b30785558/ Manley, Jennifer. “Measles and Ancient Plagues: A Note on New Scientific Evidence.” Classical World, Volume 107, Number 3, Spring 2014, pp. 393-397. https://doi.org/10.1353/clw.2014.0001 Panum, Peter Ludwig. “Observations made during the epidemic of measles on the Faroe Islands in the year 1846.” Gerstein - University of Toronto. https://archive.org/details/observationsmade00panuuoft Papania MJ, Wallace GS, Rota PA, et al. Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere: The US Experience. JAMA Pediatr. 2014;168(2):148–155. doi:10.1001/jamapediatrics.2013.4342 Patel, Minal K. et al. “Progress Toward Regional Measles Elimination — Worldwide, 2000–2019.” Morbidity and Mortality Weekly Report, November 13, 2020, Vol. 69, No. 45 (November 13, 2020). Via JSTOR. https://www.jstor.org/stable/10.2307/26967781 Rāzī, Abū Bakr Muḥammad ibn Zakarīyā. “A treatise on the small-pox and measles.” Translated by William Alexander Greenhill. 1848. https://archive.org/details/39002086344042.med.yale.edu/mode/1up Sydenham, Thomas. “The works of Thomas Sydenham, M.D.” London, 1848. https://archive.org/details/b33098682_0002 The College of Physicians of Philadelphia. “Measles.” History of Vaccines. https://historyofvaccines.org/history/measles/timeline West, Katherine. "THE RETURN OF MEASLES: With modern vaccine skepticism, the once-eliminated disease is surging in the U.S." EMS World, vol. 48, no. 6, June 2019, pp. 44+. Gale General OneFile, link.gale.com/apps/doc/A711878059/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=8d0bb2cb. Accessed 13 Feb. 2024. See omnystudio.com/listener for privacy information.
Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children's National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University […] The post SGEM #427: I Want a Treatment with a Short Course…for Pediatric Urinary Tract Infections first appeared on The Skeptics Guide to Emergency Medicine.
Welcome to our festive 2023 Episode 8 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with our legendary guest Professor Deborah Eastwood @deboraheastwood from Great Ormond Street Hospital @GreatOrmondSt & Royal National Orthopaedic Hospital @RNOHnhs ! She is the biggest name in paediatric orthopaedics – as recent President of the British Orthopaedic Association @BritOrthopaedic - previous President of the European Paediatric Orthopaedic Society as well as a great researcher, clinician and teacher, having been awarded Trainer of the Year a number of times!!! She has a wealth of knowledge on policy and keen to help promote diversity in orthopaedics @orthodiversity as well as championing sustainability. We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage? Morris et al. Bone Joint J. Dec 2023 PMID: 38035597 2. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. Zadeh et al. J Bone Joint Surg Br. Jan 2000 PMID: 10697309. 3. Soft Tissue Releases With Simultaneous Guided Growth Decrease Risk of Spastic Hip Displacement Recurrence. Hsu et al. J Pediatr Orthop. Oct 2023 PMID: 37493018 4. Fatigue-related gait adaptations in children with cerebral palsy. Oudenhoven et al. Dev Med Child Neurol. Dec 2023. PMID: 37243486. 5. Understanding caregiver experiences with disease-modifying therapies for spinal muscular atrophy: a qualitative study. Xiao L et al. Arch Dis Child. Nov 2023. PMID: 37419673. 6. Kleidon TM et al. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr. Nov 2023. PMID: 37695594 7. The Right Way to Teach Lefties - Exploring the Experiences of Left-Handed Trainees and Surgeons. Brooks et al. J Surg Educ. Nov 2023. PMID: 37563001. 8. Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy: A Randomized Clinical Trial. Araneda et al. JAMA Pediatr. Nov 2023. PMID: 37930692 9. Analysis of Growth After Transphyseal Anterior Cruciate Ligament Reconstruction in Children. Bolzinger M et al. J Pediatr Orthop. Oct 2023. PMID: 37522467. 10. Collagenase treatment decreases muscle stiffness in cerebral palsy: A preclinical ex vivo biomechanical analysis of hip adductor muscle fiber bundles. Howard JJ et al. Dev Med Child Neurol. Dec 2023. PMID: 37198748 11. HipScreen mobile app for the measurement of hip migration percentage in children with cerebral palsy: Accuracy, reliability, and discriminatory ability. Kulkarni et al. Dev Med Child Neurol. Nov 2023. PMID: 37143284 12. AI = Appropriate Insight? ChatGPT Appropriately Answers Parents' Questions for Common Pediatric Orthopaedic Conditions. Zusman NL et al. J POSNA. Nov 2023. https://jposna.org/index.php/jposna/article/view/762/920 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B Hope you all have a fantastic festive period and see you all in 2024!!! Sign up to BSCOS Annual Meeting in Leeds March 2024 at https://www.miceorganiser.com/bscos2024
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-343 Overview: In this episode, we take a look at a study exploring the effects on children's activity levels when their parents reduce smartphone use. Listen in as we discuss compelling findings that shed light on the connection, and come away with guidance on how to navigate the evolving digital landscape to promote healthier, more active lifestyles among children. Episode resource links: JAMA Pediatr. 2022 Aug; 176(8): 741–749 BMJ Open. 2019 Jan 3;9(1):e023191. doi: 10.1136/bmjopen-2018-023191 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-343 Overview: In this episode, we take a look at a study exploring the effects on children's activity levels when their parents reduce smartphone use. Listen in as we discuss compelling findings that shed light on the connection, and come away with guidance on how to navigate the evolving digital landscape to promote healthier, more active lifestyles among children. Episode resource links: JAMA Pediatr. 2022 Aug; 176(8): 741–749 BMJ Open. 2019 Jan 3;9(1):e023191. doi: 10.1136/bmjopen-2018-023191 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
Episode 3: Severe pediatric asthma-beyond standard therapy, the role of current and future therapies including biologics Description: Though severe pediatric asthma only represents from 2 to 5% of the children suffering with this condition, it represents a major share of the cost, resource utilization, and morbidity. It is important that allergists have a good gasp of this condition and how it differs from the adult population. Topics include appropriate workup, comorbidities, steroid burden. Learning Objectives: Be able to discuss the burden of severe pediatric asthma and issues in optimal medication adherence in this population Be able to evaluate the child with severe asthma and screen for corticosteroid overuse in and remedies to decrease it in this population Be able to interpret the mechanisms of action, applicable pediatric population, dosing, outcome data, and adverse effects of current and future treatments beyond standard therapy in severe pediatric asthma References: Perry, R., Braileanu, G., Palmer, T. et al. The Economic Burden of Pediatric Asthma in the United States: Literature Review of Current Evidence. PharmacoEconomics 37, 155–167 (2019). Yao T, Wang J, Chang S, et al. Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr. Published online April 19, 2021. Katial RK, Bensch GW, Busse WW, Chipps BE, Denson JL, Gerber AN, et al. Changing paradigms in the treatment of severe asthma: the role of biologic therapies. J Allergy Clin Immunol Pract 2017;5:S1–S14. Licari, A., Manti, S., Castagnoli, R. et al. Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives. Pediatr Drugs 21, 215–237 (2019)
Episode 1: Severe pediatric asthma-burden of disease, adherence issues, and comorbidities Description: Though severe pediatric asthma only represents from 2 to 5% of the children suffering with this condition, it represents a major share of the cost, resource utilization, and morbidity. It is important that allergists have a good gasp of this condition and how it differs from the adult population. Topics include appropriate workup, comorbidities, steroid burden. Learning Objectives: Be able to discuss the burden of severe pediatric asthma and issues in optimal medication adherence in this population Be able to evaluate the child with severe asthma and screen for corticosteroid overuse in and remedies to decrease it in this population Be able to interpret the mechanisms of action, applicable pediatric population, dosing, outcome data, and adverse effects of current and future treatments beyond standard therapy in severe pediatric asthma References: Perry, R., Braileanu, G., Palmer, T. et al. The Economic Burden of Pediatric Asthma in the United States: Literature Review of Current Evidence. PharmacoEconomics 37, 155–167 (2019). Yao T, Wang J, Chang S, et al. Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr. Published online April 19, 2021. Katial RK, Bensch GW, Busse WW, Chipps BE, Denson JL, Gerber AN, et al. Changing paradigms in the treatment of severe asthma: the role of biologic therapies. J Allergy Clin Immunol Pract 2017;5:S1–S14. Licari, A., Manti, S., Castagnoli, R. et al. Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives. Pediatr Drugs 21, 215–237 (2019)
Episode 2: Severe pediatric asthma-evaluation of the child, diagnostic testing, assessing steroid side effects Description: Though severe pediatric asthma only represents from 2 to 5% of the children suffering with this condition, it represents a major share of the cost, resource utilization, and morbidity. It is important that allergists have a good gasp of this condition and how it differs from the adult population. Topics include appropriate workup, comorbidities, steroid burden. Learning Objectives: Be able to discuss the burden of severe pediatric asthma and issues in optimal medication adherence in this population Be able to evaluate the child with severe asthma and screen for corticosteroid overuse in and remedies to decrease it in this population Be able to interpret the mechanisms of action, applicable pediatric population, dosing, outcome data, and adverse effects of current and future treatments beyond standard therapy in severe pediatric asthma References: Perry, R., Braileanu, G., Palmer, T. et al. The Economic Burden of Pediatric Asthma in the United States: Literature Review of Current Evidence. PharmacoEconomics 37, 155–167 (2019). Yao T, Wang J, Chang S, et al. Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr. Published online April 19, 2021. Katial RK, Bensch GW, Busse WW, Chipps BE, Denson JL, Gerber AN, et al. Changing paradigms in the treatment of severe asthma: the role of biologic therapies. J Allergy Clin Immunol Pract 2017;5:S1–S14. Licari, A., Manti, S., Castagnoli, R. et al. Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives. Pediatr Drugs 21, 215–237 (2019)
In this Complex Care Journal Club podcast episode, Dr. Eyal Cohen discusses the design and key findings of a randomized controlled trial evaluating the effectiveness of a structured complex care program in Ontario, Canada. He describes implications for clinical practice, opportunities for family partnership in research, and the next steps from this work. SPEAKERS Eyal Cohen, MD, MSc, FRCPC Program Head, Child Health Evaluative Sciences Staff Physician, Division of Pediatric Medicine The Hospital for Sick Children (SickKids), Toronto Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATES Initial publication: April 26, 2023 CITATION Cohen E, Huth K. Measuring What Matters in a Multicenter RCT: Partnering With Patients/Families and Policymakers. 04/2023. OPENPediatrics. Online Podcast. Links: https://youtu.be/tTimlHM9Oj8, https://soundcloud.com/openpediatrics/measuring-what-matters-in-a-multicenter-rct-partnering-with-patientsfamilies-and-policymakers. ARTICLE REFERENCED Cohen E, Quartarone S, Orkin J, et al. Effectiveness of Structured Care Coordination for Children With Medical Complexity: The Complex Care for Kids Ontario (CCKO) Randomized Clinical Trial [published online ahead of print, 2023 Mar 20]. JAMA Pediatr. 2023;e230115. doi:10.1001/jamapediatrics.2023.0115 https://pubmed.ncbi.nlm.nih.gov/36939728/ TRANSCRIPT https://bit.ly/41Xvaf0 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
In this podcast, an experienced conference and webinar moderator is joined by two doctors in the field of paediatric infectious diseases: David Greenberg and Maria Hemming-Harlo. In this podcast, our guest experts provide information and their perspectives on the following topics: The disease burden of rotavirus The related morbidity and mortality of rotavirus How rotavirus is transmitted The clinical picture of rotavirus infection The evidence supporting routine vaccination with RotaTeq (Rotavirus Vaccine, Live, Oral, Pentavalent) This podcast was funded by Merck Sharp & Dohme LLC. Below please find the reference list for Vax Voices, Podcast 1: The Global Burden of Rotavirus Disease and Evidence Supporting Routine Vaccination With RotaTeq to ensure listeners can further explore the content discussed. View the product information and indication for RotaTeq here. View the Select Safety Information from MSD below. Select Safety Information RotaTeq should not be administered to infants with a demonstrated history of hypersensitivity to the vaccine or any component of the vaccine. Infants with a history of intussusception or who have congenital malformation of the gastrointestinal tract that could predispose infants to intussusception should not receive RotaTeq. Infants with Severe Combined Immunodeficiency Disease or SCID should not receive RotaTeq. Administration of RotaTeq should be postponed in infants suffering from acute severe febrile illness. The presence of a minor infection is not a contraindication for immunisation. The administration of RotaTeq should be postponed in subjects suffering from acute diarrhoea or vomiting. No safety or efficacy data are available from clinical trials regarding the administration of RotaTeq to infants who are potentially immunocompromised. Cases of gastroenteritis associated with vaccine virus have been reported post marketing in infants with severe combined immunodeficiency. Vaccine virus transmission from vaccine recipient to nonvaccinated contacts has been reported. Caution is advised when considering whether to administer RotaTeq to individuals with immunodeficient contacts. In post-marketing experience, intussusception (including death) and Kawasaki disease have been reported in infants who have received RotaTeq. As a precaution, healthcare professionals should follow-up on any symptoms indicative of intussusception (severe abdominal pain, persistent vomiting, bloody stools, abdominal bloating and/or high fever) since data from observational studies indicate an increased risk of intussusception, mostly within 7 days after rotavirus vaccination. Parents/guardians should be advised to promptly report such symptoms to their healthcare provider. The level of protection provided by RotaTeq is based on the completion of all 3 doses. As with any vaccine, vaccination with RotaTeq may not result in complete protection in all recipients. HQ-ROT-00133 | 02/23 Podcast References: 1.Nelson R. COVID-19 disrupts vaccine delivery. Lancet Infect Dis. 2020;20(5):546. 2.Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Chapter 19: Rotavirus. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/rota.html. Last accessed: 6 March 2023. 3.Dormitzer PR. "Rotaviruses," Mandell GL, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier Saunders; 2019:1983-96. 4.Centers for Disease Control and Prevention (CDC). Rotavirus. Clinical information. 2021. Available at: https://www.cdc.gov/rotavirus/clinical.html. Last accessed: 13 October 2022. 5.Troeger C et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatr. 2018;172(10):958-965. Erratum in: JAMA Pediatr. 2022;176(2):208. 6.GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(9):909-948. Erratum in: Lancet Infect Dis. 2017 Sep;17(9):897. 7.Van Damme P et al. Rotavirus vaccines: considerations for successful implementation in Europe. Lancet Infect Dis. 2006;6(12):805-12. 8.Paul MO, Erinle EA. Influence of humidity on rotavirus prevalence among Nigerian infants and young children with gastroenteritis. J Clin Microbiol. 1982;15(2):212-5. 9.Finnish Institute for Health and Welfare. Infectious diseases and vaccines: rotavirus vaccine. 2020. Available at: https://thl.fi/en/web/infectious-diseases-and-vaccinations/vaccines-a-to-z/rotavirus-vaccine. Last accessed: 16 September 2022. 10.GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. 11.Franco MA et al. Immunity and correlates of protection for rotavirus vaccines. Vaccine. 2006;24(15):2718-31. 12.Gentsch JR et al. Serotype diversity and reassortment between human and animal rotavirus strains: implications for rotavirus vaccine programs. J Infect Dis. 2005;192(Suppl 1):S146-59. 13.Merck & Co. RotaTeq®. Prescribing information. 2022. Available at: https://www.merck.com/product/usa/pi_circulars/r/rotateq/rotateq_pi.pdf. Last accessed: 4 January 2023. 14.European Medicine Agency (EMA). RotaTeq. Summary of product characteristics. 2022. Available at: https://www.ema.europa.eu/en/documents/product-information/rotateq-epar-product-information_en.pdf. Last accessed: 4 January 2023. 15.Velasquez-Portocarrero DE et al. Head-to-head comparison of the immunogenicity of RotaTeq and Rotarix rotavirus vaccines and factors associated with seroresponse in infants in Bangladesh: a randomised, controlled, open-label, parallel, phase 4 trial. Lancet Infect Dis. 2022;22(11):1606-16. 16.Cortese MM, Parashar UD; Centers for Disease Control and Prevention (CDC). Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58(RR-2):1-25. 17.Vesikari T et al.; Rotavirus Efficacy and Safety Trial (REST) Study Team. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006;354(1):23-33. 18.Vesikari T et al. Efficacy of a pentavalent rotavirus vaccine in reducing rotavirus-associated health care utilization across three regions (11 countries). Int J Infect Dis. 2007;11(Suppl 2):S29-35. 19.Heyse JF; REST Study Team. Evaluating the safety of a rotavirus vaccine: the REST of the story. Clin Trials. 2008;5(2):131-9. 20.World Health Organization (WHO). Rotavirus vaccines: WHO position paper. Wkly Epidemiol Rec. 2021;96(28):301-20.
