Tuesday, May 24, 2016

Childhood Cancer Survivors - An Example of the Ecological Fallacy?

This retrospective cohort study is an important contribution to the literature, but also serves to highlight the perils of retrospective studies.

Source: Armstrong GT, Chen Y, Yasui Y, et al. Reduction in late mortality among 5-year survivors of childhood cancer. N Engl J Med. 2016;374(9):833-842; doi:10.1056/NEJMoa1510795. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among children surviving ≥5 years after childhood cancer for which treatment was initiated from 1970-1999, what is the cumulative incidence of, and factors associated with, late mortality?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, May 17, 2016

Oxygen Saturation Targets in Premature Infants - The Never-Ending Story?

This article is the latest in a series of randomized controlled trials attempting to find the safest target oxygen saturations for premature infants. It's also an extremely complex study design and report, pretty challenging to wade through, but perhaps brings us closer to the "real answer."

Source: The BOOST-II Australia and United Kingdom Collaborative Groups. Outcomes of two trials of oxygen-saturation targets in preterm infants. NEJM. 2016;374(8):749-760; doi:10.1056/NEJMoa1514212. See AAP Grand Rounds commentary by Dr. Jonathan Mintzer (subscription required).

PICO Question: Among premature infants <28 2="" 91="" age="" are="" at="" corrected="" death="" disability="" effects="" gestational="" of="" on="" or="" oxygen="" ranges="" saturation="" span="" target="" the="" vs="" weeks="" what="" years="">
Question type: Intervention
Study design: Randomized controlled trial

Tuesday, May 10, 2016

Dental Injuries in High School Sports - The Case of the Missing Denominators

Recently I helped care for a high school lacrosse player who developed mandibular osteomyelitis following wisdom tooth surgery. Once her condition was clearly headed for the better, her main focus was on when she could return to play, less so on protective equipment to prevent injury to that site.

Source: Collins CL, McKenzie LB, Ferketich AK, et al. Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years. Dent Traumatol. 2016;32(2):121-127; doi:10.1111/edt.12228. See AAP Grand Rounds commentary by Dr. Jeffrey Karp (subscription required).

PICO Question: Among US high school athletes, what is the rate of dental injury and how common is mouthguard use?
Question type: Descriptive
Study design: Prospective surveillance

Tuesday, May 3, 2016

More on Historical Controls - Hemolytic Uremic Syndrome Management

I hope I don't sound like a broken record; I commented briefly on the limitations of studies using historical controls last March, in a study of neonatal abstinence syndrome. However, the stakes are much higher in this study of hemolytic uremic syndrome (HUS). Should we overlook the limitations of historical control studies and change our practice to conform with this study's findings? Read on.

Source: Ardissino G, Tel F, Possenti I, et al. Early volume expansion and outcomes of hemolytic uremic syndrome. Pediatrics.2016;137(1):1-9; doi:10.1542/peds.2015-2153. See AAP Grand Rounds commentary by Dr. Pamela Singer (subscription required). 

PICO Question: Among children diagnosed with Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome, is early volume expansion, compared to fluid restriction, associated with improved clinical outcomes?
Question type: Intervention
Study design: Retrospective cohort

Sunday, May 1, 2016

May 2016 at Evidence eMended

Hello everyone! The May issue of AAP Grand Rounds is now available, with discussions on fetal surgery for myelomeningocele, adolescent venous thromboembolism, dental caries and vitamin D associations, and difficulties in medical follow-up in children in the child welfare system, among others.

This month in Evidence eMended, I'll be discussing oxygen saturation targets in premature infants (the subject of much controversy and ethical discussion lately), use of volume expansion for hemolytic-uremic syndrome, mouthguard impact on dental injuries in high school athletes, and factors associated with late mortality in childhood cancer. Also, May has 5 Tuesdays, meaning we'll have a special commentary on that day.

Please join me!

Tuesday, April 26, 2016

Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders - How Effective Is It?

The results of this relatively small randomized controlled trial suggest that vitamin D supplementation of severely vitamin D-deficient teenage girls with mood disorders related to premenstrual syndrome will significantly improve their symptoms. I wish they had elaborated on patient details so I could interpret the magnitude of the benefit. 

Source: Tartagni M, Cicinelli MV, Tartagni MV, et al. Vitamin D supplementation on premenstrual syndrome-related mood disorders in adolescents with severe hypovitaminosis D [published online ahead of print December 24, 2015 - In Press]. JPediatr Adolesc Gynecol. doi:10.1016/j.jpag.2015.12.006. See AAP Grand Rounds commentary by Dr. Joy Weydert (subscription required).

PICO Question: In adolescents with severe premenstrual syndrome (PMS) and vitamin D deficiency, does vitamin D supplementation reduce mood disorders associated with PMS?
Question type: Intervention
Study design: Randomized, controlled trial

Tuesday, April 19, 2016

Nebulized Hypertonic Saline for Bronchiolitis - Why Can't Researchers Get It Right?

I'm getting a little dizzy watching the pendulum swing back and forth on benefits of nebulized hypertonic saline for bronchiolitis. What gives?

Source: Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial. Pediatrics.2015;136(6):1036-1043; doi:10.1542/peds.2015-1037. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required). 

PICO Question: Among infants hospitalized for bronchiolitis, does administration of nebulized hypertonic saline decrease length of stay compared to nebulized normal saline?
Question type: Intervention
Study design: Randomized controlled

Tuesday, April 12, 2016

Can a Standardized Parent Questionnaire Diagnose Seizures in Children?

The answer to that question is a qualified "yes;" that's what Watson should be able to do! However, this study falls a little short of that goal, at least in terms of clinical utility.

Source: Douglass LM, Kuban K, Tarquinio D, et al. A novel parent questionnaire for the detection of seizures in children. PediatrNeurol 2016;54:64-69; doi:10.1016/j.pediatrneurol.2015.09.016. See AAP Grand Rounds commentary by Dr. J. Gordon Millichap (subscription required). 

PICO Question: Among children at high risk for epilepsy, how accurate is a questionnaire in establishing a history of seizures compared to assessments by pediatric neurologists?
Question type: Diagnosis
Study design: Cross-sectional

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