Tuesday, October 6, 2015

Benefits of Video Games and the Ethics of Underpowered Studies

I was intrigued by this study because it was a randomized controlled trial that found no difference in measured outcomes between the two groups, which perhaps could have been predicted without performing the study.

Source: Johnson TM, Ridgers ND, Hulteen RM, et al. Does playing a sports active video game improve young children's ball skill competence [published online ahead of print May 15, 2015]? J Sci Med Sportdoi:10.1016/j.jsams.2015.05.002. See AAP Grand Rounds commentary by Dr. Ozlem Equils (subscription required).

PICO Question: Among elementary school children, does playing sports-related active video games improve actual and perceived movement skill competence?
Question type: Treatment
Study design: Randomized controlled trial

Thursday, October 1, 2015

It's an Octoberfest of Interesting Commentary

Fall is approaching, and I'm eyeing my sworn fall enemies, the leaves on the trees in my yard, wishing they would somehow rake themselves, or at least blow over into my neighbors' yards and leave me alone. Fortunately, I have October's AAP Grand Rounds for consolation.

We have some very intriguing articles under discussion this month, including effects of prenatal second-hand smoke exposure, cephalosporin allergies in surgical patients, and two articles about end of life care in cancer patients. In the coming four Tuesdays, I'll be blogging about postconcussion syndrome, sports video games and ball skills in children, breastfeeding and dental malocclusion, and preschool predictors of literacy.

Please join me, especially if those leaves are getting you down!

Tuesday, September 29, 2015

Are Pharmaceutical Companies Deliberately Deceiving Us? Paroxetine and Imipramine for Adolescent Depression

We have another 5th Tuesday this month, and I couldn't pass up this report "restoring" a study on drug treatment for adolescent depression. Clinicians made major decisions based on the original report; we have little defense against reports in medical journals where data are "cherry-picked" to shed a favorable light on drug safety and efficacy.

Le Noury J, Nardo JM, Healy D, et al. Restoring study 329: efficacy and harms of paroxetine and imipramine in major depression in adolescence. BMJ 2015;351:h4320. doi:10.1136/bmj.h4320.

Tuesday, September 22, 2015

Alarm Fatigue in the ICU: World War 2 Lessons Revisited

No, I don't think intensive care units as we understand them existed during World War 2, and certainly not pediatric intensive care units. However, this was the time where the concept of signal to noise ratio became very important. As medical science progresses, we seem to be encountering problems with this concept more frequently.

Source: Bonafide CP, Lin R, Zander M, et al. Association between exposure to nonactionable physiologic monitor alarms and response time in a children’s hospital. J Hosp Med.2015;10(6):345-351; doi:10.1002/jhm.2331. See AAP Grand Rounds commentary by Dr. Matthew Garber (subscription required). 

PICO Question: Among pediatric nurses, is there an association between recent exposure to non-actionable monitor alarms and nurses’ response time to future alarms on the same patient?
Question type: Descriptive
Study design: Observational

Tuesday, September 15, 2015

3 Shades of Conflict of Interest in Telemedicine Research

Something happened between the time I chose to review this article in Evidence eMended and the time I wrote the article: I read the fine print. Actually the fine print was just as large as the rest of the article font, but I didn't catch it. This led me to a re-examination of conflicts of interest in medical research - the study authors, the AAP Grand Rounds reviewer, and my own.

Source: McConnochie KM, Ronis SD, Wood NE, et al. Effectiveness and safety of acute care telemedicine for children with regular and special healthcare needs. Telemedicine and e-Health. 2015;21(8):1-11; doi:10.1089/tmj.2014.0175. See AAP Grand Rounds commentary by Dr. James Marcin (subscription required). 

PICO Question: Among children with special healthcare needs (CSHCN) attending a school for CSHCN, is the use of telemedicine to evaluate acute illness in the school setting as safe and effective as telemedicine evaluations in childcare settings and in schools for children without special healthcare needs?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, September 8, 2015

Obesity, Hypertension, and Gingivitis: Terrible Trio or Just Coincidence?

This is one of those studies that attempts to find associations among various clinical findings. To be convincing, a study such as this must have biologic plausibility and show clinically relevant differences from control populations. Read on to see if this report makes the grade.

Source: Zeigler CC, Wondimu B, Marcus C, et al. Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents. BMC Oral Health. 2015;15(1):41; doi:10.1186/s12903-015-0026-6. See AAP Grand Rounds commentary by Dr. Rebecca Slayton (subscription required). 

PICO Question: Among obese adolescents, is periodontal disease associated with high blood pressure?
Question type: Descriptive

Study design: Cross-sectional 

Tuesday, September 1, 2015

Early Intervention in Autism - Hopeful Results

We spent the entire month of August on randomized controlled trials, but I had to sneak in at least 1 more for September. This study is a good illustration of a well-done study that still leaves us with more questions than answers; it provides a glimmer of hope, but a mountain of questions that need answers before full implementation.

Source: Estes A, Munson J, Rogers SJ, et al. Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. J Am Acad Chil Adolesc Psychiatry. 2015; 54(7): 580-587. doi:10.1016/j.jaac.2015.04.005. See AAP Grand Rounds commentary by Dr. Shelley Springer (subscription required). 

PICO Question: Among children with autism who begin intensive early behavioral interventions at 18-30 months, do benefits persist at age 6 years?
Question type: Intervention

Study design: Randomized controlled trial

Welcome to September!

I hope the primary care providers out there can rest a bit after the wave of camp and school physicals and settle in to see how the winter viral season unfolds. In the meantime, take a look at this month’s AAP Grand Rounds issue, with some highly intriguing reviews of articles on suicide in young black children, breastfeeding effects on hospitalization, and financial costs of abusive head trauma, among others.

In this month’s blog, I’ll be posting weekly on topics including monitor alarm fatigue in a children’s hospital, benefits of early intervention in autism, telemedicine for children with special healthcare needs, and a possible link between elevated blood pressure and periodontal disease in obese teenagers. Stay tuned!

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