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Prompting Asthma Intervention in Rochester–Uniting Parents and Providers (PAIR-UP) A Randomized Trial

from ArchPedi - 06 Oct 14

ImportanceA disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care.ObjectiveTo evaluate whether the Prompting Asthma Intervention in Rochester–Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma.Design, Setting, and ParticipantsCluster randomized trial in which 12 urban primary care practices were matched b



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Influence of the American Society of Hematology Guidelines on the Management of Newly Diagnosed Childhood Immune Thrombocytopenia

from ArchPedi - 06 Oct 14

ImportanceIn 2011, the American Society of Hematology (ASH) published updated guidelines for the management of childhood immune thrombocytopenia (ITP) recommending management with observation alone when there are mild or no bleeding symptoms, regardless of platelet count. Little is known about practice patterns of newly diagnosed ITP in the United States.ObjectiveTo understand the impact of management recommendations on practice patterns.Design, Setting, and ParticipantsRetrospective medical rec




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Social and Public Health Perspectives of Promotion of Breastfeeding

from ArchPedi - 01 Oct 14

Pediatricians often encounter clinical scenarios in which individual health benefit, public health benefit, and social values intersect. For example, circumcision benefits health for an individual by reducing the risk of urinary tract and sexually transmitted infections and also has public health benefit by reducing overall population risk of sexually transmitted infection. However, some social movements consider circumcision a violation of human rights. Similarly, abstinence can be an effective



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New Regulatory Paradigms for Innovative Drugs to Treat Pediatric Diseases

from ArchPedi - 01 Oct 14

The development of safe and effective pediatric drugs continues to fall short. The paucity of new therapies is particularly stark for rare diseases, which disproportionately affect children and collectively affect an estimated 25 million people in the United States and 30 million in Europe. Since the 1980s, US policymakers have enacted a range of policies to stimulate drug development for rare diseases, defined as those affecting fewer than 200?000 individuals in the United States. The most nota



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An Ethically Appropriate Strategy to Combat Obesity and Food Insecurity The Urban Food Initiative

from ArchPedi - 01 Oct 14

On February 26, 2013, Doug Rauch, former president of Trader Joe’s grocery chain, announced his plans for the Urban Food Initiative (UFI). The goals are to address obesity, food insecurity, and food waste by opening nonprofit supermarkets in low-income neighborhoods and providing nutritious low-cost foods. To accomplish this, he proposed selling food gathered from the 11% of fresh produce and perishables that are discarded from other supermarkets, some of which is near or past the sell-by date.



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Nine Hundred

from ArchPedi - 01 Oct 14

“My favorite class is math.”



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Continuing Evolution at JAMA Pediatrics

from ArchPedi - 01 Oct 14

The development, dissemination, and use of new information has changed rapidly over the last 15 years. These changes have affected both the lay and professional media.



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Urinary Tract Infections and Renal Damage Focusing on What Matters

from ArchPedi - 01 Oct 14

In this issue of JAMA Pediatrics, Shaikh and colleagues report their analysis of risk factors for renal scarring in infants and young children following a urinary tract infection (UTI). The methods are notable. Shaikh and colleagues sought out individual patient data from multiple published articles, and the researchers of the original studies were generous enough to provide the data, resulting in a large data set of 1280 infants and children. This is an example of admirable collaboration among



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Fighting Infections in the Neonatal Intensive Care Unit Gloves On or Off?

from ArchPedi - 01 Oct 14

In this issue, Kaufman and colleagues describe their efforts to reduce the risk of infection among critically ill neonates. Late-onset infections are devastating for infants. Whether they are classified as health care–associated infections, such as central line–associated bloodstream infections (CLABSIs), or identified as a somewhat less distinct clinical syndrome, such as necrotizing enterocolitis (NEC), these infections cause undeniable suffering. Among extremely low-birth-weight infants, an i



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Weekend Hospitalization

from ArchPedi - 01 Oct 14

More than once during the last years of my father’s life, I found myself navigating for him and my mother the many challenges and frustrations of hospitalization. His clinicians and the hospital staff were well trained and well intended. The supplies, equipment, and facilities were all first rate. But the environment within which his care was provided lacked uniform and consistent processes, which led to great variation in his everyday experience throughout his stay(s). And there was little comm



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Acid-Reducing Agents in Infants and Children Friend or Foe?

from ArchPedi - 01 Oct 14

Gastroesophageal reflux disease (GERD) is common in infants and children and has been estimated to affect as much as 3.3% of the pediatric population. Despite this, we still struggle with the management of GERD. With a growing body of literature that illustrates a lack of efficacy and alarming adverse effects, there is increasing reason to limit the empirical use of acid suppression therapy in children.



