Pediatric clinics of North America
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Pediatr. Clin. North Am. · Dec 2020
ReviewThe Critical Role of Clinical Practice Guidelines and Indicators in High-Quality Survivorship After Childhood Cancer.
Childhood cancer survivors are at significant risk for late cancer treatment-related morbidity and mortality. Physicians involved in the care of childhood cancer survivors should be aware of these specific health problems and provide high-quality, long-term follow-up care to preserve and improve survivors' health. The steps required to achieve high-quality care include synthesizing evidence (systematic reviews are helpful in this regard), developing clinical policy from evidence into evidence-based clinical practice guidelines, disseminating and implementing clinical practice guidelines, and evaluating their impact on quality of care and survivor health outcomes with quality indicators. This article describes these cornerstones of evidence-based medicine.
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Racial bias is pervasive throughout society and can impact children and adolescents in the health care, education, and criminal justice systems. This article provides a state-of-the-science review of implicit bias in health care. It also reviews the evidence of how bias impacts children in other aspects of society, explores bias as it relates to the broader context of structural racism in America, and summarizes the impact of bias and discrimination on youth academic, behavioral, and health outcomes. Evidence-based strategies are provided to help pediatricians identify and confront their own personal biases.
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The management of pediatric orthopedic trauma continues to evolve rapidly. Whereas the strong healing potential of pediatric patients often allows for the nonoperative treatment of most conditions, many injuries require urgent operative treatment to ensure that patients may return to all activities without disability. ⋯ The keys to diagnosis, acute management, nonoperative and operative treatments, and complications are discussed. The detection and management of nonaccidental trauma are also examined.
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Although recent spikes in overdose deaths are largely attributable to heroin and fentanyl, prescription opioids still account for a significant percentage of overdose deaths. Additionally, overdose deaths are not a problem solely for adults; roughly 8% of all overdose deaths occur in persons aged 15 to 24. In addition to identifying factors that increase risk for misuse and negative outcomes among adolescents, research must examine the causal mechanisms that link these factors to increased risk. Finally, the extant research must serve as the foundation for prevention/intervention strategies and identify treatments that are effective among adolescents with opioid use disorders.
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Food allergy is an immune-mediated disease and must be differentiated from other adverse effects related to food that are non-immune mediated. Symptoms of immunoglobulin (Ig) E-mediated allergy can range from mild to severe, and life-threatening anaphylaxis may occur. ⋯ Treatment approaches under investigation include immunotherapy as well as biologics and novel vaccines. Attention has also recently focused on implementing strategies for prevention of food allergy.