Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission.

Objectives: Children presenting to the emergency department (ED) requiring psychiatric admission often undergo screening electrocardiograms (ECG) as part of the medical clearance process. The diagnostic yield of screening ECGs for this purpose has not been reported. The purpose of this study was to determine the clinical utility of screening ECGs in children and adolescents requiring acute inpatient psychiatric admission.

Serotonin Toxicity in Children and Adolescents: A Systematic Review and Meta-Analysis of Cases.

Serotonin toxicity is a state of central nervous system (CNS) excitation classically featuring altered mental status, neuromuscular excitation, and autonomic instability. While retrospective studies and reviews have characterized serotonin toxicity in adults, there have been no systematic reviews of serotonin toxicity in pediatric populations. The goal of this review was to use published case reports to describe serotonin toxicity in pediatric patients and to consider the impact of age on clinical presentation.

Insidious Onset of Serotonin Syndrome in a 6-Year-Old Boy.

Serotonin syndrome, characterized by autonomic, neuromuscular, and mental status changes, is an uncommon but well-established risk of psychotropic medications. The presentation can be highly variable, especially when triggered by agents with effects on additional neurotransmitters. The presence of a nonspecific prodrome has been reported but poorly characterized and can lead to misattribution of symptoms.

Child and Adolescent Psychiatry Trainees' Attitudes Toward Prescribing and Managing Psychotropic Medications.

Objective: There has been a recent concern about the overuse of psychotropic medications in children. This study was designed to assess the attitudes held by child and adolescent psychiatry trainees toward the prescription and management of medications in the pediatric population.

Methods: An online survey was sent to all Accreditation Council for Graduate Medical Education (ACGME)-accredited child and adolescent psychiatry training programs across the USA with the goal of assessing trainee comfort and confidence with prescribing skills and concepts.

The Rare Association of Spina Bifida and Extrarenal Wilms Tumor: A Case Report and Review of the Literature.

Background: The diagnosis of nephroblastoma outside of the kidneys, in the absence of a renal primary tumor, is known as extrarenal Wilms tumor (ERWT). ERWT is an uncommon entity that typically involves the embryonic path of the developing kidneys and gonads. The occurrence of ERWT in a dysraphic spine is uncommon, with no reported cases of preoperative diagnosis, with all cases diagnosed at pathology.

Dural Venous Sinus Diameters in Children with Sickle Cell Disease: Correlation with History of Stroke in a Case-Control Study.

Objectives: The purpose of this study was to compare the diameters of the dural venous sinuses (DVSs) in children with sickle cell disease (SCD) with healthy controls and determine whether the size has any correlation to history of cerebral infarct among children with SCD.

Methods: A retrospective review compared demographics, medical history and magnetic resonance venography (MRV) findings in children with SCD with those in controls. Venous sinus diameters were measured on MRV in all subjects by the authors, who were blinded to the children's clinical history.

Bridging the Radiology-Pediatrics Interaction Gap by Incorporating a PGY4 Radiology Resident into the General Pediatrics Team.

To bridge the gap between clinicians and radiologists, radiology residents rounded with inpatient pediatric medicine teams to present and interpret daily imaging studies, as well as assist with decisions and indications for radiologic exams. Surveys were sent to team members who rotated with radiology residents, and the consensus strongly favored having radiology residents on future rotations. Team members responded that they benefitted from a better understanding of radiology exams, their indications and limitations.

The Mercy unique device identifier demonstration project: Implementing point of use product identification in the cardiac catheterization laboratories of a regional health system.

Mercy, a 4 state health system, conducted an FDA-sponsored demonstration whereby prototype unique device identifiers (UDIs) of coronary stents were implemented in its electronic information systems for safety surveillance and research. To accomplish this, a multi-disciplinary team implemented a point of use barcode scanning inventory management system in all 5 Mercy cardiac catheterization laboratories. The system's potential for improving inventory management and tracking Cath Lab supplies was felt to be sufficiently compelling for system deployment outside of the context of the demonstration.

Predictive Validity of the Beers and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States.

Objectives: To compare the predictive validity of the 2003 Beers, 2012 American Geriatrics Society (AGS) Beers, and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria.

