Outcomes in adolescent inflammatory bowel disease (IBD) following transfer from Pediatric Adult Health Care Services
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A study of 2 groups of children with IBD, one group going through a formal "transition system" (defined as "high-quality, developmentally appropriate, healthcare services that continue uninterrupted as the individual moves from adolescence to adulthood") vs. no formalized arrangement being made before transfer, indicates that the latter group exhibits more non-attendance at clinics, hospital admissions, & surgical interventions, with less drug compliance and growth.
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Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)
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ACNES is a condition resulting in chronic neuropathic pain of the ventral abdominal wall from terminal branches of the lower intercostal nerves (7-12) being "entrapped" in abdominal muscles. Patients may also report symptoms relating to autonomic nervous system function including bloating, nausea, anorexia and weight loss. As a somewhat uncommon condition it is frequently misdiagnosed, resulting in many unnecessary diagnostic interventions and procedures.
A small study of data from 9 children with ACNES (aged 10-19 years) suggests that while local anesthetic injection, with or without corticosteroids (analgesics are minimally effective) are effective in about 2/3 of patients, earlier surgical treatment results in complete recovery in almost all patients.
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Perflubron-induced lung growth in neonates with Congenital Diaphramatic hernia (CDH)
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Mechanical stretching of the lung stimulates fetal cell proliferation and improves fetal lung differentiation and maturation.
Perflubron is a liquid contrast medium which may be used to facilitate liquid breathing as it is capable of carrying more oxygen and carbon dioxide than blood.
A study of Extracorporeal membrane oxygenation (ECMO) eligible infants with left-side CDH, half of whom had Perflubron installed endotracheally with oxygen, and continuous positive airway pressure treatment; the other half receiving conventional ventilation and where survival to discharge and lung size were endpoints indicates that Perflubron-induced lung growth/gas exchange in CDH is safe and on average doubles lung size (associated with earlier surgical repair).
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Adolescent eating disorders - outcomes in young adulthood
The presence of anorexia nervosa (AN), bulimia nervosa (BM), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) was ascertained in 6,140 youths at age 14 years, and 5,069 at age 16 as part of a longitudinal study. Physical and mental outcomes were assessed two years later.
Adolescent eating disorders, including subthreshold presentations predict subsequent mental health disorders, substance abuse, self-harm and weight outcomes (overall it appears that after following therapy approximately 50% of adolescents, with AN recover fully 30% improve with some residual symptoms and 20% have a chronic cause, ED).
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Sudden Infant Death Syndrome (SIDS), Sudden Unexpected Death in Infancy (SUDI) and bed sharing
From a study of 261 infants who died and were autopsied, data suggests a significantly higher prevalence of bed sharing in SIDS than SUDI, with prone sleep position still playing an important role in SIDS' deaths. (congenital anomalies, bronchopneumonia and other infections are the most common causes of SUDI).
Acta Paediatrica
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Concomitant fundoplication and gastrostomy outcomes
"Little is known about the impact of fundoplication on peri-operative outcomes" when it occurs at the same time as gastrostomy tube (GT) placement.
Data form a study of 148 GT patients who underwent concurrent fundoplication, suggests that these patients are frequently younger, often have cardiac and respiratory risk factors and have increased morbidity/hospital length of stay.
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Using axillary temperature to approximate rectal temperature in newborns
Consecutive samples of rectal and axillary temperatures were taken on 175 infants, gestational ages 24-42 weeks.
It appears that simply adding 0.3C to the axillary temperature of premature infants, and 0.4C for the full term, yields acceptable rectal temperatures in most cases.
Acta Paediatrica
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Patient Privacy in the Age of the Patient Portal
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Let's take the case of a young female adolescent patient that has traditionally shared portal and EHR access with her parent, at the insistence of the parent. This adolescent female has just become sexually active, she wants counseling regarding avoiding STDs - and she has decided to begin using the birth control pill. Breaching her confidentiality could ultimately cause her to forgo her care. So, how do you negotiate between her privacy and the use of an EHR?
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