Tuesday, March 3, 2015

Home Births and Congenital Heart Disease Screening: An Oxymoron?

I guess this study was mostly a proof of concept attempt, showing that children born at home still could be screened for cyanotic congenital heart disease. However, it made me wonder more about how this proposal fit into the concept of home births in general.

Source: Lhohst J, Goetz E, Belling J, et al. Pulse oximetry screening for critical congenital heart disease in planned out-of-hospital births. J Pediatr. 2014;165(3):485-509; doi:10.1016/j.jpeds.2014.05.011. See AAP Grand Rounds commentary by Dr. Jeffrey Anderson (subscription required). 

PICO Question: Among infants with planned out-of-hospital births, is routine pulse oximetry feasible in identifying critical congenital heart disease?
Question type: Diagnosis
Study design: Prospective cohort

Sunday, March 1, 2015

Evidence eMended Marches On

I suspect March wasn't Julius Caesar's favorite month, but there's a lot to like in this month's offerings in AAP Grand Rounds. You'll find a wide array of topics, from central line infections to developmental hip dysplasia followup and another subanalysis from the PECARN blunt torso trauma study (see my posting just last week about the seat belt sign from this same study).

In my weekly offerings, I'll be discussing articles on the frequency of respiratory illness in young children, use of pulse-oximetry in out-of-hospital births, a clever handoff pneumonic for pediatric residents on inpatient services, and oral antibiotics for osteomyelitis, the latter being a great introduction to the concept of comparative effectiveness research.

By the way, I learned, via Wikipedia, a bit about Ides (13th or 15th day of each month, depending on its length), as well as the Nones (5th or 7th day) and the Kalends (1st day of the month).

So, Happy Kalends!

Tuesday, February 24, 2015

How Helpful is the Seat Belt Sign in Abdominal Trauma?

This very large multicenter study attempted to answer this question, but as with most studies we are left with more questions than answers. I had some fun doing my own number crunching here.

Source: Borgialli DA, Ellison AM, Ehrlich P, et al. Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Acad Emerg Med.2014;21(11):1240-1248; doi:10.1111/acem.12506. See AAP Grand Rounds commentary by Dr. Pamela Okada (subscription required).

PICO Question: Among children with blunt torso trauma after motor vehicle collisions, is the abdominal seat belt sign associated with intra-abdominal injuries?
Question type: Descriptive
Study design: Prospective cohort

Tuesday, February 17, 2015

Does Music Training Boost Your Brain?

Could it be that all my years of tenor saxophone playing made me a better doctor? Don't count on it. Still, this is a very interesting study with a great risk of being misinterpreted by the lay public.

Source: Hudziak JJ, Albaugh MD, Ducharme S, et al, for the Brain Development Cooperative Group. Cortical thickness maturation and duration of music training: health-promoting activities shape brain development. J Am Acad ChildAdolesc Psychiatry. 2014;53(11):1153-1161; doi:10.1016/j.jaac.2014.06.015. See AAP Grand Rounds commentary by Dr. J. Gordon Millichap (subscription required). 

PICO Question: Among youth aged 6-18 years, what is the association between playing a musical instrument and cerebral cortical thickness maturation?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, February 10, 2015

Will Losing Weight Increase Chances of Leukemia Survival?

Obesity is associated with increased mortality in both adult and pediatric cancers. The bigger questions are whether weight loss can improve outcomes or whether obese patients should receive more intense treatment regimens for their cancers. This study inches us forward in developing new management strategies for obese patients who develop malignancies.

Source: Orgel E, Tucci J, Alhushki W, et al. Obesity is associated with residual leukemia following induction therapy for childhood B precursor acute lymphoblastic leukemia. Blood. 2014;124(26):3932-3938; doi:10.1182/blood-2014-08-595389. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among children with acute lymphoblastic leukemia, is being overweight or obese associated with minimal residual disease after induction chemotherapy or poorer event-free survival?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, February 3, 2015

Free Long-Acting Contraception Has Benefits

I was a little surprised to see this study in the New England Journal, not because it isn't an excellent study (it is), but because its design leaves the conclusions a bit open to debate.

Source: Secura GM, Madden T, McNicholas C, et al. Provision of no-cost, long-acting contraception and teen pregnancy. N Engl J Med. 2014;371(14):1316-1323; doi:10.1056/NEJMoa1400506. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required). 

PICO Question: Among adolescents 15-19 years old, does the removal of financial and access barriers to long-acting, reversible contraception result in lower teen pregnancy, birth, and abortion rates?
Question type: Intervention
Study design: Prospective cohort

Sunday, February 1, 2015

It's Super Sunday .....

.... and, more exciting (except perhaps for Patriots and Seahawks fans), a new month's issue of AAP Grand Rounds is available. February's issue covers a wide variety of studies ranging from a descriptive study of alternative vaccination schedules in New York infants, association of pesticide exposure in pregnant women and neurodevelopmental disorders in their offspring, and oral health in autism spectrum disorder children, among others.

Over the next 4 Tuesdays, I'll be expounding on the "seat belt sign" in motor vehicle injuries, free long-acting contraception for adolescents, obesity effects on leukemia outcomes, and a possible link between playing a musical instrument and brain development. This last topic, as you might expect, would have a tendency to be picked up by the lay press. I'll tell you why I think a report on the study by a Pulitzer Prize-winning journalist for a major newspaper is very misleading.

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

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