The Practice of Obtaining a Chest Radiograph in Pediatric Patients Presenting With Their First Episode of Wheezing: A Survey of Resident Physicians

2021 ◽  
Vol 60 (11-12) ◽  
pp. 465-473
Author(s):  
Nishit H. Patel ◽  
Ameer Hassoun ◽  
Jennifer H. Chao
Keyword(s):  
Chest Radiograph ◽  
Current Practice ◽  
Pediatric Patients ◽  
Target Audience ◽  
First Episode ◽  
Resident Physicians

A chest radiograph (CXR) is not routinely indicated in children presenting with their first episode of wheezing; however, it continues to be overused. A survey was distributed electronically to determine what trainees are taught and their current practice of obtaining a CXR in children presenting with their first episode of wheezing and the factors that influence this practice. Of the 1513 trainees who completed surveys, 35.3% (535/1513) reported that they were taught that pediatric patients presenting with their first episode of wheezing should be evaluated with a CXR. In all, 22.01% (333/1513) indicated that they would always obtain a CXR in these patients, and 13.75% (208/1513) would always obtain a CXR under a certain age (4 weeks to 12 years, median of 2 years). Our study identifies a target audience that would benefit from education to decrease the overuse of CXRs in children.

A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 213-213
Author(s):  
Jasmin Hundal ◽  
Matthew J Hadfield ◽  
Alifaiz Saiyed ◽  
William Rabitaille
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Hpv Vaccine ◽  
Current Practice ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Shared Decision ◽  
Resident Physicians ◽  
Internal Medicine Residents ◽  
Attending Physicians

213 Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.

Pediatric Central Venous Catheter Management: A Review of Current Practice

2013 ◽  
Vol 18 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Mary Beth Hovda Davis
Keyword(s):  
Current Practice ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Common Complication ◽  
Successful Therapy ◽  
Central Venous ◽  
Vessel Size ◽  
Intravenous Treatment ◽  
Pediatric Populations

Abstract Due to small vessel size, obtaining stable access in pediatric patients is difficult. In addition, because needle stick pain is a concern for patients with chronic illness, central venous catheters are often utilized to provide intravenous treatment. Catheter occlusion is a common complication in pediatric patients and must be addressed to salvage the catheter and ensure successful therapy. The use of fibrinolytics for occlusion treatment have been successful in pediatric populations.

Is Pre-Psychotic Intervention Realistic in Schizophrenia and Related Disorders?

1997 ◽  
Vol 31 (6) ◽  
pp. 799-805 ◽  
Author(s):  
Alison R. Yung ◽  
Patrick D. McGorry
Keyword(s):  
Psychotic Disorders ◽  
Current Practice ◽  
Critical Evaluation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Preventive Interventions ◽  
Prodromal Phase ◽  
Ongoing Research ◽  
Economic Implications ◽  
Episode Psychosis

Objective: The aim of this paper is to discuss the logistic and ethical questions related to the possibility of intervention prior to the onset of first-episode psychosis (i.e. during the prodromal phase). Method: The method involved examination of the published literature on prevention of psychotic disorders and other mental disorders, and critical evaluation of current practice in treating pre-psychotic individuals. Results: Issues of possibly unnecessary or premature labelling, stigma and treatment arise. The question of whether such early intervention merely diagnoses the disorder earlier but does not actually improve outcome is also discussed, as are the economic implications of shifting emphasis from treatment of established disorders to preventive interventions. Conclusions: There are many legitimate concerns related to intervening in pre-psychotic individuals which must be understood by those involved in planning preventive interventions. Policies should be developed incorporating some of the ethical and economic concerns, and these need to be evaluated and changed in response to ongoing research. However, these issues need not stand in the way of the development of innovative preventive approaches to the treatment of schizophrenia and other psychotic disorders.

scholarly journals Recanalization strategies in childhood stroke in Germany

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Martin Olivieri ◽  
Anna-Lisa Sorg ◽  
Raphael Weinberger ◽  
Karin Kurnik ◽  
Christoph Bidlingmaier ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Intervention Group ◽  
Rare Event ◽  
First Episode ◽  
Facial Weakness ◽  
Arterial Ischemic Stroke ◽  
Rare Disorders ◽  
Presenting Symptoms ◽  
Nationwide Surveillance ◽  
A Minor

