Tuesday, November 24, 2015

Formula Change for Difficult Infant Behavior - We Are We Still Discussing This?

My oldest child, born while I was a first-year pediatric resident, was pretty colicky. Our pediatrician's solution was a bit of sherry in some infant electrolyte solution, which is about as evidence-based as changing formulas.

Source: Sherman AL, Anderson JA, Rudolf CD, et al. Lactose-free milk or soy-based formulas do not improve caregivers’ distress or perceptions of difficult infant behavior. J Pediatr Gastroenterol Nutr. 2015;61(1):119-129; doi:10.197/0000000000000743. See AAP Grand Rounds commentary by Dr. Ronald Holmes (subscription required). 

PICO Question: Among infants with feeding problems, do caregivers’ distress or perceptions of infant behaviors improve by feeding lactose-free milk-based or soy-based formula compared to milk-based, lactose-containing formula?
Question type: Treatment
Study design: Double-blind randomized controlled

Tuesday, November 17, 2015

Leg Injuries Following Concussion: How Big a Problem is It?

This is an interesting case-control study confirming findings of others that the sequelae of concussive sports injury comprise more than just direct effects on the brain. It's a little more difficult, however, to determine the magnitude of these additional injuries.

Source: Lynall RC, Mauntel TC, Padua DA, et al. Acute lower extremity injury rates increase following concussion in college athletes [published online ahead of print June 8, 2015]. Med Sci Sports Exerc. 2015;47:2487-92. doi:10.1249/MSS.0000000000000716. See AAP Grand Rounds commentary by Dr. Cynthia LaBella (subscription required). 

PICO Question: Among college athletes, is there an increased risk of acute lower extremity musculoskeletal injury following concussion compared to athletes without history of concussion?
Question type: Prognosis
Study design: Case-control

Tuesday, November 10, 2015

Pitfalls of Survey Studies: Sports Participation in Congenital Heart Disease

This study highlights the gaps between evidence and practice, as well as a recognition that GOBSAT should be interpreted with caution.

Source: Dean PN, Gillespie CW, Greene EA, et al. Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenit Heart Dis. 2015;10(2):169-179; doi:10.1111/chd.12221. See AAP Grand Rounds commentary by Dr. Jeffrey Anderson (subscription required). 

PICO Question: Among individuals 13-30 years old with congenital heart disease, what is their sports participation and how does sports participation or restriction affect quality of life?
Question type: Descriptive
Study design: Cross-sectional survey

Sunday, November 8, 2015

A New Look for Evidence eMended and All the AAP's Blogs

The American Academy of Pediatrics has rolled out their new consolidated blog site, AAP Gateway. All of the AAP blogs, including Evidence eMended, will appear on this site rather than in individual blogs as previously.

Not all the details have been hashed out, so until everything is completely up and running, I will continue to post my commentaries on this site as well as sending to AAP Gateway. I expect the changeover will be complete in another week or 2, so my posting for next Tuesday, November 10, may be my last to the current site.

New posts for Evidence eMended will continue to appear Tuesday mornings, and I'm hoping that those of you who have signed up for email notifications of new postings will continue to receive those. For now, there is no filter mechanism in AAP Gateway to search for content, but you can easily find me or any of the other bloggers on the site using the "Find" function on your device (e.g. Control-F for PCs and Command-F for Macs). As before, Evidence eMended, as well as the other AAP blogs, are available to everyone, not just AAP members or journal subscribers.

Nothing changes about the editorial process, i.e. I will still speak my mind. Best of all the changes, you won't be forced to look at my ugly mug on the new site!

Tuesday, November 3, 2015

A Picture is Worth a Thousand (or More) Words: Trends in Imaging for Appendicitis

Pediatric primary care providers seldom make decisions on which imaging study to choose in suspected appendicitis; more often this resides with an emergency medicine or surgical colleague. Trends in imaging practice for children have emphasized less radiation exposure, and the current studies looks at a change in management that might have evolved from these trends.

Source: Bachur RG, Levy JA, Callahan MJ, et al. Effect of reduction in the use of computed tomography on clinical outcomes of appendicitis. JAMA Pediatr. 2015;169(8):755-760; doi:10.1001/jamapediatrics.2015.0479. See AAP Grand Rounds commentary by Dr. Corey Iqbal (subscription required).

PICO Question: Among hospitals evaluating children for appendicitis, has decreased utilization of computed tomography scans for diagnosis of appendicitis resulted in a change in the rate of negative appendectomy, appendiceal perforation, or return visits to the emergency department?
Question type: Systems-based
Study Design: Retrospective case series

Sunday, November 1, 2015

Happy Fall Back!

OK, so if you're reading this, live in the US, and you haven't turned your clocks back an hour (and you don't live in Hawaii, Guam, American Samoa, Puerto Rico, US Virgin Islands, or parts of Arizona), stop reading this and go fix your clocks. Then you can read on.

In this month's issue, check out the commentary on articles pertaining to urinary tract infection, reptiles and salmonellosis, and Helicobacter infections in pediatrics. Over the next month, I'll be commenting on use of lactose-free formula for infant feeding problems (I thought we were over that long ago!), decreased use of CT scans in appendicitis evaluation, leg injury following concussion, and sports participation issues in adolescents and young adults with congenital heart disease. 

Please join me in the coming weeks!

Tuesday, October 27, 2015

Will Breastfeeding Give You Straight Teeth?

A meta-analytic study won't answer this question completely, but this particular study is an excellent example of a well-done meta-analysis.

Source: Peres KG, Cascaes AM, Nascimento GG, et al. Effect of breastfeeding on malocclusions: a systematic review and meta-analysis [published online ahead of print July 3, 2015]. Acta Paediatr; doi:10.1111/apa.13103. See AAP Grand Rounds commentary by Dr. Rebecca Slayton (subscription required).

PICO Question: Among children, is breastfeeding associated with a decreased incidence of malocclusion?
Question type: Descriptive
Study design: Systematic review and Meta-analysis 

Tuesday, October 20, 2015

Another Crystal Ball: A Biomarker for Reading Difficulty

Continuing our discussion from last week about crystal balls, here's a study highlighting a test that might predict reading problems in preschoolers.

Source: White-Schwoch T, Carr KW, Thompson EC, et al. Auditory processing in noise: a preschool biomarker for literacy. PLOS Biology.2015;13(7):e1002196; doi:10.1371/journal.pbio.1002196. See AAP Grand Rounds commentary by Dr. J. Gordon Millichap (subscription required).

PICO Question: Among 3- and 4-year-old children who have not yet learned to read, does the presence of impaired neural processing of consonants in the presence of background noise predict early and later reading difficulty?
Question type: Diagnosis
Study design: Prospective cohort

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