Tuesday, September 27, 2016

The Molecular Autopsy - Beneficial in Sudden Cardiac Death

Rates of autopsies have declined significantly in most hospitals in the US and abroad, but lessons still can be learned, especially in the era of molecular medicine.

Source: Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. N Engl J Med. 2016;374:2441-2452; doi:10.1056/NEJMoa1510687. See AAP Grand Rounds commentary by Dr. David Spar (subscription required).

Tuesday, September 20, 2016

More Sports Injury Myths Debunked - Children Can Have Successful ACL Repair and Return to Sports

Randomized controlled trials are great for (relatively) quickly finding a better treatment, but retrospective case series, supported by good record-keeping and effective follow up, sometimes can validate newer methods of management.

Source: Chicorelli AM, Micheli LJ, Kelly M, et al. Return to sport after anterior cruciate ligament reconstruction in the skeletally immature athlete. Clin J Sport Med. 2016;26(4):266-271; doi:10.1097/JSM.0000000000000275. See AAP Grand Rounds commentary by Dr. William Hennrikus (subscription required).

Tuesday, September 13, 2016

MMR Vaccine at 12 Months of Age: Is It Safe and Effective?

This study offers some reassurance about immunizing children with MMR at 12 months of age, and it also demonstrates some key take-home points for translating this type of information into clinical practice.

Source: Kontio M, Palmu AA, Syrjänen RK, et al. Similar antibody levels in 3-year-old children vaccinated against measles, mumps, and rubella at the age of 12 months or 18 months. J Infect Dis. 2016;213(12): 2005-2013; doi:10.1093/infdis/jiw058.

Tuesday, September 6, 2016

Lead Poisoning in Flint, Michigan - The Saga Continues

This whole story really saddens me. I suspect most pediatricians have been following this in the lay press, but of course there wasn't much detail in those reports. In the past few months, a clearer picture is emerging.

Source: Kennedy C, Yard E, Dignam T, et al. Blood lead levels among children aged less than 6 years - Flint, Michigan, 2013-1016. MMWR. 2016;65(25):650-654; doi:10.15585/mmwr.mm6525e1.

Thursday, September 1, 2016

Evidence eMended for September 2016

Well, from the looks of the traffic patterns in the Washington, DC, area, it must be September. Everyone is back in town, school has started, and my still relatively easy commute to work has lengthened by a few minutes. Fortunately, that won't deter me from looking at this month's issue of AAP Grand Rounds, with discussions of articles about asthma and air pollution, quality of life following gastroschisis repair, hearing loss associated with cancer therapies, and psychological traits associated with delayed resolution of postconcussion symptoms, among others.

In the next 4 Tuesdays, I'll be commenting on the "molecular autopsy," ACL surgery in skeletally immature athletes, MMR vaccine responses when given at 12 versus 18 months of age, and a closer look at the lead problem in Flint, Michigan. Please join me!

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

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