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Danielle Becker. REFERENCES Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia 2005;46 Suppl 9:117-24. PMID 16302885 Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009;73(2):126-32. PMID 19398682 Herzog AG, Fowler KM, Smithson SD, et al. Progesterone vs placebo therapy for women with epilepsy: a randomized clinical trial. Neurology 2012;78(24):1959-66. PMID 22649214 Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res 2008;81(1):1-13. PMID 18565732 Meador KJ, Baker GA, Browning N, et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr 2014;168(8):729-36. PMID 24934501 Reiter SF, Bjørk MH, Daltveit AK, et al. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav 2016;62:251-7. PMID 27513352 Taubøll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015;28:3-11. PMID 25765693 Velíšková J, Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav 2013;63(2):267-77. PMID 22504305 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
In this episode we talk with Emily Chandler and Taylor Washburn, EBB Childbirth Class graduates about their experiences in the childbirth class; their informed and empowered hospital birth; and how they navigated an extended hospital stay for newborn jaundice. Emily, is a marine scientist, and Taylor, is a teacher and rowing coach in the Boston area. Together, they love hiking, biking, rowing, and taking advantage of the great outdoors. And they're also very busy taking care of their baby. While pregnant, Emily dove headfirst into learning about pregnancy, birth, and the state of maternity care in the United States. Emily and Taylor took the Evidence Based Birth Childbirth Class with EBB instructor Chanté Perryman. Emily and Taylor share their experiences in the EBB Childbirth Class and how that informed many of the decisions they made regarding their birth plan, including Taylor being both inspired and empowered to “catch” their baby. They also share how they used the advocacy skills learned in class to better communicate with their providers and each other. After experiencing the birth they desired, complications arose when Emily experienced difficulty breastfeeding and inadequate lactation support. Difficulty was further exasperated when their newborn was diagnosed with jaundice leading to an extended hospital stay. Content Warnings: extended hospital stay due to newborn jaundice, “yellow baby,” difficulty breastfeeding, syringe feeding, lack of lactation support poor latch, heel pricks and bilirubin testing, treatment for elevated bilirubin, poor outcomes for Black and Brown infants with jaundice Resources: Access the CDC article on Jaundcie here Access the Evidence Based Birth® Signautre Articles on: The Evidence on Premature Rupture of Membranes here The Evidence on Group B Strep here The Evidence on Pitocin® in the Third Stage here Listen to EBB 145- Fatherhood and Advocacy in Birth with JacMichael Perryman here Listen to EBB 244 - Evidence on AROM, AVD and Internal Monitoring here Learn more about Chanté Perryman's EBB Childbirth Class and services here or on her Instagram account @babydreamsmc Learn more about The Nest Collaborative for lacation support here References: Here are the scientific references on jaundice for the blog article: · Dunn, P. M. (2003). Dr Erasmus Darwin (1731–1802) of Lichfield and placental respiration. Arch Dis Child Fetal Neonatal Ed;88:F346– 8. · Katheria, A. C., Lakshminrusimha, S., Rabe, H., et al. (2017). Placental transfusion: a review. Journal of Perinatology; 37:105-111. · McDonald, S. J., Middleton, P., Dowswell, T., et al. (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD004074 · Ashish, K. C., Rana, N., Malqvist, M., et al. (2017). Effects of Delayed Umbilical Cord Clamping vs. Early Clamping on Anemia in Infants at 8 and 12 months: A Randomized Clinical Trial. JAMA Pediatr;171(3):264-270. · Mercer, J. S., Erickson-Owens, D. A., Deoni, S. C. L., et al. (2018). Effects of Delayed Cord Clamping on Four-Month Ferritin Levels, Brain Myselin Content, and Neurodevelopment: A Randomized Controlled Trial. · Andersson, O., Lindquist, B., Lindgren, M., et al. (2015). Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr;169:631–8. · CDC article on Jaundice: https://www.cdc.gov/ncbddd/jaundice/facts.html Go to our YouTube channel to see video versions of the episode listed above!! For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on: TikTok Instagram Pinterest Ready to get involved? Check out our Professional membership (including scholarship options) here Find an EBB Instructor here Click here to learn more about the Evidence Based Birth® Childbirth Class.
Date: February 27, 2023 Reference: Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr. 2022. Guest Skeptic: Dr. Marisu Rueda-Altez is a pediatric infectious disease fellow at Children's National Hospital in Washington, DC. She is also the […] The post SGEM #397: Give a Little Bit…of Oseltamivir to Pediatric Patients Admitted with Influenza first appeared on The Skeptics Guide to Emergency Medicine.
Episode 130: Epigenetics in childhood obesitySaakshi and Dr. Arreaza discuss some principles of epigenetics implicated in the development of obesity in children. Written by Saakshi Dulani, MS3, Western University College of Osteopathic Medicine of the Pacific. Edited by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.This topic is constantly expanding, and I'm excited to talk about it. It is a fact that epigenetic changes play a role in the development of certain diseases such as Prader-Willi syndrome, Fragile X syndrome, and various cancers. It has been demonstrated that certain foods can alter gene expression in animals, for example. What is epigenetics?Epigenetics is the regulation of gene expression without a change in the base sequence of DNA. Epigenetics means “on top of” the genes. Genes can be turned “on” or “off” as a response to external influences. Obesity and Epigenetics.The link between genetics and obesity is complex, but it is known that epigenetics plays a significant role in childhood obesity. Surprisingly, exposure to environmental factors starts in the uterus. Fetuses are exposed to intrauterine signals that increase their potential to develop obesity. Factors such as in-utero hyperglycemia, gestational diabetes mellitus, and early childhood diet and lifestyle practices can affect the development of the gut microbiome, modify gene expression through DNA methylation, and increase the risk of childhood obesity. These gene expression changes can be passed on to future generations. DNA methylation is the addition of a methyl group to part of the DNA molecule. That methyl group acts as a “chemical cap,” which prevents gene expression. Another example of epigenetics is histone modification. Histones are proteins that are used by DNA as spools to wrap around pieces of information that are “not needed”. The reason why a scalp cell and a neuron are different is that the expression of certain genes is suppressed while other genes are expressed.Factors that influence obesity.Some factors that increase the risk of childhood obesity through epigenetic changes include neonatal intestinal microbiome, C-section delivery, maternal insulin resistance, exposure to antibiotics and other environmental toxins, early introduction of complementary foods, parental diets high in carbohydrates and low in fruits and vegetables, and poor sleep. There are many other factors, but we will discuss only a few of them.Microbiome:The microbiome is a whole new world that is being explored by many investigators. The gut microbiome refers to the diverse community of organisms, including bacteria, fungi, and viruses, that reside in the human intestine. The neonatal intestinal microbiome is established during the first two years of life and may be influenced by factors such as the method of delivery, maternal obesity, and the maternal gut microbiome. Some bacteria worth mentioning are Bacteroides, Clostridium, and Staphylococcus. These gut bacteria are higher in pregnant women who have obesity, and they also have a low count of Bifidobacterium. Infants born to obese mothers have higher levels of bacteria associated with increased energy harvest compared to infants born to normal-weight mothers. The gut microbiome of infants delivered by C-section is different than infants delivered vaginally.Link to antibiotics:Early exposure to antibiotics is associated with the development of resistance in microorganisms. The intestinal microbiota exposed to antibiotics also shows reduced diversity. Antibiotics can decrease the number of mitochondria and impair their function, which is important in maintaining energy metabolism. Evidence suggests that some antibiotics can cause mutations in the mitochondrial genome, and they have a direct effect on the microbiome and influence metabolism. There is a strong association between early-life antibiotic exposure and childhood adiposity, with a strong dose-response relationship. A stronger association has been seen with exposure to broad-spectrum antibiotics and macrolides. Maternal insulin resistance (IR):Insulin resistance means that the mother needs levels of insulin that are higher than normal to stay normoglycemic. It means the insulin receptors are “exhausted” and do not respond to normal levels of insulin. Insulin does NOT cross the blood-placenta barrier, but glucose and other nutrients do. This causes the fetus to have an abundance of glucose that stimulates the secretion of high levels of insulin by the fetal pancreas to stay normoglycemic. The combination of insulin + glucose is the perfect combination for anabolism, adipocyte hyperplasia, and fetal growth. That explains why mothers with insulin resistance deliver larger babies (macrosomia). Maternal insulin resistance is a predictor of infant weight gain and body fat in the first year of life. This is not influenced by the mother's BMI before pregnancy. Maternal insulin resistance causes alterations in gene regulation for lipids, amino acids, and inflammation, leading to long-term health implications for both the mother and future pregnancies.C-section and obesity:C-section delivery is a saving procedure for many obstetrical emergencies. C-sections have improved the survival of larger infants and their mothers. C-sections are more frequent among populations with obesity and sedentary lifestyles. This method of delivery is also strongly associated with childhood obesity. Among many other reasons, whenever a vaginal delivery is feasible, a vaginal delivery is preferred over a c-section. In summary, we discussed 4 factors that may influence childhood obesity: the newborn microbiome, exposure to antibiotics, maternal insulin resistance, and C-sections. There are many other factors that we did not talk about, but the more we know about genetics, epigenetics, and metabolism, the closer we get to a better understanding of obesity._____________________Conclusion: Now we conclude our episode number 130, “Epigenetics in childhood obesity.” Saakshi discussed with Dr. Arreaza that the in-utero environment can alter gene expression and increase the risk of obesity in children. Some factors, such as maternal insulin resistance and changes in gut microbiome, can be the cause of obesity in some children. This week we thank Hector Arreaza and Saakshi Dulani. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Sources:Burdge GC, Hoile SP, Uller T, Thomas NA, Gluckman PD, Hanson MA, Lillycrop KA. Progressive, transgenerational changes in offspring phenotype and epigenotype following nutritional transition. PLoS One. 2011;6(11):e28282. doi: 10.1371/journal.pone.0028282. Epub 2011 Nov 30. PMID: 22140567; PMCID: PMC3227644. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227644/Rachael Rettner, Epigenetics: Definition & Examples, Live Science, published on June 24, 2013, available at: https://www.livescience.com/37703-epigenetics.htmlMulligan CM, Friedman JE. Maternal modifiers of the infant gut microbiota: metabolic consequences. J Endocrinol. 2017;235: R1-R12.Aghaali, M. and S. S. Hashemi-Nazari (2019). “Association between early antibiotic exposure and risk of childhood weight gain and obesity: a systematic review and meta-analysis.” J Pediatr Endocrinol Metab 32(5): 439-445.Yuan C, Gaskins AJ, Blaine AI, et al. Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr. 2016;170(11):e162385. doi: 10.1001/jamapediatrics.2016.2385.Royalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/
Screen time and concussions is a popular topic. Everyday someone asks me whether or not they should be using screens post-concussion and if so, how, and for how long. Most of my responses are “as tolerated”. Let your symptoms be your guide and take a lot of rest. Today's episode I outline a study that tried to quantify screen time use early, in the healing phase and relate it to person outcomes. Did you restrict screens during your concussion ? Did it help or hinder you ? **Episode correction the study was ages 12-25 y/o NOT 20-25 y/o** *Episode Resources* Macnow et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021 Nov 1;175(11):1124-1131. doi: 10.1001/jamapediatrics.2021.2782. --- Send in a voice message: https://podcasters.spotify.com/pod/show/concast/message
在1歲時看螢幕的時間越長，3歲時得到自閉症的風險越高。但這可能是怎麼形成的呢？ 《美國醫學會-兒科學期刊》（JAMA Pediatrics）今天刊登了一篇我們的評論，分析「在哪段時間看電子螢幕」（screen timing），可能比「看螢幕的時間」（screen time）與自閉症的風險更有關。 #看螢幕的時間會增加自閉症風險 近期JAMA Pediatrics刊登一項日本的大型世代追蹤1歲的嬰兒每天看電子螢幕的時間越長，追蹤到他們3歲的時候，男孩有比較高的自閉類群疾患（autism spectrum disorder，簡稱自閉症）風險。這項研究採用各種嚴謹的統計方法驗證這項發現：例如1歲時候看螢幕的時間，會增加3歲時自閉症的風險，但如果是用3歲時看螢幕的時間，則沒有顯著的關聯性、而每天看螢幕的時間用不同的基準值來比較，結果都顯示看螢幕時間越長，自閉症風險越高的趨勢。 #如何解釋電子螢幕與自閉症風險？ 這項研究在統計分析呈現重要而且可信的結果，但是解釋可能造成自閉症風險的原因其實非常不容易。發表這篇研究的團隊，只在論文簡單提及幾項基礎的動物研究，猜測電子產品的電磁場，可能與自閉症風險有關。 我們的論述則認為，如果在這項研究調查的「每天看電子螢幕的總時間」還進一步能多瞭解「在哪個時間段看」，特別是「睡前看螢幕的時間」，將有助於解釋可能的機制，以及有學理基礎的幼兒使用電子產品對策。 #在哪個時段看電子螢幕為什麼更重要 美國兒科醫學會除了建議不同年齡兒童看電子螢幕的時間，還有一項重要的提醒：為孩子佈置一個沒有電子產品的睡覺空間。這是根據睡前使用電子產品對孩子的睡眠、健康的大量實證研究成果訂下的建議。睡眠作息的擾亂，比起原論文提到的電磁場，有多而且更明確的研究顯示和自閉症風險的關聯性。自閉症的孩子不僅有很高的比例有睡眠的問題，與睡眠相關的褪黑激素（melatonin）也是可能與自閉症相關的一種神經傳導物質。在光照特別是在看電子螢幕時，光線會抑制褪黑激素的分泌，讓人入睡困難或是睡眠品質不佳。褪黑激素也具有抗氧化的作用，特別是在神經生長發育期間如果分泌較少，也被認為會造成較大的氧化壓力，而影響神經系統的發育，增加諸如自閉症等神經發展疾病的風險。 ＃為孩子佈置一個沒有電子產品的睡覺空間 我們的這篇評論，支持在孩子1歲的神經發育早期階段，如果看螢幕時間較長，到了3歲得到自閉症風險增加的重要研究發現；也提出「在哪個時間段看」，特別是「睡前看螢幕的時間」是另一項重點。雖然電子產品可能已經是每個家庭不可或缺的一部分，但為孩子佈置一個沒有電子產品的睡覺空間，仍是值得推廣的健康習慣。 ＊本文感謝兩位共同作者：統計學家林聖軒醫師分析研究方法的詮釋；自閉症研究權威高淑芬副院長對這篇評論嚴謹的修訂 參考文獻 1. 論文原文： Kushima M, Kojima R, Shinohara R, et al; Japan Environment and Children's Study Group. Association between screen time exposure in children at 1 year of age and autism spectrum disorder at 3 years of age: the Japan Environment and Children's Study. JAMA Pediatr. 2022;176(4):384-391. 2. 我們的評論：Lin YH, Lin SH, Gau SS. Screen Timing May Be More Likely Than Screen Time to Be Associated With the Risk of Autism Spectrum Disorder. 3. 原作者回應：Kushima M, Yamagata Z. Screen Timing May Be More Likely Than Screen Time to Be Associated With the Risk of Autism Spectrum Disorder—Reply Powered by Firstory Hosting
Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at the impact of screen time on duration of post-concussive symptoms 125 patients aged 12-25 diagnosed with a concussion were randomized to either abstain from or have unrestricted screen time for 48 hours after injury Patients with unrestricted screen time averaged approximately 5 hours/day of screen time Patients in the no screen time group averaged approximately 1 hour/day of screen time Statistically significant difference in duration of post-concussive symptoms Unrestricted screen time cohort averaged 8 days of post-concussive symptoms No screen time cohort averaged 3.5 days of post-concussive symptoms ED physicians should encourage patients to limit screen time as much as possible in the first 48 hours after a concussion to promote faster recovery from post-concussive symptoms References Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021;175(11):1124-1131. Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 101ème épisode, Nicolas et Sébastien traiteront de différents sujets: la contraception orale d'urgence chez les patientes obèses, l'ézétimibe en dyslipidémie, les effets (ou pas) de la vitamine D et la restriction du temps d'écran sur le dodo. Les objectifs pour cet épisode sont les suivants: Discuter de l'efficacité d'une double dose de lévonorgestrel en contraception orale d'urgence chez des patientes obèsesExpliquer les avantages et les inconvénients de l'ajout de l'ézétimibe à une statine dans le traitement de la dyslipidémieExpliquer le rôle de la vitamine D dans la prévention des fracturesDiscuter de l'effet de la réduction du temps d'écran sur le sommeil et l'activité physique Ressources pertinentes en lien avec l'épisode Double dose de lévonorgestrel en contraception orale d'urgenceEdelman AB et coll. Double Dosing Levonorgestrel-Based Emergency Contraception for Individuals With Obesity: A Randomized Controlled Trial. Obstet Gynecol. 2022;140:48-54. Étude RACINGKim BK et coll; RACING investigators. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022;400:380-390. Étude VITALLeBoff MS et coll. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med. 2022;387:299-309. Éditorial de l'étude VITALCummings SR, Rosen C. VITAL Findings - A Decisive Verdict on Vitamin D Supplementation. N Engl J Med. 2022;387:368-370. Étude SCREENSPedersen J et coll. Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022;176:741-749. Revue systématique des traitements pharmacologiques en insomnieDe Crescenzo F et coll. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet. 2022;400:170-184.
