Sunday, May 1, 2016

May 2016 at Evidence eMended

Hello everyone! The May issue of AAP Grand Rounds is now available, with discussions on fetal surgery for myelomeningocele, adolescent venous thromboembolism, dental caries and vitamin D associations, and difficulties in medical follow-up in children in the child welfare system, among others.

This month in Evidence eMended, I'll be discussing oxygen saturation targets in premature infants (the subject of much controversy and ethical discussion lately), use of volume expansion for hemolytic-uremic syndrome, mouthguard impact on dental injuries in high school athletes, and factors associated with late mortality in childhood cancer. Also, May has 5 Tuesdays, meaning we'll have a special commentary on that day.

Please join me!

Tuesday, April 26, 2016

Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders - How Effective Is It?

The results of this relatively small randomized controlled trial suggest that vitamin D supplementation of severely vitamin D-deficient teenage girls with mood disorders related to premenstrual syndrome will significantly improve their symptoms. I wish they had elaborated on patient details so I could interpret the magnitude of the benefit. 

Source: Tartagni M, Cicinelli MV, Tartagni MV, et al. Vitamin D supplementation on premenstrual syndrome-related mood disorders in adolescents with severe hypovitaminosis D [published online ahead of print December 24, 2015 - In Press]. JPediatr Adolesc Gynecol. doi:10.1016/j.jpag.2015.12.006. See AAP Grand Rounds commentary by Dr. Joy Weydert (subscription required).

PICO Question: In adolescents with severe premenstrual syndrome (PMS) and vitamin D deficiency, does vitamin D supplementation reduce mood disorders associated with PMS?
Question type: Intervention
Study design: Randomized, controlled trial

Tuesday, April 19, 2016

Nebulized Hypertonic Saline for Bronchiolitis - Why Can't Researchers Get It Right?

I'm getting a little dizzy watching the pendulum swing back and forth on benefits of nebulized hypertonic saline for bronchiolitis. What gives?

Source: Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial. Pediatrics.2015;136(6):1036-1043; doi:10.1542/peds.2015-1037. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required). 

PICO Question: Among infants hospitalized for bronchiolitis, does administration of nebulized hypertonic saline decrease length of stay compared to nebulized normal saline?
Question type: Intervention
Study design: Randomized controlled

Tuesday, April 12, 2016

Can a Standardized Parent Questionnaire Diagnose Seizures in Children?

The answer to that question is a qualified "yes;" that's what Watson should be able to do! However, this study falls a little short of that goal, at least in terms of clinical utility.

Source: Douglass LM, Kuban K, Tarquinio D, et al. A novel parent questionnaire for the detection of seizures in children. PediatrNeurol 2016;54:64-69; doi:10.1016/j.pediatrneurol.2015.09.016. See AAP Grand Rounds commentary by Dr. J. Gordon Millichap (subscription required). 

PICO Question: Among children at high risk for epilepsy, how accurate is a questionnaire in establishing a history of seizures compared to assessments by pediatric neurologists?
Question type: Diagnosis
Study design: Cross-sectional

Tuesday, April 5, 2016

Is It Time to Reconsider Azithromycin Therapy for Urogenital Chlamydia Infections?

Every year or so, I find an article that I can use to teach almost all aspects of evidence-based medicine; this is my article for 2016. I could spend all 4 blog posts this month pointing out key features of this study, but instead I'll contain my enthusiasm and mention 3 take-home points.

Source: Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection. N Engl JMed. 2015;373(26):2512-2521; doi:10.1056/NEJMoa1502599. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required). 

PICO Question: Among youth aged 12-21 years with urogenital chlamydia infection, is treatment with oral azithromycin associated with more treatment failures compared to treatment with oral doxycycline?
Question type: Intervention
Study design: Randomized 

Friday, April 1, 2016

April Come She Will... to Evidence eMended

The streams are ripe in April, and so is this month's edition of AAP Grand Rounds and Evidence eMended. April's AAP Grand Rounds covers wide-ranging topics, from ankle sprains in young children and outcomes of planned out-of-hospital births to childhood firearm deaths and genetic clues to childhood cancer risk. For the blog this month, I'll be discussing the ongoing controversy of hypertonic saline use in bronchiolitis (wasn't that already settled?), antibiotic treatment of urogenital chlamydia infection, vitamin D treatment of premenstrual syndrome, and utility of a pediatric seizure questionnaire. Please join me every Tuesday, and whistle a happy April tune!

Tuesday, March 29, 2016

Is Your Physician Implicitly Biased? A Fifth Tuesday Follow-up to My New Year's Resolution

Regular readers of Evidence eMended will recall my end of the year posting on implicit bias in physicians. At that time, I explained implicit bias as ".. the unintended, somewhat submerged bias in all of us that can result in disparities in the health care we provide." I spoke about my early experiences with Project Implicit, a research site with testing aimed at helping us all recognize our own implicit biases, with the hope that this increased self-awareness will allow us to control our biases such that they don't interfere with good patient care. I also promised to follow up on this posting to tell you about my ongoing experiences with Project Implicit testing.

I haven't been as zealously devoted to taking a weekly bias test as I had planned, but by now I've completed several modules. I won't tell you my findings exactly, other than to say I haven't been overly surprised; I expected that, like many people, I had a modest degree of implicit bias in some areas. What I have been most pleased with, however, is the experience of going through the test modules. I can see how the researchers used the rapid response images to collect data on my recognition patterns, and I found myself very excited to complete each module and see how my floundering to categorize various images produces summary results. 

In a sense, then, it's actually the process of interacting with the modules that has been helpful to me, and thus I remain very strong in my advice to readers to join me in the experience. It's never too late for New Year's resolutions - why not start now at Project Implicit!

Also, I do urge you to go back to my December 29 blog posting to look at the comment from Keyon Mitchell, a medical student at UC Davis who is pushing for implicit bias to become a staple in medical student education. 

Tuesday, March 22, 2016

Infant Bruising: When Is It Abuse?

This is a rare study: the relatively modest goals are clearly stated, the findings aren't hyped beyond what the data support, and it raises interesting questions for the future.

Source: Pierce MC, Magana JN, Kaczor K, et al. The prevalence of bruising among infants in pediatric emergency departments. AnnEmerg Med. 2016;67(1):1-8; doi:10.1016/j.annemergmed.2015.06.021. See AAP Grand Rounds commentary by Dr. James Anderst (subscription required).

PICO Question: Among previously healthy infants presenting to pediatric emergency departments, what is the prevalence of bruising?
Question type: Descriptive
Study design: Prospective observational

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