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Pregnancy Outcomes for Kidney Transplant Recipients With Transplantation as a Child

from ArchPedi - 02 Feb 15

ImportancePregnancy outcomes for women who received a kidney transplant in childhood are uncertain.ObjectivesTo report pregnancy outcomes for women with kidney transplantation in childhood (aged Design, Setting, and ParticipantsObservational cohort study in Australia and New Zealand of all women with a functioning kidney transplant included in the Australia and New Zealand Dialysis and Transplant Registry for whom at least 1 pregnancy was reported between January 1, 1963, and December 31, 2012.M



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Hospital Variation and Risk Factors for Bronchopulmonary Dysplasia in a Population-Based Cohort

from ArchPedi - 02 Feb 15

ImportanceBronchopulmonary dysplasia (BPD) remains a serious morbidity in very low-birth-weight (VLBW) infants (ObjectiveTo identify individual risk factors for BPD development and hospital variation of BPD rates across all levels of neonatal intensive care units (NICUs) within the California Perinatal Quality Care Collaborative.Design, Setting, and ParticipantsRetrospective cohort study (January 2007 to December 2011) from the California Perinatal Quality Care Collaborative including more than




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Addressing the Challenges of Clinician Training for Long-Acting Reversible Contraception

from ArchPedi - 01 Feb 15

Long-acting reversible contraceptive (LARC) methods are gaining greater popularity in the United States as both patients and health care professionals become educated about their high contraceptive efficacy, relatively few contraindications, and ease of use. In fact, LARC is recommended by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents. Use of LARC among 15- to 19-year-olds increased from 1% to



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Teens and Gun Trafficking A Call for Pediatric Advocacy

from ArchPedi - 01 Feb 15

At a meeting of the Greater Boston Interfaith Organization in April 2013, Mirna Luz Ramos takes the microphone. With a cracking voice and tears, she talks about her 19-year-old son, Jorge. He was shot and killed while walking the dog outside of her home. She found him dying on the sidewalk. As she talks, many in the audience are weeping with her.



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Women in Pediatrics

from ArchPedi - 01 Feb 15

When we were sick during our childhood, most of us were cared for by our mothers; this nurturing characteristic of women plays an important role in pediatrics. That is not to say that some men are not nurturing—we all are better for knowing them.



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Outpatient Antibiotic Therapy for Acute Osteomyelitis in Children Balancing Safety and Efficacy

from ArchPedi - 01 Feb 15

The ability to provide long-term antibiotic therapy for acute osteomyelitis was revolutionized by the use of peripherally inserted central catheters (PICCs). Peripherally inserted central catheters provided an alternative for children to receive antibiotic therapy outside the health care setting, which reduced their hospital length of stay and improved their quality of life. However, PICCs can be complicated by infectious and noninfectious sequelae. Clinicians must weigh the risks of intravenous



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High-Value, Cost-Conscious Medical Education

from ArchPedi - 01 Feb 15

Health care professionals must balance the harms and costs of tests and treatments against the potential benefits in order to provide high-value, cost-conscious care. Clinical researchers, in turn, identify the diagnostic tests, treatments, delivery systems, and clinical pathways that will provide an evidence-based foundation for patient care. Unfortunately, despite a growing recognition of the economic stressors in medical education systems and an awareness that instructional approaches vary in



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Intervention Effects on Diurnal Cortisol Rhythms of Child Protective Services–Referred Infants in Early Childhood Preschool Follow-up Results of a Randomized Clinical Trial

from ArchPedi - 01 Feb 15

ImportanceA number of interventions for at-risk children have shown benefits for children’s hypothalamic-pituitary-adrenal axis activity immediately after treatment. It is critical to examine whether such changes are maintained over time, given that physiological regulation is implicated in later mental and physical health outcomes.ObjectiveTo examine whether differences in diurnal cortisol production between children receiving the active parenting intervention and children in the control group



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Comparative Effectiveness of Intravenous vs Oral Antibiotics for Postdischarge Treatment of Acute Osteomyelitis in Children

from ArchPedi - 01 Feb 15

ImportancePostdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy.ObjectiveTo compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route.Design, Setting, and Participant



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Associations Between Initial Water Pipe Tobacco Smoking and Snus Use and Subsequent Cigarette Smoking Results From a Longitudinal Study of US Adolescents and Young Adults

from ArchPedi - 01 Feb 15

ImportanceMany adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes.ObjectiveTo assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking.Design, Setting, and ParticipantsWe conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained wheth



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Improving Cardiopulmonary Resuscitation With a CPR Feedback Device and Refresher Simulations (CPR CARES Study) A Randomized Clinical Trial

from ArchPedi - 01 Feb 15

ImportanceThe quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines.ObjectiveTo determine whether “just-in-time” (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA.Design, Setting, and



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Risk and Protective Factors for Falls From Furniture in Young Children Multicenter Case-Control Study

from ArchPedi - 01 Feb 15

ImportanceFalls from furniture are common in young children but there is little evidence on protective factors for these falls.ObjectiveTo estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years.Design, Setting, and ParticipantsMulticenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children