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-289 Overview: Excessive screen time has been associated with numerous adverse health outcomes. Join us for a look at a fascinating new study that explores how limiting screen time can increase physical activity in children. Listen to this brief podcast before you counsel your next patient on how screen time can affect their children's (and their) health. Episode resource links: Pedersen J,et al. Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022 May 23:e221519 Screen Time and Children. American Academy of Child and Adolescent Psychiatry: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-289 Overview: Excessive screen time has been associated with numerous adverse health outcomes. Join us for a look at a fascinating new study that explores how limiting screen time can increase physical activity in children. Listen to this brief podcast before you counsel your next patient on how screen time can affect their children's (and their) health. Episode resource links: Pedersen J,et al. Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022 May 23:e221519 Screen Time and Children. American Academy of Child and Adolescent Psychiatry: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato
*The opinions are our own, and do not reflect the opinions of BSCOS, their working groups, committees or members.* Welcome to Episode 3 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Mr Nev Davies from Royal Berkshire Hospital. We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. **To learn more about SKIPP Charity visit www.skippcharity.org ** Please follow BSCOS on twitter: @BSCOS_UK REFERENCES: 1. ACL Injury Prevention: Where have we come from and where are we going? Arundale et al. J Orthop Res. Jan 2022. PMID 33913532 2. Prolonged Brace Treatment Does Not Result in Improved Acetabular Indices in Infantile Dislocated Hips. Upasani et al (IHDR). J Pediatr Orthop. May 2022. PMID 35200217 3. How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study. Park et al. Acta Orthop Trauma Surg. June 2022. PMID 33417029 4. Influence of shelf acetabuloplasty on the outcomes of total hip arthroplasty in hips with dysplasia: a case-control study. Benad et al. Int Orthop. May 2022. PMID 35113185 5. Association Between Screen Time Exposure in Children at 1 Year of Age and Autism Spectrum Disorder at 3 Years of Age: The Japan Environment and Children's Study. Kushima et al. JAMA Pediatr. April 2022. PMID 35099540 6. Prolonged non-weightbearing treatment decreases femoral head deformity compared to symptomatic treatment in the initial stage of Legg-Calvé-Perthes disease. Peck et al. J Pediatr Orthop B. May 2022. PMID 34028380 7. Effect of Different Corticosteroid Dosing Regimens on Clinical Outcomes in Boys With Duchenne Muscular Dystrophy: A Randomized Clinical Trial. Guglieri et al. JAMA. April 2022. PMID 35381069 8. Short-term causal effects of common treatments in ambulatory children and young adults with cerebral palsy: three machine learning estimates. Schwartz et al. Scientific Reports. May 2022. PMID 35551496 9. 3D-printed cutting guidesfor lower limb deformity correction in the young population. Gigi R et al. J Pediatr Orthop. May-June 2022. PMID 35200209 10. Observation Versus Cast Treatment of Toddler's Fractures. Enriquez et al. J Pediatr Orthop. May-June 2022. PMID 35180728 11. Incidence of Deep Vein Thrombosis in Cerebral Palsy Following an Orthopaedic Surgical Event. Sees JP et al. J Pediatr Orthop. May-June 2022. PMID 35180727 12. Long-term effects of spasticity, including SDR, for individuals with cerebral palsy. MacWilliams BA et al. Dev Med Child Neurol. May 2022. PMID 34755903 13. The influence of tone on proximal femoral and acetabular geometry in neuromuscular hip displacement: A comparison of cerebral palsy and spinal muscle atrophy. Ulusaloglu AC et al. J Child Orthop. April 2022. PMID 35620131 14. The impact of mentoring in trauma and orthopaedic training: a systematic review. Enson J et al. Ann R Colleg Surg Engl. June 2022. PMID 35446153 15. The Pin: An Orthopaedic Transformation. Lindsay SE et al. J POSNA. May 2022.
Description: A year ago, we published an episode looking at diabetes management in the context of ongoing restrictions in many parts of the world. Since then, a wealth of clinical data has continued to be published on the bidirectional relationship between diabetes and Covid-19, so today we're taking a closer look at these data. We're joined by Professor Partha Kar, National Specialty Advisor, Diabetes for NHS England, to discuss what the data mean for clinical practice. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at https://diabetes.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: Kamrath C, et al. Incidence of Type 1 Diabetes in Children and Adolescents During the COVID-19 Pandemic in Germany: Results From the DPV Registry. Diabetes Care. 2022 Jan 17:dc210969. Gottesman BL, et al. Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic. JAMA Pediatr. 2022 Apr 1;176(4):414-415. McGlacken-Byrne SM, et al. The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave. Diabet Med. Sep 2021;38(9):e14640. Barrett CE, et al. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged
REFERENCES CITED IN THIS EPISODE (and TIME STAMP) TELOGEN EFFLUVIUM Monari et al (starts at 4:20). Post-SARS-CoV-2 Acute Telogen Effluvium: An Expected Complication. J Clin Med. 2022 Feb 24;11(5):1234. Muller-Ramos P et al. Post-COVID-19 hair loss: prevalence and associated factors among 5,891 patients. Int J Dermatol 2022 Jan 26. Guarnieri G et al (starts at 9:07). Relationship between hair shedding and systemic inflammation in COVID-19 pneumonia. Ann Med. 2022;54(1):869-874. Wong-Chew RM et al (starts at 13:11). Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City. Ther Adv Infect Dis. 2022 Jan 11;9:20499361211069264. Fernandez-de-Las-Penas et al. Female Sex Is a Risk Factor Associated with Long-Term Post-COVID Related-Symptoms but Not with COVID-19 Symptoms: The LONG-COVID-EXP-CM Multicenter Study. J Clin Med. 2022 Jan 14;11(2):413. Ali MD (starts at 18:49). Proton pump inhibitors' use and risk of iron deficiency anaemia: a systematic review and meta-analysis. Curr Rev Clin Exp Pharmacol. 2022 Mar 7. TRICHOTILLOMANIA AND PEDIATRIC EMOTIONAL HEALTH Wang et al (starts at 24:29). Trichotillomania occurs during the COVID-19 pandemic in an adolescent. World J Pediatr. 2022 Feb 28;1-2. Saunders NR et al. Utilization of Physician-Based Mental Health Care Services Among Children and Adolescents Before and During the COVID-19 Pandemic in Ontario, Canada. April 2022 JAMA Pediatrics.2022 Apr 1;176(4):e216298. Racine N et al. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis JAMA Pediatr. 2021;175(11):1142-1150. Pathoulas et al. Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic. J Am Acad Dermatol. 2021 Mar;84(3):771-773. Öner Ü. Children with trichotillomania in COVID-19 outbreak. J Cosmet Dermatol. 2021;20(7):1967–8. TINEA CAPITIS Salah NB et al (starts at 31:19). Erythema nodosum in patients with kerion of scalp. Clin Exp Dermatol. 2021 Dec;46(8):1577-1578. Blake T et al. Erythema nodosum - a review of an uncommon panniculitis. Dermatol Online J. 2014 Apr 16;20(4):22376. Kumar P and Pandhi D (starts at 41:09). Role of Trichoscopy in the Management of Tinea Capitis in Two Infants: A Case Report. J Cutan Aesthet Surg. Oct-Dec 2021;14(4):443-445.
Contributor: Nick Tsipis, MD Educational Pearls: Observational study in Israel evaluated cohort of vaccinated pregnant women receiving the initial Pfizer-BioNTech COVID-19 mRNA vaccine Looked at 24,288 newborns with about 16,697 exposed to maternal vaccination in utero Longitudinal follow up showed no significant difference in preterm births, neonatal hospitalizations, post-natal hospitalizations, congenital abnormalities, or mortality While this is not a randomized-controlled trial, this observational trial has a very large population that was studied supporting the safety profile of birth outcomes relating to receiving COVID mRNA vaccines during pregnancy References Goldshtein I, Steinberg DM, Kuint J, et al. Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes [published online ahead of print, 2022 Feb 10]. JAMA Pediatr. 2022;e220001. doi:10.1001/jamapediatrics.2022.0001 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-259 Overview: Per CDC data, approximately 2.5 million Americans present each year to emergency departments with head injuries, and 15% of all high school students report experiencing at least one concussion. Current guidelines recommend physical and cognitive rest for 24-48 hours post-concussion with minimal guidance on screen time parameters. Recent evidence is emerging that supports avoidance of screen time and encouragement of aerobic activity as strategies to shorten and lessen post-concussion symptoms. Join us as we discuss 2 recent studies regarding screen-time and aerobic exercise that add critical information to best practice for reducing post-concussion symptoms. Episode resource links: John J Leddy, Christina L Master, Rebekah Mannix, Douglas J Wiebe, Matthew F Grady, William P Meehan, Eileen P Storey, Brian T Vernau, Naomi J Brown, Danielle Hunt, Fairuz Mohammed, Andrea Mallon, Kate Rownd, Kristy B Arbogast, Adam Cunningham, Mohammad N Haider, Andrew R Mayer, Barry S Willer. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health, 2021; DOI: 10.1016/S2352-4642(21)00267-4 Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online September 07, 2021. doi:10.1001/jamapediatrics.2021.2782 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783638#graphical-abstract-tab DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685. doi:10.15585/mmwr.mm6724a3 University at Buffalo. (2021, September 30). Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes, study suggests: Daily aerobic exercise significantly reduced the risk of prolonged recovery. ScienceDaily. Retrieved October 2, 2021 from www.sciencedaily.com/releases/2021/09/210930213654.htm McCrory P ,Meeuwisse W,Dvorak J,etal. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017- 097699 Centers for Disease Control and Prevention. Recovery from concussion. Centers for Disease Control and Prevention; 2019. Accessed October 12, 2020. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Guest: Guest Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-259 Overview: Per CDC data, approximately 2.5 million Americans present each year to emergency departments with head injuries, and 15% of all high school students report experiencing at least one concussion. Current guidelines recommend physical and cognitive rest for 24-48 hours post-concussion with minimal guidance on screen time parameters. Recent evidence is emerging that supports avoidance of screen time and encouragement of aerobic activity as strategies to shorten and lessen post-concussion symptoms. Join us as we discuss 2 recent studies regarding screen-time and aerobic exercise that add critical information to best practice for reducing post-concussion symptoms. Episode resource links: John J Leddy, Christina L Master, Rebekah Mannix, Douglas J Wiebe, Matthew F Grady, William P Meehan, Eileen P Storey, Brian T Vernau, Naomi J Brown, Danielle Hunt, Fairuz Mohammed, Andrea Mallon, Kate Rownd, Kristy B Arbogast, Adam Cunningham, Mohammad N Haider, Andrew R Mayer, Barry S Willer. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health, 2021; DOI: 10.1016/S2352-4642(21)00267-4 Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online September 07, 2021. doi:10.1001/jamapediatrics.2021.2782 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783638#graphical-abstract-tab DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685. doi:10.15585/mmwr.mm6724a3 University at Buffalo. (2021, September 30). Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes, study suggests: Daily aerobic exercise significantly reduced the risk of prolonged recovery. ScienceDaily. Retrieved October 2, 2021 from www.sciencedaily.com/releases/2021/09/210930213654.htm McCrory P ,Meeuwisse W,Dvorak J,etal. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017- 097699 Centers for Disease Control and Prevention. Recovery from concussion. Centers for Disease Control and Prevention; 2019. Accessed October 12, 2020. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Contributor: Aaron Lessen, MD Educational Pearls: Preterm deliveries in the ED can be complex and preventing hypothermia is essential to the health of the baby Recent meta-analysis examined methods for warming preterm deliveries to prevent hypothermia The most effective way to warm the baby is by wrapping them in plastic References Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, et al. Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr. 2021;175(9):e210775. doi:10.1001/jamapediatrics.2021.0775 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today! Diversity and Inclusion Award
Date: July 14th, 2021 Reference: Pernica et al. Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial. JAMA Pediatr. 2021. Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder of website lead of Don't Forget the Bubbles (DFTB). When not […]
Vi har igen psykolog PhD Lene Meyer i studiet. Inden for psykologien er det åbenbart almen viden at vægtfokus, vejning og kategorisering som overvægtig er relateret til vægtøgning og udvikling af spiseforstyrrelser. Det har vi ikke interesseret os seriøst for i lægevidenskaben hidtil, for den viden tilhører jo et andet fagformråde - psykologien... Det er oplagt, at man er nødt til at tænke vægtfeltet og spiseforstyrrelsesfeltet sammen. På lignende vis kan man trække på flere andre fagområder som kan nuancere vores forståelse. Hvad sker der for eksempel når sundhedsplejerskerne vejer vores børn i skolerne? Kan det være skadeligt?Referencer til videnskabelige artiklerBørn ned til 3 år tillægger tykke mennesker onde karakteristika (1). Mødres kropsutilfreds, vægtsnak i familier og forældre, der kommenterer på deres børns kroppe (2). Hvis børn får at vide de er for tykke (too fat) Project EAT 5 år senere forstyrret spisning og høj BMI (3,4). RCT-studie af vejning i skoler i USA, større vægtutilfreds og mere vægtsnak blandt børn der blev vejet (5). Børn bliver tykkere fordi der fokuseres på vægt: At anse sig for at være for tyk er forbundet med at spise dårligere mad, mindre fysisk aktiv og højere BMI (6,7). Review, der konkluderer at vægttabsinterventioner ikke er forbundet med øget risiko for spiseforstyrrelser - men gør det på et spinkelt grundlag (8). Tykke børn har lavere livskvalitet end kræftramte børn (9). Kropsopfattelse er forbundet med depression (10), angst (11), spiseforstyrrelser (12), diabetes (13) og selvmordsforsøg (14). Piger der synes de er for tykke 1/3 af 11-årige og 50 % af 14-årige (15). 1. Spiel EC, Paxton SJ, Yager Z. Weight attitudes in 3- to 5-year-old children: Age differences and cross-sectional predictors. Body Image. 2012;9(4):524-527. doi:10.1016/j.bodyim.2012.07.0062. Neumark-Sztainer D, Bauer KW, Friend S, Hannan PJ, Story M, Berge JM. Family Weight Talk and Dieting: How Much Do They Matter for Body Dissatisfaction and Disordered Eating Behaviors in Adolescent Girls? J Adolesc Health. 2010;47(3):270-276. doi:10.1016/j.jadohealth.2010.02.0013. Hunger JM, Tomiyama AJ. Weight Labeling and Disordered Eating Among Adolescent Girls: Longitudinal Evidence From the National Heart, Lung, and Blood Institute Growth and Health Study. J Adolesc Health. 2018;63(3):360-362. doi:10.1016/j.jadohealth.2017.12.0164. Hunger JM, Tomiyama AJ. Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years. JAMA Pediatr. 2014;168(6):579. doi:10.1001/jamapediatrics.2014.1225. Madsen KA, Thompson HR, Linchey J, et al. Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial. JAMA Pediatr. Published online November 16, 2020. doi:10.1001/jamapediatrics.2020.47686. Haynes A, Kersbergen I, Sutin A, Daly M, Robinson E. A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes: Perceived overweight and weight management. Obes Rev. 2018;19(3):347-363. doi:10.1111/obr.126347. Dues K, Kandiah J, Khubchandani J, Haroldson A. Adolescent Body Weight Perception: Association With Diet and Physical Activity Behaviors. J Sch Nurs. Published online January 23, 2019:1059840518824386. doi:10.1177/10598405188243868. Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta‐analysis.