AbstractChildhood arterial ischemic stroke (CAIS) is a rare event. Diverse etiologies, risk factors, symptoms and stroke mimics hamper obtaining a fast diagnosis and implementing immediate recanalization strategies. Over a period of 3 years (2015–2017), the data of 164 pediatric patients (> 28 days of life-18 years) with a first episode of AIS were submitted to a hospital-based nationwide surveillance system for rare disorders (ESPED). We report a subgroup analysis of patients who have undergone recanalization therapy and compare these data with those of the whole group. Twenty-eight patients (17%) with a median age of 12.2 years (range 3.3–16.9) received recanalization therapy. Hemiparesis, facial weakness and speech disturbance were the main presenting symptoms. The time from onset of symptoms to confirmation of diagnosis was significantly shorter in the intervention group (4.1 h vs. 20.4 h, p ≤ 0.0001). Only in one patient occurred a minor bleed. Cardiac disease as predisposing risk factor was more common in the recanalization group. Recanalization therapies are feasible and increasingly applied in children with AIS. High awareness, timely diagnosis and a large amount of expertise may improve time to treatment and make hyperacute therapy an option for more patients.

scholarly journals Transition of Care for Pediatric and Adult Patients with Venous Thromboembolism in the American Thrombosis Hemostasis Network

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4711-4711
Author(s):  
Madhvi Rajpurkar ◽  
Maura Malone ◽  
Jim Munn ◽  
Julie Jaffray ◽  
Crystal Watson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Research Funding ◽  
Pediatric Patients ◽  
Anticoagulation Therapy ◽  
Adult Patients ◽  
First Episode ◽  
Transition Of Care ◽  
Significant Difference

Abstract Background Venous thromboembolism (VTE) is the third leading cause of cardiovascular morbidity and mortality worldwide in adults and is increasingly seen in children. Optimal transition of care (TOC) from the inpatient to the outpatient setting may lead to improved outcomes for patients with VTE. Although several examples of TOC for patients with VTE exist, this project (ATHN 4: Transition of Care for Patients with VTE) is the first to create a uniform TOC model in the U.S that includes both pediatric and adult patients. The aim of this study was to improve the transition of care of adult and pediatric patients discharged on an anticoagulant after a first episode of VTE and evaluate patient/parent understanding and adherence to anticoagulation therapy-related instructions at seven and 30 days after hospital discharge. Methods Pediatric and adult hospitalized patients with a first episode of VTE requiring anticoagulation therapy were eligible to participate in ATHN 4, a multi-center quality improvement (QI) project conducted by the American Thrombosis and Hemostasis Network (ATHN). The project has two phases: a pre-intervention (PI) phase with no change in standard TOC practice, and a QI intervention phase consisting of enhanced education with standardized Comprehensive Discharge Instruction Modules (CDIM) for each anticoagulant. Demographics, disease, treatment characteristics, and outcomes were collected. Knowledge and feedback questionnaires were administered at 30 days post-discharge. Adult and pediatric data from the PI phase are presented. Results Complete data were submitted for 188 (91%) patients who were enrolled in the PI phase between May 2016 and March 2017 (Table 3). Results show that 73 (39%) were under 18 years of age, 90 (48%) were female, and 156 (83%) were non-Hispanic. A significant difference (p<0.001) in the location of the first VTE was noted among the pediatric and adult patients (Table 4). Approximately 66% (n=48) of the pediatric patients had a DVT, compared to 30% (n=34) of the adult patients. There were more adults with PE as compared to pediatric patients(43% vs. 3%). Adult and pediatric patients differ substantially (p <0.001) with respect to anticoagulant prescriptions. Pediatric patients were more likely to be prescribed Enoxaparin at discharge compared to adults (86% vs. 21%). Additionally, a significantly larger proportion of adult compared to pediatric patients was prescribed Warfarin (17% vs. 3%). Direct oral anticoagulants (DOACs) were mainly prescribed in the adult patients: Apixaban (24% vs. 0%) and Rivaroxaban (18% vs. 3%) compared to the pediatric patients. Based on the responses provided by the patients or guardians (for pediatric patients) during the Day 30 follow-up, there was almost an equal distribution among pediatric and adult patients who by clinical assessment were determined to have correctly taken the prescribed anticoagulant between the time of discharge and follow-up (98.6% of pediatrics and 97.4% of adults). Conclusions Our quality improvement study shows that the majority of pediatric and adult patients correctly took the anticoagulation medication prescribed to them at discharge for at least a month. Majority of pediatric patients presented with a DVT while PE was the most common presentation in adult patients. Enoxaparin and Apixaban were the most commonly prescribed anticoagulants to pediatric and adult patients, respectively. Factors affecting anticoagulation adherence and outcomes in these patients are currently being analyzed. Disclosures Rajpurkar: Bristol Myers Squibb: Research Funding; Shire: Honoraria; HEMA biologics: Honoraria; Pfizer: Honoraria, Research Funding; Novonordisk: Honoraria. Jaffray:Octapharma: Consultancy; CSL Behring: Consultancy, Research Funding; Bayer: Consultancy.

