April 13, 2016
Volume VII | Issue No. 15

Trajectories of functioning into adulthood following treatment for adolescent depression
From a study of 196 adolescents (<18 years of age) diagnosed with depression, who underwent cognitive behavioral, drug therapy, a combination of both, (or no therapy) for 3.5 years and who were then followed for the next 36 weeks, it appears that all treated adolescents have improved global functioning and achievements of developmental milestones (college, employment, etc.), while untreated patients and/or those with multiple psychiatric comorbidities have a greater risk of poorer outcomes.

Journal of Adolescent Health

See related video HERE>> 
Does "Restraint" use correlate for the need of trauma team activation in motor vehicle crash rollovers (MVC-R)
A study of 690 patients <16 years involved in MVC-R which evaluated "restraint status" the need for transfusion or intervention in the Emergency Department (ED), hospital and intensive care (IC) length of stay and mortality indicates that those improperly restrained (48%) are more likely to require intubation, receive blood transfusion in the ED, require ICU care, have a longer hospital length of stay and a higher mortality than those properly restrained.
"Restraint status" with the rollover criteria should be incorporated into activation of the trauma team.
Co-occurrence of developmental and behavioral problems in moderate to late preterm-born children (MLP)
Emotional and behavioral problems (EBP) occur in 39% of four year old moderate to late preterm infants with developmental delay. Increased awareness is necessary to potentially improve long-term outcomes.



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Mother/baby skin-to-skin (S-T-S) contact

Three interesting articles address the benefits of maternal infant mother/baby skin-to-skin (STS) contact.
1.  A study on 10 infants born at 26-35 weeks gestation investigated infant pain (plus other parameters) during venipuncture with STS contact (vs. being in an incubator or crib), shows that STS contact reduces infant pain (particularly important as pain related stress appears to affect brain growth and function in very premature infants).
Acta Paediatrica

2.  Low birth weight newborn infants (1,500-2,500gm) randomized to receive routine care at or after birth, or STS contact over the first six hours of life, where intravenous fluid requirements, respiratory support and antibiotic usage was measured, indicates that STS care infants appear to be more stable and to require less subsequent medical support.
Video Feature 
Mother/baby skin-to-skin contact
Mother/baby skin-to-skin contact
Sperm parameters in adolescent varicocele patients with symmetrical testicular volumes

"Idiopathic varicocele is a common condition that may impair fertility". Treatment is usually only undertaken when symptoms or testicular growth arrest occurs.

A prospective study of 41 un-operated upon adolescents (median age 15.4 years; range 12-17 years) with varicocele (mostly visible) who had sperm samples measured (by masturbation) for semen volume, sperm concentration and forward motility indicates that median sperm concentration and forward motility does not correlate with age with 83% having normal sperm parameters (WHO definition).

Measurement of radiation exposure when using the Mini C-Arm to reduce pediatric upper extremity fracture

The C-arm is a radiographic imaging scanner used primarily for fluoroscopic imaging during orthopedic, surgical, critical and emergency care procedures. Previous studies have underreported radiation exposure with the use of the Mini C-arm during pediatric forearm fracture reductions.

It appears from a study of 86 consecutive pediatric patients where reductions and casting of a fracture was undertaken by Orthopedic Residents in an Emergency Department that radiation levels using the C-arm exceed those from conventional radiographs (in most cases). More Resident training appears to be needed.

Journal of Pediatric Orthopaedics
Intravenous fluid for acute migraine pain
"A total of 1.2 million patients annually present to the US Emergency Departments (ED) with migraine headaches", and intravenous fluids (IVF) are frequently given to treat the acute symptoms. Little (or no) data is available to support its use.
A post hoc short-term analysis of data collected on 570 migraine patients treated with intravenous metoclopramide (20% of whom were treated additionally with IVF's) and assessed for relief of pain at 1 hour and at 24 hours, indicates that intravenous fluids do not improve pain outcome among patients with acute migraine treated with IV metoclopramide.
3 EHR Must-Have Features to Find Success in Next Leg of ICD-10

Guest Blog by Dr. Seth Flam 
October 1 2015 came and we all survived. Many providers are finding that their claims are being paid. But ... we are in the honeymoon period. Remember, a few months prior to the start of ICD-10, CMS relaxed the claim submission standard.  
Later this year, more precise coding of claims will be required. There are three reasons that many billing systems will fail...

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