Clinical Pediatrics最新文献

Montelukast by inhibiting leukotriene receptors in the bladder can prevent the activation of mast cells. We investigated the effectiveness of Montelukast in reducing the symptoms of children with bladder pain syndrome (BPS). In this randomized clinical trial, children were allocated into groups of intervention (Montelukast and oxybutynin) and the control (oxybutynin). At the beginning and after 14 days, questions from mothers of children about their urinary condition were asked about the frequency of nocturnal enuresis, frequent urination, urinary incontinence, urinary urgency, and their pain severity. There was no significant difference between two groups in terms of frequency of nocturnal enuresis, frequent urination, urinary incontinence, and urinary urgency. Regarding the frequency of pain distribution, the frequency of pain-free people in the Montelukast group was higher than control group (84.4% vs 56.3%, P = .023). The results showed that adding Montelukast to oxybutynin has a significant decrease in pain in children with BPS.

In mild cases, it is difficult to diagnose pancreatic exocrine insufficiency (PEI). There is no gold standard method for the diagnosis of PEI. A reliable method is needed for preliminary diagnosis of PEI. The PEI-TEST was applied to the patients with nonspecific gastrointestinal complaints. Serum amylase, lipase, serum trypsinogen, and fecal elastase 1 (FE-1) were analyzed from each patient. According to the PEI-TEST, PEI was present in 42 (47.7%) and PEI was not present in 46 (52.3%) patients. No significant difference was observed between the 2 groups with regard to age, gender and amylase, lipase, serum trypsinogen, and FE-1. When an FE-1 value of <200 µg/dL was considered as indicating PEI, the sensitivity and specificity of the test were found to be 47.4% and 52.2%, respectively. Although it is promising that PEI-TEST is a validated test in our country and suitable for our society, it is not suitable for pediatric patients.

Parental strategies for home management of pain crisis in children with sickle cell anemia are not well studied. Non-steroidal anti-inflammatory medications (NSAIDs) are thought of as the mainstay of home and in-patient pain management for pediatric patients with sickle cell disease. Parents and providers often fear the use of opioids due to the risk of addiction. Medical marijuana is a potential adjunct therapy, but parental concerns regarding its use are not known. We aimed to assess parental strategies for home pain control, as well as attitudes toward the use of medical marijuana in children with sickle cell disease. Although medical marijuana may be a safer alternative to opioids, parents had similar concerns regarding marijuana. There were significant concerns regarding the societal implications of marijuana use. Further study of the utility of marijuana is warranted, but clinicians must look beyond the medical and consider the social consequences that may impact treatment acceptability.

We conducted a quality improvement (QI) study to increase rates of firearm screening/safety counseling by 25% over 10 months for children (4-18 years) at preventive visits in an academic continuity clinic. Plan-Do-Study-Act (PDSA) cycles consisted of 1) (January 2023) educating providers about best practices for screening, safe storage counseling, and use of cable firearm locks; 2) (May 2023) revising the preventive visit note template to prompt providers on best practices; and 3) (September 2023) providing caregiver educational resources to support safe storage practices. The baseline firearm screening rate was 38%. After PDSA 1, screening rates were 34%; following PDSA 2, screening rates increased to 82.5%; after PDSA 3, rates were 95%. This QI intervention increased provider screening for firearms, confidence in safety counseling, and confidence in the use of cable firearm locks during preventive visits. Revising the note template had the largest effect on increasing screening rates.

Clinicians continue to seek out ways to decrease antibiotic usage and its sequelae for infants with risk factors for Early Onset Sepsis (EOS). We carried out a large system intervention (LSI) to decrease antibiotic usage, decrease the proportion of infants exposed to any antibiotics and evaluate the financial impact of this intervention. Antibiotic use was monitored from January 2018 through June 2020 for infants born at York Hospital ≥ 35 weeks gestation and discharged from Newborn Nursery. LSIs, including the Kaiser Sepsis Calculator, were implemented January-June 2019. Quality metrics were compared 12-months before and after the intervention. Overall, 5021 infants were discharged from the nursery. Antibiotic usage decreased 68% and infant exposure to antibiotics decreased 64%. There was a savings of $697 per at risk newborn and there were no readmissions for EOS. A Systemic LSI can safely reduce newborn antibiotic exposure and create significant cost saving.

This study aimed to describe the home-built environment of children with medical complexity (CMC) using novel photovoice methodology. Parents/guardians of CMC uploaded and discussed photographs of their home environment through semi-structured interviews. Conventional content analysis was applied to interview transcripts embedded with corresponding photographs. All participants modified their home environment to optimize the health, function, and well-being of the child and family; extent of modifications varied. Two main themes and subthemes characterized the home-built environment: (1) replicating hospital function and structure: ensuring accessibility, promoting safety, optimizing organization of supplies, and equipment and (2) maintaining a sense of home: self-expression, entertaining, family participation, and comfort. Elements of hospital structure and function and traditional home aesthetics and utility were equally important to families, the interplay between both facets informed modifications. By understanding the home-built environment, pediatric providers can more holistically support the health and well-being of CMC and their caregivers.

The study aimed to investigate the correlation between children's attendance at the emergency department and the cyberchondria of parents. The population for this cross-sectional study comprised parents of children aged 0 to 18 attending the emergency department. Research data were collected using an Information Form, the Cyberchondria Severity Scale (CSS). The participants had mean CSS scores of 41.45 ± 19.22. There were significant differences observed between the reason for choosing the emergency department with mean scores for the total CSS (F = 2.289, P = .021), distress (F = 2.466, P = .013), and compulsion (F = 2.822, P = .005) subscales. A weak positive correlation was identified between the number of attendances at the emergency department in the last year and the excessiveness (r = .204) subscale. Participants had moderate levels of CSS. According to the research findings, most parents attended the emergency department for non-urgent reasons. In addition, as the cyberchondria severity level of parents increased, their attendance at health institutions and emergency departments was determined to increase.

Complementary therapies are used to treat many pediatric symptoms and health conditions, and chiropractic care is one of the most commonly used forms of complementary therapies by children and adolescents. Research studies have investigated the evidence behind and safety of chiropractic care in pediatrics with various musculoskeletal and non-musculoskeletal conditions. There are limited data with a range of findings and often no definite conclusion. Despite the paucity of evidence of benefits of chiropractic care in children, the considerations around safety, and the differing opinions regarding pediatric chiropractic practice inside and outside the field, many pediatric patients visit chiropractors, and chiropractors often care for pediatric patients. Pediatric health care providers should discuss the use of all complementary therapies with patients, so guidance can be optimal with a focus on promoting health and safety.