Pediatric clinics of North America
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Pediatr. Clin. North Am. · Apr 2013
ReviewCongenital cytomegalovirus infection: new prospects for prevention and therapy.
Cytomegalovirus is the commonest congenital viral infection in the developed world, with an overall prevalence of approximately 0.6%. Approximately 10% of congenitally infected infants have signs and symptoms of disease at birth, and these symptomatic infants have a substantial risk of subsequent neurologic sequelae. ⋯ Antiviral therapy for children with symptomatic congenital cytomegalovirus infection is effective at reducing the risk of long-term disabilities and should be offered to families with affected newborns. An effective preconceptual vaccine against CMV could protect against long-term neurologic sequelae and other disabilities.
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Rocky Mountain spotted fever is typically undifferentiated from many other infections in the first few days of illness. Treatment should not be delayed pending confirmation of infection when Rocky Mountain spotted fever is suspected. Doxycycline is the drug of choice even for infants and children less than 8 years old.
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Pediatr. Clin. North Am. · Dec 2012
Sleep science, schedules, and safety in hospitals: challenges and solutions for pediatric providers.
Sleep deprivation is common among resident physicians and clinical fellows. Current evidence about sleep science, performance, shift work, and medical errors consistently demonstrates positive impact from reduction of excessive duty hours, particularly when shift length is shortened. ⋯ Accreditation Council on Graduate Medical Education trainee duty hour guidelines are reviewed. Practical approaches to evidence-based scheduling of shift-work are also discussed, with attention to improving patient safety.
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Pediatr. Clin. North Am. · Dec 2012
Standardization of case reviews (morbidity and mortality rounds) promotes patient safety.
The morbidity and mortality conference (M&M) is a long-standing practice in medicine. Originally created to identify errors and improve care, the primary focus of M&M has moved toward an emphasis on education of trainees. A structured format for the M&M conference can help the interdisciplinary team address causes of adverse patient outcomes and identify opportunities for systems improvement.