As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd.Papers discussed in today's episode are listed and timestamped below.enjoy!-----02:18 Arias, A. V., Lucas, D. J. & Shafi, N. I. Respiratory Syncytial Virus Bronchiolitis Complicated by Necrotizing Enterocolitis: A Case Series. Pediatrics 147, e2020022707 (2020). https://pediatrics.aappublications.org/content/147/5/e202002270708:42Kuzniewicz, M. W. et al. Predicting the Need for Phototherapy After Discharge. Pediatrics 147, e2020019778 (2021). https://pediatrics.aappublications.org/content/147/5/e202001977818:00Barton, H. J. et al. Medical Device Workarounds in Providing Care for Children With Medical Complexity in the Home. Pediatrics 147, e2020019513 (2021). https://pediatrics.aappublications.org/content/147/5/e202001951334:12Fuller, A. E. et al. Mortality Among Parents of Children With Major Congenital Anomalies. Pediatrics 147, e2020028571 (2021).https://pediatrics.aappublications.org/content/147/5/e202002857143:06Dhudasia, M. B. et al. Intrapartum Group B Streptococcal Prophylaxis and Childhood Allergic Disorders. Pediatrics 147, e2020012187 (2021). https://pediatrics.aappublications.org/content/147/5/e202001218748:29Prakalapakorn, S. G., Greenberg, L., Edwards, E. M. & Ehret, D. E. Y. Trends in Retinopathy of Prematurity Screening and Treatment: 2008–2018. Pediatrics e2020039966 (2021) doi:10.1542/peds.2020-039966. https://pediatrics.aappublications.org/content/early/2021/05/08/peds.2020-03996653:15Villar, J. et al. Association Between Preterm-Birth Phenotypes and Differential Morbidity, Growth, and Neurodevelopment at Age 2 Years. Jama Pediatr 175, 483–493 (2021). https://jamanetwork.com/journals/jamapediatrics/fullarticle/277677461:45Chinnappan, A. et al. Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates. Jama Pediatr 175, (2021).https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779856
In 2017, John Leddy, MD, FAMSSM, led a team of researchers that received the first AMSSM CRN $300,000 Multi-Site Research Grant, which supports quality, multi-site research to address key priority areas within the field of sports medicine. Christina Master, MD, and William Meehan III, MD, served as co-principal investigators for the research project titled “Sub-symptom aerobic exercise therapy to improve recovery from acute sport-related concussion: A randomized controlled trial.” On the inaugural CRN Spotlight podcast, Dr. Leddy discusses his research with Dr. Jake Wessels, and answers the following questions: What did your research entail, and why did you choose to apply for CRN funding? How did you initially come to the idea for these research efforts? What are some of the findings regarding this study? How did you go about collecting the data for this research? Can this research provide guidance for clinicians when it comes to return-to-play considerations? Are there aspects to this grant funding that are unique to the CRN, compared to other funding opportunities? Learn more about Dr. Leddy’s research, which is unpublished as of this episode’s release: https://www.amssm.org/amssm-awards-$300000-rese-p-219.html?StartPos=&Type Resources: Bezherano I, Haider MN, Willer BS, Leddy JJ. Practical Management: Prescribing Subsymptom Threshold Aerobic Exercise for Sport-Related Concussion in the Outpatient Setting. Clin J Sport Med. 2020 Feb 13. doi: 10.1097/JSM.0000000000000809. Epub ahead of print. PMID: 32058454. Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019 Apr 1;173(4):319-325. doi: 10.1001/jamapediatrics.2018.4397. PMID: 30715132 Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is Medicine for Concussion. Curr Sports Med Rep. 2018 Aug;17(8):262-270. doi: 10.1249/JSR.0000000000000505. PMID: 30095546; PMCID: PMC6089233.
喝冰水會得癌症、會導致肝臟堆積脂肪、會對腸胃不好嗎？這邊找了一些研究報告大家可以參考： 資料來源： Wong JMW, Ebbeling CB, Robinson L, Feldman HA, Ludwig DS. Effects of Advice to Drink 8 Cups of Water per Day in Adolescents With Overweight or Obesity: A Randomized Clinical Trial. JAMA Pediatr. 2017 May 1;171(5):e170012. Brown CM, Dulloo AG, Montani JP. Water-induced thermogenesis reconsidered: the effects of osmolality and water temperature on energy expenditure after drinking. J Clin Endocrinol Metab. 2006 Sep;91(9):3598-602. Thornton SN. Increased Hydration Can Be Associated with Weight Loss. Front Nutr. 2016 Jun 10;3:18. Stookey JJ. Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review. Nutrients. 2016 Jan 2;8(1). pii: E19. Zoeller, R.T., N.Kabeer and H.E. Albers.1990. Cold exposure elevates cellular levels of messenger ribonucleic acid encoding thyrotropin-releasing hormone in paraventricular nucleus despite elevated levels of thyroid hormones. Endocrinology 127(6); 2955-2962 Wu S.Y., J.S. Stern, D.A. Fisher and Z. Glick. 1987. Cold-induced increase in brown fat thyroxine 5'-monodeiodinase is attenuated in Zucker obese rat. Am. J. Physiol. 252:E63-E67 Harrop, J.S., Ashwell and M.R. Hopton. 1985. Circannual and within-individual variation of thyroid function tests in normal subjects. Ann. Clin. Biochem. 22:371-375 Gong, D.W., Y.He, M.Karas and M. Reitman. 1997. Uncoupling protein-3 is a mediator of thermogenesis regulated by thyroid hormone, β3-adrenergic agonists, and leptin. J. Biol. Chem. 272:24129-24132 Westerterp-Plantenga, MS., WD. Van Marken Lichtenbelt, H. Strobbe and P. Schrauwen. 2002. Energy metabolism in humans at lowered ambient temperature. Eur.J.Clin.Nutr. 56:288-296 各位朋友，若您有醫美、減肥、健康相關問題，請直接到「景升診所」官網任一頁面留言，或用下列方法與我們聯絡： 直接撥打24小時專線 +886-931919066 Line id=“Gscline" WeChat id=“Gscline" 哈囉，大家好: 我們有幾個不同的頻道： Grand Health 大健康 （健康加財富、知足就是福）https://goo.gl/6EGLMd Grand Beauty 大醫美 （好好愛自己、就從現在起）https://goo.gl/g1E1rq Grand Touring 大旅遊 （大叔向前跑、永遠沒煩惱）https://goo.gl/7HN4bk 歡迎大家欣賞，喜歡就請按個讚，想獲取最新訊息就按「訂閱」吧！ 我們會提供更多更新的知識和訊息給大家。 感謝以下單位的幫助： ✪景升診所 https://www.genesis-clinic.org https://www.gscline.com ✪愛瘦美官網 https://www.isome.com.tw ✪邱醫師醫話園 https://www.okclinic.gscline.com ✪隆乳 https://www.gscline.com/ifatgraft/breast-adsc-htm ✪減肥 https://www.gscline.com/islimcenter-htm/fat-htm ✪自體脂肪隆乳 https://www.gscline.com/ifatgraft/breast-adsc-htm ✪瘦臉 https://www.gscline.com/ilipolysis-htm/fll-face-htm ✪瘦手臂 https://www.gscline.com/ilipolysis-htm/fll-arm-htm ✪瘦小腹 https://www.gscline.com/ilipolysis-htm/fll-abdomen-htm ✪瘦腿 https://www.gscline.com/ilipolysis-htm/fll-leg-htm ✪瘦大腿 https://www.gscline.com/ilipolysis-htm/fll-thigh-htm ✪抽脂 https://www.gscline.com/liposuction-new-technique/fat_liposuction-htm ✪男性女乳 https://www.gscline.com/ihair-htm/fll-gynecomastia-htm ✪狐臭 https://www.gscline.com/ihair-htm/laserhyperhidrosis-htm
Childhood obesity is a prevalent problem but perhaps not as commonly addressed in doctors’ appointments due to a variety of reasons. In part two of their conversation, Dr. Dusty Marie Narducci, MD speaks with Dr. Caitlyn Mooney, MD about childhood obesity, including the following questions: · At what point would you recommend intervening? · Once a weight loss goal is determined, how do you move forward? · How exactly does diet play a role in obesity? · What is the role of physical activity, and what are the current activity recommendations? · What’s the evidence regarding interventions for childhood obesity? · Is there a role for pharmacological therapy in treatment? And what about surgical intervention? · Is there a role for counseling in certain populations? Related Articles and Links: Paul R. Stricker, Avery D. Faigenbaum, Teri M. McCambridge and COUNCIL ON SPORTS MEDICINE AND FITNESS Pediatrics June 2020, 145 (6) e20201011; DOI: https://doi.org/10.1542/peds.2020-1011 Brown T, Moore TH, Hooper L, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. Thomas H. Inge, MD, PhD1; Meg H. Zeller, PhD1; Todd M. Jenkins, PhD1; et al. Perioperative Outcomes of Adolescents Undergoing Bariatric Surgery The Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr. 2014;168(1):47-53. doi:10.1001/jamapediatrics.2013.4296
Childhood obesity is a prevalent problem but perhaps not as commonly addressed in doctors’ appointments due to a variety of reasons. Dr. Dusty Marie Narducci, MD speaks with Dr. Caitlyn Mooney, MD on the AMSSM Sports Medcast all about childhood obesity. In part one of their conversation, Dr. Narducci tackles the following questions: · Why is it important to know about childhood obesity? · What defines obesity, and what causes it in children? · What are BMI z-scores, and how much can clinicians rely on BMI as a measurement? · What are the comorbidities of obesity in childhood and adolescents? · What are the musculoskeletal implications of obesity? · What is the prognosis of childhood obesity? Related Articles and Links: BMI Z-Score and Percentile Calculator: https://www.bcm.edu/bodycomplab/BMIapp/BMI-calculator-kids.html BMI Percentile Calculator for Child and Teen https://www.cdc.gov/healthyweight/bmi/calculator.html Boutelle KN, Rhee KE, Liang J, et al. Effect of Attendance of the Child on Body Weight, Energy Intake, and Physical Activity in Childhood Obesity Treatment: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:622. US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, et al. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 317:2417. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213
Dr. Anand Shah, Vice President of Social Health at Kaiser Permanente speaks with Dr. Stacy Lindau, tenured professor at the University of Chicago, founder of NowPow, and president of MAPSCorps. This conversation is the first of several conversations about health care sector efforts to increase Awareness about both patient and community-level social conditions. Dr. Shah and Dr. Lindau share why whole person care matters to them personally and delve into the opportunities and challenges to taking social risk screening to scale. Some references mentioned by our speakers in this episode: SIREN Coffee & Science Episode 0 NASEM. Integrating Social Care into the Delivery of Health Care. 2019. CMS 2021 E&M code changes related to social determinants of health Gottlieb LM, Hessler D, Long D, et al. Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Pediatr. 2016:e162521. Tong ST, Liaw WR, Kashiri PL, et al. Clinician experiences with screening for social needs in primary care. J Am Board Fam Med. 2018;31(3):351-363. Lindau ST, Makelarski JA, Abramsohn EM, et al. CommunityRx: A real-world controlled clinical trial of a scalable, low-intensity community resource referral intervention. Am J Public Health. 2019:e1-e7. Wilson JMG, Jungner G, World Health Organization. Principles and practice of screening for disease. 1968. Dr. Lindau's disclosure statement: Under the terms of Grant Number 1C1CMS330997-01-00 (Lindau, PI) from the Department of Health and Human Services, Centers for Medicare & Medicaid Services we were expected to develop a sustainable business model which will continue and support the model that we tested after award funding ends. I am the founder and owner of a social impact company NowPow, LLC and president of MAPSCorps, 501(c)(3). Neither the University of Chicago nor UChicago Medicine is endorsing or promoting NowPow or its business, products, or services. I will not discuss off label use or investigational use in my presentation.
FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P
FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P
Join DA Health Connect as we talk about condom responsibilities, sex amongst our youth, and overall misinformation regarding how sex is presented to our youth. Episode Notes: Sexual Transmitted Infections (STIs) are at a record high in the United States. While they can impact anyone, black adolescents are at increased risk of contracting HIV and other STIs and experiencing an unplanned pregnancy. In this episode, we discuss current sexual interventions to decrease these risky behaviors, STIs health impacts, prevention strategies, the critical role we play in the black community to spread awareness, and more. Here's a glance at this episode… [01:32] Dr. Des gives an overview of the article and the importance of discussing sexual health with the black youth. [04:07] Dr. Des provides statistics on sexual health among black adolescents compared to white counterparts. [06:20] Ms. Tae discusses thoughts on the article and current generation of youth and why interventions are needed more than ever. [10:04] Dr. Des and Ms. Tae discuss and reflect on the fashion of having particular condom brands (Magnums vs. Lifestyle) [16:03] Dr. Des and Ms. Tae discuss whose responsibility it is to carry condoms, and why is it negative perceptions of women carrying condoms. [18:00] Dr. Des and Ms. Tae explain why most adults are afraid to discuss sex with their children. [26:05] Dr. Des and Ms. Tae discuss future recommendations. [43:03] Dr. Des and Ms. Tae provide recommendations and possible interventions to start in your community. The article mentioned in this episode: Association of Sexual Health Interventions with Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis. Evans R, Widman L, Stokes MN, Javidi H, Hope EC, Brasileiro J. Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(7):676-689. doi:10.1001/jamapediatrics.2020.0382 Make sure you follow us on Clubhouse, Instagram, and Facebook, where we talk more about this episode & give some tips to continue the conversation about Health Equity. [ https://instagram.com/dahealthconnect ] [Clubhouse: @DrDes & @ar.taee] Do not forget to subscribe, rate, follow, and share this podcast! Please leave us your thoughts in the comments section as well! Click here to listen now!
