Pediatric clinics of North America
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Pediatr. Clin. North Am. · Aug 2019
ReviewTeaching at the Bedside: Strategies for Optimizing Education on Patient and Family Centered Rounds.
Resident and attending concern about the potential for decreased teaching has been cited as one of the drawbacks to the adoption of family-centered rounds (FCR). Despite these concerns, FCR can enhance clinical education through direct exposure to multiple patients by all team members, as well as by allowing faculty to teach, model, observe, and assess learners' clinical skills more effectively than in nonbedside settings. This article provides many strategies and approaches to bedside teaching designed to enhance education and communication among care team members as well as patients and their families.
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Globally, significant progress in health equity for children has been made, but much work remains. This article discusses why and how the pediatric community in North America is building a global health (GH) workforce, for domestic "local global" and "international global child health" settings. ⋯ The authors highlight currently available training approaches and resources for each group. Global child health is now within the purview of every pediatrician in North America.
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Early-onset sepsis (EOS) is an important cause of neonatal morbidity. Despite extensive study, identifying at-risk newborns remains challenging, especially if they are initially well appearing. ⋯ Recent studies indicate that more precise risk assessment and alternative management strategies could decrease the number of infants exposed to blood draws and antibiotics during evaluations for EOS. This article reviews existing guidelines and provides an overview of the Bayesian sepsis calculator and serial observation as an alternative to laboratory studies and empirical antibiotics.
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Nephrogenic diabetes insipidus (NDI) results from the inability of the late distal tubules and collecting ducts to respond to vasopressin. The lack of ability to concentrate urine results in polyuria and polydipsia. ⋯ Secondary NDI is associated with electrolyte abnormalities, obstructive uropathy, or certain medications. Management of NDI can be difficult with only symptomatic treatment available, using low-solute diet, diuretics, and prostaglandin inhibitors.
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Pediatr. Clin. North Am. · Dec 2018
ReviewRecognition, Diagnostics, and Management of Pediatric Severe Sepsis and Septic Shock in the Emergency Department.
Several new studies have emerged in recent years that have attempted to aid emergency department providers in recognizing and treating pediatric patients with severe sepsis and septic shock. National guidelines and supporting literature are unanimous in recommendations that early recognition and timely therapeutics are necessary for improved survival and decreased morbidity. The literature is less concrete in defining how emerging advances in the field can aid in time-sensitive care of these patients. This article summarizes the recent literature as it pertains to the initial presentation of severe sepsis and septic shock in the pediatric patient within the emergency department.