Tuesday, March 24, 2015

40 Years in the Desert of Osteomyelitis

When I began my pediatric infectious diseases fellowship over 30 years ago, it was already well-established that a short course of IV therapy, followed by a more extended regimen of high-dose oral antibiotic therapy, was effective treatment for uncomplicated acute hematogenous osteomyelitis. Why are we still discussing this 40 years after landmark studies supported this approach?

Source: Keren R, Shah SS, Srivastava R, et al. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015; 169(2):120-128. doi:10.1001/jamapediatrics.2014.2822. See AAP Grand Rounds commentary by Dr. Matthew Garber (subscription required). 

PICO Question: Among children hospitalized with acute hematogenous osteomyelitis, how does postdischarge treatment with intravenous antibiotics compare to treatment with oral antibiotics?
Question type: Intervention
Study design: Retrospective cohort

Tuesday, March 17, 2015

Handoffs as Tradeoffs - Have Trainee Duty Hour Restrictions Decreased Medical Errors?

Welcome to the morass that is 21st century medicine: a multitude of available tests and treatments, improved survival accompanied by increased complexity in patient care, the (usually dysfunctional) electronic health record, and Big Data. Plop the Accreditation Council for Graduate Medical Education's duty hour restrictions into this, and you have a recipe for disaster. Is there anyone left who actually knows the patient? Here's a little progress to stem the tide.

Source: Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med.2014;371(19):1803-1812; doi:10.1056/NEJMsa1405556. See AAP Grand Rounds commentary by Dr. Justin Schreiber (subscription required). 

PICO Question: Among pediatric residents, does use of a standardized handoff improvement program decrease preventable adverse events and medical errors?
Question type: Prevention
Study design: Prospective intervention

Tuesday, March 10, 2015

A "Cheap" Study of Colds and Flu

We have several classic household studies of respiratory illness epidemiology from the 1960s and 1970s, but not much recently. It's pretty expensive to do household surveillance studies, but this group of investigators tried to get by save a few dollars and still provide us with some more current information.

Source: Monto AS, Malosh RE, Petrie JG, et al. Frequency of acute respiratory illnesses and circulation of respiratory viruses in households with children over 3 surveillance seasons. J Infect Dis. 2014;210(11):1792-1799; doi:10.1093/infdis/jiu327. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

PICO Question: Among households with children, what are the frequencies and causative agents of acute respiratory illnesses?
Question type: Descriptive
Study design: Longitudinal prospective cohort

Tuesday, March 3, 2015

Home Births and Congenital Heart Disease Screening: An Oxymoron?

I guess this study was mostly a proof of concept attempt, showing that children born at home still could be screened for cyanotic congenital heart disease. However, it made me wonder more about how this proposal fit into the concept of home births in general.

Source: Lhohst J, Goetz E, Belling J, et al. Pulse oximetry screening for critical congenital heart disease in planned out-of-hospital births. J Pediatr. 2014;165(3):485-509; doi:10.1016/j.jpeds.2014.05.011. See AAP Grand Rounds commentary by Dr. Jeffrey Anderson (subscription required). 

PICO Question: Among infants with planned out-of-hospital births, is routine pulse oximetry feasible in identifying critical congenital heart disease?
Question type: Diagnosis
Study design: Prospective cohort

Sunday, March 1, 2015

Evidence eMended Marches On

I suspect March wasn't Julius Caesar's favorite month, but there's a lot to like in this month's offerings in AAP Grand Rounds. You'll find a wide array of topics, from central line infections to developmental hip dysplasia followup and another subanalysis from the PECARN blunt torso trauma study (see my posting just last week about the seat belt sign from this same study).

In my weekly offerings, I'll be discussing articles on the frequency of respiratory illness in young children, use of pulse-oximetry in out-of-hospital births, a clever handoff pneumonic for pediatric residents on inpatient services, and oral antibiotics for osteomyelitis, the latter being a great introduction to the concept of comparative effectiveness research.

By the way, I learned, via Wikipedia, a bit about Ides (13th or 15th day of each month, depending on its length), as well as the Nones (5th or 7th day) and the Kalends (1st day of the month).

So, Happy Kalends!

Tuesday, February 24, 2015

How Helpful is the Seat Belt Sign in Abdominal Trauma?

This very large multicenter study attempted to answer this question, but as with most studies we are left with more questions than answers. I had some fun doing my own number crunching here.

Source: Borgialli DA, Ellison AM, Ehrlich P, et al. Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Acad Emerg Med.2014;21(11):1240-1248; doi:10.1111/acem.12506. See AAP Grand Rounds commentary by Dr. Pamela Okada (subscription required).

PICO Question: Among children with blunt torso trauma after motor vehicle collisions, is the abdominal seat belt sign associated with intra-abdominal injuries?
Question type: Descriptive
Study design: Prospective cohort

Tuesday, February 17, 2015

Does Music Training Boost Your Brain?

Could it be that all my years of tenor saxophone playing made me a better doctor? Don't count on it. Still, this is a very interesting study with a great risk of being misinterpreted by the lay public.

Source: Hudziak JJ, Albaugh MD, Ducharme S, et al, for the Brain Development Cooperative Group. Cortical thickness maturation and duration of music training: health-promoting activities shape brain development. J Am Acad ChildAdolesc Psychiatry. 2014;53(11):1153-1161; doi:10.1016/j.jaac.2014.06.015. See AAP Grand Rounds commentary by Dr. J. Gordon Millichap (subscription required). 

PICO Question: Among youth aged 6-18 years, what is the association between playing a musical instrument and cerebral cortical thickness maturation?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, February 10, 2015

Will Losing Weight Increase Chances of Leukemia Survival?

Obesity is associated with increased mortality in both adult and pediatric cancers. The bigger questions are whether weight loss can improve outcomes or whether obese patients should receive more intense treatment regimens for their cancers. This study inches us forward in developing new management strategies for obese patients who develop malignancies.

Source: Orgel E, Tucci J, Alhushki W, et al. Obesity is associated with residual leukemia following induction therapy for childhood B precursor acute lymphoblastic leukemia. Blood. 2014;124(26):3932-3938; doi:10.1182/blood-2014-08-595389. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among children with acute lymphoblastic leukemia, is being overweight or obese associated with minimal residual disease after induction chemotherapy or poorer event-free survival?
Question type: Descriptive
Study design: Retrospective cohort

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