We would like to wish you all a very merry Christmas. It is the season of goodwill so on this episode, we dive into the topic of giving to others without expecting anything in return. The overwhelming evidence suggests that giving has multiple health benefits. It makes you happy, improves your physical and mental health, improves social connections, benefits the workplace and best of all, it’s contagious! Whether you choose to give money, time, knowledge or simply make a cup of tea for someone, the benefits are real and measurable. In this festive period we hope that in your own way, whilst keeping safe you can spread some Christmas joy. Join us on the podcast to find out more! If you have any suggestions or would like to share your personal story, please do get in touch @freshheartproject on Instagram, @freshheartproj on Twitter or via the website www.freshheartproject.com. This podcast is not a substitute for medical advice from your healthcare professional. Remember be kind to yourself and small sustainable steps create great change. Helplines It’s been a difficult year and some of us have inadvertently found it a lot harder. If you are struggling, please do know that help is out there. Shout is the UK's first 24/7 text service - free on all major mobile networks any time, anywhere. text: 85258 Samaritans - provide confidential, non-judgemental emotional support. You can phone, email, write a letter or talk to someone. Telephone: 116 123 (24 hours a day, free to call) The NHS website has a comprehensive list of organisations you can turn to. https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/ If you’re not based in the UK, please seek local help. You can see your doctor, look for national helplines or organisations or simply call a friend. You are not alone. References Soyoung QP et al. A neural link between generosity and happiness. Nat Commun. 2017 Jul 11;8:15964. https://doi.org/10.1038/ncomms15964 . William MB et al. Altruism relates to health in an ethnically diverse sample of older adults. J Gerontol B Psychol Sci Soc Sci. 2005 May;60(3):P143-52. https://doi.org/10.1093/geronb/60.3.p143 . Okun MA et al. Volunteering by older adults and risk of mortality: a meta-analysis. Psychol Aging. 2013 Jun;28(2):564-77. https://doi.org/10.1037/a0031519. Whillans AV et al. Is spending money on others good for your heart? Health Psychology, 2016. 35(6), 574-583. https://doi.org/10.1037/hea0000332 Sneed RS & Cohen S. A prospective study of volunteerism and hypertension risk in older adults. Psychology and Aging, 2013 28(2), 578–586. https://doi.org/10.1037/a0032718 (https://psycnet.apa.org/doi/10.1037/a0032718) Schreier HM et al. Effect of volunteering on risk factors for cardiovascular disease in adolescents: a randomized controlled trial. JAMA Pediatr. 2013 Apr;167(4):327-32. https://doi.org/10.1001/jamapediatrics.2013.1100 Wang Y et al. Altruistic behaviors relieve physical pain. Proc Natl Acad Sci U S A. 2020;117(2):950-958. https://doi.org/10.1073/pnas.1911861117 Hansen T et al, Dynamics of Volunteering and Life Satisfaction in Midlife and Old Age: Findings from 12 European Countries. Soc. Sci. 2018, 7(5), 78 https://doi.org/10.3390/socsci7050078 Poulin MJ et al. Giving to Others and the Association Between Stress and Mortality (https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300876) . American Journal of Public Health. 2013. 103, 1649-1655. https://doi.org/10.2105/AJPH.2012.300876 Fowler JH & Christakis NA. Cooperative behavior cascades in human social networks. PNAS. March 23, 2010 107 (12) 5334-5338; https://doi.org/10.1073/pnas.0913149107
FDA 批准MAPK激酶抑制剂治疗手术无法切除的1型神经纤维瘤BMJ 哮喘发作与空气污染和母亲孕期吸烟有关Nature Metabolism 母亲运动带来的后代的健康获益是通过母乳中的3′-唾液酸乳糖介导的司美替尼（selumetinib）神经纤维瘤是常染色体显性遗传病，分1、2和3型。1型神经纤维瘤最常见，标志性特征是多发的牛奶咖啡斑和相关皮肤神经纤维瘤。没有针对性的总体的治疗，只能对症治疗。50%的1型神经纤维瘤患者合并丛状神经纤维瘤，丛状神经纤维瘤是一种组织学上良性的周围神经鞘肿瘤，常累及多个神经束，造成毁容、运动功能障碍、疼痛、甚至脊髓受压。司美替尼是一种MAPK激酶的抑制剂，在2020年4月，FDA批准了司美替尼用于治疗1型神经纤维瘤。《司美替尼治疗不能手术的丛状神经纤维瘤患儿》New England Journal of Medicine，2020年4月 (1)这项开放标签的2期试验，旨在确定丛状神经纤维瘤患儿服用司美替尼后的临床益处和安全性。50名、平均年龄10.2岁的、不能手术的丛状神经纤维瘤的1型神经纤维瘤病患儿入组，随机接受了司美替尼和安慰剂治疗。最常见的神经纤维瘤相关症状包括毁容（44人）、运动功能障碍（33人）和疼痛（26人）。治疗后70%达到了部分缓解，56%≥1年的持久缓解。1年后，肿瘤疼痛评分平均降低了2分，疼痛对日常功能、总体健康相关生活质量、力量和关节活动范围等多项功能结局也观察到了有临床意义的改善。其中5人因副作用停药；6人疾病发展。最常见的毒性作用为恶心、呕吐或腹泻、无症状的肌酸磷酸激酶水平升高、痤疮样皮疹及甲沟炎。结论：对于手术无法切除的丛状神经纤维瘤患儿，司美替尼产生了持久的缩小肿瘤作用。儿童哮喘哮喘（asthma）是一种异质性疾病，特点是慢性气道炎症。12岁以下儿童哮喘是最常见的儿童期慢性疾病，约80%的患儿在5岁以前出现症状，咳嗽、哮鸣、呼吸急促、胸闷胸痛是常见的症状。最常见的诱发因素包括病毒性上呼吸道感染（合胞病毒、流感病毒、鼻病毒）、运动、天气、二手烟和变应原（如尘螨、宠物毛发、花粉、霉菌）。《病例队列研究：空气污染和家庭相关因素与儿童哮喘发作和持续性喘息的关系》BMJ，2020年8月(2)研究目的探讨儿童哮喘和持续性喘息发病的危险因素（空气污染和家庭相关因素）。这项全国病例对照研究中随访了1-15岁儿童儿童哮喘发病率升高，与父母患有哮喘（风险比 2.29）、母亲在怀孕期间吸烟（风险比 1.20）相关。儿童哮喘发病率低，与父母受教育程度高（风险比0.72）和父母收入高（风险比 0.85）相关。空气污染物PM2.5和PM10与哮喘的风险增加和持续喘息相关。结论：暴露于空气污染中的儿童更容易患哮喘和持续性喘息，哮喘与父母哮喘病史、父母教育程度和母亲在怀孕期间吸烟有关。《观察性研究：母亲在怀孕期间吸烟影响子女成年后哮喘发作》European Respiratory Journal 2020年7月 (3)研究的目的是确定产前哮喘和成人哮喘发病之间的关系。研究纳入5200名、1966年芬兰北部出生的、31岁前未诊断为哮喘的人群。研究发现孕妇妊娠最后3个月吸烟，其后代31岁至46岁之间哮喘累积发病率（男性为5.1%，女性为8.8%），尤其是与无哮喘病史（风险比9.63）或咳嗽喘息病史（风险比3.21）的后代中有显著相关性。同时在妊娠期吸烟与31岁时子代的用力呼气量（FEV1）/用力肺活量（FVC）比率之间有发现了显著的相关性，在在RUNX1单倍型rs11702779-AA的后代中成年期患哮喘的风险比为5.53。结论：怀孕期间吸烟与后代成年后哮喘累积发病率有关。《观察性研究：空气污染和从出生到成年的哮喘发展》European Respiratory Journal 2020年7月 (4)空气污染对青春期至成年期哮喘发展的影响尚不清楚，研究纳入了3687个参与者，评估空气污染和哮喘发生的年龄的相关关系。研究20岁之前哮喘的发病率，与出生地空气污染物的比例增加相关（接触PM10的风险比为1.09，接触NO2的风险比为1.20）。对近期家庭居住地的空气污染进行分析后，得到了类似的结果。结论：早年暴露在空气污染中，特别是来自机动交通的污染，与儿童、青春期到成年早期罹患哮喘的风险增加有关。《哮喘患儿卧室颗粒物过滤与气道病理生理变化的关系》JAMA Pediatrics，2020年8月 (5)细颗粒物PM2.5是一种普遍存在的空气污染物，可沉积在小气道中，对哮喘起着至关重要的作用。来自杜克大学与北京上海的研究人员合作，研究PM2.5过滤装置的使用是否能改善哮喘患儿的小气道生理学和呼吸系统炎症。研究人员在患儿的卧室里随机安装了真实的过滤设备和假的过滤设备，试验前有2周的洗脱期，研究是在臭氧含量低的季节在中国上海的郊区进行的。研究纳入轻中度哮喘的、共43个、5-13岁的儿童参加了研究。室外PM2.5浓度中度升高（28.6-69.8μg/m3)；经过滤的卧室PM2.5浓度比不经过滤降低63.4%。过滤的卧室空气能显著改善气道力学，总气道阻力下降24.4%，减少小气道阻力43.5%，呼气流量峰值也显著改善。这些改善与卧室PM2.5的减少显著相关。总体的小气道功能改善均没有统计学意义，但在不伴有嗜酸性气道炎症的参与者中改善显著（13.2%）。结论：室内PM2.5过滤可以通过改善气道力学和功能，减少炎症，改善哮喘患者肺部的气体流动。《VDKA研究：补充维生素D3对低维生素D和哮喘患儿哮喘加重的影响》JAMA，2020年8月 (6)研究的目的探讨维生素D3的补充是否能改善儿童哮喘和低维生素D水平严重恶化的时间。这项随机、双盲、安慰剂对照临床试验，纳入6-16岁的、哮喘严重发作高危儿童共192人，平均年龄9.8岁，女孩40%维生素D3组的37.5%和安慰剂组的34.4%出现≥1次严重恶化。补充维生素D3并没有显著改善哮喘严重恶化的时间，没有显著改善病毒诱导哮喘严重加重的时间，没有显著改善糖皮质激素剂量减量的患者比例，也没有显著减少糖皮质激素的累积剂量。两组严重不良事件相似。结论：该研究不支持在持续性哮喘和低维生素D水平的儿童维生素D3来预防哮喘加重。《前瞻性队列研究：抗生素的使用减少，影响肠道菌群和儿童哮喘发病率》Lancet Respiratory Medicine，2020年7月 (7)在欧洲和北美的一些地区，儿童哮喘的发病率正在下降；有研究提示婴儿期使用抗生素与哮喘风险增加有关。该研究的目的是验证哮喘发病率的降低是否与抗生素处方减少有关，并验证这种变化是由肠道菌群变化介导的。本研究包括基于人群和前瞻性队列分析，使用加拿大不列颠哥伦比亚省（人口400万·700万）每年抗生素处方率和哮喘诊断率的管理数据进行人群分析。2000 - 2014年，1-4岁儿童的哮喘发病率从27·3‰ 下降到20·2‰，降幅26·0%。发病率的降低与
FDA 批准MAPK激酶抑制剂治疗手术无法切除的1型神经纤维瘤BMJ 哮喘发作与空气污染和母亲孕期吸烟有关Nature Metabolism 母亲运动带来的后代的健康获益是通过母乳中的3′-唾液酸乳糖介导的司美替尼（selumetinib）神经纤维瘤是常染色体显性遗传病，分1、2和3型。1型神经纤维瘤最常见，标志性特征是多发的牛奶咖啡斑和相关皮肤神经纤维瘤。没有针对性的总体的治疗，只能对症治疗。50%的1型神经纤维瘤患者合并丛状神经纤维瘤，丛状神经纤维瘤是一种组织学上良性的周围神经鞘肿瘤，常累及多个神经束，造成毁容、运动功能障碍、疼痛、甚至脊髓受压。司美替尼是一种MAPK激酶的抑制剂，在2020年4月，FDA批准了司美替尼用于治疗1型神经纤维瘤。《司美替尼治疗不能手术的丛状神经纤维瘤患儿》New England Journal of Medicine，2020年4月 (1)这项开放标签的2期试验，旨在确定丛状神经纤维瘤患儿服用司美替尼后的临床益处和安全性。50名、平均年龄10.2岁的、不能手术的丛状神经纤维瘤的1型神经纤维瘤病患儿入组，随机接受了司美替尼和安慰剂治疗。最常见的神经纤维瘤相关症状包括毁容（44人）、运动功能障碍（33人）和疼痛（26人）。治疗后70%达到了部分缓解，56%≥1年的持久缓解。1年后，肿瘤疼痛评分平均降低了2分，疼痛对日常功能、总体健康相关生活质量、力量和关节活动范围等多项功能结局也观察到了有临床意义的改善。其中5人因副作用停药；6人疾病发展。最常见的毒性作用为恶心、呕吐或腹泻、无症状的肌酸磷酸激酶水平升高、痤疮样皮疹及甲沟炎。结论：对于手术无法切除的丛状神经纤维瘤患儿，司美替尼产生了持久的缩小肿瘤作用。儿童哮喘哮喘（asthma）是一种异质性疾病，特点是慢性气道炎症。12岁以下儿童哮喘是最常见的儿童期慢性疾病，约80%的患儿在5岁以前出现症状，咳嗽、哮鸣、呼吸急促、胸闷胸痛是常见的症状。最常见的诱发因素包括病毒性上呼吸道感染（合胞病毒、流感病毒、鼻病毒）、运动、天气、二手烟和变应原（如尘螨、宠物毛发、花粉、霉菌）。《病例队列研究：空气污染和家庭相关因素与儿童哮喘发作和持续性喘息的关系》BMJ，2020年8月(2)研究目的探讨儿童哮喘和持续性喘息发病的危险因素（空气污染和家庭相关因素）。这项全国病例对照研究中随访了1-15岁儿童儿童哮喘发病率升高，与父母患有哮喘（风险比 2.29）、母亲在怀孕期间吸烟（风险比 1.20）相关。儿童哮喘发病率低，与父母受教育程度高（风险比0.72）和父母收入高（风险比 0.85）相关。空气污染物PM2.5和PM10与哮喘的风险增加和持续喘息相关。结论：暴露于空气污染中的儿童更容易患哮喘和持续性喘息，哮喘与父母哮喘病史、父母教育程度和母亲在怀孕期间吸烟有关。《观察性研究：母亲在怀孕期间吸烟影响子女成年后哮喘发作》European Respiratory Journal 2020年7月 (3)研究的目的是确定产前哮喘和成人哮喘发病之间的关系。研究纳入5200名、1966年芬兰北部出生的、31岁前未诊断为哮喘的人群。研究发现孕妇妊娠最后3个月吸烟，其后代31岁至46岁之间哮喘累积发病率（男性为5.1%，女性为8.8%），尤其是与无哮喘病史（风险比9.63）或咳嗽喘息病史（风险比3.21）的后代中有显著相关性。同时在妊娠期吸烟与31岁时子代的用力呼气量（FEV1）/用力肺活量（FVC）比率之间有发现了显著的相关性，在在RUNX1单倍型rs11702779-AA的后代中成年期患哮喘的风险比为5.53。结论：怀孕期间吸烟与后代成年后哮喘累积发病率有关。《观察性研究：空气污染和从出生到成年的哮喘发展》European Respiratory Journal 2020年7月 (4)空气污染对青春期至成年期哮喘发展的影响尚不清楚，研究纳入了3687个参与者，评估空气污染和哮喘发生的年龄的相关关系。研究20岁之前哮喘的发病率，与出生地空气污染物的比例增加相关（接触PM10的风险比为1.09，接触NO2的风险比为1.20）。对近期家庭居住地的空气污染进行分析后，得到了类似的结果。结论：早年暴露在空气污染中，特别是来自机动交通的污染，与儿童、青春期到成年早期罹患哮喘的风险增加有关。《哮喘患儿卧室颗粒物过滤与气道病理生理变化的关系》JAMA Pediatrics，2020年8月 (5)细颗粒物PM2.5是一种普遍存在的空气污染物，可沉积在小气道中，对哮喘起着至关重要的作用。来自杜克大学与北京上海的研究人员合作，研究PM2.5过滤装置的使用是否能改善哮喘患儿的小气道生理学和呼吸系统炎症。研究人员在患儿的卧室里随机安装了真实的过滤设备和假的过滤设备，试验前有2周的洗脱期，研究是在臭氧含量低的季节在中国上海的郊区进行的。研究纳入轻中度哮喘的、共43个、5-13岁的儿童参加了研究。室外PM2.5浓度中度升高（28.6-69.8μg/m3)；经过滤的卧室PM2.5浓度比不经过滤降低63.4%。过滤的卧室空气能显著改善气道力学，总气道阻力下降24.4%，减少小气道阻力43.5%，呼气流量峰值也显著改善。这些改善与卧室PM2.5的减少显著相关。总体的小气道功能改善均没有统计学意义，但在不伴有嗜酸性气道炎症的参与者中改善显著（13.2%）。结论：室内PM2.5过滤可以通过改善气道力学和功能，减少炎症，改善哮喘患者肺部的气体流动。《VDKA研究：补充维生素D3对低维生素D和哮喘患儿哮喘加重的影响》JAMA，2020年8月 (6)研究的目的探讨维生素D3的补充是否能改善儿童哮喘和低维生素D水平严重恶化的时间。这项随机、双盲、安慰剂对照临床试验，纳入6-16岁的、哮喘严重发作高危儿童共192人，平均年龄9.8岁，女孩40%维生素D3组的37.5%和安慰剂组的34.4%出现≥1次严重恶化。补充维生素D3并没有显著改善哮喘严重恶化的时间，没有显著改善病毒诱导哮喘严重加重的时间，没有显著改善糖皮质激素剂量减量的患者比例，也没有显著减少糖皮质激素的累积剂量。两组严重不良事件相似。结论：该研究不支持在持续性哮喘和低维生素D水平的儿童维生素D3来预防哮喘加重。《前瞻性队列研究：抗生素的使用减少，影响肠道菌群和儿童哮喘发病率》Lancet Respiratory Medicine，2020年7月 (7)在欧洲和北美的一些地区，儿童哮喘的发病率正在下降；有研究提示婴儿期使用抗生素与哮喘风险增加有关。该研究的目的是验证哮喘发病率的降低是否与抗生素处方减少有关，并验证这种变化是由肠道菌群变化介导的。本研究包括基于人群和前瞻性队列分析，使用加拿大不列颠哥伦比亚省（人口400万·700万）每年抗生素处方率和哮喘诊断率的管理数据进行人群分析。2000 - 2014年，1-4岁儿童的哮喘发病率从27·3‰ 下降到20·2‰，降幅26·0%。发病率的降低与
FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，
FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，
While Autism Spectrum Disorder (ASD) affects millions across the U.S., many do not realize that the adult ASD population, in particular, lacks resources and research. This podcast aims to explore this disparity in order to educate and connect the population with resources on the subject. Sources Wax Stag, FaltyDL. “Summit.” II. mp3. “Autism Fact Sheet.” National Autism Association, 2020, nationalautismassociation.org/resources/autism-fact-sheet/. “Autism Statistics and Facts.” Autism Speaks, 2020, www.autismspeaks.org/autism-statistics. Angela Hodkiewicz, Alise Garcia. “Autism.” Autism Policy Issues Overview, 2016, www.ncsl.org/research/health/autism-policy-issues-overview.aspx. Buescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of Autism Spectrum Disorders in the United Kingdom and the United States . JAMA Pediatr. 2014;168(8):721–728. doi:10.1001/jamapediatrics.2014.210 Bishop-Fitzpatrick, Lauren, and Amy J H Kind. “A Scoping Review of Health Disparities in Autism Spectrum Disorder.” Journal of autism and developmental disorders vol. 47, 11 (2017): 3380-3391. doi:10.1007/s10803-017-3251-9. Khowaja, Meena K et al. “Sociodemographic Barriers to Early Detection of Autism: Screening and Evaluation Using the M-CHAT, M-CHAT-R, and Follow-Up.” Journal of autism and developmental disorders vol. 45,6 (2015): 1797-808. doi:10.1007/s10803-014-2339-8. Mason, D., Ingham, B., Urbanowicz, A., Michael, C., Birtles, H., Woodbury-Smith, M., Brown, T., James, I., Scarlett, C., Nicolaidis, C., & Parr, J. R. (2019). A Systematic Review of What Barriers and Facilitators Prevent and Enable Physical Healthcare Services Access for Autistic Adults. Journal of autism and developmental disorders, 49(8), 3387–3400. https://doi.org/10.1007/s10803-019-04049-2 Quillian Lincoln, et al. “Meta-Analysis of Field Experiments Shows No Change in Racial Discrimination in Hiring over Time.” Proceedings of the National Academy of Sciences of the United States of America, vol. 114, no. 41, 2017, p. 10870. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=edsjsr&AN=edsjsr.26488684&site=eds-live. Roux, A. M., Shattuck, P. T., Rast, J. E., & Anderson, K. A. “National autism indicators report: Developmental disability services and outcomes in adulthood.” Philadelphia: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University. (2017). https://drexel.edu/autismoutcomes/publications-and-reports/publications/National-Autism-Indicators-Report-Developmental-Disability-Services-and-Outcomes-in-Adulthood/ Solomon, C. Autism and Employment: Implications for Employers and Adults with ASD. J Autism Dev Disord 50, (2020): 4209–4217. https://doi.org/10.1007/s10803-020-04537-w.
