Pediatrics
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Review Case Reports
Remission From Behavioral Dysregulation in a Child With PTSD After Receiving Procedural Ketamine.
Ketamine, an N-methyl-D-aspartate-type glutamate receptor antagonist, has long been used for anesthesia and has recently been investigated for its rapid antidepressant effects in adults with treatment-resistant depression and posttraumatic stress disorder (PTSD). We report a case of a child with PTSD and episodes of severe aggression and emotional dysregulation that were refractory to multiple medical and behavioral interventions. ⋯ We review the sparse literature on the uses of ketamine for behavioral purposes in children. This case suggests that ketamine should be further explored as a potential treatment option for children with severe refractory behavioral aggression.
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Adolescence is a formative period when health care services have a unique opportunity to influence later health outcomes. Unmet health care need in adolescence is known to be associated with poor contemporaneous health outcomes; it is unknown whether it predicts poor adult health outcomes. ⋯ Reported unmet health care need in adolescence is common and is an independent predictor of poor adult health. Strategies to reduce unmet adolescent need should address health engagement and care quality, as well as cost barriers to accessing services.
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Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency. ⋯ Physician feedback on practice patterns relative to peers results in reduction in resource use for several common ED conditions without adversely affecting ED efficiency or quality of care.
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Adolescents face peak risks for onset and intensification of alcohol and marijuana use. However, we know little about these behaviors and their associations with knowledge or treatment adherence among chronically ill youth, a medically vulnerable group. ⋯ Alcohol and marijuana use are common among youth with chronic medical conditions. Alcohol use is associated with treatment nonadherence. Education and preventive interventions are warranted to ameliorate risk.
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Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence. ⋯ Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use.