Pediatric spinal surgery postoperative infections are highly variable, ranging from acute postoperative infections necessitating urgent, and probably repeated, irrigation and debridement with retention of spinal implants to delayed, insidious-appearing infections that smolder. Appreciation of the pathophysiology, bacterial organisms, risk factors and preventative measures are paramount in minimizing not only potentially devastating individual patient outcomes but also in recognizing the tremendous economic burden placed on our healthcare system. The history, physical examination, laboratory values and radiographic imaging of these delayed infections can be underwhelming. Awareness and heightened clinical suspicion must be maintained in order to accurately diagnose these surgical site infections. Experience and keen clinical intuition effectively preserve the ultimate goals of pediatric spinal surgery, mainly halting the progression of deformity and safely correcting existing deformity, allowing physiologi...
{"title":"Complications of infection in pediatric spine surgery","authors":"C. Harrod, R. Boykin, Daniel J. Hedequist","doi":"10.2217/PHE.09.61","DOIUrl":"https://doi.org/10.2217/PHE.09.61","url":null,"abstract":"Pediatric spinal surgery postoperative infections are highly variable, ranging from acute postoperative infections necessitating urgent, and probably repeated, irrigation and debridement with retention of spinal implants to delayed, insidious-appearing infections that smolder. Appreciation of the pathophysiology, bacterial organisms, risk factors and preventative measures are paramount in minimizing not only potentially devastating individual patient outcomes but also in recognizing the tremendous economic burden placed on our healthcare system. The history, physical examination, laboratory values and radiographic imaging of these delayed infections can be underwhelming. Awareness and heightened clinical suspicion must be maintained in order to accurately diagnose these surgical site infections. Experience and keen clinical intuition effectively preserve the ultimate goals of pediatric spinal surgery, mainly halting the progression of deformity and safely correcting existing deformity, allowing physiologi...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"579-592"},"PeriodicalIF":0.0,"publicationDate":"2009-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.61","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adolescence should mark a time of exploration, self-discovery and the development of a sense of meaning and purpose in life. Adolescent suicidality represents the ultimate threat to these normal developmental processes. Factors impacting the likelihood of adolescent self-directed violence are numerous and this reality can often leave providers and youth advocates with a dilemma when attempting to identify suicidal youths. Universal screening in primary clinic settings provides an opportunity to identify youths most at risk of suicide. Multiple levels exist for provider and youth advocate intervention in the prevention of adolescent suicide.
{"title":"Suicidal events in adolescents: how clear are the warning signs?","authors":"N. Duke, I. Borowsky","doi":"10.2217/PHE.09.52","DOIUrl":"https://doi.org/10.2217/PHE.09.52","url":null,"abstract":"Adolescence should mark a time of exploration, self-discovery and the development of a sense of meaning and purpose in life. Adolescent suicidality represents the ultimate threat to these normal developmental processes. Factors impacting the likelihood of adolescent self-directed violence are numerous and this reality can often leave providers and youth advocates with a dilemma when attempting to identify suicidal youths. Universal screening in primary clinic settings provides an opportunity to identify youths most at risk of suicide. Multiple levels exist for provider and youth advocate intervention in the prevention of adolescent suicide.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"551-563"},"PeriodicalIF":0.0,"publicationDate":"2009-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.52","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hodgkin lymphoma (HL) is very responsive to front-line therapy, with durable event-free survival exceeding 75%. Survivors suffer long-term effects of therapy and some experience recurrent or refractory disease requiring rescue therapy. High-dose chemotherapy with autologous stem-cell transplantation increases the chance for long-term survival in this population, especially when reinduction therapy achieves complete response. As single agents, or within combination regimens, gemcitabine and vinorelbine have favorable toxicity profiles and are active against multiple malignancies, including relapsed and refractory HL. In Phase II trials the response to the combination of gemcitabine and vinorelbine in relapsed/refractory HL is better than or comparable to other more toxic regimens. The combination was not more effective than other drugs in front-line HL treatment; however, its addition to upfront therapy of slow-responding patients with HL is likely to enhance effectiveness with low toxicity.
