Pediatric Clinics of North America via MedWorm.com MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Pediatric Clinics of North America' source. Sat, 30 Jan 2010 15:12:44 +0100 Index http://www.medworm.com/index.php?rid=3050453&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001588%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050453 Tue, 01 Dec 2009 00:00:00 +0100 3050453 History, Law, and Policy as a Foundation for Health Care Delivery for Australian Indigenous Children http://www.medworm.com/index.php?rid=3050452&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001345%2Fabstract%3Frss%3Dyes This article identifies significant historical and contemporary issues, programs, and progress to better understand the current policy in Australia relating to Aboriginal child health and well-being. A legislative perspective gives context to contemporary issues based on legally sanctioned historical practices specifically designed to make Aboriginal peoples disappear, particularly through the control and assimilation of Indigenous children. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050452 Tue, 01 Dec 2009 00:00:00 +0100 3050452 History, Law, and Policy as a Foundation for Health Care Delivery for American Indian and Alaska Native Children http://www.medworm.com/index.php?rid=3050451&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001321%2Fabstract%3Frss%3Dyes Most American Indian and Alaska Native Children (AIAN) receive health care that is based on the unique historical legacy of tribal treaty obligations and a trust relationship of sovereign nation to sovereign nation. From colonial America to the early 21st century, the wellbeing of AIAN children has been impacted as federal laws were crafted for the health, education and wellbeing of its AIAN citizens. Important public laws are addressed in this article, highlighting the development of the Indian Health Service (IHS), a federal agency designed to provide comprehensive clinical and public health services to citizens of federally recognized tribes. The context during which various acts were made into law are described to note the times during which the policy making process took place. Polici... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050451 Tue, 01 Dec 2009 00:00:00 +0100 3050451 Injuries and Injury Prevention Among Indigenous Children and Young People http://www.medworm.com/index.php?rid=3050450&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001308%2Fabstract%3Frss%3Dyes Throughout the world, injuries and violence are a leading cause of mortality and suffering among Indigenous communities. Among American Indian and Alaska Native children aged 1 to 19 years, 71% of deaths are from injuries. Motor-vehicle accidents, attempted suicide, and interpersonal violence are the most common causes of injuries in highly industrialized countries. For Indigenous populations in middle- and low-income countries, trauma caused by motor-vehicle accidents, agricultural injuries, interpersonal violence, child labor, and the ravages of war are priorities for intervention. To be effective, injury-prevention efforts should be based on scientific evidence, be developmentally and culturally appropriate, and draw on the inherent strengths of Indigenous communities. (Source: Pediatri... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050450 Tue, 01 Dec 2009 00:00:00 +0100 3050450 Early Child Development and Developmental Delay in Indigenous Communities http://www.medworm.com/index.php?rid=3050449&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900131X%2Fabstract%3Frss%3Dyes This article highlights special conditions in Indigenous communities related to child development. It addresses the challenges of screening and evaluation for developmental delay in the context of Indigenous cultures, and in settings where resources are often inadequate. It is clear that careful research on child development in Indigenous settings is urgently needed. Intervention strategies tied to cultural traditions could enhance interest, acceptability, and ultimately developmental outcomes in children at risk. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050449 Tue, 01 Dec 2009 00:00:00 +0100 3050449 Oral Health of Indigenous Children and the Influence of Early Childhood Caries on Childhood Health and Well-being http://www.medworm.com/index.php?rid=3050448&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001242%2Fabstract%3Frss%3Dyes This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050448 Tue, 01 Dec 2009 00:00:00 +0100 3050448 Behavioral and Mental Health Challenges for Indigenous Youth: Research and Clinical Perspectives for Primary Care http://www.medworm.com/index.php?rid=3050447&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001291%2Fabstract%3Frss%3Dyes After first discussing historical, community and epidemiologic perspectives pertaining to mental health problems of Indigenous youth and families, this article reviews available research data on behavioral and mental health interventions and the roles that Native and Indigenous research programs are serving. Given the legacy of transgenerational trauma experienced by Indigenous peoples, community-based research and treatment methods are essential for solving these problems. The primary care provider stands in a unique position within the community to offer a “coinvestigator spirit” to youth and families in the pursuit of improving behavioral health. Strategies are presented for using the research literature, and collaborating with communities and families to help solve behavioral and m... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050447 Tue, 01 Dec 2009 00:00:00 +0100 3050447 Clinical Management of Type 2 Diabetes in Indigenous Youth http://www.medworm.com/index.php?rid=3050446&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001278%2Fabstract%3Frss%3Dyes This article reviews the epidemiology, disease burden, treatment, and challenges in achieving successful clinical management of this disorder in Indigenous youth. Screening criteria and the complications and comorbidities of type 2 diabetes are also reviewed. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050446 Tue, 01 Dec 2009 00:00:00 +0100 3050446 Skin Disorders, Including Pyoderma, Scabies, and Tinea Infections http://www.medworm.com/index.php?rid=3050445&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001163%2Fabstract%3Frss%3Dyes Pyoderma, scabies, and tinea are common childhood skin disorders too often considered to be merely of nuisance value. More than 111 million children are believed to have pyoderma, with many also co-infected with scabies, tinea, or both. These skin disorders cannot be differentiated by ethnicity or socioeconomic status but, in high-prevalence areas, poverty and overcrowded living conditions are important underlying social determinants. Each is transmitted primarily through direct skin-to-skin contact. For many Indigenous children, these skin conditions are part of everyday life. Although rarely directly resulting in hospitalization or death, there is a high and largely unmet demand for effective management at the primary health-care level, particularly for pyoderma and scabies. Despite part... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050445 Tue, 01 Dec 2009 00:00:00 +0100 3050445 Acute Rheumatic Fever and Rheumatic Heart Disease in Indigenous Populations http://www.medworm.com/index.php?rid=3050444&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001254%2Fabstract%3Frss%3Dyes Acute rheumatic fever and rheumatic heart disease are diseases of socioeconomic disadvantage. These diseases are common in developing countries and in Indigenous populations in industrialized countries. Clinicians who work with Indigenous populations need to maintain a high index of suspicion for the potential diagnosis of acute rheumatic fever, particularly in patients presenting with joint pain. Inexpensive medicines, such as aspirin, are the mainstay of symptomatic treatment of rheumatic fever; however, antiinflammatory treatment has no effect on the long-term rate of progression or severity of chronic valvular disease. The current focus of global efforts at prevention of rheumatic heart disease is on secondary prevention (regular administration of penicillin to prevent recurrent rheuma... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050444 Tue, 01 Dec 2009 00:00:00 +0100 3050444 Acute and Chronic Otitis Media http://www.medworm.com/index.php?rid=3050443&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001217%2Fabstract%3Frss%3Dyes Otitis media (OM) is a common illness in young children. OM has historically been associated with frequent and severe complications. Nowadays it is usually a mild condition that often resolves without treatment. For most children, progression to tympanic membrane perforation and chronic suppurative OM is unusual (low-risk populations); this has led to reevaluation of many interventions that were used routinely in the past. Evidence from a large number of randomized controlled trials can help when discussing treatment options with families. Indigenous children in the United States, Canada, Northern Europe, Australia, and New Zealand experience more OM than other children. In some places, Indigenous children continue to suffer from the most severe forms of the disease. Communities with more ... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050443 Tue, 01 Dec 2009 00:00:00 +0100 3050443 Glomerulonephritis and Managing the Risks of Chronic Renal Disease http://www.medworm.com/index.php?rid=3050442&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900128X%2Fabstract%3Frss%3Dyes This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in ad... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050442 Tue, 01 Dec 2009 00:00:00 +0100 3050442 Acute and Persistent Diarrhea http://www.medworm.com/index.php?rid=3050441&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001187%2Fabstract%3Frss%3Dyes Socially disadvantaged Indigenous infants and children living in western industrialized countries experience high rates of infectious diarrhea, no more so than Aboriginal children from remote and rural regions of Northern Australia. Diarrheal disease, poor nutrition, and intestinal enteropathy reflect household crowding, inadequate water and poor sanitation and hygiene. Acute episodes of watery diarrhea are often best managed by oral glucose-electrolyte solutions with continuation of breastfeeding and early reintroduction of feeding. Selective use of lactose-free milk formula, short-term zinc supplementation and antibiotics may be necessary for ill children with poor nutrition, persistent symptoms, or dysentery. Education, high standards of environmental hygiene, breastfeeding, and immuniz... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050441 Tue, 01 Dec 2009 00:00:00 +0100 3050441 Chronic Respiratory Symptoms and Diseases Among Indigenous Children http://www.medworm.com/index.php?rid=3050440&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001266%2Fabstract%3Frss%3Dyes Children from Indigenous populations experience more frequent, severe, and recurrent lower respiratory infections as infants and toddlers. The consequences of these infections are chronic lung disorders manifested by recurrent wheezing and chronic productive cough. These symptoms are aggravated more frequently by active and passive tobacco smoke exposure among Indigenous groups. Therapies for these symptoms, although not specific to children of Indigenous origins, are described as is the evidence for their use. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050440 Tue, 01 Dec 2009 00:00:00 +0100 3050440 Lower Respiratory Tract Infections http://www.medworm.com/index.php?rid=3050439&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001175%2Fabstract%3Frss%3Dyes Acute lower respiratory infections (ALRI) are the major cause of morbidity and mortality in young children worldwide. ALRIs are important indicators of the health disparities that persist between Indigenous and non-Indigenous children in developed countries. Bronchiolitis and pneumonia account for the majority of the ALRI burden. The epidemiology, diagnosis, and management of these diseases in Indigenous children are discussed. In comparison with non-Indigenous children in developing countries they have higher rates of disease, more complications, and their management is influenced by several unique factors including the epidemiology of disease and, in some remote regions, constraints on hospital referral and access to highly trained staff. The prevention of repeat infections and the early... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050439 Tue, 01 Dec 2009 00:00:00 +0100 3050439 Undernutrition and Obesity in Indigenous Children: Epidemiology, Prevention, and Treatment http://www.medworm.com/index.php?rid=3050438&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001229%2Fabstract%3Frss%3Dyes Over the past 50 years there has been a shift in nutritional problems amongst Indigenous children in developed countries from under-nutrition and growth faltering to overweight and obesity; the major exception is small numbers of Indigenous children predominately living in remote areas of Northern Australia. Nutritional problems reflect social disadvantage and occur with disproportionately high incidence in all disadvantaged subgroups. There is limited evidence of benefit from any strategies to prevent or treat undernutrition and obesity; there are a limited number of individual studies with generalizable high grade evidence of benefit. Potential solutions require a whole of society approach. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050438 Tue, 01 Dec 2009 00:00:00 +0100 3050438 Vaccine Preventable Diseases and Vaccination Policy for Indigenous Populations http://www.medworm.com/index.php?rid=3050437&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001205%2Fabstract%3Frss%3Dyes There are many similarities regarding the health status of Indigenous people in the 4 English-speaking developed countries of North America and the Pacific (United States, Canada, Australia, New Zealand), where they are all now minority populations. Although vaccines have contributed to the reduction or elimination of disease disparities for many infections, Indigenous people continue to have higher morbidity and mortality from many chronic and infectious diseases compared with the general populations in their countries. This review summarizes the available data on the epidemiology of vaccine-preventable diseases in Indigenous populations in these 4 countries in the context of the vaccination strategies used and their impact, with the aim of identifying successful strategies with the poten... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050437 Tue, 01 Dec 2009 00:00:00 +0100 3050437 Indigenous Newborn Care http://www.medworm.com/index.php?rid=3050436&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001230%2Fabstract%3Frss%3Dyes Infant mortality and morbidity disparities occur between non-Indigenous and Indigenous populations of Australia, Canada, New Zealand, and the United States. Neonatal mortality is due to high-risk births, which vary according to prevalence of the maternal risk factors of smoking, alcohol consumption, infection, and disorders of nutritional status, whereas postneonatal mortality is predominantly influenced by environmental factors. Aside from changing socioeconomic conditions, a continuum of maternal and child health care is likely to be the most effective measure in reducing these health disparities. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050436 Tue, 01 Dec 2009 00:00:00 +0100 3050436 An Overall Approach to Health Care for Indigenous Peoples http://www.medworm.com/index.php?rid=3050435&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001199%2Fabstract%3Frss%3Dyes Indigenous peoples across all the continents of the globe live with major gaps in health status and health outcomes associated with well-described social determinants of health, such as poverty and poor education. Indigenous peoples face additional health determinant issues associated with urbanization, isolation from traditional territories, and loss of cultural continuity. Indigenous children are particularly vulnerable as they grow up in isolation from their cultural and social roots and yet are also separated from the mainstream environment of their society. Programs to address these difficult health issues should be viewed as complex clinical interventions with health researchers, social scientists, and clinicians working together with Indigenous peoples to identify the most pressing ... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050435 Tue, 01 Dec 2009 00:00:00 +0100 3050435 Preface http://www.medworm.com/index.php?rid=3050434&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001357%2Fabstract%3Frss%3Dyes Why does the subject of health issues in Indigenous children deserve a special issue? Is the management of common disease in Indigenous children different from that for non-Indigenous children? Why adopt an evidence-based approach? (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050434 Tue, 01 Dec 2009 00:00:00 +0100 3050434 Forthcoming Issues http://www.medworm.com/index.php?rid=3050433&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001564%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050433 Tue, 01 Dec 2009 00:00:00 +0100 3050433 Contents http://www.medworm.com/index.php?rid=3050432&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001552%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050432 Tue, 01 Dec 2009 00:00:00 +0100 3050432 CME Accreditation Page and Author Disclosure http://www.medworm.com/index.php?rid=3050431&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900162X%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3050431 Tue, 01 Dec 2009 00:00:00 +0100 3050431 Index http://www.medworm.com/index.php?rid=3002142&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001448%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002142 Thu, 01 Oct 2009 00:00:00 +0100 3002142 Drug-Induced Nutrient Deficiencies http://www.medworm.com/index.php?rid=3002141&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000807%2Fabstract%3Frss%3Dyes Good clinical care extends beyond mere diagnosis and treatment of disease to appreciation that nutrient deficiencies can be the price of effective drug therapy. The major risk factors for developing drug-induced nutrient deficiencies are lack of awareness by the prescribing physician and long duration of drug therapy. The field of pharmacogenomics has potential to improve clinical care by detecting patients at risk for complications from drug therapy. Further improvements in patient safety rely on physicians voluntarily reporting serious suspected adverse drug reactions. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002141 Thu, 01 Oct 2009 00:00:00 +0100 3002141 Refeeding Syndrome http://www.medworm.com/index.php?rid=3002140&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000832%2Fabstract%3Frss%3Dyes This article reviews the pathophysiology, the clinical manifestations, and the management of RFS. The key to prevention is identifying patients at risk and being aware of the potential complications involved in rapidly reintroducing feeds to a malnourished patient. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002140 Thu, 01 Oct 2009 00:00:00 +0100 3002140 Nutritional Deficiencies in Intestinal Failure http://www.medworm.com/index.php?rid=3002139&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001138%2Fabstract%3Frss%3Dyes This article presents how an improved understanding of digestive pathophysiology is essential for diagnosis, successful management, and prevention of nutrient deficiencies in children with IF. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002139 Thu, 01 Oct 2009 00:00:00 +0100 3002139 Optimizing Nutritional Management in Children with Chronic Liver Disease http://www.medworm.com/index.php?rid=3002138&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000819%2Fabstract%3Frss%3Dyes Malnutrition is common in infants and children with chronic liver disease (CLD) and may easily be underestimated by clinical appearance alone. The cause of malnutrition in CLD is multifactorial, although insufficient dietary intake is probably the most important factor and is correctable. Fat malabsorption occurs in cholestatic disorders, and one must also consider any accompanying fat-soluble vitamin and essential fatty acid deficiencies. The clinician should proactively evaluate, treat, and re-evaluate response to treatment of nutritional deficiencies. Because a better nutritional state is associated with better survival before and after liver transplantation, aggressive nutritional management is an important part of the care of these children. (Source: Pediatric Clinics of North America... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002138 Thu, 01 Oct 2009 00:00:00 +0100 3002138 Nutritional Deficiencies During Critical Illness http://www.medworm.com/index.php?rid=3002137&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000820%2Fabstract%3Frss%3Dyes A significant proportion of critically ill children admitted to the pediatric intensive care unit (PICU) present with nutritional deficiencies. Malnourished hospitalized patients have a higher rate of complications, increased mortality, longer length of hospital stay, and increased hospital costs. Critical illness may further contribute to nutritional deteriorate with poor outcomes. Younger age, longer duration of PICU stay, congenital heart disease, burn injury, and need for mechanical ventilation support are some of the factors that are associated with worse nutritional deficiencies. Failure to estimate energy requirements accurately, barriers to bedside delivery of nutrients, and reluctance to perform regular nutritional assessments are responsible for the persistence and delayed detect... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002137 Thu, 01 Oct 2009 00:00:00 +0100 3002137 Nutrition Management of Pediatric Patients Who Have Cystic Fibrosis http://www.medworm.com/index.php?rid=3002136&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000844%2Fabstract%3Frss%3Dyes This article reviews nutrition topics frequently discussed in relationship to CF and presents intriguing new information describing nutrients currently being studied for their impact on overall health of patients who have CF. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002136 Thu, 01 Oct 2009 00:00:00 +0100 3002136 Nutritional Deficiencies in Obesity and After Bariatric Surgery http://www.medworm.com/index.php?rid=3002135&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900087X%2Fabstract%3Frss%3Dyes This article reviews current knowledge of nutritional deficits in obese and overweight individuals and those that commonly present after bariatric surgery and summarizes current recommendations for screening and supplementation. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002135 Thu, 01 Oct 2009 00:00:00 +0100 3002135 Nutritional Deficiencies in Children on Restricted Diets http://www.medworm.com/index.php?rid=3002134&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001102%2Fabstract%3Frss%3Dyes Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002134 Thu, 01 Oct 2009 00:00:00 +0100 3002134 Nutrient Deficiencies in the Premature Infant http://www.medworm.com/index.php?rid=3002133&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900114X%2Fabstract%3Frss%3Dyes This article reviews the normal accretion of nutrients in the fetus, discusses specific nutrient deficiencies that are exacerbated in the postnatal period, and identifies key areas for future research. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002133 Thu, 01 Oct 2009 00:00:00 +0100 3002133 Protein Energy Malnutrition http://www.medworm.com/index.php?rid=3002132&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000868%2Fabstract%3Frss%3Dyes Protein energy malnutrition (PEM) is a common problem worldwide and occurs in both developing and industrialized nations. In the developing world, it is frequently a result of socioeconomic, political, or environmental factors. In contrast, protein energy malnutrition in the developed world usually occurs in the context of chronic disease. There remains much variation in the criteria used to define malnutrition, with each method having its own limitations. Early recognition, prompt management, and robust follow up are critical for best outcomes in preventing and treating PEM. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002132 Thu, 01 Oct 2009 00:00:00 +0100 3002132 Nutritional Deficiencies During Normal Growth http://www.medworm.com/index.php?rid=3002131&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001114%2Fabstract%3Frss%3Dyes This article reviews these nutritional deficiencies and other less commonly seen deficiencies in children who are otherwise growing normally. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002131 Thu, 01 Oct 2009 00:00:00 +0100 3002131 Preface http://www.medworm.com/index.php?rid=3002130&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001151%2Fabstract%3Frss%3Dyes We are honored to edit this issue on “Nutritional Deficiencies” in the Pediatric Clinics of North America. The last issue of Pediatric Clinics of North America addressing nutritional problems was published 7 years ago. We have highlighted a spectrum of nutritional deficiencies ranging from those occurring despite normal health to those associated with a variety of disease states. Our aim is to provide pediatric practitioners and trainees across the globe with a comprehensive and practical clinical review that links pathophysiology with clinical manifestations and management strategies. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002130 Thu, 01 Oct 2009 00:00:00 +0100 3002130 Forthcoming Issues http://www.medworm.com/index.php?rid=3002129&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001424%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002129 Thu, 01 Oct 2009 00:00:00 +0100 3002129 Contents http://www.medworm.com/index.php?rid=3002128&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001412%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002128 Thu, 01 Oct 2009 00:00:00 +0100 3002128 CME Author Disclosure and Accreditation Page http://www.medworm.com/index.php?rid=3002127&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001333%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3002127 Thu, 01 Oct 2009 00:00:00 +0100 3002127 Index http://www.medworm.com/index.php?rid=2673135&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001060%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673135 Fri, 31 Jul 2009 23:00:00 +0100 2673135 How Health Policy Influences Quality of Care in Pediatrics http://www.medworm.com/index.php?rid=2673134&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000686%2Fabstract%3Frss%3Dyes This article describes some “voltage drops” in health care that impede delivery of high quality health care. The growing emphasis on quality is reflected in provisions of the new Child Health Program Reauthorization Act of 2009 (CHIPRA) legislation. In addition to providing funding for health coverage for over four million more children, it also includes the most significant federal investment in pediatric quality to date. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673134 Fri, 31 Jul 2009 23:00:00 +0100 2673134 Pay for Performance: Quality- and Value-Based Reimbursement http://www.medworm.com/index.php?rid=2673133&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000571%2Fabstract%3Frss%3Dyes There is urgent need to reform health care reimbursement models, including physician compensation, to address high health care costs, despite numerous quality initiatives. Pay for performance (P4P) is a model that attempts to align financial incentives with better outcomes and value rather than the current system of rewarding volume and intensity of care delivered. P4P has been implemented in other countries besides the United States and is perhaps most advanced in the United Kingdom. Measurement for P4P is evolving, as are the types of incentives; neither is perfect at this time. For P4P to succeed, all health care stakeholders will need to collaborate. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673133 Fri, 31 Jul 2009 23:00:00 +0100 2673133 A Pediatrician's Opinion http://www.medworm.com/index.php?rid=2673132&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000601%2Fabstract%3Frss%3Dyes Pediatricians are inundated by phrases such as “pay for performance” and “enhancement of payments tied into quality measurements.” Although there is no argument that we must provide high quality care to our patients and must continuously improve ourselves, we need flexibility within the managed care criteria. Medicine is not only a science, but it is also an art with many interpretations. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673132 Fri, 31 Jul 2009 23:00:00 +0100 2673132 Maintenance of Certification: The Role of the American Board of Pediatrics in Improving Children's Health Care http://www.medworm.com/index.php?rid=2673131&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000649%2Fabstract%3Frss%3Dyes This article describes the evolution of board certification for pediatricians and the current ongoing assessment process called Maintenance of Certification (MOC). To be called a board-certified pediatrician under the MOC framework requires a level of training, competence, and knowledge that can only be achieved by completing a rigorous, defined, closely monitored training program approved by the Accreditation Council for Graduate Medical Education and then demonstrating a level of knowledge comparable to established standards by passing the initial certifying examination. Once this landmark baseline threshold is reached, the emphasis shifts to demonstrating lifelong professional development and the ability to deliver quality care and to continually improving that care through MOC. (Source... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673131 Fri, 31 Jul 2009 23:00:00 +0100 2673131 Nursing: Key to Quality Improvement http://www.medworm.com/index.php?rid=2673130&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000595%2Fabstract%3Frss%3Dyes This article explains in detail the importance of nursing care in the quality agenda and explores the existing gaps in this field of science. Key stakeholders and groups that advocate and focus on specific quality agendas within the field of pediatrics are briefly described. Pediatric health care uses a multidisciplinary model of delivery; each discipline uses specific domains of knowledge and interventions, making it difficult to separate them when evaluating patient outcomes. Much work needs to be conducted using health services research approaches that link and partition the overall and combined contribution of discipline-specific providers. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673130 Fri, 31 Jul 2009 23:00:00 +0100 2673130 The Role of Health Information Technology in Quality Improvement in Pediatrics http://www.medworm.com/index.php?rid=2673129&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900073X%2Fabstract%3Frss%3Dyes This article explores the many roles of HIT in quality improvement from several perspectives. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673129 Fri, 31 Jul 2009 23:00:00 +0100 2673129 The Medical Home–Improving Quality of Primary Care for Children http://www.medworm.com/index.php?rid=2673128&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000728%2Fabstract%3Frss%3Dyes This article provides an overview of the challenges faced in United States health care delivery systems that affect child health, explains how the medical home might address them, describes methods for measuring quality in medical homes, and identifies barriers to implementation of the model. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673128 Fri, 31 Jul 2009 23:00:00 +0100 2673128 Quality Improvement and Patient Safety in the Pediatric Ambulatory Setting: Current Knowledge and Implications for Residency Training http://www.medworm.com/index.php?rid=2673127&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000650%2Fabstract%3Frss%3Dyes The outpatient environment has been the leading edge of improvement work in pediatrics and it has similarly served as an effective locale for the training of pediatric residents in the science of improvement. This review summarizes what is known about the measurement of quality and patient safety in pediatric ambulatory settings. The current Accreditation Council for Graduate Medical Education (ACGME) requirements for resident training in improvement and their application in these settings are discussed. Some approaches and challenges to meeting these requirements are reviewed. Finally, some future directions that this work may follow are presented; the goal is to strengthen the effectiveness of improvement methods and their linkage to professional education. (Source: Pediatric Clinics of ... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673127 Fri, 31 Jul 2009 23:00:00 +0100 2673127 Implementing a Pediatric Rapid Response System to Improve Quality and Patient Safety http://www.medworm.com/index.php?rid=2673126&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000716%2Fabstract%3Frss%3Dyes Life-threatening events are common in today's hospitals, where an increasing proportion of patients with urgent admission are cared for by understaffed, often inexperienced personnel. Medical errors play a key role in causing adverse events and failure to rescue deteriorating patients. In-hospital cardiac arrest outcomes are generally poor, but these events are often preceded by a pattern of deterioration with abnormal vital signs and mental status. When hospital staff or family members observe warning signs and trigger timely intervention by a rapid response team, rates of cardiac arrest and mortality can be reduced. Rapid response team involvement can be used to trigger careful review of preceding events to help uncover important systems issues and allow for further improvements in patie... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673126 Fri, 31 Jul 2009 23:00:00 +0100 2673126 Transforming Safety and Effectiveness in Pediatric Hospital Care Locally and Nationally http://www.medworm.com/index.php?rid=2673125&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000613%2Fabstract%3Frss%3Dyes Achieving dramatic, sustainable improvements in the safety and effectiveness of care for children requires a transformational approach to how hospitals individually focus on improvement and learn from each other to achieve national goals. The authors describe a theoretic framework for transformation that includes setting system-level priorities, aligning measures with each priority, identifying breakthrough targets, testing interventions to get results, and spreading successful interventions throughout the organization. Essential key drivers of transformation include leadership, building will, transparency, a business case for quality, patient and family engagement, improvement infrastructure, improvement capability, and reliability and standardization. Improving national system-level meas... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673125 Fri, 31 Jul 2009 23:00:00 +0100 2673125 Standardize to Excellence: Improving the Quality and Safety of Care with Clinical Pathways http://www.medworm.com/index.php?rid=2673124&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000583%2Fabstract%3Frss%3Dyes Providing practitioners with locally developed, consensus-driven, evidence-based clinical pathways can improve the quality of care by (1) incorporating national guidelines and recommendations into routine care practices, increasing the use of validated practice; 2) reducing unnecessary variation in care by a single physician or group of physicians, improving efficiency and timeliness and reducing disparities; and (3) standardizing care processes, improving safety. Pathways make it easier to identify opportunities for future improvements in care processes while simultaneously making those improvements easier to enact. Pediatric hospitalists have a vital role in creating, implementing, evaluating, and improving clinical pathways. Involving house staff enriches the scholarly components of pat... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673124 Fri, 31 Jul 2009 23:00:00 +0100 2673124 Neonatal Intensive Care Unit Collaboration to Decrease Hospital-Acquired Bloodstream Infections: From Comparative Performance Reports to Improvement Networks http://www.medworm.com/index.php?rid=2673123&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000777%2Fabstract%3Frss%3Dyes This two-part article provides a general guide to thinking about data-driven clinical performance evaluation and describes two statewide improvement networks anchored in such comparisons. Part 1 examines key ideas for making fair comparisons among providers. Part 2 describes the development of a data-driven collaborative that aims to reduce central line associated bloodstream infections in neonatal ICUs across New York State, and a more mature collaborative in California that has already succeeded in reducing these infections; it provides sufficient detail and tools to be of practical help to others seeking to create such networks. The content illustrates concepts with broad applicability for pediatric quality improvement. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673123 Fri, 31 Jul 2009 23:00:00 +0100 2673123 The Pediatric Quality of Life Inventory: Measuring Pediatric Health-Related Quality of Life from the Perspective of Children and Their Parents http://www.medworm.com/index.php?rid=2673122&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000704%2Fabstract%3Frss%3Dyes Health-related quality of life (HRQOL) has been recognized as an important outcome, some contend the most important outcome for children's health care interventions. The PedsQL Measurement Model was designed as a modular approach to measuring pediatric health-related quality of life, developed to integrate the relative merits of generic and disease-specific approaches. We suggest that part of the process of improving the quality of health care includes measuring HRQOL outcomes from the perspective of children and their parents on a routine basis, consistent with a consumer-based health care system approach. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673122 Fri, 31 Jul 2009 23:00:00 +0100 2673122 Quality Improvement, Clinical Research, and Quality Improvement Research—Opportunities for Integration http://www.medworm.com/index.php?rid=2673121&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000625%2Fabstract%3Frss%3Dyes This article describes some of the opportunities for and challenges of integrating QI and more traditional forms of clinical research to achieve broad improvements in medical care. The authors suggest that such integration would include more active experimentation in the health care delivery system and that the application of QI methods offers a rational, effective, and reasonably fast method to support the learning required to adapt new knowledge to specific practice environments and to create and test innovations needed to improve systems of care delivery. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673121 Fri, 31 Jul 2009 23:00:00 +0100 2673121 Approach to Improving Quality: the Role of Quality Measurement and a Case Study of the Agency for Healthcare Research and Quality Pediatric Quality Indicators http://www.medworm.com/index.php?rid=2673120&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000637%2Fabstract%3Frss%3Dyes This article describes the current landscape for measurement in pediatrics compared to adult care, provides a case study of the development and application of a publicly available and federally funded pediatric indicator set using routinely collected hospital discharge data, and addresses challenges and opportunities in selecting and using measures as a function of intended purpose. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673120 Fri, 31 Jul 2009 23:00:00 +0100 2673120 Modifying the Toyota Production System for Continuous Performance Improvement in an Academic Children's Hospital http://www.medworm.com/index.php?rid=2673119&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000698%2Fabstract%3Frss%3Dyes This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673119 Fri, 31 Jul 2009 23:00:00 +0100 2673119 Model for Improvement - Part Two: Measurement and Feedback for Quality Improvement Efforts http://www.medworm.com/index.php?rid=2673118&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000662%2Fabstract%3Frss%3Dyes This article presents a pragmatic approach to measurement and feedback for quality improvement efforts in local health care settings, such as hospitals or clinical practices. The authors include evidence-based strategies from health care and other industries, augmented with practical examples from the authors' collective years of experience designing measurement and feedback strategies. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673118 Fri, 31 Jul 2009 23:00:00 +0100 2673118 Model for Improvement - Part 1: A Framework for Health Care Quality http://www.medworm.com/index.php?rid=2673117&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000765%2Fabstract%3Frss%3Dyes The Model for Improvement is a rigorous and reasonable method for busy health care practitioners to use to improve patient outcomes. The use of this model requires practice for clinicians to be comfortable, but mastery is critical to develop the necessary skills to participate in quality improvement initiatives. The future of health care in the United States depends on every practitioner delivering safe, effective, and efficient care. The case study demonstrates how this methodology can be applied in any busy health care setting. Incorporating this approach to quality improvement into daily work will improve clinical outcomes and advance health care delivery and design. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673117 Fri, 31 Jul 2009 23:00:00 +0100 2673117 Unwarranted Variation in Pediatric Medical Care http://www.medworm.com/index.php?rid=2673116&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900056X%2Fabstract%3Frss%3Dyes This article provides a survey on the concepts, methods, and applications of the study of unwarranted variation in health care with particular attention to children's medical services. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673116 Fri, 31 Jul 2009 23:00:00 +0100 2673116 Making the Case to Improve Quality and Reduce Costs in Pediatric Health Care http://www.medworm.com/index.php?rid=2673115&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000674%2Fabstract%3Frss%3Dyes This article makes a case for the urgent need to improve health care quality and reduce costs. It provides an overview of the importance of the quality movement and the definition of quality, including the concept of clinical and operational quality. Some national drivers for quality improvement as well as drivers of escalating health care costs are discussed, along with the urgency of reducing health care costs. The link between quality and cost is reviewed using the concept of value in health care, which combines quality and cost in the same equation. The article ends with a discussion of future directions of the quality movement, including emerging concepts, such as risk-adjustment, shared responsibility for quality, measuring quality at the individual provider level, and evolving legal... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673115 Fri, 31 Jul 2009 23:00:00 +0100 2673115 Foreword: A Great Start and A Long Way to Go http://www.medworm.com/index.php?rid=2673114&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000741%2Fabstract%3Frss%3Dyes Could any of us have imagined how far the field of pediatric quality improvement would come in less than two decades? The number of individuals who were committing their careers to pediatric quality—either through research or management—could likely have fit within a telephone booth, and certainly within a minivan, in the early 1990s. In looking at the contents of this issue of the Pediatric Clinics of North America, it is clear how far our field has come—how much greater the breadth and number of individuals involved, how much deeper our understanding of the nature of our quality problem, how much improved our tools are to measure quality and our methods are for taking action to improve performance. We now can point to real beacons of success, actual programs that have made dramatic... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673114 Fri, 31 Jul 2009 23:00:00 +0100 2673114 Preface http://www.medworm.com/index.php?rid=2673113&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000753%2Fabstract%3Frss%3Dyes Few issues are more central to the ongoing debate about health care in the United States than the quality and cost of care. As we start tackling some of these issues, three simple but eloquent statements should be engrained in our minds: (1) Business as usual will not help us achieve the health care system that our children deserve. (2) Every system is perfectly designed to achieve exactly the results it gets. (3) Knowing is not enough; we must apply. Willing is not enough; we must do. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673113 Fri, 31 Jul 2009 23:00:00 +0100 2673113 Erratum http://www.medworm.com/index.php?rid=2673112&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000790%2Fabstract%3Frss%3Dyes An error appeared in the article “Molecular and Cellular Basis of Congenital Heart Disease” in the October 2006 issue of Pediatric Clinics of North America. In Table 1 on page 997, the incidence of the syndromes listed is incorrect. The incidence should be per 100,000  live births. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673112 Fri, 31 Jul 2009 23:00:00 +0100 2673112 Forthcoming Issues http://www.medworm.com/index.php?rid=2673111&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001047%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673111 Fri, 31 Jul 2009 23:00:00 +0100 2673111 Contents http://www.medworm.com/index.php?rid=2673110&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509001035%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2673110 Fri, 31 Jul 2009 23:00:00 +0100 2673110 Index http://www.medworm.com/index.php?rid=2566147&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000509%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566147 Sun, 31 May 2009 23:00:00 +0100 2566147 Prenatal Diagnosis of Congenital Heart Disease http://www.medworm.com/index.php?rid=2566146&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000352%2Fabstract%3Frss%3Dyes This article presents advancements in the field of fetal echocardiography and the significant impact of these within the fields of pediatric cardiology, perinatology, and neonatology. A prenatal diagnosis of congenital heart disease allows for improved counseling of the parents, guides the timing and optimal location of delivery, and allows appropriate planning and consultation between the cardiologist and neonatologist. It also facilitates accurate diagnosis and management of fetal arrhythmias, identifies potential candidates for in utero cardiac intervention, and serves as the imaging guidance technique for these procedures. The goals, indications, advantages, limitations, and spectrum of congenital heart disease that can be diagnosed are reviewed. (Source: Pediatric Clinics of North Ame... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566146 Sun, 31 May 2009 23:00:00 +0100 2566146 Group B Streptococcus and Early-Onset Sepsis in the Era of Maternal Prophylaxis http://www.medworm.com/index.php?rid=2566145&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000364%2Fabstract%3Frss%3Dyes Despite an era of marked success with universal screening, Group B Streptococcus (GBS) continues to be an important cause of early-onset sepsis, and thus remains a significant public health issue. Improved eradication of GBS colonization and disease may involve universal screening in conjunction with rapid diagnostic technologies or other novel approaches. Given the complications and potential limitations associated with maternal intrapartum prophylaxis, however, vaccines may be the most effective means of preventing neonatal GBS disease. The global utility of conjugated GBS vaccines may be hampered by the variability of serotypes in diverse populations and geographic locations. Modern technologies, such as those involving proteomics and genomic sequencing, are likely to hasten the develop... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566145 Sun, 31 May 2009 23:00:00 +0100 2566145 Identification of Neonates at Risk for Hazardous Hyperbilirubinemia: Emerging Clinical Insights http://www.medworm.com/index.php?rid=2566144&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000388%2Fabstract%3Frss%3Dyes Hyperbilirubinemia is the most common condition requiring evaluation and treatment in neonates. Identifying among all newborns those few at risk to develop marked hyperbilirubinemia is a clinical challenge. Clinical, epidemiologic, and genetic risk factors associated with severe hyperbilirubinemia include late preterm gestational age, exclusive breastfeeding, glucose-6-phosphate dehydrogenase deficiency, ABO hemolytic disease, East Asian ethnicity, jaundice observed in the first 24 hours of life, cephalohematoma or significant bruising, and history of a previous sibling treated with phototherapy. It is increasingly apparent that the etiopathogenesis of severe hyperbilirubinemia is often multifactorial, and emerging evidence suggests that combining risk factor assessment with measurement of... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566144 Sun, 31 May 2009 23:00:00 +0100 2566144 Commonly Encountered Surgical Problems in the Fetus and Neonate http://www.medworm.com/index.php?rid=2566143&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000418%2Fabstract%3Frss%3Dyes This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566143 Sun, 31 May 2009 23:00:00 +0100 2566143 Neurodevelopmental Outcome of the Premature Infant http://www.medworm.com/index.php?rid=2566142&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000157%2Fabstract%3Frss%3Dyes Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW, ≤1000 g) and at the limits of viability (22 to 25 weeks). But improvements in survival have not been accompanied by proportional reductions in the incidence of disability in this population. Thus, survival is not an adequate measure of success in these infants who remain at high risk for neurodevelopmental and behavioral morbidities. There is now increasing evidence of sustained adverse outcomes into school age and adolescence, not only for ELBW infants but for infants born late preterm. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566142 Sun, 31 May 2009 23:00:00 +0100 2566142 Regionalization and Mortality in Neonatal Intensive Care http://www.medworm.com/index.php?rid=2566141&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900039X%2Fabstract%3Frss%3Dyes This article examines the outcome data for very low birth weight infants in low-volume, mid-volume, and high-volume neonatal ICUs (NICUs) and argues for regionalization of NICU services on the basis of both medical outcomes and economic rationality. It recognizes some of the obstacles to regionalization of these services and presents ways to surmount them. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566141 Sun, 31 May 2009 23:00:00 +0100 2566141 Use of Therapeutic Hypothermia for Term Infants with Hypoxic-Ischemic Encephalopathy http://www.medworm.com/index.php?rid=2566140&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000170%2Fabstract%3Frss%3Dyes Newborn encephalopathy represents a clinical syndrome with diverse causes, many of which may result in brain injury. Hypoxic-ischemic encephalopathy represents a subset of newborns with encephalopathy and, in contrast to other causes, may have a modifiable outcome. Laboratory research has demonstrated robust neuroprotection associated with reductions of brain temperature following hypoxia-ischemia in animals. The neuroprotective effects of hypothermia reflect antagonism of multiple cascades of events that contribute to brain injury. Clinical trials have translated laboratory observations into successful interventions. Hypoxicischemic encephalopathy is often unanticipated, unavoidable, and may occur in any obstetric setting. Pediatricians and other providers based in community hospitals pla... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566140 Sun, 31 May 2009 23:00:00 +0100 2566140 Advances in the Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn http://www.medworm.com/index.php?rid=2566139&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000376%2Fabstract%3Frss%3Dyes Rapid evaluation of a neonate who is cyanotic and in respiratory distress is essential for achieving a good outcome. Persistent pulmonary hypertension of the newborn (PPHN) can be a primary cause or a contributing factor to respiratory failure, particularly in neonates born at 34 weeks or more of gestation. PPHN represents a failure of normal postnatal adaptation that occurs at birth in the pulmonary circulation. Rapid advances in therapy in recent years have led to a remarkable decrease in mortality for the affected infants. Infants who survive PPHN are at significant risk for long-term hearing and neurodevelopmental impairments, however. This review focuses on the diagnosis, recent advances in management, and recommendations for the long-term follow-up of infants who have PPHN. (Source: ... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566139 Sun, 31 May 2009 23:00:00 +0100 2566139 Health Issues of the Late Preterm Infant http://www.medworm.com/index.php?rid=2566138&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000327%2Fabstract%3Frss%3Dyes “Late preterm” birth is not such an unusual occurrence; in fact these infants were the first group of premature infants who pediatricians learned to treat, and did so with such remarkable success that physicians no longer consider them to be of high risk. So, why the sudden interest in this group? There is now enough evidence that this population is not as benign as previously thought. They have increased mortality when compared to term infants and are at increased risk for complications including transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS), persistent pulmonary hypertension (PPHN), respiratory failure, temperature instability, jaundice, feeding difficulties and prolonged neonatal intensive care unit (NICU) stay. Evidence is currently emerging that late pr... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566138 Sun, 31 May 2009 23:00:00 +0100 2566138 Goals and Strategies for Prevention of Preterm Birth: An Obstetric Perspective http://www.medworm.com/index.php?rid=2566137&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000169%2Fabstract%3Frss%3Dyes Complications of prematurity surpass congenital malformations as the leading cause of infant mortality in the United States. Since 1990, there has been a steady rise in preterm birth, alarming health professionals from all disciplines. This review from a prenatal perspective confirms those concerns and describes the risks and opportunities that may attend efforts to improve the health of fetuses, newborns, and infants. Fetal and live-born outcomes are included. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566137 Sun, 31 May 2009 23:00:00 +0100 2566137 Delivery Room Management of the Newborn http://www.medworm.com/index.php?rid=2566136&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000133%2Fabstract%3Frss%3Dyes This article outlines the current practices in delivery room management of the neonate. Developments in cardiopulmonary resuscitation techniques for term and preterm infants and advances in the areas of cerebral resuscitation and thermoregulation are reviewed. Resuscitation in special circumstances (such as the presence of congenital anomalies) are also covered. The importance of communication with other members of the health care team and the family is discussed. Finally, future trends in neonatal resuscitation are explored. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566136 Sun, 31 May 2009 23:00:00 +0100 2566136 Newborn Screening for Genetic Disorders http://www.medworm.com/index.php?rid=2566135&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000121%2Fabstract%3Frss%3Dyes Newborn screening has become an integral part of the evaluation of more than 4 million newborns a year in the United States and of most newborns in industrialized countries and many in developing countries. Because the term “newborn screening” refers to many procedures performed in a nursery such as screening for hearing loss or congenital heart disease, this discussion is limited to screening for genetic or congenital disorders with blood spotted on filter paper cards. This discussion reflects primarily the experiences and current status of NBS programs in the United States. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566135 Sun, 31 May 2009 23:00:00 +0100 2566135 Fetal Assessment During Pregnancy http://www.medworm.com/index.php?rid=2566134&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS003139550900011X%2Fabstract%3Frss%3Dyes This article addresses the goals of fetal monitoring during pregnancy. Methods of fetal surveillance are reviewed, as well as the meaning of abnormal fetal testing and how these results relate to fetal and neonatal outcome. Overall, pediatricians who understand the goals, methods, and interpretation of fetal testing can communicate more effectively with the delivering obstetric team in anticipation of optimizing obstetric and pediatric outcomes. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566134 Sun, 31 May 2009 23:00:00 +0100 2566134 Current Status of the Approach to Assisted Reproduction http://www.medworm.com/index.php?rid=2566133&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000340%2Fabstract%3Frss%3Dyes Assisted reproductive technologies are important tools in the clinical armamentarium used to treat both female and male infertility disorders. Pre-implantation genetic diagnosis offers couples at risk of having children with inheritable disorders the ability to analyze the genetic make-up of embryos before transfer. For patients undergoing treatment of cancer with chemotherapy or radiation therapy, these technologies offer the potential for the preservation of future fertility. As technology evolves, it is likely the clinical applications of assisted reproduction will continue to develop and expand in the future to enhance fertility. (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566133 Sun, 31 May 2009 23:00:00 +0100 2566133 Developmental Origins of Adult Disease http://www.medworm.com/index.php?rid=2566132&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000145%2Fabstract%3Frss%3Dyes Intrauterine growth retardation (IUGR) has been linked to development of type 2 diabetes in adulthood. Using a rat model, we tested the hypothesis that uteroplacental insufficiency disrupts the function of the electron transport chain in the fetal β-cell and leads to a debilitating cascade of events. The net result is progressive loss of β-cell function and eventual development of type 2 diabetes in the adult. Studies in the IUGR rat demonstrate that an abnormal intrauterine environment induces epigenetic modifications of key genes regulating β-cell development; experiments directly link chromatin remodeling with suppression of transcription. Future research will be directed at elucidating the mechanisms underlying epigenetic modifications in offspring. (Source: Pediatric Clinics of Nor... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566132 Sun, 31 May 2009 23:00:00 +0100 2566132 Preface http://www.medworm.com/index.php?rid=2566131&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000406%2Fabstract%3Frss%3Dyes Had he been alive today, Patrick Bouvier Kennedy would have been hailed as a triumph of neonatal care—after all, he was the son of the former United States President, John F. Kennedy and former First Lady Jacqueline B. Kennedy. Born prematurely at 34-weeks gestation, he would have been aptly labeled as a late preterm neonate; however, based on his birth weight (2.1 kg) and gestational age, few would have predicted the outcome he had then, were he to be born in 2009. But then, in 1963, little was available to the clinician for the management of hyaline membrane disease— no routine use of neonatal ventilators, no device to provide airway positive pressure, no surfactant, and no antenatal steroids. He died two days after his birth; the New York Times obituary said that “the battle for t... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566131 Sun, 31 May 2009 23:00:00 +0100 2566131 Forthcoming Issues http://www.medworm.com/index.php?rid=2566130&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000480%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566130 Sun, 31 May 2009 23:00:00 +0100 2566130 Contents http://www.medworm.com/index.php?rid=2566129&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.pediatric.theclinics.com%2Farticle%2FPIIS0031395509000479%2Fabstract%3Frss%3Dyes (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2566129 Sun, 31 May 2009 23:00:00 +0100 2566129 Pediatric Clinics of North America. Common respiratory symptoms and illnesses: a graded evidence based approach. Preface. http://www.medworm.com/index.php?rid=2197602&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135577%26dopt%3DAbstract Authors: Chang AB PMID: 19135577 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2197602 Sun, 01 Feb 2009 05:00:00 +0100 2197602 Preface. http://www.medworm.com/index.php?rid=2099476&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135577%26dopt%3DAbstract Authors: Chang AB PMID: 19135577 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099476 Wed, 14 Jan 2009 03:57:18 +0100 2099476 Respiratory Noises: How Useful are They Clinically? http://www.medworm.com/index.php?rid=2099475&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135578%26dopt%3DAbstract Authors: Mellis C Although clinicians place considerable weight on the identification of the various forms of noisy breathing, there are serious questions regarding both the accuracy (validity) and the reliability (repeatability) of these noises. To avoid diagnostic errors, clinicians need to consider the whole constellation of symptoms and signs, and not focus on the specific "type" of noise. Given the high error rate with "parent-reported wheeze" there is a need to reexamine the extensive literature on the epidemiology of wheeze in infants and young children, because parent-reported wheeze is unconfirmed by a clinician. It is obvious we need more high-quality research evidence to derive better evidence on the clinical utility of these noises, and their natural history. PMID: 1913... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099475 Wed, 14 Jan 2009 03:57:15 +0100 2099475 Cough. http://www.medworm.com/index.php?rid=2099474&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135579%26dopt%3DAbstract Authors: Chang AB The management of cough in children should be etiologically based. This requires that all children with cough should be carefully evaluated and managed differently than adults because the etiologic factors and treatment in children are significantly different than that in adults. In all children with cough, exacerbation factors should be sought and intervention options for cessation advised or initiated. Parental expectations and specific concerns should also be sought and addressed. PMID: 19135579 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099474 Wed, 14 Jan 2009 03:57:10 +0100 2099474 Perceptions and pathophysiology of dyspnea and exercise intolerance. http://www.medworm.com/index.php?rid=2099473&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135580%26dopt%3DAbstract Authors: Weinberger M, Abu-Hasan M Dyspnea is a complex psychophysiologic sensation that requires intact afferent and efferent pathways for the full perception of the neuromechanical dissociation between the respiratory effort attempted and the work actually accomplished. The sensation is triggered or accentuated by a variety of receptors located in the chest wall, respiratory muscles, lung parenchyma, carotid body, and brain stem. The sensation of dyspnea is stronger in patients with higher scores for anxiety and has been reported in patients with anxiety disorders with no cardiopulmonary disease. These observations demonstrate the importance of cerebral cognition in this complex symptom. Ten cases are presented that illustrate different clinical manifestations of dyspnea. PMID: 1... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099473 Wed, 14 Jan 2009 03:57:07 +0100 2099473 Chest pain and chest wall deformity. http://www.medworm.com/index.php?rid=2099472&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135581%26dopt%3DAbstract Authors: Gokhale J, Selbst SM Chest pain and chest wall deformities are common in children. Although most children with chest pain have a benign diagnosis, some have a serious etiology for pain, so the complaint must be addressed carefully. Unfortunately, there are few prospective studies to evaluate this complaint in children. Serious causes for chest pain are rare, making it difficult to develop clear guidelines for evaluation and management. The child who appears well, has a normal physical examination, and lacks worrisome history deserves reassurance and careful follow-up rather than extensive studies. Multicenter studies are needed to better define this important symptom. PMID: 19135581 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099472 Wed, 14 Jan 2009 03:57:03 +0100 2099472 Recurrent respiratory infections. http://www.medworm.com/index.php?rid=2099471&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135582%26dopt%3DAbstract Authors: Bush A The child who has recurrent infections poses one of the most difficult diagnostic challenges in pediatrics. The clinician faces a two-fold challenge in determining first whether the child is normal or has a serious disease, and then, in the latter case, how to confirm or exclude the diagnosis with the minimum number of the least invasive tests. It is hoped that, in the absence of good-quality evidence for most clinical scenarios, the experience-based approach described in this article may prove a useful guide to the clinician. PMID: 19135582 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099471 Wed, 14 Jan 2009 03:57:00 +0100 2099471 Upper Respiratory Tract Infections (Including Otitis Media). http://www.medworm.com/index.php?rid=2099470&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135583%26dopt%3DAbstract Authors: Morris PS Upper respiratory tract infections (including otitis media) are the most common illnesses affecting children. Most illnesses are mild and resolve completely without specific treatment, but the frequency of infection and association with fever and constitutional symptoms creates significant distress for the child and the family. By understanding the evidence available from high-quality studies, the clinician can advise the families on appropriate action. The goal of this article is to support clinicians in answering the following questions: (1) What happened to children with these conditions when no additional treatment was provided? (2) Which interventions have been assessed in well-designed studies? (3) Which interventions have been shown to improve outcomes? (4) Ho... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099470 Wed, 14 Jan 2009 03:56:57 +0100 2099470 Acute bronchiolitis and croup. http://www.medworm.com/index.php?rid=2099469&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135584%26dopt%3DAbstract Authors: Everard ML Croup and acute bronchiolitis are common forms of virally induced respiratory disease in infancy and early childhood. There is good evidence that corticosteroids can ameliorate disease severity and alter the natural history of symptoms in patients who have croup and that temporary symptomatic benefit can be obtained from the use of nebulized adrenaline. The principle weakness when reviewing therapeutic interventions for acute bronchiolitis is the lack of a clear diagnostic test or definition. Current evidence suggests that oxygen is the only useful pharmacologic agent for correcting hypoxia. PMID: 19135584 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099469 Wed, 14 Jan 2009 03:56:54 +0100 2099469 Pneumonia and Other Respiratory Infections. http://www.medworm.com/index.php?rid=2099468&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135585%26dopt%3DAbstract This article reviews the management of pneumonia and its complications from the perspective of both developed and resource-poor settings. In addition, evidence-based management of other respiratory infections, including tuberculosis, is discussed. Finally, the management of common complications of pneumonia is reviewed. PMID: 19135585 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099468 Wed, 14 Jan 2009 03:56:50 +0100 2099468 Bronchiectasis in Children. http://www.medworm.com/index.php?rid=2099467&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135586%26dopt%3DAbstract This article focuses on the grading and recommendations for chronic therapies of bronchiectasis caused by cystic fibrosis (CF)- and non-CF-related conditions. The scope of this article is to focus on outpatient treatment and not include as-needed treatment for mild or severe pulmonary exacerbations associated with bronchiectasis. PMID: 19135586 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099467 Wed, 14 Jan 2009 03:56:47 +0100 2099467 Aspiration lung disease. http://www.medworm.com/index.php?rid=2099466&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135587%26dopt%3DAbstract Authors: de Benedictis FM, Carnielli VP, de Benedictis D The term aspiration lung disease describes several clinical syndromes, with massive aspiration and chronic lung aspiration being at two extremes of the clinical spectrum. Over the years, significant advances have been made in understanding the mechanisms underlying dysphagia, gastroesophageal function, and airway protective reflexes and new diagnostic techniques have been introduced. Despite this, characterizing the presence or absence of aspiration, and under what circumstances a child might be aspirating what, is extremely challenging. Many children are still not adequately diagnosed or treated for aspiration until permanent lung damage has occurred. A multidisciplinary approach is mandatory for a correct diagnosis in addition ... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099466 Wed, 14 Jan 2009 03:56:44 +0100 2099466 Asthma in Childhood. http://www.medworm.com/index.php?rid=2099465&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135588%26dopt%3DAbstract This article addresses the disparity in response between the two age groups, presents the available pediatric evidence, and highlights the important areas in which further research is required. Evidence-based recommendations for acute and interval management of pediatric asthma are provided. PMID: 19135588 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099465 Wed, 14 Jan 2009 03:56:41 +0100 2099465 Congenital airway lesions and lung disease. http://www.medworm.com/index.php?rid=2099464&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135589%26dopt%3DAbstract Authors: Masters IB Structural upper and lower airway disorders and parenchymal disorders are uncommon in pediatric practice, but many pediatricians will encounter them and be responsible for the ongoing care of these patients. Pediatricians need to be cognizant of these diagnoses because, even though management of these disorders generally lacks an evidence base, existing principles of good care surrounding accurate diagnosis, classifications of severity, judicious use of investigations, medication, and surgical approaches are essential to good outcomes. PMID: 19135589 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099464 Wed, 14 Jan 2009 03:56:38 +0100 2099464 Obstructive sleep breathing disorders. http://www.medworm.com/index.php?rid=2099463&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135590%26dopt%3DAbstract Authors: Au CT, Li AM Obstructive sleep apnea (OSA) is increasingly recognized in children. There is accumulating robust evidence to support early diagnosis and treatment of this condition. The purpose of this review is to provide an update on the epidemiology, clinical features, complications, and treatment of childhood OSA. The authors have also proposed an easy-to-follow flowchart on the management of children with snoring or sleep disturbance for clinical use by busy pediatricians. PMID: 19135590 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099463 Wed, 14 Jan 2009 03:56:35 +0100 2099463 Chronic Respiratory Failure and Neuromuscular Disease. http://www.medworm.com/index.php?rid=2099462&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135591%26dopt%3DAbstract Authors: Kennedy JD, Martin AJ The outlook for children with respiratory complications of neuromuscular disease has improved significantly in the past 15 years. This has been the result of many advances in clinical care, including improved monitoring of lung function and hypoventilation during sleep; coordinated respiratory care by experienced physicians with access to specialized respiratory services, especially physiotherapy; and, most importantly, the widespread introduction of noninvasive ventilation. PMID: 19135591 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099462 Wed, 14 Jan 2009 03:56:31 +0100 2099462 Domiciliary oxygen for children. http://www.medworm.com/index.php?rid=2099461&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19135592%26dopt%3DAbstract Authors: Balfour-Lynn IM Domiciliary oxygen is used increasingly in pediatric practice, and the largest patient group to receive it is ex-premature babies with chronic neonatal lung disease. Because of a scarcity of good evidence to inform clinicians, there is a lack of consensus over many issues, even those as fundamental as the optimum target oxygen saturation. Nevertheless, many children benefit from receiving supplemental oxygen at home, particularly because it helps to keep them out of the hospital. PMID: 19135592 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2099461 Wed, 14 Jan 2009 03:56:28 +0100 2099461 Preface. http://www.medworm.com/index.php?rid=2002494&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041455%26dopt%3DAbstract Authors: Greydanus DE, Patel DR, Pratt HD PMID: 19041455 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002494 Mon, 01 Dec 2008 05:00:00 +0100 2002494 Learning disabilities: definitions, epidemiology, diagnosis, and intervention strategies. http://www.medworm.com/index.php?rid=2002493&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041456%26dopt%3DAbstract Authors: Lagae L Learning problems occur in about 5% of school-aged children. Learning disabilities are specific and life-long but present with different school problems at different ages, depending on such factors as age, medical history, family history, and intelligence quotient. Proper individualized diagnosis and treatment plans are necessary to remediate these problems and to offer adequate coping strategies. Many children who have learning problems can be classified into one of two major categories: the dyslexia group or the nonverbal learning disability group. The role of the medical professional is important to guide parents in the diagnostic and therapeutic process. PMID: 19041456 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002493 Mon, 01 Dec 2008 05:00:00 +0100 2002493 Abusive head trauma in infants and young children: a unique contributor to developmental disabilities. http://www.medworm.com/index.php?rid=2002492&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041457%26dopt%3DAbstract This article discusses the history, epidemiology, clinical aspects, developmental outcomes, and associated injuries of this unique contributor to developmental disabilities. Prevention of abusive injuries and prevention of child abuse and neglect are also discussed. PMID: 19041457 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002492 Mon, 01 Dec 2008 05:00:00 +0100 2002492 Medical Home and Transition Planning for Children and Youth with Special Health Care Needs. http://www.medworm.com/index.php?rid=2002491&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041458%26dopt%3DAbstract Authors: Burdo-Hartman WA, Patel DR Although many physicians may practice medical home medicine, most of the health care system is set up for acute episodic care. For children and youth with special health care needs (CYSHCN), this is costly and inefficient care and unsatisfactory for the patient and family. Transition or the purposeful planned movement of adolescents and young adults with chronic conditions from child-centered to adult-centered care began to evolve in the 1980s as more and more CYSHCN survived into adulthood. There is some progress being made in the implementation of the medical home that may facilitate a more effective transition of young individuals who have developmental disabilities. The greatest barrier to successful transition remains ensuring affordable, contin... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002491 Mon, 01 Dec 2008 05:00:00 +0100 2002491 Pulmonary Care of Children and Adolescents with Developmental Disabilities. http://www.medworm.com/index.php?rid=2002490&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041459%26dopt%3DAbstract This article discusses the common pulmonary problems affecting children with developmental disabilities. Topics to be discussed include gastroesophageal reflux, drooling, and dysphagia and their relation to aspiration and aspiration pneumonia, upper airway obstruction and obstructive sleep apnea, and the role of airway clearance. Case studies are used to introduce a discussion of the underlying etiology, currently accepted methods to evaluate the conditions, and evidence-based treatment options. The goal of managing these problems is to use anticipatory guidance when possible and choose therapies that improve the child's quality of life with minimal side effects. PMID: 19041459 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002490 Mon, 01 Dec 2008 05:00:00 +0100 2002490 Sexuality issues and gynecologic care of adolescents with developmental disabilities. http://www.medworm.com/index.php?rid=2002489&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041460%26dopt%3DAbstract This article considers sexuality issues and reproductive care of adolescents with developmental disabilities. Potential consequences of disability on sexuality are reviewed, including sexual abuse and sexual dysfunction. Comprehensive sexuality education is vital for normal growth and development of all youth including those with developmental disabilities. PMID: 19041460 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002489 Mon, 01 Dec 2008 05:00:00 +0100 2002489 Nephrologic issues in children with developmental disabilities. http://www.medworm.com/index.php?rid=2002488&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041461%26dopt%3DAbstract This article explores both populations from a nephrologic viewpoint. PMID: 19041461 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002488 Mon, 01 Dec 2008 05:00:00 +0100 2002488 Gastrointestinal care of children and adolescents with developmental disabilities. http://www.medworm.com/index.php?rid=2002487&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041462%26dopt%3DAbstract This article discusses nutrition in and specific conditions affecting children and adolescents who have disabilities. It is geared toward the practitioner of pediatrics to provide education regarding nutritional needs and how to meet them in these patients. The article reviews common problems in diagnosis and management, with particular emphasis on day-to-day issues that are in the purview of the primary care physician, and presents some recent developments in these topics. PMID: 19041462 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002487 Mon, 01 Dec 2008 05:00:00 +0100 2002487 Care of the adolescent with spina bifida. http://www.medworm.com/index.php?rid=2002486&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041463%26dopt%3DAbstract This article reviews the monitoring and treatment considerations that have led to such a significant improvement in outcomes in patients who have myelodysplasia. PMID: 19041463 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002486 Mon, 01 Dec 2008 05:00:00 +0100 2002486 Team Processes and Team Care for Children with Developmental Disabilities. http://www.medworm.com/index.php?rid=2002485&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041464%26dopt%3DAbstract This article reviews multidisciplinary, interdisciplinary, and transdisciplinary approaches to delivering health care to children and adolescents who have developmental disabilities. PMID: 19041464 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002485 Mon, 01 Dec 2008 05:00:00 +0100 2002485 Acquired hearing loss in adolescents. http://www.medworm.com/index.php?rid=2002484&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041465%26dopt%3DAbstract Authors: Katbamna B, Flamme GA Studies on prevalence of acquired hearing loss across the life span have shown a trend of increase in hearing loss with age. A parallel decline in age of recreational use of loud music and cigarette smoking suggests that these early listening and recreational habits may be major contributing factors to the chronic hearing disability seen in later years. In recognition of these new recreational patterns of adolescents and young adults, Healthy People 2010 has issued a list of objectives for prevention of noise-induced hearing loss and smoking in adolescents and young adults through early education and intervention. In this article, the authors describe the effects of noise- and music-induced and smoking-induced hearing loss and provide guidelines for early... