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Flushing of the vagina and prepuce
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Acquiring an uncontaminated urine specimen to diagnose urinary tract infection may be difficult in young children.
An interesting study of micturating cystourethrograms (MCUG) in 562 children indicates that 38% of uncircumcised boys (particularly those <12months of age &/or with vesicoureteral reflux ) have ballooning of their foreskin, and 14.3% of girls have vaginal reflux, during voiding. Both increase the likelihood of urinary contamination when urine is obtained by "clean catch" or with a bag.
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High-flow nasal cannula (HFNC) oxygen vs. standard oxygen therapy for bronchiolitis
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An analysis of cost-effectiveness and pediatric intensive care admission rates for infants diagnosed with bronchiolitis which compared standard oxygen therapy to HFNC oxygen administration indicates that HFNC is more effective, costs less and is recommended as the preferred approach for hospitalized infants with bronchiolitis.
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Etiology of acute respiratory infections (ARIs) in infants
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A birth cohort followed for the first year of life in which each episode of ARI was documented with identification of the causative organism, suggests that most infections (1.8 episodes per year per infant) are upper respiratory (63.3%) and viral (rhinovirus -42%; Respiratory Syncytial virus -20%; parainfluenza virus 16.8%; and coronavirus -17%).
Lower respiratory tract infections are usually viral, bacterial and mixed bacterial-viral infections. Peak months are winter and fall.
Pediatric Infectious Disease Journal
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| Acute Respiratory Infections |
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Post-surgical repair of congenital diaphragmatic hernia (CDH) and long-term pulmonary function
There are at least three types of CDH with Bochdalek hernias (postero-lateral) on the left side being the most common. The acute and chronic side-effects following repair are mostly due to pulmonary hypoplasia and pulmonary hypertension.
A study of 27 CHD survivors aged 5-20 years clinically and spirometrically evaluated (and compared to a 2:1 matched control group) indicates that 48% continue to have both clinical and spirometric evidence of pulmonary disease; 50% have lower peak oxygen consumption, and on exercise oxygen related heart rate, tidal volume and minute ventilation are all decreased.
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Adolescent idiopathic scoliosis and weight
Though there are many causes of the spine to curve sideway (twisting or rotating) in adolescents >10 years of age "idiopathic" appears to be the most common. Many children will have small curves which require no treatment, though negative changes may occur rapidly with a growth spurt.
A retrospective study of 150 patients (normal weight, over weight and obese) to determine the effect of BMI on the severity of the curve in idiopathic scoliosis, indicates that overweight and obese children develop significantly greater curvatures with almost all requiring surgical correction.
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Palivizumab (Synergis) in high risk infants with respiratory syncytial virus (RSV) infections
While RSV infections in infants most commonly present with a cold-like illness, 25-40% may have evidence of bronchiolitis or pneumonia; many of whom require hospitalization. Palivizumab is a whole monoclonal antibody produced by recombinant DNA technology to RSV protein F. It is recommended by the AAP as an RSV preventative measure in high risk infants.
A study 14,468 infants compared hospitalization rates between premature infants and those with an underlying disorder who were given Palivizumab.
RSV hospitalization rates appear particularly high for those infants with neuro-muscular diseases, and airway anomalies. Bronchopulmonary dysplasia, significant congenital heart disease, Down Syndrome and prematurity (<28 weeks gestation) also significantly predict hospitalization.
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Infected congenital epicardial cyst
"Cysts within the pericardial cavity are rare" and are usually divided into epicardial and pericardial subtypes. Frequently they are asymptomatic; however when large they can compress surrounding vital structures, causing significant morbidity (and should then be excised).
An unusual presentation in a three year old boy who presented to an Emergency Department with acute abdominal pain, fever and vomiting in whom an infected epicardial cyst was eventually diagnosed, reminds us that the etiology of an "acute abdomen" may reside (very rarely!) in the chest.
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| Miami Children's Health System's journey from a stand alone children's specialty hospital to the pediatric health system known today all around the world |
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The Independent Medical Practice is Far From Dead ... And It Can Thrive Under MACRA
Seth Flam, DO |
HealthFusion
As healthcare transitions to value-based care and presents an increasingly challenging environment for independent practitioners, the notion that physicians are selling their practices and taking jobs as employees of hospitals and health systems permeates the healthcare community.
In a recent survey, twenty percent of residents asked would be open to a partnership with another physician, implying they'd be willing to co-own a practice. This suggests that the entrepreneurial spirit isn't entirely dormant among newly trained doctors.
The independent practice is hardly dying out among established physicians, as well. A new AMA report actually found that growth in hospital ownership has been slow while most physicians s
till provide care for patients in small practices.
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