Pediatric clinics of North America
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Family-centered rounds (FCRs) are multidisciplinary rounds that involve medical teams partnering with patients and families in daily medical decision-making. Multiple FCR benefits have been identified including improving patient satisfaction, communication, discharge planning, medical education, and patient safety. ⋯ In the last decade, many programs have incorporated FCRs into daily practice due to their multiple perceived benefits. Future FCRs should focus on better operationalizing of FCRs and reporting on objective outcomes measures such as improved communication, coordination, and patient satisfaction that are crucial for healthcare.
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Pediatric hospitalists are increasingly common in community hospitals and are playing increasingly important roles. Scope of practice and staffing models vary significantly by program. Unique aspects of small pediatric hospital medicine programs in hospitals with limited pediatric subspecialty and surgical support are discussed, including clinical and logistic considerations, training needs, and advocacy roles.
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Pediatr. Clin. North Am. · Apr 2014
ReviewDiagnosis and management of morphea and lichen sclerosus and atrophicus in children.
Morphea (localized scleroderma) is a rare fibrosing disorder of the skin and underlying tissues characterized by skin thickening and hardening due to increased collagen deposition. The significance of the disease depends on the extent of the lesions, potential for functional disability or cosmetic disfigurement, and presence or absence of extracutaneous manifestations. Treatment is tailored; circumscribed forms may require only topical treatment, while forms causing functional impairment or severe cosmetic change may require systemic treatment. Although localized scleroderma has a good prognosis, some clinical subtypes can be deforming and irreversibly disabling, especially when affecting the extremities or the face.
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The spectrum of blunt cardiac trauma ranges from asymptomatic myocardial contusion to fatal cardiac arrhythmias and/or cardiac rupture. Although cardiac rupture is common in fatal traffic accidents, these patients rarely reach hospital care. ⋯ Most cases are dead at the scene and never reach hospital. The incidence of cardiac sequelae in survivors is high, and these patients should be evaluated with early and late echocardiography to detect anatomic or functional cardiac involvement.
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Pediatr. Clin. North Am. · Dec 2013
ReviewDevelopmental hemostasis: clinical implications from the fetus to the adolescent.
The coagulation system involves a dynamic group of procoagulation and anticoagulation proteins that appear early in fetal life and whose levels change throughout childhood and into the teenage years. This process is called developmental hemostasis. Developmental hemostasis creates unique challenges for clinicians affecting the diagnosis and treatment of coagulation disorders during early childhood. The objective of this review is to assist pediatricians in understanding the coagulation system in fetal life and childhood and to provide guidance for interpreting basic coagulation testing, which will result in an improved ability to diagnose and treat patients with hemostatic and thrombotic disorders.