Current opinion in pediatrics
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Curr. Opin. Pediatr. · Aug 2009
ReviewConfidentiality, consent, and caring for the adolescent patient.
This study reviews the healthcare-related rationale for providing confidential care to adolescents, as well as the legal framework for the provision of such care. ⋯ Confidentiality for adolescents has important implications for the quality provision of healthcare for this vulnerable population. Physicians and other healthcare providers must be aware of these health implications, as well as federal policies, common law, and their individual state's laws pertaining to this important topic.
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Curr. Opin. Pediatr. · Jun 2009
ReviewPrimary ciliary dyskinesia: improving the diagnostic approach.
The diagnosis of primary ciliary dyskinesia (PCD) has relied on analysis of ciliary motility and ultrastructure; however, these tests are not readily available and have not been standardized. Consequently, the diagnosis of PCD may be delayed or missed or made incorrectly. This review outlines the potential utility of new diagnostic tests, including measurement of nasal nitric oxide production and systematic analysis for mutations in genes encoding ciliary proteins. ⋯ The incorporation of nasal nitric oxide measurement as a screening test to define probable PCD cases and gene mutation analysis to make a definitive diagnosis of PCD should enhance diagnostic evaluation of PCD.
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Curr. Opin. Pediatr. · Jun 2009
ReviewUpdate on epinephrine (adrenaline) for pediatric emergencies.
Epinephrine (adrenaline) is a medication widely used in the pediatric emergency department. This article reviews the most recent evidence and recommendations behind the many applications of epinephrine as they apply to the care of children in emergency departments. ⋯ Epinephrine is the recommended first-line treatment for anaphylaxis and moderate-to-severe croup. Its role in asthma and bronchiolitis is less clear. Traditional beta2-agonists are seen as first-line therapies for moderate bronchiolitis and asthma exacerbations. Epinephrine may have a role for subsets of patients with both of these illnesses. The preferred route for parenteral treatment is intramuscular. Epinephrine is well tolerated as an adjunct to local anesthesia when used in digital blocks in digits with normal perfusion. Although autoinjectors allow faster access to epinephrine for anaphylaxis, there are many issues surrounding their use and indications.
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Curr. Opin. Pediatr. · Jun 2009
ReviewSedation for emergent diagnostic imaging studies in pediatric patients.
To review and summarize current literature regarding sedation for imaging studies in pediatric patients in the Emergency Department and acute care setting. ⋯ Although avoiding sedation for diagnostic imaging studies is optimal, there are multiple agents with reasonable safety profiles that can be utilized by personnel trained in pediatric airway management in order to obtain adequate emergent imaging studies.
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Simulation has been widely adopted as a training and assessment tool in medical education. Conventional teaching methods may be inadequate to properly train healthcare providers for rare but potentially lethal events in pediatrics such as trauma and respiratory arrest. Recent studies suggest pediatric acute care providers have limited exposure to critically ill patients and also lack the skills to manage them. Simulation has the potential to fill this educational void. This review will highlight the role of simulation as an educational and assessment tool, with a particular emphasis on retention of knowledge and skills. ⋯ Simulation is an effective training tool for pediatric acute care providers. Further research is necessary to develop validated performance assessment tools and demonstrate improvement in clinical outcomes after simulation training.