Date: June 14th, 2020 Guest Skeptic: Dr. Dennis Ren is a Pediatric Emergency Medicine fellow at Children's National Hospital in Washington, DC. Reference: Kuppermann et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019. Case: A 5-week-old full term female presents to the Emergency Department […]
UMSOM class of 2015 alum and psychiatrist Dr. Melissa Shepard sits down with Dr. Neda Frayha for some real talk on the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period. Spoiler alert: it's more than yoga. This conversation originally aired on Hippo Education's podcasts. Resources: Free mental health crisis line for physicians impacted by Covid-19 related issues, staffed by US Psychiatrists (support only, cannot prescribe medications). 1-888-409-0141. www.physiciansupportline.com COVID-19 Resource and Information Guide. National Alliance on Mental Illness. https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf Mental Health America, Mental Health And COVID-19 – Information And Resources Darnall B. The COVID-19 Wellness and Coping Toolkit: 11 Tips for Health Care Workers, Patients, and the Public. Psychology Today, 31 March 2020. https://www.psychologytoday.com/us/blog/empowered-relief/202003/the-covid-19-wellness-and-coping-toolkit Good Therapy. https://www.goodtherapy.org Psychology Today, Find a Therapist. Doxy.me Physician Support Line. https://doxy.me/physiciansupportline Free access to Headspace Plus app (guided meditations) for healthcare professionals. https://www.headspace.com/health-covid-19 Center for Mind-Body Medicine at Georgetown. Introduction to evidenced-based techniques for helping people through and after trauma (things like guided imagery, body scans, breathing techniques) https://cmbm.org/thetransformation/resources/ References: Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976 Chen QC, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry 2020; 7(4):E15-16. doi:https://doi.org/10.1016/S2215-0366(20)30078-X Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure. Health Psychology. 2020 May;39(5): 355-357. Advance online publication. doi: https://doi.org/10.1037/hea0000875 Rosenberg AR. Cultivating deliberate resilience during the coronavirus disease 2019 pandemic. JAMA Pediatr. Published online April 14, 2020. doi:10.1001/jamapediatrics.2020.1436 Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562 Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. Published online April 13, 2020. doi: 10.1056/NEJMp2008017
2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin. 2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy! Produced by James E. Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES [BRAIN FOOD] Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7. Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43. Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94. Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22. Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103. Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8. Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180. Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680. Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404. Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42. Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988. Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36. [OF MEASLES AND MEN] Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750. Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16. Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48. Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215. Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619. Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196. Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en [NON-INFECTIOUS NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANT] Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78. Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572. Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14. Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77. Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.
In questo episodio parliamo di metriche e del perché se ne facessimo a meno staremmo tutti molto meglio!Lo spunto arriva dai risultati di una ricerca pubblicati recentemente su una importante rivista di pediatria, che hanno evidenziato un legame significativo tra l'utilizzo dei social network e lo sviluppo di sintomi depressivi. Riferimento bibliografico:Boers E, Afzali MH, Newton N, Conrod P. Association of Screen Time and Depression in Adolescence. /JAMA Pediatr./ Published online July 15, 2019. doi:10.1001/jamapediatrics.2019.1759Contatti: luciano.barrila@icloud.comhttps://www.correrepensando.net
The first wave of the opioid crisis began in 1991 when physicians began to overprescribe narcotic analgesics for pain. Eventually, addiction led to abuse and the fatality rates began to climb. In response, the US government cracked down on narcotic prescriptions--leading a surge in the price of medical grade opioids. By 2010, the cost of pharmacologic opiates was unaffordable, and users reverted back to the (now cheaper) alternative, heroin. 2013 marked the third wave of the opioid crisis, whereby synthetic, high-potency opiates like fentanyl and carfentanyl were being infused into other opiate products. With each wave, the world witnessed a spike in the number of opioid-related deaths, and thus far, our solutions have only led to new problems. But there is more to the opioid crisis than the effect of opioids on the voluntary user. In 2017, we released a show highlighting the clinical consequences and management of opioid dependence on infants born to mothers who had used opioids during their pregnancy. This week, we have remastered the 2017 program and included an update at the end. Produced by James E. Siegler. Music courtesy of Little Glass Men, Jason Shaw, and Chris Zabriskie. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479. Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13. Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813. Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310. Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60. Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM and Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141. MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB and Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172:345-351. Gomez-Pomar E and Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr. 2018;6:33.
Since January 1, 2019, there have been nearly 900 confirmed US cases of measles across 24 states. This is 10 times greater than the number of cases in the US 3 years ago, and it is the largest outbreak the US has seen since 1994. The month of May also marks the first reported case of measles in the state of Pennsylvania, where BrainWaves is produced. So this week on the program, Jim Siegler speaks with Dr. Erika Mejia (pediatrician) about the medical and sociopolitical triggers for this outbreak, the misconceptions of the measles-mumps-rubella vaccine, and finally, what you can do to keep measles from "going viral"*. Produced by James E. Siegler and Erika Mejia. Music courtesy of Advent Chamber Orchestra, Coldnoise, Josh Woodward, Kevin McLeod, and Lee Roosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750. Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16. Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48. Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215. Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619. Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196. Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en *Truth-be-told, measles claims the lives of 100,000 people around the globe every year. It has already gone viral. This was just a figure of speech.
When it comes to managing patients with epilepsy, there isn't a one-size-fits-all approach. And it would be wrong to assume you could treat a woman the same way you would treat a man. There are a number of special considerations to keep in mind--especially birth control and pregnancy. Not to mention the increase risk of seizures during menses for some women. In this week's program, we revisit one of the earliest shows we put together in 2016 on the special considerations when it comes to women with epilepsy. Dr. Danielle Becker--an epileptologist at Penn--joins Jim Siegler for the discussion. Produced by James E. Siegler. Music courtesy of Josh Woodward. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. REFERENCES Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW and Neurodevelopmental Effects of Antiepileptic Drugs Study G. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. Veliskova J and Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63:267-77. Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, Liporace JD, Harden CL, Dworetzky BA, Pennell PB, Massaro JM and Progesterone Trial Study G. Progesterone vs placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78:1959-66. Tauboll E, Sveberg L and Svalheim S. Interactions between hormones and epilepsy. Seizure. 2015;28:3-11. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005;46 Suppl 9:117-24. Reiter SF, Bjork MH, Daltveit AK, Veiby G, Kolstad E, Engelsen BA and Gilhus NE. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav. 2016;62:251-257. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of N and American Epilepsy S. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126-32.
EM Pulse Live Edition: WR SAEM Day 2 Wrap-up It was another exciting day at the Western Regional SAEM conference in Napa, CA! This episode recaps Day 2, including the Western EM Challenge and some fantastic plenary speakers. Highlights include time management for EM physicians, social emergency medicine, care for LGBTQI patients, the future of medical education, exercise in medicine, and building your social media brand. The conference is trending of social media - follow #WRSAEM19, @wrsaem19, and, of course, @empulsepodcast for all the details. How did we do? This is a new type of podcasting for us and we’d love your feedback! Hit us up on social media or at ucdavisem.com. Hosts: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Linda Herman, Emergency Medicine Residency Program Director at Kaweah Delta Dr. Harrison Alter, Research Director for the Highland Department of Emergency Medicine and Founder and Executive Director of the Levitt Center Dr. Mike Gisondi, Vice Chair of Education for the Department of Emergency Medicine at Stanford University Dr. Angela Jarman, Assistant Professor of Emergency Medicine at UC Davis Dr. Rachel Bentzen, Assistant Professor of Emergency Medicine and Sports Medicine at Oregon Health Science University Dr. Nikita Joshi, Emergency Medicine Faculty at Alameda Health System Dr. Jim Holmes, Professor of Emergency Medicine at UC Davis and WR SAEM 2019 Conference Chair Resources: Nasca TJ, Thomas CW. Medicine in 2035: Selected Insights From ACGME's Scenario Planning. J Grad Med Educ. 2015;7(1):139-42. Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections[published online ahead of print, 2019 Feb 18]. JAMA Pediatr. 2019;10.1001/jamapediatrics.2018.5501. doi:10.1001/jamapediatrics.2018.5501 Kuppermann N, Ghetti S, Schunk JE, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378(24):2275-2287. ********************************************** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.
