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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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JAMA Pediatrics

from ArchPedi - 01 Feb 15

JAMA Pediatrics Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision-making.




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Dermatologists, Imiquimod, and Treatment of Molluscum Contagiosum in Children Righting Wrongs

from ArchDerm - 01 Feb 15

“Half of what we’re teaching you is wrong,” one of my medical school deans would often say. “The problem,” he would continue, “is that we don’t know which half.”



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Introducing the Clinical Evidence Synopsis Section

from ArchDerm - 01 Feb 15

Harmonization of types of articles across the 10 journals of The JAMA Network provides an opportunity for JAMA Dermatology to adopt formats that were very well received by readers of other journals. JAMA led the development of the clinical evidence synopsis with the intention of providing a clinically relevant brief review of evidence-based guidelines and systematic reviews. The extensive evidence-based reviews done by organizations such as the Cochrane Collaboration, the US Preventive Services



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Worry About Developing Melanoma in the Pigmented Lesion Clinic Does It Warrant a Solution?

from ArchDerm - 01 Feb 15

In this issue Moye and colleagues examine psychological distress in patients with atypical mole syndrome attending a pigmented lesion clinic (PLC) who are receiving biannual total body skin examination using total body digital photography (TBDP). The authors propose that TBDP, which involves high-resolution digital photography with professional lighting and standardized patient poses to document the body surface, has potentially important psychological benefits. The photographs generated through



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Effects of Total-Body Digital Photography on Cancer Worry in Patients With Atypical Mole Syndrome

from ArchDerm - 01 Feb 15

ImportanceCancer worry about developing melanoma in at-risk patients may affect one’s quality of life and adherence to screening. Little is known about melanoma-related worry in patients with atypical mole syndrome (AMS).ObjectivesTo quantify levels and elucidate predictors of worry related to developing melanoma in patients with AMS and to determine whether total-body digital photography (TBDP) in pigmented lesion clinics (PLCs) reduces worry.Design, Setting, and ParticipantsIn this pretest-pos



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Central Obesity and High Blood Pressure in Pediatric Patients With Atopic Dermatitis

from ArchDerm - 01 Feb 15

ImportanceAtopic dermatitis (AD) is associated with multiple potential risk factors for obesity and high blood pressure (BP), including chronic inflammation, sleep disturbance, and mental health comorbidity. Previous studies found associations between general obesity and AD. However, it is unknown whether AD is associated with central obesity and/or high BP.ObjectivesTo determine whether central obesity and high BP are increased in pediatric AD.Design, Setting, and ParticipantsThis case-control



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Patient-Centered, Direct-Access Online Care for Management of Atopic Dermatitis A Randomized Clinical Trial

from ArchDerm - 01 Feb 15

ImportanceNew models of health care delivery for dermatological care have the potential to increase access and improve patient-centered outcomes.ObjectiveTo compare effectiveness of a direct-access, online model for follow-up dermatologic care in pediatric and adult patients with atopic dermatitis with that of in-person office visits.Design, Setting, and ParticipantsThis was a 1-year, randomized controlled equivalency clinical trial in medically underserved areas, outpatient clinics, and the gen



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Effect of Psoriasis Severity on Hypertension Control A Population-Based Study in the United Kingdom

from ArchDerm - 01 Feb 15

ImportanceHypertension is prevalent among patients with psoriasis. The effect of psoriasis and its severity on hypertension control is unknown.ObjectiveTo determine the association between uncontrolled blood pressure and psoriasis, both overall and according to objectively measured psoriasis severity, among patients with diagnosed hypertension.Design, Setting, and ParticipantsPopulation-based cross-sectional study nested in a prospective cohort drawn from The Health Improvement Network (THIN), a



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Cutaneous Adverse Effects Associated With the Tyrosine-Kinase Inhibitor Cabozantinib

from ArchDerm - 01 Feb 15

ImportanceCabozantinib S-malate is a vascular endothelial growth factor receptor 2, c-MET, and RET multitargeted tyrosine kinase inhibitor that has antiangiogenic and antitumorigenic properties with potential efficacy for the treatment of several cancers. Cutaneous reactions, one of the most frequently observed adverse effects associated with tyrosine kinase inhibitors, can significantly affect patients’ quality of life and drug adherence and represent a major therapeutic challenge to maximizing