{"title":"Gemcitabine and vinorelbine therapy for patients with Hodgkin lymphoma","authors":"M. Al-Rahawan, P. Alarcón","doi":"10.2217/PHE.09.51","DOIUrl":"https://doi.org/10.2217/PHE.09.51","url":null,"abstract":"Hodgkin lymphoma (HL) is very responsive to front-line therapy, with durable event-free survival exceeding 75%. Survivors suffer long-term effects of therapy and some experience recurrent or refractory disease requiring rescue therapy. High-dose chemotherapy with autologous stem-cell transplantation increases the chance for long-term survival in this population, especially when reinduction therapy achieves complete response. As single agents, or within combination regimens, gemcitabine and vinorelbine have favorable toxicity profiles and are active against multiple malignancies, including relapsed and refractory HL. In Phase II trials the response to the combination of gemcitabine and vinorelbine in relapsed/refractory HL is better than or comparable to other more toxic regimens. The combination was not more effective than other drugs in front-line HL treatment; however, its addition to upfront therapy of slow-responding patients with HL is likely to enhance effectiveness with low toxicity.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"525-532"},"PeriodicalIF":0.0,"publicationDate":"2009-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.51","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children with intractable epilepsy have frequent hospital admissions secondary to acute exacerbation of seizures or status epilepticus. Delay in medical management can lead to permanent neurological damage. Randomized clinical trials demonstrate that benzodiazepines are still the cornerstones of the acute management of seizures, but treatment is still evolving owing to the approval of newer medications. A decade ago, approval of fosphenytoin, parental valproate and rectal diazepam made an impact in the acute management of seizures. The use of rectal diazepam and intranasal and buccal midazolam for acute repetitive seizures resulted in reduced hospital admissions. In recent years, intravenous levetiracetum has also had an impact in treating status epilepticus and acute exacerbation of seizures. However, larger, prospective, multicenter trials are required to prove the efficacy of newer agents in acute seizure management.
{"title":"Acute seizure management in children","authors":"Batool F. Kirmani","doi":"10.2217/PHE.09.59","DOIUrl":"https://doi.org/10.2217/PHE.09.59","url":null,"abstract":"Children with intractable epilepsy have frequent hospital admissions secondary to acute exacerbation of seizures or status epilepticus. Delay in medical management can lead to permanent neurological damage. Randomized clinical trials demonstrate that benzodiazepines are still the cornerstones of the acute management of seizures, but treatment is still evolving owing to the approval of newer medications. A decade ago, approval of fosphenytoin, parental valproate and rectal diazepam made an impact in the acute management of seizures. The use of rectal diazepam and intranasal and buccal midazolam for acute repetitive seizures resulted in reduced hospital admissions. In recent years, intravenous levetiracetum has also had an impact in treating status epilepticus and acute exacerbation of seizures. However, larger, prospective, multicenter trials are required to prove the efficacy of newer agents in acute seizure management.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"543-549"},"PeriodicalIF":0.0,"publicationDate":"2009-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.59","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Implications of mass screening for childhood celiac disease","authors":"M. Bonamico, R. Nenna","doi":"10.2217/PHE.09.42","DOIUrl":"https://doi.org/10.2217/PHE.09.42","url":null,"abstract":"","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"413-415"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vomiting is a common complaint in any healthcare facility that deals with children. A child recently presented to our emergency department with an occult cause of vomiting, which led to the development of the following differential diagnosis of vomiting in children. Although usually of gastrointestinal origin, vomiting can be caused by the dysfunction of many different organ systems, the results of which may range from benign to life threatening. The differential diagnosis is presented in order of frequency, in order to make it as clinically relevant as possible, and then each section is further broken down to the pathophysiology, the historical facts, the pertinent physical examination findings, and the therapeutics of each diagnosis is discussed in variable detail.
{"title":"Vomiting in the pediatric age group","authors":"N. Mullen","doi":"10.2217/PHE.09.47","DOIUrl":"https://doi.org/10.2217/PHE.09.47","url":null,"abstract":"Vomiting is a common complaint in any healthcare facility that deals with children. A child recently presented to our emergency department with an occult cause of vomiting, which led to the development of the following differential diagnosis of vomiting in children. Although usually of gastrointestinal origin, vomiting can be caused by the dysfunction of many different organ systems, the results of which may range from benign to life threatening. The differential diagnosis is presented in order of frequency, in order to make it as clinically relevant as possible, and then each section is further broken down to the pathophysiology, the historical facts, the pertinent physical examination findings, and the therapeutics of each diagnosis is discussed in variable detail.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"24 1","pages":"479-503"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evaluation of: O’Brien MA, Prosser LA, Paradise JL et al.: New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics 123(6), 1452–1463 (2009). Vaccines have the potential to impact on otitis media, a leading cause of childhood morbidity. O ‘Brien et al. created a computerized model to project the potential health and economic benefits of bacterial vaccines targeted against Streptococcus pneumoniae, nontypeable Hemophilus influenzae and Moraxella catarrhalis against otitis media. They concluded that reasonably priced bacterial vaccines could achieve cost-effectiveness and potentially prevent millions of episodes of acute otitis media annually.