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002484 Mon, 01 Dec 2008 05:00:00 +0100 2002484 Childhood visual impairment: normal and abnormal visual function in the context of developmental disability. http://www.medworm.com/index.php?rid=2002483&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19041466%26dopt%3DAbstract Authors: Nyong'o OL, Del Monte MA Abnormal or failed development of vision in children may give rise to varying degrees of visual impairment and disability. Disease and organ-specific mechanisms by which visual impairments arise are presented. The presentation of these mechanisms, along with an explanation of established pathologic processes and correlative up-to-date clinical and social research in the field of pediatrics, ophthalmology, and rehabilitation medicine are discussed. The goal of this article is to enhance the practitioner's recognition and care for children with developmental disability associated with visual impairment. PMID: 19041466 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2002483 Mon, 01 Dec 2008 05:00:00 +0100 2002483 Preface. http://www.medworm.com/index.php?rid=1898530&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929051%26dopt%3DAbstract Authors: Greydanus DE, Patel DR, Pratt HD PMID: 18929051 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898530 Wed, 01 Oct 2008 04:00:00 +0100 1898530 Global developmental delay and mental retardation or intellectual disability: conceptualization, evaluation, and etiology. http://www.medworm.com/index.php?rid=1898529&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929052%26dopt%3DAbstract Authors: Shevell M Global developmental delay and mental retardation or intellectual disability offer challenges to the practitioner at several different levels. Accurate recognition of these most common of subtypes of neurodevelopmental disabilities is a central precondition to their correct evaluation and management. Proper evaluation is a time- and labor-intensive process that emphasizes several different goals. Guidelines now exist to assist the practitioner in selecting the appropriate investigation path to be pursued, and these guidelines should be used to inform the selections of investigations made. Although challenging and time consuming, the evaluation of these children offers many professional rewards and is a necessary first step in a family's adaptation to their child's ch... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898529 Wed, 01 Oct 2008 04:00:00 +0100 1898529 Role of the dysmorphologic evaluation in the child with developmental delay. http://www.medworm.com/index.php?rid=1898528&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929053%26dopt%3DAbstract This article focuses on the dysmorphologic evaluation of the child who has developmental delay or cognitive impairment. Attention is focused on minor anomalies, because those are often considered to be the dysmorphic features that are the component manifestations of a particular syndrome. This article provides a brief discussion of craniofacial, skin, and limb anomalies (which are more likely to be noted not only by clinicians but also by allied health workers) and notes which features are particularly helpful clues to common syndromes, metabolic disorders, or autism syndromes. PMID: 18929053 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898528 Wed, 01 Oct 2008 04:00:00 +0100 1898528 Primary care for children and adolescents with down syndrome. http://www.medworm.com/index.php?rid=1898527&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929054%26dopt%3DAbstract This article reviews the general health care guidelines pertaining to pediatric patients with Down syndrome and presents, in a systems-based approach, an update of the current evidence behind these guidelines. To ensure the best possible long-term outcome for these patients, clinicians should provide routine well-child examinations and immunizations while maintaining a high index of suspicion for comorbid conditions more common in Down syndrome. The primary care provider should be prepared to provide information on community resources, to coordinate care with subspecialists, and to refer to early intervention services as soon as the diagnosis is made. PMID: 18929054 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898527 Wed, 01 Oct 2008 04:00:00 +0100 1898527 Clinical approach to the diagnoses of inborn errors of metabolism. http://www.medworm.com/index.php?rid=1898526&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929055%26dopt%3DAbstract This article aims to address the basics of IEMs for familiarizing primary care physicians with different types of metabolic disorders, basic diagnostic strategies, newborn screening programs, and appropriate treatment strategies. Advances in diagnostic and therapeutic options are resulting in increasing longevity and improvement in the clinical outcome of many of these patients. PMID: 18929055 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898526 Wed, 01 Oct 2008 04:00:00 +0100 1898526 Autism: Definition, Neurobiology, Screening, Diagnosis. http://www.medworm.com/index.php?rid=1898525&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929056%26dopt%3DAbstract This article highlights the definition, neurobiology, screening, and diagnosis of autism. The genetics, immunology, imaging, and neurophysiology of autism are reviewed, with particular emphasis on areas that impact pediatricians. Early recognition of the social deficits that characterize autism is key to maximizing the potential of these children. PMID: 18929056 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898525 Wed, 01 Oct 2008 04:00:00 +0100 1898525 Clinical management of adolescents with autism. http://www.medworm.com/index.php?rid=1898524&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929057%26dopt%3DAbstract This article provides the reader with an overview of the major psychosocial issues related to adolescents with autism. This discussion is followed by an interjection of medications that may be useful in maximizing the functioning of adolescents with autism. PMID: 18929057 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898524 Wed, 01 Oct 2008 04:00:00 +0100 1898524 Speech and language development and disorders in children. http://www.medworm.com/index.php?rid=1898523&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929058%26dopt%3DAbstract Authors: Sharp HM, Hillenbrand K Language disorders are identified when a person has difficulty with expressive language, receptive language, or pragmatic language. Speech disorders are identified when a person's voice, fluency, or articulation call attention to the speaker because his or her speech is sufficiently different from the norm. Speech and language development should be consistent with a child's overall development and can be tracked using typical milestone markers. Differential diagnosis is critical to designing appropriate intervention, which should be tailored to the parents' goals along with the child's clinical and educational needs. Early identification and intervention assist in educational planning and are often associated with better long-term outcomes. Any speech-l... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898523 Wed, 01 Oct 2008 04:00:00 +0100 1898523 Hearing impairment in children. http://www.medworm.com/index.php?rid=1898522&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929059%26dopt%3DAbstract This article describes the current standard for infant hearing loss identification and intervention. Since the standard of care was driven by the recommendations made by the Joint Committee on Infant Hearing, a summary of the most recent recommendations is provided, followed by illustrative case studies that highlight how implementation of these guidelines allow access to the critical window for auditory and speech-language development. PMID: 18929059 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898522 Wed, 01 Oct 2008 04:00:00 +0100 1898522 Cerebral palsy: medical aspects. http://www.medworm.com/index.php?rid=1898521&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929060%26dopt%3DAbstract This article provides an overview of etiology and diagnosis, with a system-based discussion of management. PMID: 18929060 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898521 Wed, 01 Oct 2008 04:00:00 +0100 1898521 Cerebral Palsy: Orthopedic Aspects and Rehabilitation. http://www.medworm.com/index.php?rid=1898520&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929061%26dopt%3DAbstract Authors: Berker AN, Yalçın MS Cerebral palsy is the most common chronic disability of childhood today. The concept of management rather than cure forms the basis of intervention. Therapy programs should be integrated with summer camps, home activities, and school, enabling the child and the family to live as close to normal as possible. Successful rehabilitation should prevent additional problems, minimize disability, and create a happy child. PMID: 18929061 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898520 Wed, 01 Oct 2008 04:00:00 +0100 1898520 Use of Psychotropic Medications in Children with Developmental Disabilities. http://www.medworm.com/index.php?rid=1898519&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18929062%26dopt%3DAbstract This article describes three developmental disorders-autistic spectrum disorders, fragile X syndrome, and fetal alcohol syndrome-and their associated mental health issues, and provides recommendations for pharmacologic interventions. PMID: 18929062 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1898519 Wed, 01 Oct 2008 04:00:00 +0100 1898519 Pediatric Resuscitation. Preface. http://www.medworm.com/index.php?rid=1804721&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675021%26dopt%3DAbstract Authors: Schexnayder SM, Zaritsky AL PMID: 18675021 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1804721 Fri, 01 Aug 2008 04:00:00 +0100 1804721 Preface. http://www.medworm.com/index.php?rid=1681360&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675021%26dopt%3DAbstract Authors: Schexnayder SM, Zaritsky AL PMID: 18675021 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681360 Fri, 01 Aug 2008 04:00:00 +0100 1681360 Background and epidemiology of pediatric cardiac arrest. http://www.medworm.com/index.php?rid=1681359&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675022%26dopt%3DAbstract Authors: Zideman DA, Hazinski MF Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progressions of respiratory failure and shock, sudden cardiac arrest may result from sudden arrhythmias. With better understanding of the epidemiology of pediatric cardiac arrest, clinicians can better tailor therapy to optimize outcome. PMID: 18675022 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681359 Fri, 01 Aug 2008 04:00:00 +0100 1681359 CPR-Why the New Emphasis? http://www.medworm.com/index.php?rid=1681358&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675023%26dopt%3DAbstract Authors: Berg MD, Nadkarni VM, Berg RA The importance of high quality, prompt cardiopulmonary resuscitation (CPR) for patients in cardiac arrest is receiving new attention and emphasis. This extends to CPR for children. In this article, the authors examine the differences in pediatric anatomy and the mechanisms of blood flow during CPR. Additionally, new evidence on the frequent poor performance of CPR and mechanisms to improve it are presented. PMID: 18675023 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681358 Fri, 01 Aug 2008 04:00:00 +0100 1681358 Airway management. http://www.medworm.com/index.php?rid=1681357&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675024%26dopt%3DAbstract Authors: Bingham RM, Proctor LT The pediatric airway and respiratory function differ from those in adults. Optimum management requires consideration of these differences, but the application of adult principles is usually sufficient to buy time in an emergency until specialist pediatric help is available. Simple airway opening techniques such as head tilt and jaw thrust are usually sufficient to open the child's airway, but there is now a range of equipment available to bypass supraglottic airway obstruction-the strengths and weaknesses of such devices are explored in this article. The role of endotracheal intubation is also discussed, along with the pros and cons of the use of cuffed endotracheal tubes in children, and methods of confirming tracheal placement of the tube. PMID: 18... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681357 Fri, 01 Aug 2008 04:00:00 +0100 1681357 Tachyarrhythmias and defibrillation. http://www.medworm.com/index.php?rid=1681356&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675025%26dopt%3DAbstract This article summarizes the 2005 American Heart Association Guidelines for Pediatric Advanced Life Support regarding tachyarrhythmias, including treatment with antiarrhythmics and direct current countershock therapy, and provides an update of recent literature since the guidelines were published. PMID: 18675025 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681356 Fri, 01 Aug 2008 04:00:00 +0100 1681356 Vascular access and drug therapy in pediatric resuscitation. http://www.medworm.com/index.php?rid=1681355&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675026%26dopt%3DAbstract Authors: de Caen AR, Reis A, Bhutta A Using the evidence brought together through the 2005 International Liaison Committee on Resuscitation evidence evaluation process and the subsequent 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the role for specific drug therapy in pediatric cardiac arrest is outlined. The drugs discussed include epinephrine, vasopressin, calcium, sodium bicarbonate, atropine, magnesium, and glucose. The literature addressing how best to deliver these drugs to the critically ill child is also presented, specifically looking at the use of intraosseous and endotracheal drug therapy. PMID: 18675026 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681355 Fri, 01 Aug 2008 04:00:00 +0100 1681355 Extracorporeal cardiopulmonary resuscitation in refractory pediatric cardiac arrest. http://www.medworm.com/index.php?rid=1681354&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675027%26dopt%3DAbstract Authors: Fiser RT, Morris MC The purpose of this article is to discuss the indications for extracorporeal cardiopulmonary resuscitation (ECPR), physiologic and mechanical issues that arise in patients managed with ECPR, and optimal patient selection for ECPR. ECPR can provide very good outcomes for some children who, in all likelihood, would otherwise have died. Having the capability to routinely offer ECPR represents an enormous institutional commitment of people and resources. For ECPR to be successful, it must be rapidly deployed, patients must be selected with care, and consistently excellent conventional CPR must take place while awaiting ECPR. PMID: 18675027 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681354 Fri, 01 Aug 2008 04:00:00 +0100 1681354 Postresuscitation care. http://www.medworm.com/index.php?rid=1681353&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675028%26dopt%3DAbstract This article examines the pathophysiology of the postarrest reperfusion state; postresuscitation care of the respiratory and cardiovascular systems; postresuscitation neurologic management; therapeutic hypothermia; blood glucose control; immunologic disturbances and infections; coagulation abnormalities; and gastrointestinal and hepatic dysfunction, among other topics. PMID: 18675028 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681353 Fri, 01 Aug 2008 04:00:00 +0100 1681353 Outcome following cardiopulmonary arrest. http://www.medworm.com/index.php?rid=1681352&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675029%26dopt%3DAbstract This article summarizes the current state of outcomes and outcome predictors following pediatric cardiopulmonary arrest with special emphasis on neurologic outcome. The authors briefly describe the factors associated with outcome and review clinical signs, electrophysiology, neuroimaging, and biomarkers used to predict outcome after cardiopulmonary arrest. Although clinical signs, imaging, and somatosensory evoked potentials are best associated with outcome, there are limited data to guide clinicians. Combinations of these predictors will most likely improve outcome prediction, but large-scale outcome studies are needed to better define these predictors. PMID: 18675029 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681352 Fri, 01 Aug 2008 04:00:00 +0100 1681352 Medical emergency and rapid response teams. http://www.medworm.com/index.php?rid=1681351&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675030%26dopt%3DAbstract Authors: Tibballs J, van der Jagt EW Hospitals that care for children are establishing medical emergency or rapid response teams as system solutions for preventing unexpected but foreseeable respiratory and cardiac arrest on inpatient units. Typically, an experienced team of doctors and nurses responds quickly to a direct request by any level of staff or even a parent for assistance with a child whose physiologic parameters meet predetermined criteria or whose condition causes concern to them. Several pediatric studies comparing outcomes before and after introduction of these rapid response systems reported reductions in rates of respiratory or cardiac arrest and death but no prospective study has compared pediatric hospitals that have implemented rapid response teams to hospitals that... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681351 Fri, 01 Aug 2008 04:00:00 +0100 1681351 Teamwork during resuscitation. http://www.medworm.com/index.php?rid=1681350&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675031%26dopt%3DAbstract This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation. PMID: 18675031 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681350 Fri, 01 Aug 2008 04:00:00 +0100 1681350 Resuscitation education: narrowing the gap between evidence-based resuscitation guidelines and performance using best educational practices. http://www.medworm.com/index.php?rid=1681349&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675032%26dopt%3DAbstract This article presents discussion of the quality of resuscitation delivered to patients, a brief history of the development of cardiopulmonary resuscitation and attempts to translate the science of resuscitation to the bedside through effective educational strategies, a review of educational best practices that relate to resuscitation education, and discussion of the role of medical simulation in resuscitation training. PMID: 18675032 [PubMed - in process] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681349 Fri, 01 Aug 2008 04:00:00 +0100 1681349 Future directions in cardiocerebral resuscitation. http://www.medworm.com/index.php?rid=1681348&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18675033%26dopt%3DAbstract Authors: Hickey RW, Nadkarni V Outcomes from pediatric cardiac arrest and cardiopulmonary resuscitation (CPR) seem to be incrementally improving. The past 2 decades have brought advances in the understanding of the pathophysiology of cardiac arrest and ventricular fibrillation, better treatment strategies, and a more robust standard for CPR epidemiology and research reporting. The evolution of practice based on an improved understanding of the pathophysiology and timing, intensity, duration, and variability of the hypoxic-ischemic insult should lead to goal-directed therapy gated to the phase of cardiac arrest and the postarrest period encountered. By strategically focusing therapies to specific phases of cardiac arrest and resuscitation and to the evolving pathophysiology and by imple... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1681348 Fri, 01 Aug 2008 04:00:00 +0100 1681348 Pediatric critical care. Preface. http://www.medworm.com/index.php?rid=1654220&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501752%26dopt%3DAbstract Authors: Orlowski JP PMID: 18501752 [PubMed - indexed for MEDLINE] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1654220 Sun, 01 Jun 2008 04:00:00 +0100 1654220 Preface. http://www.medworm.com/index.php?rid=1468282&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501752%26dopt%3DAbstract Authors: Orlowski JP PMID: 18501752 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468282 Tue, 27 May 2008 14:12:32 +0100 1468282 Hypothermia Therapy for Cardiac Arrest in Pediatric Patients. http://www.medworm.com/index.php?rid=1468281&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501753%26dopt%3DAbstract Authors: Hutchison JS, Doherty DR, Orlowski JP, Kissoon N Cardiac arrest is associated with high morbidity and mortality in children. Hypothermia therapy has theoretical benefits on brain preservation and has the potential to decrease morbidity and mortality in children following cardiac arrest. The American Heart Association guidelines recommend that it should be considered in children after cardiac arrest. Methods of inducing hypothermia include simple surface cooling techniques, intravenous boluses of cold saline, gastric lavage with ice-cold normal saline, and using the temperature control device with extracorporeal life support. We recommend further study before a strong recommendation can be made to use hypothermia therapy in children with cardiac arrest. PMID: 18501753 [PubM... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468281 Tue, 27 May 2008 14:12:29 +0100 1468281 Surfactant for Pediatric Acute Lung Injury. http://www.medworm.com/index.php?rid=1468280&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501754%26dopt%3DAbstract This article reviews exogenous surfactant therapy and its use in mitigating acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) in infants, children, and adults. Biophysical and animal research documenting surfactant dysfunction in ALI/ARDS is described, and the scientific rationale for treatment with exogenous surfactant is discussed. Major emphasis is placed on reviewing clinical studies of surfactant therapy in pediatric and adult patients who have ALI/ARDS. Particular advantages from surfactant therapy in direct pulmonary forms of these syndromes are described. Also discussed are additional factors affecting the efficacy of exogenous surfactants in ALI/ARDS. PMID: 18501754 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468280 Tue, 27 May 2008 14:12:26 +0100 1468280 Diabetic Ketoacidosis in the Pediatric ICU. http://www.medworm.com/index.php?rid=1468279&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501755%26dopt%3DAbstract This article discusses the assessment and treatment of DKA in the setting of the pediatric ICU. PMID: 18501755 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468279 Tue, 27 May 2008 14:12:21 +0100 1468279 In-Hospital Pediatric Cardiac Arrest. http://www.medworm.com/index.php?rid=1468278&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501756%26dopt%3DAbstract Authors: Berg MD, Nadkarni VM, Zuercher M, Berg RA The understanding of the incidence, epidemiology, etiology, and pathophysiology of pediatric cardiac arrest has evolved greatly in the past two decades. This includes recognition that cardiopulmonary resuscitation delays in cardiac arrest are especially injurious, ventricular arrythmias are not as uncommon in children as previously believed, and four distinct phases of cardiac arrest can be delineated. Performance of, and technologic advances in, the treatment of cardiac arrest make this an exciting time in the field. PMID: 18501756 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468278 Tue, 27 May 2008 14:12:19 +0100 1468278 The Psychologic Impact on Children of Admission to Intensive Care. http://www.medworm.com/index.php?rid=1468277&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501757%26dopt%3DAbstract Authors: Colville G There is growing literature on the psychologic impact on parents and families of having a child on the pediatric intensive care unit (PICU), but less is known about the child's experience. In this article the relevant literature is explored and illustrated with examples from the author's research. Recurring themes are the persistence of distress in a significant minority of children and the association between parental anxiety and child's psychologic symptoms. The evidence on the extent of children's factual and delusional memories relating to PICU is also examined. Finally, the implications of the current state of knowledge for future research and for clinical work are discussed. PMID: 18501757 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of N... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468277 Tue, 27 May 2008 14:12:15 +0100 1468277 Multiple Organ System Extracorporeal Support in Critically Ill Children. http://www.medworm.com/index.php?rid=1468276&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501758%26dopt%3DAbstract This article provides a framework for this multidisciplinary team approach for implementing these therapies. PMID: 18501758 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468276 Tue, 27 May 2008 14:12:12 +0100 1468276 Immunoparalysis and Adverse Outcomes from Critical Illness. http://www.medworm.com/index.php?rid=1468275&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501759%26dopt%3DAbstract Authors: Frazier WJ, Hall MW Proper immunologic balance between pro- and anti-inflammatory forces is necessary for recovery from critical illness. Persistence of a marked compensatory anti-inflammatory innate immune response after an insult is termed immunoparalysis. Critically ill patients demonstrating prolonged, severe reductions in monocyte HLA-DR expression or ex vivo tumor necrosis factor alpha production are at high risk for nosocomial infection and death. Reversal of immunoparalysis can be accomplished through the administration of immunostimulatory agents or tapering of exogenous immunosuppression. Evidence suggests that this may be associated with improved clinical outcomes. Immune-monitoring protocols are needed to identify patients who may benefit from immunomodulatory tria... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468275 Tue, 27 May 2008 14:12:09 +0100 1468275 The Poisoned Child in the Pediatric Intensive Care Unit. http://www.medworm.com/index.php?rid=1468274&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501760%26dopt%3DAbstract Authors: Hanhan UA Acutely poisoned children remain a common problem facing pediatricians working in acute care medicine in the United States and worldwide. The management of such children continues to be challenging, and their care has evolved throughout the years. The concept of gastric decontamination in acute poisoning has significantly changed over the past 10 years, and many of the previously used techniques have been abandoned or fallen out of favor for lack of evidence to their benefit or unacceptable serious risks and side effects. Supportive care continues to be the cornerstone in managing most poisoned children. Only a few patients benefit from antidotes or specific interventions. PMID: 18501760 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North Amer... Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468274 Tue, 27 May 2008 14:12:04 +0100 1468274 Pediatric Intensivist Extenders in the Pediatric ICU. http://www.medworm.com/index.php?rid=1468273&cid=s_33244_33_f&fid=33244&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18501761%26dopt%3DAbstract This article explores the use of physician extenders in the pediatric ICU setting. The Libby Zion case is highlighted because of its impact on the use of manpower in the hospital setting. The history of physician extenders, including the hospitalist, physician assistant (PA), and nurse practitioner (NP), is discussed. Findings indicate a positive impact within the pediatric intensive care setting with the use of NPs and PAs. The American Academy of Pediatrics has supported the use of physician extenders in the care of hospitalized children. PMID: 18501761 [PubMed - as supplied by publisher] (Source: Pediatric Clinics of North America) Pediatric Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1468273 Tue, 27 May 2008 14:12:00 +0100 1468273