Author: Sue Chilton, MD Educational Pearls: Measles is highly contagious Typically patients just look sick Remember 4 & 4, 14, and 4-C’s: Contagious 4 days before and after onset of rash 14 days for rash to appear Cough, coryza, conjunctivitis (non-purulent), and Koplik’s spots Under 2 and over 20 are highest risk groups 1 in 1000 will die Subacute sclerosing panencephalitis is one of the most feared, degenerative, 100% fatal complications that can occur up to two decades after initial infection Editor’s Note: Don’t be pro-plague - if you can, vaccinate your children. References: https://www.denverpost.com/2019/01/16/denver-measles-exposure/ Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849. Summarized and edited by Erik Verzemnieks, MD
“Hot” Off the Press: Infant Fever Rule - Episode 15 Talking about neonatal fever makes most people hot under the collar! Fortunately, PECARN is on the case. Their latest paper was just published TODAY in JAMA Peds: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. In this month’s episode, we learn about some the challenges of having a febrile infant - from a mom’s perspective. Then we discuss when, why, and how to apply the latest PECARN rule with the notorious DNK, also known as Dr. Nate Kuppermann! What is your approach to the febrile infant? What are some of the hardest parts about providing care to our hot little ones? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. Hosts: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee Resources: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. Nathan Kuppermann, MD, MPH1; Peter S. Dayan, MD, MSc2; Deborah A. Levine, MD3; et al. JAMA Pediatr. Published online February 18, 2019. doi:10.1001/jamapediatrics.2018.5501 Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants. Gomez B, Mintegi S, Bressan S, Da Dalt L, et. al. Pediatrics. 2016 Aug;138(2). pii: e20154381. doi: 10.1542/peds.2015-4381. Epub 2016 Jul 5. Management of the Febrile Young Infant: Update for the 21st Century. Woll C, Neuman MI, Aronson PL. Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303. Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger with Invasive Bacterial Infections. Cruz AT, Mahajan P, Bonsu BK, Bennett JE et. al. JAMA Pediatr. 2017 Nov 6;171(11):e172927. doi: 10.1001/jamapediatrics.2017.2927. Epub 2017 Nov 6. *************************************** Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe, CA. Come play and learn with us at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19 Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services. Dr. Nathan KuppermannSarah and Julia
Although recent studies suggest that ‘rooming-in’ is associated with a decreased need for pharmacological treatment and length of stay for infants with neonatal abstinence syndrome (NAS), more research is required to determine the effective components and short-term and long-term NAS outcomes, including risks. Professor Alison Twycross talks to Dr Karen A McQueen, Lakehead University School of Nursing, Thunder Bay Ontario, Canada, about her recent commentary published by Evidence-Based Nursing: “‘Rooming-in’ could be an effective non-pharmacological treatment for infants with neonatal abstinence syndrome”. Read it for free for the next two months on the EBN website: https://ebn.bmj.com/content/21/4/110. Commentary on: MacMillan, KDL. et al. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review with meta-analysis. JAMA Pediatr. 2018; 172; 345-351.
Author: Mike Hunt, MD Educational Pearls: Measles is highly contagious and successfully infects 90% of those at risk exposed to the virus. 10 day prodrome where patients are asymptomatic. 3 day period of characteristic cough, coryza, conjunctivitis, fever and Koplick spots with a maculopapular rash that moves from head through trunk Infection risk extends three to four days after the onset of rash but also three to four days prior to onset. Have fun with that. A potential exposure, say in an emergency department waiting room, needs review of any exposed patient’s immunization history to contain spread References: Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
This week we review 1) Rattlesnake Bites: “Rattlesnake Envenomation.” VetFolio, www.vetfolio.com/toxicology/rattlesnake-envenomation. “The Use of Rattlesnake (Crotaline) Antivenom.” Using Activated Charcoal in Medical Toxicology | California Poison Control System | UCSF, calpoison.org/news/use-rattlesnake-crotaline-antivenom. “Rattlesnake Antivenin (Antivenin (Crotalidae) Polyvalent): Side Effects, Interactions, Warning, Dosage & Uses.” RxList, www.rxlist.com/rattlesnake-antivenin-drug.htm#warnings_precautions. 2) Fatty Acid Supplements: “Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus”. N Engl J Med 2018; 379:1540-1550. DOI: 10.1056/NEJMoa1804989. 3) Anesthesia Use in Children: O'leary JD, Janus M, Duku E, et al. Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among Matched Sibling Pairs. JAMA Pediatr. 2018 Nov 5. [Epub ahead of print]. doi: 10.1001/jamapediatrics.2018.3662. 4) Surgery for Liver Metastases: Ratti F, Fiorentini G, Cipriani F, Catena M, Paganelli M, Aldrighetti L. Laparoscopic vs Open Surgery for Colorectal Liver Metastases. JAMA Surg. July 18, 2018. doi:10.1001/jamasurg.2018.2107 Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Levels of Greatness by Scott Holmes from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
This week we review 1) Digital pill: Belluck, Pam. “First Digital Pill Approved to Worries About Biomedical ‘Big Brother.’” The New York Times, The New York Times, 13 Nov. 2017, www.nytimes.com/2017/11/13/health/digital-pill-fda.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health®ion=rank&module=package&version=highlights&contentPlacement=2&pgtype=sectionfront. 2) Brain aneurysms: Ajay Malhotra, Xiao Wu, Howard P. Forman, Charles C. Matouk, Dheeraj Gandhi, Pina Sanelli. Management of Tiny Unruptured Intracranial AneurysmsA Comparative Effectiveness Analysis. JAMA Neurol. Published online November 20, 2017. doi:10.1001/jamaneurol.2017.3232 3) Case presentation: Sukesh Sukumaran, Vini Vijayan. Infantile-Onset Fever and Urticaria. JAMA Pediatr.2017;171(11):1122–1123. doi:10.1001/jamapediatrics.2017.2531 Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
Not all head trauma is minor. Not all minor head trauma is clinically significant. How can we sort out the overtly ok from the sneakily serious? Mnemonics for bedside risk stratification of minor pediatric blunt head trauma, based on PECARN studies: [Details in Audio] Blunt Head Trauma in Children < 2 years of Age Blunt Head Trauma in Children ≥ 2 years of Age Image Gently Campaign Medical Imaging Record (maintain like an immunization card) Brochure for Parents: Just in Time Education Selected References Dayan PS et al. Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma. Ann Emerg Med. 2014; 63(6):657-665. Dayan PS et al. Headache in Traumatic Brain Injuries from Blunt Head Trauma. Pediatrics. 2015; 135(3):504-512. Horeczko T, Kuppermann N. To scan or not to scan: pediatric minor head trauma in your office, clinic or emergency department. Contemporary Pediatrics. 2012;29(8):40-47. Kupperman et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-70. Lee LK et al. Isolated Loss of Consciousness in Children with Minor Blunt Head Trauma. JAMA Pediatr. 2014; 168(9):837-843. Magana JN, Kuppermann N. The PECARN TBI Rules Do Not Apply To Abusive Head Trauma. Acad Emerg Med. 2017; 24(3)382-384. Rogers AJ et al. Children with Arachnoid Cysts who Sustain Blunt Head Trauma: Injury Mechanisms and Outcomes. Acad Emerg Med. 2016; 23:358-361. This post and podcast are dedicated to Kevin Klauer, DO, EJD, FACEP for his dedication to education, and for his unique balance of safety and keeping it real. Thank you.
This week we review 1) Traumatic Brain Injury in Football: Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, Alosco ML, Solomon TM, Nowinski CJ, McHale L, Cormier KA, Kubilus CA, Martin BM, Murphy L, Baugh CM, Montenigro PH, Chaisson CE, Tripodis Y, Kowall NW, Weuve J, McClean MD, Cantu RC, Goldstein LE, Katz DI, Stern RA, Stein TD, McKee AC. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360-370. doi:10.1001/jama.2017.8334 https://concussionfoundation.org/CTE-resources/what-is-CTE http://jamanetwork.com/journals/jama/article-abstract/2645082 2) Markers of Alzheimer's: Kunkle BW, Vardarajan BN, Naj AC, Whitehead PL, Rolati S, Slifer S, Carney RM, Cuccaro ML, Vance JM, Gilbert JR, Wang L, Farrer LA, Reitz C, Haines JL, Beecham GW, Martin ER, Schellenberg GD, Mayeux RP, Pericak-Vance MA. Early-Onset Alzheimer Disease and Candidate Risk Genes Involved in Endolysosomal Transport. JAMA Neurol. Published online July 24, 2017. doi:10.1001/jamaneurol.2017.1518 3) Vaccine Hesitancy: Lo NC, Hotez PJ. Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States. JAMA Pediatr. Published online July 24, 2017. doi:10.1001/jamapediatrics.2017.1695 "Measles." World Health Organization. World Health Organization, n.d. Web. 28 July 2017. Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
This week we review 1) E-cigarette Use: Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang J, Primack BA, Andrews JA, Miech RA, Spindle TR, Dick DM, Eissenberg T, Hornik RC, Dang R, Sargent JD. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young AdultsA Systematic Review and Meta-analysis. JAMA Pediatr. Published online June 26, 2017. doi:10.1001/jamapediatrics.2017.1488 https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes 2) ECT therapy http://www.ncbi.nlm.nih.gov/pubmed/15774232 http://www.ncbi.nlm.nih.gov/pubmed/12642045 http://www.ncbi.nlm.nih.gov/pubmed/17635894 http://www.ncbi.nlm.nih.gov/pubmed/25219389 3) Case presentation: Mukerji, S. S., Gonzalez, R. G., Gandhi, R. T., & Kraft, S. (2017). Case 20-2017 — A 48-Year-Old Man with Weight Loss, Confusion, Skin Lesions, and Pancytopenia. New England Journal of Medicine, 376(26), 2580-2589. doi:10.1056/nejmcpc1616401 Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
This week we review 1) Time to Appendectomy Outcomes: Serres SK, Cameron DB, Glass CC, Graham DA, Zurakowski D, Karki M, Anandalwar SP, Rangel SJ. Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children. JAMA Pediatr. Published online June 19, 2017. doi:10.1001/jamapediatrics.2017.0885 2) Which Diets Work: Aragon AA, Schoenfeld BJ, Wildman R, et al. International society of sports nutrition position stand: diets and body composition. J Int Soc Sports Nutr. 2017;14:16. 3) Laughter and opioid release: Manninen, Sandra, Lauri Tuominen, Robin I. Dunbar, Tomi Karjalainen, Jussi Hirvonen, Eveliina Arponen, Riitta Hari, Iiro P. Jääskeläinen, Mikko Sams, and Lauri Nummenmaa. "Social Laughter Triggers Endogenous Opioid Release in Humans." The Journal of Neuroscience 37.25 (2017): 6125-131. Web. Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
This week we review 1) Long-Acting Contraception: Francis JKR, Gold MA. Long-Acting Reversible Contraception for Adolescents A Review. JAMA Pediatr. Published online May 30, 2017. doi:10.1001/jamapediatrics.2017.0598 2) Triple Negative Breast Cancer: Gámez-Pozo A, Trilla-Fuertes L, Prado-Vázquez G, et al. "Prediction of Adjuvant Chemotherapy Response in Triple Negative Breast Cancer with Discovery and Targeted Proteomics." PLOS One. 2017 June 8. doi.org/10.1371/journal.pone.0178296 3) Tasting Water: Zocchi D, Wennemuth G, and Oka Y.“The cellular mechanism for water detection in the mammalian taste system.” Nat Neurosci. 2017 May 29. doi: 10.1038/nn.4575. [Epub ahead of print] 4) Hypoxia and OSA: Vilaseca A, Campillo N, Torres M, et al. "Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea." PLOS One. 2017 June 8. doi.org/10.1371/journal.pone.0179444 Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
"By the pricking of my thumbs, Something wheezing this way comes." -- Witches in Macbeth, with apologies to William Shakespeare "Bronchiolitis is like a pneumonia you can’t treat. We support, while the patient heals." -- Coach, still apologetic to the Bard The Who The U.S. definition is for children less than two years of age, while the European committee includes infants less than one year of age. This is important: toddlerhood brings with it other conditions that mimic bronchiolitis – the first-time wheeze in a toddler may be his reactive airway response to a viral illness and not necessarily bronchiolitis. The What The classic clinical presentation of bronchiolitis starts just like any other upper respiratory tract infection: with nasal discharge and cough, for the first 1-2 days. Only about 1/3 of infants will have a low-grade fever, usually less than 39°C. We may see the child in the ED at this point and not appreciate any respiratory distress – this is why precautionary advice is so important in general. Then, lower respiratory symptoms come: increased work of breathing, persistent cough, tachypnea, retractions, belly breathing, grunting, and nasal flaring. Once lower respiratory symptoms are present, like increased work of breathing, they typically peak at day 3. This may help to make decisions or counsel parents depending on when the child presents and how symptomatic he is. You’ll hear fine crackles and wheeze. A typical finding in bronchiolitis is a minute-to-minute variation in clinical findings – one moment the child could look like he’s drowning in his secretions, and the next minute almost recovered. This has to do with the dynamic nature of the secretion, plugging, obstruction, coughing, dislodgement, and re-plugging. The Why Respiratory syncytial virus is the culprit in up to 90% of cases of bronchiolitis. The reason RSV is so nasty is the immune response to the virus: it binds to epithelial cells, replicates, and the submucosa becomes edematous and hypersecretes mucus. RSV causes the host epithelia and lymphocytes to go into a frenzy – viral fusion proteins turn the membranes into a sticky goop – cells fuse into other cells, and you have a pile-on of multinucleated dysfunction. This mucosal chaos causes epithelial necrosis, destruction of cilia, mucus plugs, bronchiolar obstruction, air trapping, and lobar collapse. High-Risk Groups Watch out especially for young infants, so those less than 3 months of age. Apnea may be the presenting symptom of RSV. Premature infants, especially those less than 32 weeks’ gestation are at high risk for deterioration. The critical time is 48 weeks post-conceptional age. Other populations at high-risk for deterioration: congenital heart disease, pulmonary disease, neuromuscular disorders, metabolic disorders. Guiding Principles In the full term child, greater than one month, and otherwise healthy (no cardiac, pulmonary, neuromuscular, or metabolic disease), we can look to three simple criteria for home discharge. If the otherwise healthy child one month and older is: Euvolemic Not hypoxic Well appearing He can likely go home. The How Below is a list of modalities, treatments, and the evidence and/or recommendations for or against: Chest Radiograph Usually not necessary, unless the diagnosis is uncertain, or if the child is critically ill. Factors that are predictive of a definite infiltrate are: significant hypoxia (< 92%), grunting, focal crackles, or high fever (> 39°C). Ultrasound Not ready for prime time. Two small studies, one by Caiulo et al in the European J or Pediatrics and one by Basile et al. in the BMC Pediatrics that show some preliminary data, but not enough to change practice yet. Viral Testing Qualitative PCR gives you a yes or no question – one that you’ve already answered. It is not recommended for routine use. PCR may be positive post-infection for several weeks later (details in audio). Quantitative PCR measures viral load; an increased quantitative viral load is associated with increased length of stay, use of respiratory support, need for intensive care, and recurrent wheezing. However, also not recommended for routine use. There is one instance in which viral testing in bronchiolitis can be helpful – in babies less than a month of life, the presence of RSV virus is associated with apnea. Blood or Urine Testing Routine testing of blood or urine is not recommended for children with bronchiolitis. Levine et al in Pediatrics found an extremely low risk of serious bacterial illness in young febrile infants with RSV. The main thing is not to give in to anchoring bias here. If an infant of 3 months of age or older has a clear source for his low-grade fever – and that is his bronchiolitis – then you have a source, and very rarely do you need to go looking any further. He’s showing you the viral waterfall from his nose, and his increased work of breathing. It’s not going to be in his urine. Bronchodilators! Should we use bronchodilators in bronchiolitis? It seems lately that this is a loaded question – with strong feelings on either side amongst colleagues. The short answer is that the American Academy of Pediatrics, the UK’s National Institute for Health and Care Excellence, as well as the Canadian Pediatric Society currently recommend against them. However, in continental Europe and Australia, the language is softened to “not routinely recommended”. Pros and Cons in Audio; the 2006 AAP Guidelines and the 2014 AAP Guidelines use same data to come to divergent recommendations. Steroids There is no role for steroids in the treatment of bronchiolitis, even in those with a family or personal history of atopy. Nebulized Hypertonic Saline May show some benefit in admitted patients, after repeated treatments; no data to support its use in ED patients (no immediate effect). Nebulized Epinephrine One randomized controlled double blinded study in eight centers in Norway published in the NEJM showed no benefit to nebulized epinephrine over nebulized saline. Again, probably asking too much of one single intervention. The Cochrane review found 19 studies that included a total of 2256 children with acute bronchiolitis treated with nebulized epinephrine. There were no differences in length of hospital stay between the placebo and treatment groups, and so they concluded that for inpatients, nebulized epinephrine is not worth the hassle. However – and this may just be an artifact of meta-analysis – there may be some benefit to outpatients. One study of combined high-dose steroid and epinephrine therapy was not statistically significant when other factors were controlled, but Cochrane concluded that nebulized epinephrine itself may be helpful for outpatients. It won’t affect the overall disease time course, but it may make them feel better enough to go home from the ED and continue observation there. High-Flow Nasal Cannula Oxygen High-flow oxygen via nasal cannula requires specialized equipment and delivers humidified oxygen at 1-2 L/g/min. In addition to oxygenation, high flow nasal cannula also likely offers some low-grade positive end-expiratory pressure, which may help with alveolar recruitment. The evidence for its use is based on observational studies, which have found improved respiratory parameters and reduced rates of intubation. Nasal CPAP also has some promising properties in the right clinical setting. Antibiotics Not recommended. When bronchiolitis is from a clear viral source, the risk of accompanying bacteremia is less than 1%. A meta-analysis of randomized clinical trials found that antibiotics in bronchiolitis did not improve duration of symptoms, length of hospital stay, need for oxygen therapy, or hospital admission. Summary: The Good, the Bad, and the Ugly The Good Nasal suction and hydration are your best allies. You may elect to give a bronchodilator as a trial once and reexamine, if you’re a bronchodilating believer. The Bad Steroids, antibiotics, and a blind obeying of the guidelines. Weigh the risks and benefits of every intervention, including hospitalization – it’s not always a benign thing. The Ugly Take a moment to assess the child and make a clinical diagnosis of bronchiolitis, after you’ve excluded cardiac disease, anatomic anomalies, and foreign body aspiration. Wheezing without upper respiratory symptoms is not viral, and it is not bronchiolitis. When all else fails, remember: in the otherwise healthy, term infant greater than a month of age, if he is well appearing, euvolemic, and not hypoxic, he will often do well with good precautionary advice and supportive care at home. Every thing else: be skeptical, be thorough, and above all, be careful. References Alansari K, Toaimah FH, Khalafalla H, El Tatawy LA, Davidson BL, Ahmed W. Caffeine for the Treatment of Apnea in Bronchiolitis: A Randomized Trial. J Pediatr. 