Current opinion in pediatrics
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Curr. Opin. Pediatr. · Oct 2009
Surgical advances in the treatment of adults with congenital heart disease.
This article reviews three common abnormalities requiring surgical treatment in adults with congenital heart disease (CHD): Ebstein's anomaly, the failing Fontan, and pulmonary valve disease. ⋯ Surgery for Ebstein's anomaly can now be offered to older patients at low risk and with good late outcome. The operation includes tricuspid valve repair or replacement and frequent concomitant procedures such as atrial septal defect closure, arrhythmia surgery (the maze procedure), and coronary artery bypass grafting. Fontan conversion involves: conversion of the previously created atriopulmonary connection to a total cavopulmonary artery, extracardiac Fontan; arrhythmia surgery, typically with a modified biatrial maze procedure along with placement of an antitachycardia, dual-chamber pacemaker with steroid-eluting epicardial leads in all patients; and concomitant procedures to treat associated lesions. The need for PVR is increasing for many adults with CHD. In the past, residual defects such as chronic pulmonary regurgitation following repair of tetralogy of Fallot were considered benign. Recent evidence suggests that pulmonary regurgitation causes significant morbidity, producing right ventricular dilatation and dysfunction, exercise intolerance, arrhythmias, and sudden death. Multiple options exist for PVR including several recent developments such as PVR with a man-made polytetrafluoroethylene bicuspid valve and percutaneous PVR.
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Curr. Opin. Pediatr. · Oct 2009
ReviewThe adult with congenital heart disease: medical and surgical considerations for management.
The purpose of the present review is to outline some of the challenges of surgical and medical management in the adult with congenital heart disease (CHD). ⋯ Adults with CHDs present difficult challenges in the preoperative, intraoperative, and postoperative setting. Regional centers of excellence with congenitally-trained cardiac surgeons, cardiologists, and other medical subspecialists are required to optimize outcome.
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Curr. Opin. Pediatr. · Aug 2009
ReviewConfidentiality, consent, and caring for the adolescent patient.
This study reviews the healthcare-related rationale for providing confidential care to adolescents, as well as the legal framework for the provision of such care. ⋯ Confidentiality for adolescents has important implications for the quality provision of healthcare for this vulnerable population. Physicians and other healthcare providers must be aware of these health implications, as well as federal policies, common law, and their individual state's laws pertaining to this important topic.
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Curr. Opin. Pediatr. · Jun 2009
ReviewPrimary ciliary dyskinesia: improving the diagnostic approach.
The diagnosis of primary ciliary dyskinesia (PCD) has relied on analysis of ciliary motility and ultrastructure; however, these tests are not readily available and have not been standardized. Consequently, the diagnosis of PCD may be delayed or missed or made incorrectly. This review outlines the potential utility of new diagnostic tests, including measurement of nasal nitric oxide production and systematic analysis for mutations in genes encoding ciliary proteins. ⋯ The incorporation of nasal nitric oxide measurement as a screening test to define probable PCD cases and gene mutation analysis to make a definitive diagnosis of PCD should enhance diagnostic evaluation of PCD.
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Simulation has been widely adopted as a training and assessment tool in medical education. Conventional teaching methods may be inadequate to properly train healthcare providers for rare but potentially lethal events in pediatrics such as trauma and respiratory arrest. Recent studies suggest pediatric acute care providers have limited exposure to critically ill patients and also lack the skills to manage them. Simulation has the potential to fill this educational void. This review will highlight the role of simulation as an educational and assessment tool, with a particular emphasis on retention of knowledge and skills. ⋯ Simulation is an effective training tool for pediatric acute care providers. Further research is necessary to develop validated performance assessment tools and demonstrate improvement in clinical outcomes after simulation training.