Tuesday, August 30, 2016

Is Wikipedia a High Quality Evidence-Based Resource?

The cop-out answer to that question is "sometimes." Wikipedia is a nice resource, but beware, the hidden dangers of unreliability are likely on the upswing.

Pinsker J. The covert world of people trying to edit Wikipedia - for pay. The Atlantic, August 11, 2015. Accessed from http://www.theatlantic.com/business/archive/2015/08/wikipedia-editors-for-pay/393926/.

Tuesday, August 23, 2016

Child Abuse - Making the Safety Net System Safer

This retrospective study presents data that both support and refute its main conclusion that children with suspected non-accidental trauma receive better care when admitted to a surgical service. In my opinion, the authors focused too strongly on 1 side of the debate.

Source: Magoteaux S, Gilbert M, Langlais CS, et al. Should children with suspected nonaccidental trauma be admitted to a surgical service? J Am Coll Surg. 2016;222(5):838-843; doi:10.1016/j.jamcollsurg.2015.12.049. See AAP Grand Rounds commentary by Dr. Corey Iqbal (subscription required).

PICO Question: Among children hospitalized for suspected nonaccidental trauma, is their care better on a pediatric surgical service compared to a nonsurgical service?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, August 16, 2016

The Doctor is In ..... the Cloud

I'm a great fan of electronic innovations in medicine, but one needs to exercise caution not to be seduced by cool technology that doesn't really add anything to population health. That's why it's nice to see a randomized controlled trial of such an innovation.

Source: Robinson C, Gund A, Sjöqvist B et al. Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits. Acta Paediatrica. 2016; 105(8):902-9. doi:10.1111/apa.13407. See AAP Grand Rounds commentary by Dr. James Marcin and Ms. Jaimie Kissee (subscription required).

PICO Question: Among families with infants discharged from a NICU, does telemedicine, in addition to standard care, reduce the number of emergency hospital visits compared to standard health care alone following discharge?
Question type: Intervention
Study design: Randomized control

Tuesday, August 9, 2016

Starvation Therapy For Surgical Procedures in Children?

Yes, that title is a bit harsh, but I meant to capture your attention. The description of surgical fasting guidelines in this study reminds me of the bad old days of extended NPO periods for infant gastroenteritis management - it doesn't make sense in today's medical world, and it may be harmful. The real problem lies in how practice change can be implemented.

Source: Brunet-Wood K, Simons M, Evasiuk A, et al. Surgical fasting guidelines in children: are we putting them into practice? J Pediatr Surg. 2016; 51:1298-302. doi:10.1016/j.jpedsurg.2016.04.006. See AAP Grand Rounds commentary by Dr. Corey Iqbal (subscription required).

PICO Question: Among children having surgery, how compliant are pre- and postoperative fasting times with evidence-based guidelines?
Question type: Descriptive
Study design: Prospective cohort

Tuesday, August 2, 2016

Is Newborn Screening Ready To Enter the Genomic Testing World?

Personalized medicine is on the way; in fact, it's already arrived for a few medical entities such as pharmacogenomics. But, are we ready to transition newborn screening to these new technologies?

Source: Bodian DL, Klein E, Iyer RK, et al. Utility of whole-genome sequencing for detection of newborn screening disorders in a population cohort of 1,696 neonates. Genet Med. 2016;18(3):221-230; doi:10.1038/gim.2015.111. See AAP Grand Rounds commentary by Dr. Rizwan Hamid (subscription required).

PICO Question: Among infants, how does whole genome sequencing compare to traditional newborn screening for disease detection?
Question type: Descriptive
Study design: Cohort

Monday, August 1, 2016

Evidence eMended for August 2016

With much of the country sweltering under so-called heat domes, it's nice to feel a nice, cool breeze from the August issue of AAP Grand Rounds. (OK, a bit of a stretch, but at least reading this month's issue should take your mind off the heat!) You can brush up on topics ranging from celiac disease risks to neonatal herpes infections and factors associated with necrotizing enterocolitis, among others.

In this month's Evidence eMended, I'll be discussing whole genome sequencing as a newborn screening tool, telemedicine for neonatal intensive care nursery follow up, and 2 articles dealing with aspects of pediatric surgery. Also, don't forget this month's 5th Tuesday special feature on Wikipedia as a reliable (?) source of information.

Tuesday, July 26, 2016

A Blood Test for Sports Head Trauma?

Wouldn't it be nice to have a simple blood test to alert clinicians when an athlete may be getting into trouble with head injuries? Wouldn't it be nicer to have a nutritional supplement to lessen the risk of neurologic damage from sports? Read on.

Source: Oliver JM, Jones MT, Kirk KM, et al. Effect of docosahexaenoic acid on a biomarker of head trauma in American football. Med Sci Sports Exerc. 2016;48(6):974-982; doi:10.1249/MSS.0000000000000875. See AAP Grand Rounds commentary by Dr. Joy Weydert (subscription required).

PICO Question: Among National Collegiate Athletic Association football athletes, do serum neurofilament light levels increase with the number and magnitude of head impacts, and does docosahexaenoic acid attenuate this increase?
Question type: Interventional
Study design: Randomized controlled trial

Tuesday, July 19, 2016

Adoption of Children From Emotionally-Depriving Institutions: Timing Matters?

AAP Grand Rounds doesn't often review articles from social science journals. The format of the article is a bit different, but the story the authors tell us is revealing.

Source: Julian MM, McCall RB. Social skills in children adopted from socially-emotionally depriving institutions. Adopt Q. 2016;19(1):44-62; doi:10.1080/10926755.2015.1088106. See AAP Grand Rounds commentary by Dr. Emily Todd (subscription required).

PICO Question: Among children adopted from institutions, does age of adoption, age of assessment, or gender impact social skills?
Question type: Descriptive
Study design: Survey

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