Articles: pediatrics.
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Pediatric emergency care · Dec 2010
ReviewA systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research.
In this systematic review, we evaluated the effectiveness of emergency department (ED)-based management interventions for mental health presentations with an aim to provide recommendations for pediatric care. ⋯ Pediatric studies have demonstrated that the use of specialized care models for mental health care can reduce hospitalization, return ED visits, and length of ED stay. Evaluation of these models using more rigorous study designs and the inclusion of patient-based outcomes will improve this evidence base. Adult-based studies provided recommendations for pediatric research including a focus on triage and restraint use.
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Randomised controlled trials (RCT) offer an opportunity to learn about frequency and character of adverse drug reactions. To improve the quality of reporting adverse effects, the Consort group published recommendations. The authors studied the application of these recommendations in RCTs performed in children. ⋯ Reporting of adverse drug reactions in RCTs is often inadequate. Authors should anticipate and define adverse drug reactions. During research all adverse events should be monitored and assessed actively. Monitoring and assessment should be described in articles in accordance with the extended Consort recommendations. Both authors and editors share the responsibility for the improvement of reporting safety data.
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Multicenter Study
Adherence to safety guidelines on paediatric procedural sedation: the results of a nationwide survey under general paediatricians in The Netherlands.
Following two fatal accidents during paediatric procedural sedation (PS), the authors investigated the level of adherence to established safety standards on PS in a nationwide cohort of fully trained general paediatricians, entrusted with PS. ⋯ Potentially unsafe PS practices are common under Dutch general paediatricians, despite the availability of guidelines. The design of guidelines should include a goal-directed plan for implementation including training, initiatives for continuous quality assurance and improvement and repeated measurements of adherence to guidelines.
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Case Reports
Seizures temporally associated with nitrous oxide administration for pediatric procedural sedation.
Nitrous oxide is an inhaled agent commonly used by dental staff to provide anxiolysis and analgesia for dental procedures and by anesthesia personnel as an adjunct to more potent general anesthetic gases. More recently, nitrous oxide has been used to provide sedation/analgesia for a variety of medical procedures in children outside of the operating room, including lumbar puncture, laceration repair, fracture reduction, and urologic imaging. ⋯ Although temporally related, no causality is established. Review of the medical and dental literature confirm the rarity of these events.