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Planning for Effective Hospital Discharge

from ArchPedi - 01 Oct 14

Hospital discharges occur more than 35 million times per year in the United States and the process of discharging the patient is one of very few processes common to all hospitalizations where the patients survive. Patients’ safety is at risk when discharge plans do not ensure that the patients, their families, and their caregivers have the knowledge and support they need to thrive beyond the hospital’s walls. Hospital costs increase and access to beds for new patients diminish when discharges ar



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Integrating Medical Plans Within Family Life

from ArchPedi - 01 Oct 14

Our daughter Zoe was born with a set of severe congenital heart defects that left her unable to survive without a heart transplant, which she received when only 5 weeks old. Infections, viruses, failure to thrive, transfusions, and many more complications required numerous hospital stays. She has received care in the neonatal intensive care unit, the cardiac intensive care unit, and the general inpatient unit. By age 2 years, she had been hospitalized 10 times and an additional 3 times in the la



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Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection A Meta-analysis With Individual Patient Data

from ArchPedi - 01 Oct 14

ImportanceNo studies have systematically examined the accuracy of clinical, laboratory, and imaging variables in detecting renal scarring in children and adolescents with a first urinary tract infection.ObjectivesTo identify independent prognostic factors for the development of renal scarring and to combine these factors in prediction models that could be useful in clinical practice.Data SourcesMEDLINE and EMBASE.Study SelectionWe included patients aged 0 to 18 years with a first urinary tract i



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Minimally Invasive Surfactant Administration in Preterm Infants A Meta-narrative Review

from ArchPedi - 01 Oct 14

ImportanceSurfactant administration by minimally invasive methods that allow for spontaneous breathing might be safer and more effective than administration with endotracheal intubation and mechanical ventilation; however, the efficacy and safety of minimally invasive methods have not been reviewed.ObjectiveTo conduct a meta-narrative review of the efficacy and safety of minimally invasive surfactant administration using a thin catheter, aerosolization, a laryngeal mask airway, and pharyngeal ad



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Nonsterile Glove Use in Addition to Hand Hygiene to Prevent Late-Onset Infection in Preterm Infants Randomized Clinical Trial

from ArchPedi - 01 Oct 14

ImportanceLate-onset infections commonly occur in extremely preterm infants and are associated with high rates of mortality and neurodevelopmental impairment. Hand hygiene alone does not always achieve the desired clean hands, as microorganisms are still present more than 50% of the time. We hypothesize that glove use after hand hygiene may further decrease these infections. ObjectiveTo determine if nonsterile glove use after hand hygiene before all patient and intravenous catheter contact, comp



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Origin of Cardiovascular Risk in Overweight Preschool Children A Cohort Study of Cardiometabolic Risk Factors at the Onset of Obesity

from ArchPedi - 01 Oct 14

ImportanceTo date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored.ObjectivesTo assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities.Design, Setting, and ParticipantsThe Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evalua



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Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children’s

from ArchPedi - 01 Oct 14

ImportanceIn adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes.ObjectiveTo estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia.Design, Setting, and ParticipantsThis retrospective cohort study from 1999 to 2011 featured index hosp



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Changes in Gastric and Lung Microflora With Acid Suppression Acid Suppression and Bacterial Growth

from ArchPedi - 01 Oct 14

ImportanceThe use of acid suppression has been associated with an increased risk of upper and lower respiratory tract infections in the outpatient setting but the mechanism behind this increased risk is unknown. We hypothesize that this infection risk results from gastric bacterial overgrowth with subsequent seeding of the lungs.ObjectivesTo determine if acid-suppression use results in gastric bacterial overgrowth, if there are changes in lung microflora associated with the use of acid suppressi



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Efficacy of a Telephone-Delivered Sexually Transmitted Infection/Human Immunodeficiency Virus Prevention Maintenance Intervention for Adolescents A Randomized Clinical Trial

from ArchPedi - 01 Oct 14

ImportanceBehavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.ObjectiveTo evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.Design, Setting, and ParticipantsIn a 2-arm randomized supplemental treatme



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Efficacy and Safety of Histamine-2 Receptor Antagonists

from ArchPedi - 01 Oct 14

ImportanceHistamine-2 receptor antagonists (H2RAs) are frequently used in the treatment of gastroesophageal reflux disease (GERD) in children; however, their efficacy and safety is questionable.ObjectiveTo systematically review the literature to assess the efficacy and safety of H2RAs in pediatric GERD.Evidence ReviewPubMed, EMBASE, and the Cochrane database were searched for randomized clinical trials investigating the efficacy and safety of H2RAs in pediatric GERD. Two reviewers independently



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A Framework of Pediatric Hospital Discharge Care Informed by Legislation, Research, and Practice

from ArchPedi - 01 Oct 14

To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10?000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal l




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Concerns About Concussion Rates in Female Youth Soccer

from ArchPedi - 01 Oct 14

To the Editor We are writing in response to the excellent article published in a recent issue of JAMA Pediatrics by O’Kane et al. The authors’ concern for the risk of concussion among middle-school–aged female soccer players matches that from our own clinical experience and is an important addition to sports medicine literature. The article provides strong support for a relatively high incidence rate of concussion among this population and recognizes a worrisome reluctance to seek medical attent


 

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