2016 May 14. pii: S0022-3476(16)30170-6. [Epub ahead of print] American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93. Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JA. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev. 2014 Jan 20;(1):CD009609. Bergroth E, Aakula M, Korppi M, Remes S, Kivistö JE, Piedra PA, Camargo CA Jr, Jartti T. Post-bronchiolitis Use of Asthma Medication: A Prospective 1-year Follow-up Study. Pediatr Infect Dis J. 2016 Apr;35(4):363-8. Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, MacLean M, McCormick J, Paton JY, Wee F, Thomas H, Riding K, Turner SW, Williams C, McIntosh E, Lewis SC; Bronchiolitis of Infancy Discharge Study (BIDS) group. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep 12;386(9998):1041-8. Flett KB, Breslin K, Braun PA, Hambidge SJ. Outpatient course and complications associated with home oxygen therapy for mild bronchiolitis. Pediatrics. 2014 May;133(5):769-75. Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2016 Aug 20. [Epub ahead of print] Halstead S, Roosevelt G, Deakyne S, Bajaj L. Discharged on supplemental oxygen from an emergency department in patients with bronchiolitis. Pediatrics. 2012 Mar;129(3):e605-10. Johnson LW, Robles J, Hudgins A, Osburn S, Martin D, Thompson A. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines? Pediatrics. 2013 Mar;131 Suppl 1:S103-9. Lashkeri T, Howell JM, Place R. Capnometry as a predictor of admission in bronchiolitis. Pediatr Emerg Care. 2012 Sep;28(9):895-7. Lehners N, Tabatabai J, Prifert C, Wedde M, Puthenparambil J, Weissbrich B, Biere B, Schweiger B, Egerer G, Schnitzler P. Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders. PLoS One. 2016 Feb 11;11(2):e0148258. Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015 Sep 18;(9):CD006915. Mammas IN, Spandidos DA. Paediatric Virology in the Hippocratic Corpus. Exp Ther Med. 2016 Aug;12(2):541-549. Mansbach JM, Clark S, Teach SJ, Gern JE, Piedra PA, Sullivan AF, Espinola JA, Camargo CA Jr. Children Hospitalized with Rhinovirus Bronchiolitis Have Asthma-Like Characteristics. J Pediatr. 2016 May;172:202-204.e1. Meissner HC. Viral Bronchiolitis in Children. N Engl J Med. 2016 Jan 7;374(1):62-72. Munywoki PK, Koech DC, Agoti CN, Kibirige N, Kipkoech J, Cane PA, Medley GF, Nokes DJ. Influence of age, severity of infection, and co-infection on the duration of respiratory syncytial virus (RSV) shedding. Epidemiol Infect. 2015 Mar;143(4):804-12. Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Theophilos T, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013 Apr;1(2):113-20. Epub 2012 Dec 21. Oakley E et al. Nasogastric Hydration in Infants with Bronchiolitis Less Than 2 Months of Age. J Pediatr. 2016. [Article in Press] Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA Pediatr. 2016 Jun 1;170(6):602-8. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C, Vilaró J. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2016 Feb 1;2:CD004873. Skjerven HO et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med. 2013 Jun 13;368(24):2286-93. This post and podcast are dedicated to Linda Girgis MD, FAAFP, for her authenticity, innovation, and clear and honest voice on the the frontlines. Thank you, Dr Linda. Bronchiolitis Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
Blood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about? The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential diagnosis) In the ED, we can simplify by categorizing by age and appearance. Neonates GI bleeding in the neonate (less than one month of age) is serious until proven otherwise. Well appearing? If this in obvious anal fissure, then no further work-up is necessary. Counsel on proper feeding and follow-up. Evaluate for potential swallowed maternal blood by examining mother with a chaperone, then perform the Apt test. Consider allergic proctocolitis if the child is well. Counsel the breastfeeding mother on diet modification. If formula fed, the child should feed through thus until the primary care physician decides whether to start the sticky process of changing up formulas. If unclear, consider a complete blood count and/or further work-up and admission if unwell. Ill Appearing? The three most dangerous diagnoses in the neonate are necrotizing enterocolitis, malrotation with volvulus, and inherited coagulopathy. It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Inherited conditions may not be known to the family early on, as they have not yet heard back from the neonatal screening done at birth. Pitfalls in the neonate and infant Genitourinary bleeding; hematuria; or uric acid crystals: the classic fake out here is the orange or pink stained diaper – that is actually residue from deposits of uric acid crystals in the urine, an almost always benign phenomenon in which the concentrated crystals oxidize and stain the diaper, frightening the parents. Think -- pink stain, without clot: Infants and Young Children Well appearing? Through the first year to age 5, things like infectious colitis and gastritis are common. Ill appearing? Think about intussusception, cryptic liver disease, or esophageal bleeding. Check the skin – is that a dark purple palpable rash on the buttocks? Think Henoch-Schoenlein purpura. Focus: Meckel's Diverticulum Meckel’s diverticulum is the most common congenital malformation of the GI tract, and the most common cause of GI bleeding in the toddler. It is a remnant of the omphalomesenteric tract – it came from a long tube that once connected the yolk sac to the lumen of the midgut. A stranded island of gastric tissue secretes acid in the intestine, where it doesn’t belong. Sometimes these islands never cause much trouble. When it does present itself, a Meckel’s diverticulum usually follows the rule of twos: Presents by age 2 Affects 2% of the population Often 2 inches in length May include 2 types of mucosa Found within 2 feet of the ileocecal valve. Not actively bleeding: technetium-99 pertechnate scintigram (Meckel’s scan). Actively bleeding: radio-labeled red blood-cell scan (resuscitate and call your surgeons!) Pitfalls in the infant and young child Epistaxis; food-related misadventures Older Child and Adolescent Well appearing? Mallory-Weiss tears after forceful vomiting; trivial hemoptysis after viral symptoms; pill esophagitis in the child is just learning to swallow medications. Always consider foreign body ingestion. Ill Appearing? Varices from cryptic liver disease; hemorrhagic gastritis; vascular malformation, such as a Dieulafoy lesion, where a tortuous small artery ends just superficial to the gastric mucosa, and can erode through and erupt. Focus: Inflammatory Bowel Disease Approximately a quarter of patients with inflammatory bowel disease (IBD) -- both Ulcerative Colitis and Crohn disease – will present by age 20. Children and adolescents may present with the classic symptoms of IBD: abdominal pain, weight loss, bloody diarrhea, but many present atypically with isolated signs like poor growth, anemia, or delayed puberty. You may also suspect IBD in the child with other extra-intestinal symptoms like oral ulcers, clubbing, erythema nodosum, jaundice, or hepatomegaly. On history and physical examination, you may get one of three cardinal presentations Fatigue, history of anemia, in a stable child who comes to the ED with bloody diarrhea Chronic diarrhea, chronic abdominal pain, and poor weight gain or weight loss A fulminant presentation, with severe abdominal pain, frankly bloody stools, tenesmus, fever, leukocytosis, and hypoalbuminemia. On exam, look for general appearance, glossitis from B2 deficiency, hair loss and brittle nails form protein loss, purpura (from vitamin C and vitamin K deficiencies). Look for evidence of episcleritis or uveitis. Listen for rubs as in pericarditis. Do a good abdominal exam, especially looking for hepatomegaly. Perirectal skin tags are not uncommon. Children with IBD may form urinary calculi form oxalate crystal deposition. Do a thorough skin and neurologic exam. Treatment for both ulcerative colitis and Crohn’s disease is similar. Induction therapy: children with mild disease get aminosalicylates; those with moderate disease get steroids; and those with severe disease get cyclosporine. Maintenance regimens to prevent relapse include aminosalicylates, mercaptopurine, and azathioprine. Surgical treatments for refractory colitis include an ileal pouch and anal anastomosis – also called a J pouch, a type of neorectum created surgically by folding loops of ileum back on themselves and stitching them together to create a larger rectal reservoir where the rectum once was. A neorectum allows the child to have voluntary control of his stools again. Stabilizing the Pediatric GI Bleed Life-threatening GI bleeding in children is, thankfully, rare, but we have to be prepared. Give blood for compensated shock, prepare for massive transfusion if giving more than 40 mL/kg total blood products. Differing Etiologies: adults and children The reasons for upper GI bleed in adults are vastly different from those of children. In adults, mostly the life-threats are due to liver disease, varices, or hemorrhagic gastritis. In children, critical upper GI bleed is often secondary to critical illness (hemorrhagic gastritis or stress ulcer), or vascular malformation. Critical lower gastrointestinal bleeding may be from Meckel's diverticulum or other congenital angiodysplasia. Endoscopy Get your patient urgent endoscopy as soon as possible after arrival if there is active bleeding. Otherwise, according to the Belgian guidelines, stable children may have endoscopy within the first 24 hours of hospitalization. The reported efficacy of endoscopy for controlling upper GI bleeding in children is approximately 90%. Miscellaneous Nasogastric tube? No routine role (unreliable to rule out or stratify upper GI bleed). Proton pump inhibitor? No good data, but no major common contraindications. Octreotide, vasopressin, broad-spectrum antibiotics? May use adult data to extrapolate in the proper etiologic context. General Advice for the Brisk GI Bleed in Children This is a rare, but potentially life threatening situation, so anticipate how the child can decline, and get your team assembled: your pediatric intensivist, gastroenterologist, and surgeon – especially if we can’t ge the upper GI bleed to abate with endoscopy. The sooner you activate the team, the better. Summary The broad differential diagnosis may be paralyzing, and frustrating, since much of it we cannot discern in the ED. Consider actionable, high-yield etiologies based on age and appearance. Neonates Well appearing? Think rectal fissure, maternal blood, or allergic proctocolitis Ill appearing? Think necrotizing enterocolitis, malrotation, or an inherited coagulaopathy. Infants, and Young Children Well appearing? Think infectious colitis and gastritis. Ill appearing? Think intussusception and Meckel’s diverticulum. Older Children and Adolescents Well appearing? Think Mallory Weiss tear from vomiting, or gastritis Ill appearing? Think metabolic, cryptic liver disease, or inflammatory bowel disease. For everyone – a careful history and a good physical exam will point you tto the etiology, or risk-stratify for further outpatient evaluation and management. References Bozic MA, Puri K, Molleston JP. Screening and Prophylaxis for Varices in Children with Liver Disease. Curr Gastroenterol Rep. 2015 Jul;17(7):27. Chaïbou M, Tucci M, Dugas MA, Farrell CA, Proulx F, Lacroix J. Clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit: a prospective study. Pediatrics. 1998 Oct;102(4 Pt 1):933-8. Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, Macken E, Penaloza A, Piessevaux H, Stéphenne X, Van Biervliet S, Laterre PF. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg. 2011 Mar;74(1):45-66. Garcia-Tsao G, Bosch J. Varices and Variceal Hemorrhage in Cirrhosis: A New View of an Old Problem. Clin Gastroenterol Hepatol. 2015 Nov;13(12):2109-17. Kaya A, Toyran M, Civelek E, Misirlioglu E, Kirsaclioglu C, Kocabas CN. Characteristics and Prognosis of Allergic Proctocolitis in Infants. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):69-73. Lacroix J, Nadeau D, Laberge S, Gauthier M, Lapierre G, Farrell CA. Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med. 1992 Jan;20(1):35-42. Osman D, Djibré M, Da Silva D, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care. 2012 Nov 9;2(1):46. Owensby S et al. Diagnosis and Management of Upper Gastrointestinal Bleeding in Children. J Am Board Fam Med. 2015; 28(1):134-145. Rosen MJ et al. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60. Rufo PA, Bousvaros A. Current therapy of inflammatory bowel disease in children. Paediatr Drugs. 2006;8(5):279-302. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012 Mar 14;307(10):1072-9. Thomson MA, Leton N, Belsha D. Acute upper gastrointestinal bleeding in childhood: development of the Sheffield scoring system to predict need for endoscopic therapy. J Pediatr Gastroenterol Nutr. 2015 May;60(5):632-6. This post and podcast are dedicated to Carlo D'Apuzzo, MD for his creativity, innovation, and dedication to the highest standards of emergency care. Le tue pillole sono buona medicina. Grazie, Carlo per tutto quello che fai per il mondo #FOAMed. GI Bleeding in Children Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Danielle Becker. REFERENCES 1. Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13. 2. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW and Neurodevelopmental Effects of Antiepileptic Drugs Study G. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. 3. Veliskova J and Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63:267-77. 4. Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, Liporace JD, Harden CL, Dworetzky BA, Pennell PB, Massaro JM and Progesterone Trial Study G. Progesterone vs placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78:1959-66. 5. Tauboll E, Sveberg L and Svalheim S. Interactions between hormones and epilepsy. Seizure. 2015;28:3-11. 6. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005;46 Suppl 9:117-24. 7. Reiter SF, Bjork MH, Daltveit AK, Veiby G, Kolstad E, Engelsen BA and Gilhus NE. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav. 2016;62:251-257. 8. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of N and American Epilepsy S. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126-32.
Welcome to the EBN podcast. Dr Roberta Heale, Associate Editor, will explore a recent commentary in EBN on Child Health with the commentary author. The discussion is designed to help you think about issues raised in the commentary and to explore implications of this study related to practice. In this podcast, Dr Kenneth A. Dodge, from Duke University in the USA and Dr Heale will discuss the findings of a study that focused on the long term effects of home visits by nurses and paraprofessionals on infants and toddlers of low income families. Dr Dodge reflects on the study and critically explores the findings, offering his thoughts on the implications for modifications of home visit programs as well as future research. Read the articles: Nurse home visits for infants and toddlers of low income families improve behavioural, language and attention outcomes at age 6 to 9 years; paraprofessional visits improve visual attention and task switching http://goo.gl/PrjbEp. Original research article: Olds DL, Holmberg JR, Donelan-McCall N, et al. Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatr 2014;168:114-21.
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