Pediatrics
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Clinical Trial
Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients.
To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population. ⋯ A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.
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Filling a prescription is the important first step in medication adherence, but has not been studied in pediatric primary care. The objective of this study was to use claims data to determine the rate of unfilled prescriptions in pediatric primary care and examine factors associated with prescription filling. ⋯ More than 20% of prescriptions in a pediatric primary care setting were never filled. The significant associations with clinical site, visit type, and electronic prescribing suggest system-level factors that affect prescription filling. Development of interventions to increase adherence should account for the factors that affect primary adherence.
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Case Reports
Favorable outcome in a newborn with molybdenum cofactor type A deficiency treated with cPMP.
Molybdenum cofactor deficiency (MoCD) is a lethal autosomal recessive inborn error of metabolism with devastating neurologic manifestations. Currently, experimental treatment with cyclic pyranopterin monophosphate (cPMP) is available for patients with MoCD type A caused by a mutation in the MOCS-1 gene. Here we report the first case of an infant, prenatally diagnosed with MoCD type A, whom we started on treatment with cPMP 4 hours after birth. ⋯ Rapid improvement of GM quality together with normal FMs at 3 months is highly predictive of normal neurologic outcome. We demonstrated that a daily cPMP dose of even 80 μg/kg in the first 12 days reduced the effects of neurodegenerative damage even when seizures and cramped-synchronized GMs were already present. We strongly recommend starting cPMP treatment as soon as possible after birth in infants diagnosed with MoCD type A.
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Resident work hour changes in children's hospitals: impact on staffing patterns and workforce needs.
Changes to the structure and nature of resident duty hour assignments can create compensatory workforce needs in hospital or outpatient settings to ensure appropriate patient care. The objective of this study was to understand what, if any, adjustments children's hospitals have made in staffing and assignments of specific duties during the past 2 years as a result of residency duty hour changes, and what changes are anticipated in the upcoming 2 years. ⋯ Changes in work hours for pediatric residents appear to have an impact on workforce planning within pediatric hospitals. Decreases in available resident work hours will create an increasing demand, primarily for nonresident physicians, PNPs, and NNPs.
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We sought to determine the impact of rotavirus vaccine implementation on gastroenteritis (GE)-related calls to a large telephone triage service in Tennessee. ⋯ A decline in GE-related call proportions among young children after rotavirus vaccine licensure was documented by using a novel surveillance platform that captures mild GE not detected in other surveillance systems. Since rotavirus vaccine licensure, peak call proportions correlate with regional norovirus activity, highlighting the role of that pathogen in community GE.