Tuesday, January 27, 2015

Minimizing Bias in Retrospective Studies

This study provides some interesting figures on late infections in childhood cancer survivors, but that's not the reason I chose to discuss it in these pages. Rather, I wanted to highlight a couple of nice features that can mitigate bias (and therefore false conclusions) in retrospective survey studies.

Source: Perkins JL, Chen Y, Harris A, et al. Infections among long-term survivors of childhood and adolescent cancer. a report from the Childhood Cancer Survivor Study. Cancer.2014;120(16):2514-2521; doi:10.1002/cncr.28763. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among survivors of childhood cancer for ≥5 years, is there an increased risk of infection, and if so, what factors increase the risk of infection?
Question type: Descriptive
Study design: Retrospective Survey

Tuesday, January 20, 2015

Epilepsy Unmasked by Vaccination - Further Evaluation Often Helpful

This Dutch study is of interest, though I think the title of the article is a bit misleading. However, it does provide some help when considering when to refer children with epilepsy for extensive genetic testing and other evaluations.

Source: Verbeek NE, Jansen FE, Vermeer-de Bondt PE, et al. Etiologies for seizures around the time of vaccination. Pediatrics. 2014;134(4):658-666; doi:10.1542/peds.2014-0690. See AAP Grand Rounds commentary by Dr. Gordon Millichap (subscription required). 

PICO Question: Among children under 2 years of age with seizures after vaccination who are subsequently diagnosed with epilepsy, what are the determined causes of seizures?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, January 13, 2015

Big Time Problems with Medication Adherence: Leukemia in Children

More lives can be saved by implementing known effective disease prevention and treatment than by developing new treatments. It's frustrating when patients don't take medications as prescribed, but clinicians need to turn this frustration into action. This study identifies a big problem with acute leukemia treatment in children and provides some clues into how we can do better, pending more definitive studies of interventions.

Source: Bhatia S, Landier W, Hageman L, et al. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study. Blood. 2014;24(15):2345-2353; doi:10.1182/blood-2014-01-552166. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among children with acute lymphoblastic leukemia, are race-specific sociodemographic factors associated with differences in adherence to oral chemotherapy? 
Question type: Descriptive
Study design: Prospective cohort

Tuesday, January 6, 2015

Beware the Button Battery

Yesterday I picked up a new button battery for my bathroom scale, and unfortunately it worked perfectly. Now I've realized how many extra pounds I acquired over the holidays, which probably accounts for part of my less-than-glowing review of this battery ingestion research.

Source: Russell RT, Griffin RL, Weinstein E, et al. Esophageal button battery ingestions: decreasing time to operative intervention by level I trauma activation. J Pediatr Surg. 2014;49(9):1360-1362; doi:10.1016/j.jpedsurg.2014.01.050. See AAP Grand Rounds commentary by Dr. Corey Iqbal (subscription required).

PICO Question: Among children with button battery ingestion, does level 1 trauma activation compared to standard emergency department triage result in shorter time to operative removal?
Question type: Intervention
Study design: Retrospective cohort

Thursday, January 1, 2015

Happy 2015!

Hello everyone, and welcome to 2015. January's AAP Grand Rounds has many interesting topics, including a new look at diabetic ketoacidosis management, sleep patterns in hyperactive children, salt consumption in US children, and more. Over the next few weeks, I'll expand on commentaries for button battery ingestions, infections in childhood cancer survivors, adherence to chemotherapy in pediatric cancer patients (wouldn't you think it would be close to 100%?), and etiologies of seizure disorders beginning around the time of vaccinations.

Enjoy the glut of winter sports games and holiday parties, then tune in this weekend for this month's first posting.

Tuesday, December 30, 2014

Bashing Dr. Oz - Reliability of Medical Talk Shows

This posting sets my personal record for most time-consuming and most painful. Recently, an article in BMJ rated advice from medical talk shows, and I decided to devote my fifth Tuesday wild-card post in December to review the data. Knowing that I had some bias going into this, I took some extra steps to try to keep a balanced view.

Korownyk C, et al. Televised medical talk shows - what they recommend and the evidence to support their recommendations: a prospective observational study. BMJ 2014; 349:g7346. doi: 10.1136/bmj.g7346.

Tuesday, December 23, 2014

Do You Agree with New RSV Prophylaxis Guidelines?

Or, perhaps a better question, do you dare to disagree with AAP Guidelines? Front line practitioners likely don't have the time to investigate every practice guideline in depth, but it's nice to know how to do so if you don't want to fall victim to practicing cookbook medicine.

Committee on Infectious Diseases and Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134:415-420. doi:10.1542/peds.2014-1665. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

Tuesday, December 16, 2014

The Down Side of Adolescent Obesity: Don't Miss an Eating Disorder

With all the emphasis on curbing overweight and obesity, have we missed opportunities to identify eating disorders in such individuals. These authors provide some evidence for this, with some suggestions to identify such individuals.

Source: Lebow J, Smith LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders [published online ahead of print]. J Adolesc Health; 2014; in press. doi:10.1016/j.jadohealth.2014.06.005. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required). 

PICO Question: Among treatment-seeking adolescents with restrictive eating disorders, what is the prevalence of a history of overweight or obesity?
Question type: Descriptive
Study design: Retrospective cohort 

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