Pediatrics
-
Multicenter Study
Improving the rate of preschool vision screening: an interrupted time-series analysis.
To implement a 6-month quality improvement project in 13 clinics in North Carolina to improve vision screening rates for children 3 through 5 years of age. ⋯ We were successful in standardizing vision testing. Even with training, the proportion of untestable children was high. Rates of documented referral were low, which reflects provider concerns about testing accuracy. New strategies are needed to improve testability and ensure timely referral and follow-up after an abnormal vision screen result.
-
Although research on complementary and alternative medicine (CAM) therapies is still limited, systematic reviews have revealed sufficient evidence to conclude that CAM can be effective for certain conditions. In this article we discuss clinicians' responsibilities to inform parents/patients about CAM alternatives and use the example of acupuncture for chemotherapy-induced nausea and vomiting. Chemotherapy-induced nausea and vomiting remain significant adverse effects of cancer therapy, and some patients cannot find relief with standard therapies. ⋯ However, as CAM therapies such as acupuncture become better studied and their safety and efficacy are established, the scope of disclosure required may expand to include them. The legal and ethical obligation to obtain informed consent to treatment requires disclosure and discussion of therapies when there is reliable evidence of potential therapeutic benefit. At the same time, the more limited state of knowledge regarding effects of a particular therapy in the pediatric population must be factored into decision-making when treating a child.
-
Hyperventilation in pediatric resuscitation: performance in simulated pediatric medical emergencies.
To examine the hypothesis that pediatric resuscitation providers hyperventilate patients via bag-valve-mask (BVM) ventilation during performance of cardiopulmonary resuscitation (CPR), quantify the degree of excessive ventilation provided, and determine if this tendency varies according to provider type. ⋯ Hyperventilation occurred in simulated pediatric resuscitation and did not vary according to provider type. Future educational interventions should focus on avoidance of excessive ventilation.
-
Annually, millions of children are exposed to anesthetic agents that cause apoptotic neurodegeneration in immature animals. To explore the possible significance of these findings in children, we investigated the association between exposure to anesthesia and subsequent (1) learning disabilities (LDs), (2) receipt of an individualized education program for an emotional/behavior disorder (IEP-EBD), and (3) scores of group-administered achievement tests. ⋯ Repeated exposure to anesthesia and surgery before the age of 2 was a significant independent risk factor for the later development of LDs but not the need for educational interventions related to emotion/behavior. We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence.
-
Comparative Study
Disparities in provider elicitation of parents' developmental concerns for US children.
To examine factors associated with provider elicitation of parents' developmental concerns among US children. ⋯ Racial/ethnic and linguistic disparities exist in provider elicitation of developmental concerns. Addressing lack of insurance, medical homes, and specific medical-home components might reduce disparities.