{"title":"Health and economic benefits of bacterial vaccines in the prevention of otitis media","authors":"Stella U. Kalu, T. Chonmaitree","doi":"10.2217/PHE.09.41","DOIUrl":"https://doi.org/10.2217/PHE.09.41","url":null,"abstract":"Evaluation of: O’Brien MA, Prosser LA, Paradise JL et al.: New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics 123(6), 1452–1463 (2009). Vaccines have the potential to impact on otitis media, a leading cause of childhood morbidity. O ‘Brien et al. created a computerized model to project the potential health and economic benefits of bacterial vaccines targeted against Streptococcus pneumoniae, nontypeable Hemophilus influenzae and Moraxella catarrhalis against otitis media. They concluded that reasonably priced bacterial vaccines could achieve cost-effectiveness and potentially prevent millions of episodes of acute otitis media annually.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"435-438"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.41","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are a limited number of disorders affecting the hip in children that demand urgent surgical treatment. Slipped capital epiphysis is the most frequently encountered. Fractures of the femoral neck, although less common, endanger the viability of the femoral head. A number of musculoskeletal infections, including septic arthritis, osteomyelitis of the proximal femur, pyomyositis and necrotizing fasciitis, present diagnostic challenges. Any of these conditions can cause irreparable harm that can be influenced by prompt, accurate diagnosis and appropriate medical and surgical treatment. Traumatic pelvic injuries requiring surgery are not discussed in this review.
{"title":"Hip disorders in children requiring urgent surgical treatment","authors":"B. Hotchkiss","doi":"10.2217/PHE.09.46","DOIUrl":"https://doi.org/10.2217/PHE.09.46","url":null,"abstract":"There are a limited number of disorders affecting the hip in children that demand urgent surgical treatment. Slipped capital epiphysis is the most frequently encountered. Fractures of the femoral neck, although less common, endanger the viability of the femoral head. A number of musculoskeletal infections, including septic arthritis, osteomyelitis of the proximal femur, pyomyositis and necrotizing fasciitis, present diagnostic challenges. Any of these conditions can cause irreparable harm that can be influenced by prompt, accurate diagnosis and appropriate medical and surgical treatment. Traumatic pelvic injuries requiring surgery are not discussed in this review.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"457-463"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leslie N. Rhodes, Ambre' L. Huff, D. Kelly, W. Warner, J. Sawyer
The increasing demand for fracture care in pediatric patients, along with the shortage of fellowship-trained pediatric orthopedic surgeons and the growing number of uninsured or under-insured children, places considerable demands on institutions that provide such care. High-volume, multidisciplinary, outpatient fracture clinics can be efficient and cost effective, and can ease the burden on crowded emergency departments. Using a team approach with an orthopedic surgeon and a number of mid-level care providers stream-lines care and makes the most efficient use of the varied skills of these individuals. The fracture-care team may include nurse practitioners, physician assistants, nurse coordinators, orthopedic technicians, physical therapists, radiology technicians and even social services, such as case managers, child-life specialists and translators. Having all of these resources readily accessible provides a ‘one-stop shop’ for pediatric fracture care. This can decrease the number of visits to the emerge...
{"title":"Pediatric fracture clinics: current status and future directions","authors":"Leslie N. Rhodes, Ambre' L. Huff, D. Kelly, W. Warner, J. Sawyer","doi":"10.2217/PHE.09.43","DOIUrl":"https://doi.org/10.2217/PHE.09.43","url":null,"abstract":"The increasing demand for fracture care in pediatric patients, along with the shortage of fellowship-trained pediatric orthopedic surgeons and the growing number of uninsured or under-insured children, places considerable demands on institutions that provide such care. High-volume, multidisciplinary, outpatient fracture clinics can be efficient and cost effective, and can ease the burden on crowded emergency departments. Using a team approach with an orthopedic surgeon and a number of mid-level care providers stream-lines care and makes the most efficient use of the varied skills of these individuals. The fracture-care team may include nurse practitioners, physician assistants, nurse coordinators, orthopedic technicians, physical therapists, radiology technicians and even social services, such as case managers, child-life specialists and translators. Having all of these resources readily accessible provides a ‘one-stop shop’ for pediatric fracture care. This can decrease the number of visits to the emerge...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"439-444"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The implementation of school-based screening has resulted in a large number of adolescents with idiopathic scoliosis with relatively small curve magnitudes presenting to the clinician. Deciding on appropriate management requires an understanding of the natural history and factors associated with progression of spinal deformity. This is a challenging field and has not been fully defined. The physician will need to make the most use of available data and individualize treatment for the child. Although the patient’s age at presentation, the Risser sign, the patient’s menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term.
{"title":"Factors associated with spinal deformity progression in adolescent idiopathic scoliosis","authors":"K. Tan","doi":"10.2217/PHE.09.44","DOIUrl":"https://doi.org/10.2217/PHE.09.44","url":null,"abstract":"The implementation of school-based screening has resulted in a large number of adolescents with idiopathic scoliosis with relatively small curve magnitudes presenting to the clinician. Deciding on appropriate management requires an understanding of the natural history and factors associated with progression of spinal deformity. This is a challenging field and has not been fully defined. The physician will need to make the most use of available data and individualize treatment for the child. Although the patient’s age at presentation, the Risser sign, the patient’s menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"3 1","pages":"445-449"},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.09.44","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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