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Specialized Surveillance for Individuals at High Risk for Melanoma A Cost Analysis of a High-Risk Clinic

from ArchDerm - 01 Feb 15

ImportanceRegular surveillance of individuals at high risk for cutaneous melanoma improves early detection and reduces unnecessary excisions; however, a cost analysis of this specialized service has not been undertaken.ObjectiveTo determine the mean cost per patient of surveillance in a high-risk clinic from the health service and societal perspectives.Design, Setting, and ParticipantsWe used a bottom-up microcosting method to measure resource use in a consecutive sample of 102 patients treated



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Treatment of Keratosis Pilaris With 810-nm Diode Laser A Randomized Clinical Trial

from ArchDerm - 01 Feb 15

ImportanceKeratosis pilaris (KP) is a common skin disorder of follicular prominence and erythema that typically affects the proximal extremities, can be disfiguring, and is often resistant to treatment. Shorter-wavelength vascular lasers have been used to reduce the associated erythema but not the textural irregularity.ObjectiveTo determine whether the longer-wavelength 810-nm diode laser may be effective for treatment of KP, particularly the associated skin roughness/bumpiness and textural irre



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Posaconazole Treatment of Extensive Skin and Nail Dermatophytosis Due to Autosomal Recessive Deficiency of CARD9

from ArchDerm - 01 Feb 15

ImportanceDeep dermatophytosis is a disease that involves dermatophytic infection of the dermis and/or lymph nodes and sometimes the central nervous system. Autosomal recessive deficiency of the CARD9 (caspase recruitment domain 9) protein has been described in 17 patients with deep dermatophytosis from Algeria, Tunisia, and Morocco.ObservationsWe report a case of extensive dermatophytosis due to autosomal recessive CARD9 deficiency in a patient of Egyptian origin. This patient had extensive sup



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Drug-Associated Dermatomyositis Following Ipilimumab Therapy A Novel Immune-Mediated Adverse Event Associated With Cytotoxic T-Lymphocyte Antigen 4 Blockade

from ArchDerm - 01 Feb 15

ImportanceIpilimumab, a human monoclonal antibody targeted against cytotoxic T-lymphocyte antigen 4, has shown promise in the treatment of metastatic melanoma. However, given its mechanism of action, immune-related adverse effects have been reported with this therapy. Despite increasing reports of immune-related adverse effects related to ipilimumab therapy, dermatomyositis associated with this agent has not previously been reported.ObservationsWe describe a woman undergoing treatment with ipili



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First-line Treatment of Pemphigus Vulgaris With a Combination of Rituximab and High-Potency Topical Corticosteroids

from ArchDerm - 01 Feb 15

ImportanceThe main component of the first-line treatment of pemphigus vulgaris is high doses of systemic corticosteroids, but adverse effects of these drugs are frequent and sometimes severe. Rituximab has shown effectiveness as a corticosteroid-sparing agent or in case of relapse. To our knowledge, the effectiveness of rituximab as a first-line treatment without systemic corticosteroids has not been evaluated.ObservationsFive women in their 50s, 60s, or 70s with pemphigus vulgaris (Pemphigus Di



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Hemorrhagic Panniculitis Caused by Delayed Microemboli From Intravascular Device

from ArchDerm - 01 Feb 15

ImportanceThe breakdown of previously inserted intravascular devices can lead to microemboli that can clinically mimic the symptoms of common disorders, such as senile purpura, and have subtle histologic findings. However, device failure can occur gradually and start months after placement. If not identified early, microemboli to noncutaneous sites can cause significant morbidity and mortality.ObservationsA woman in her 70s presented 6 months after a complex aortic aneurysm repair with several l



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Pediatric Atopic Dermatitis and Associated Morbidities

from ArchDerm - 01 Feb 15

Pediatric atopic dermatitis (AD) is a cumbersome disease that has medical and psychosocial consequences for the child and family unit. With an ever-increasing prevalence, currently 10.7% in the United States, AD is managed by numerous medical professionals, most of whom are not dermatologists. Nonetheless, management of AD by dermatologists is commonplace. As such, it is imperative that primary care physicians and dermatologists work together as a seamless health care team to ensure that the pat



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Addressing the Knowledge Gap in Clinical Recommendations for Management and Complete Excision of Clinically Atypical Nevi/Dysplastic Nevi Pigmented Lesion Subcommittee Consensus Statement

from ArchDerm - 01 Feb 15

ImportanceThe management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence.ObjectivesTo outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how posit


 

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