scholarly journals Recanalization strategies in childhood stroke: a 3-year surveillance study in Germany

2021 ◽  
Author(s):  
Martin Olivieri ◽  
Anna-Lisa Sorg ◽  
Raphael Weinberger ◽  
Karin Kurnik ◽  
Christoph Bidlingmaier ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Intervention Group ◽  
Rare Event ◽  
First Episode ◽  
Childhood Stroke ◽  
Facial Weakness ◽  
Rare Disorders ◽  
Presenting Symptoms ◽  
Nationwide Surveillance ◽  
A Minor

Abstract Objective Childhood acute ischemic stroke (CAIS) is a rare event. Diverse etiologies, risk factors, symptoms and stroke mimics hamper obtaining a fast diagnosis and implementing immediate recanalization strategies. Methods Over a period of 3 years (2015–2017), the data of 164 pediatric patients (> 28 days of life-18 years) with a first episode of AIS were submitted to a hospital-based nationwide surveillance system for rare disorders (ESPED). We report a subgroup analysis of patients who have undergone recanalization therapy and compare these data with those of the whole group. Results Twenty-eight patients (17%) with a median age of 12.2 years (range: 3.3–16.9) received recanalization therapy. Hemiparesis, facial weakness and speech disturbance were the main presenting symptoms. The time from onset of symptoms to confirmation of diagnosis was significantly shorter in the intervention group (4.1h vs. 20.4 h, p = < 0.0001). Only in one patient occurred a minor bleed. Cardiac disease as predisposing risk factor was more common in the recanalization group. Conclusion Recanalization therapies are feasible and increasingly applied in children with AIS. High awareness, timely diagnosis and a large amount of expertise may improve time to treatment and make hyperacute therapy an option for more patients improving their outcomes.

Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study

2009 ◽  
Vol 15 (3) ◽  
pp. 363-370 ◽  
Author(s):  
M Atzori ◽  
PA Battistella ◽  
P Perini ◽  
M Calabrese ◽  
M Fontanin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Prospective Study ◽  
Pediatric Patients ◽  
Age At Onset ◽  
Acute Disseminated Encephalomyelitis ◽  
First Episode ◽  
Laboratory Findings ◽  
Clinical Onset ◽  
Magnetic Resonance Imaging Mri

Objective The purpose of the study was to compare and contrast the initial presenting demographic, clinical, neuroimaging, and laboratory features in a cohort of children affected from multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). Methods A 12-year prospective study was conducted in 68 pediatric patients (age ≤ 17 years) who presented with a first episode of central nervous system inflammation suggestive of a demyelinating multifocal pathology. All patients had undergone magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The mean follow-up period, as at ending on December 31, 2007, was 6.8 ± 2.7 years (range 3.2–12.6 years). Results At clinical onset, children who developed MS during the follow-up (48 patients; 34 females, 14 males; mean age at onset: 14.4 ± 2.5) significantly differed from children affected by ADEM (20 patients; 8 females, 12 males; mean age at onset: 8.1 ± 3.8 ) for the following parameters: prevalence of females affected (female/male ratio: 2.8 versus 0.6, P = 0.03); mean age at onset ( P < 0.001); monosymptomatic onset (73% vs 30%, P = 0.002); encephalopathy-like onset (0% vs 50%, P < 0.001); presence of oligoclonal IgG bands (IgGOB) in CSF (83% vs 10%, P < 0.001); and periventricular (79% vs 20%, P < 0.001), brain stem (12.5% vs 60%, P = 0.000), and basal ganglia (10% vs 50%, P < 0.001) lesions at MRI. Conclusions Our findings depict a pattern of demographic, clinical, neuroimaging, and laboratory findings that can help to distinguish, at clinical onset, children suffering from ADEM from those who will develop MS. Childhood-onset MS seems not to differ from adult-onset MS from both clinical and paraclinical features.

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