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Preeclampsia, Placental Insufficiency, and Autism Spectrum Disorder or Developmental Delay

from ArchPedi - 01 Feb 15

ImportanceIncreasing evidence suggests that autism spectrum disorder (ASD) and many forms of developmental delay (DD) originate during fetal development. Preeclampsia may trigger aberrant neurodevelopment through placental, maternal, and fetal physiologic mechanisms.ObjectiveTo determine whether preeclampsia is associated with ASD and/or DD.Design, Setting, and ParticipantsThe Childhood Autism Risks from Genetics and the Environment (CHARGE) study is a population-based, case-control investigatio



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Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion

from ArchPedi - 01 Feb 15

ImportanceIn 2009, Washington State enacted legislation outlining the medical care of children and adolescents with concussion (ie, the Lystedt Law), with all other states and Washington, DC passing legislation by January 2014.ObjectiveTo evaluate the effect of concussion laws on health care utilization rates from January 1, 2006, through June 30, 2012, in states with and without legislation.Design, Setting, and ParticipantsFor commercially insured children aged 12 to 18 years from all 50 states



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Nonalcoholic Fatty Liver Disease A Challenge for Pediatricians

from ArchPedi - 01 Feb 15

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and is considered the most common form of chronic liver disease in children. Several factors contribute to NAFLD development, including race/ethnicity, genetic factors, environmental exposures, and alterations in the gut microbiome. The histologic spectrum of NAFLD ranges from simple steatosis to the more aggressive nonalcoholic steatohepatitis (NASH). Fibrosis and eventually cirrhosis can develop fro



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Electronic Cigarette Use and Exposure in the Pediatric Population

from ArchPedi - 01 Feb 15

Electronic cigarette (e-cigarette) use has gained recent widespread popularity and acceptance in the general population. What effect e-cigarettes may have on pediatric health remains unknown. Although many jurisdictions have laws that prevent the sale of e-cigarettes to minors and the use of e-cigarettes in public places, infants, children, and adolescents are increasingly exposed to them. In this pediatric-focused review, we discuss the history of these devices, user demographics, known health




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Clinical Outcomes After Bilevel Positive Airway Pressure Treatment for Acute Asthma Exacerbations

from ArchPedi - 01 Feb 15

Guidelines for the management of acute asthma exacerbations recommend noninvasive ventilation as an “experimental approach for treatment of respiratory failure due to severe asthma exacerbation.”(p398) Clinicians in our tertiary pediatric emergency department have the option to use bilevel positive airway pressure (BiPAP) as treatment for children with asthma exacerbations who have no signs of respiratory failure. We sought to examine whether these patients have improved clinical outcomes.



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Accuracy of Bayley Scores as Outcome Measures in Trials of Neonatal Therapies

from ArchPedi - 01 Feb 15

Long-term follow-up of extremely preterm infants is essential because the proportion of infants who survive is increasing while neurodevelopmental impairment rates remain high. Psychometric tests, such as the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), are commonly used to measure early childhood outcomes in obstetric and neonatal randomized trials. However, the composite scores on psychometric tests can be inaccurate because of administrative and technical error



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Risk Model for Renal Scarring Validation and Implications Still Needed for Primary Care Practice

from ArchPedi - 01 Feb 15

To the Editor We read the article by Shaikh et al recently published in JAMA Pediatrics with interest and were captivated by the concept of a model that could be used to determine the risk for renal scarring based on 3 noninvasive components (temperature, causal organism, and ultrasonography). However, based on limitations inherent in the methods, we caution against unreserved acceptance of these results. As the authors point out (and we agree), their findings require validation and further disc



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Risk Model for Renal Scarring: Validation and Implications Still Needed for Primary Care—Reply

from ArchPedi - 01 Feb 15

In Reply We thank Drs Bunting-Early and Figueroa for their interest in our article. Although they correctly point out that some of the data included are relatively old and that our analysis is retrospective (albeit using prospectively collected data), they do not proffer any reasons why these characteristics make the data unreliable. Individual-patient data meta-analysis is considered the best available study design to address risk prediction because it uses all available data and avoids confoun



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Ethics and Etiquette in Neonatal Intensive Care The Value of Parents’ Engagement in Everyday Ethics and Recommendations for Further Advancing the Field

from ArchPedi - 01 Feb 15

To the Editor We read the special communication by Janvier and Lantos recently published in JAMA Pediatrics with great interest and wholeheartedly agree that “when families voice their dissatisfaction with the NICU, it is often not because they think their baby has not received good medical care. Instead, it is because the parents’ needs have not been acknowledged and addressed.” To meet this challenge, the authors developed an etiquette-based systematic approach for physician-parent communicati



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Ethics and Etiquette in Neonatal Intensive Care—Reply

from ArchPedi - 01 Feb 15

In Reply We thank Barello and colleagues for providing information about patient-health engagement to improve patient and family outcomes. In the previous few years, there have been numerous initiatives designed to engage patient and family participation in children’s care. In investigations of neonatology, these initiatives are generally aimed at educating health care professionals by teaching them skills or ways to structure difficult conversations. These approaches may improve communication b



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Risks of Hookah Smoking

from ArchPedi - 01 Feb 15

Tobacco use is the leading preventable cause of death and illness worldwide. During the past 45 years, rates of cigarette smoking have decreased in the United States owing to greater understanding of the health risks of smoking, indoor smoking bans, media and advertising restrictions, and increased public awareness. However, the use of alternative forms of tobacco, such as hookah, is rising, threatening these successful efforts.


 

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