Design: Retrospective cohort.

Setting: Managed care administrative claims data from 2006 to 2009.

Integrating Collaborative Interprofessional Simulation into Pre-Licensure Health Care Programs.

This interprofessional education activity incorporated National League of Nursing unfolding case studies and patient simulation with nursing, pharmacy, and medical students. Faculty developed a full-day simulation experience; the most unique element was a team meeting where nursing students presented home health findings to an interprofessional team, and students worked together to design a comprehensive plan of care. All students were in their geriatric specialty program rotations.

Differential effects of chlorinated and oxidized phospholipids in vascular tissue: implications for neointima formation.

The presence of inflammatory cells and MPO (myeloperoxidase) in the arterial wall after vascular injury could increase neointima formation by modification of phospholipids. The present study investigates how these phospholipids, in particular oxidized and chlorinated species, are altered within injured vessels and how they affect VSMC (vascular smooth muscle cell) remodelling processes. Vascular injury was induced in C57BL/6 mice and high fat-fed ApoE-/- (apolipoprotein E) mice by wire denudation and ligation of the left carotid artery (LCA).

Diagnostic accuracy of behavioral, activity, ferritin, and clinical indicators of restless legs syndrome.

Study Objectives: Lack of a valid diagnostic measure of restless legs syndrome (RLS) for persons with dementia, who do not have the cognitive ability to report complex symptoms, impedes RLS treatment and research in this population. The aim of this study was to determine the sensitivity and specificity of a combination of indicators for identifying RLS that could eventually be used to diagnose RLS in persons with dementia.

Design: 3-day, prospective instrument validation.

Development and evaluation of a student-led Medicare Part D Planning Clinic.

Objective: To describe the creation of a student-led Medicare Part D Planning Clinic and to present satisfaction survey data evaluating the clinic.

Design: Prospective pre- and post-assessment satisfaction surveys.

Setting: University of Arkansas for Medical Sciences Institute on Aging.

Why pick on propoxyphene? The evidence demands it.

While propoxyphene may have filled a niche when it was first marketed in 1957, newer, safer agents are now available. Multiple experts list the drug as one to avoid in the elderly patient. Evidence-based practice requires its use be minimized, especially in individuals over the age of 65.

Trans-aortic counterpulsation: a viable alternative?

Transthoracic intra-aortic balloon pump (IABP) insertion has been a relatively rare and uncommon procedure. However, it is an established beneficial option in patients with severe peripheral vascular disease (PVD) accompanied with bi-lateral femoral arterial occlusion. There are several viable alternatives to trans-aortic IABP insertion, including trans-axillary or in abdominal aorta (requiring a laparotomy).

The pharmacist and the Medicare Modernization Act: beauty and the beast?

Pharmacists across the nation envisioned great benefits from a nationally funded prescription drug insurance program to aid our senior and disabled patients. The Medicare Modernization Act of 2003 (MMA), containing this prescription drug provision, reminds me of a wild animal that you begin to see in the distance moving toward you. You try to find higher ground to give a defensive advantage.

Raccoonpox in a Canadian cat.

Poxvirus infections affecting the skin of cats are extremely rare in North America, in contrast to Europe where cowpox virus is well recognized as an accidental pathogen in cats that hunt small rodents. The virus or viruses responsible for the anecdotal cases in North America have never been characterized. This paper reports a case of raccoonpox infection in a Canadian cat.

Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study.

Background: The ability of patients to adhere to a medication regimen is imperative for achieving optimal outcomes. Elderly patients, especially those with memory loss, should be evaluated for their ability to manage medications to prevent significant drug-related problems. Assessment tools to determine the ability to manage medication therapy have not been tested in elderly patients with cognitive impairment.

Antimicrobial therapy and resistance in dermatologic pathogens of the elderly.

Dermatologic infections are treated to improve the elderly patient's quality of life and prevent disability and death. Pharmacokinetic changes, social issues, and the risk for adverse effects and drug interactions, however, increase the challenge to achieve successful treatment of those over age 65 as compared with younger patients. This challenge grows ever larger when coupled with the increasing trends of resistance among bacteria and fungi.

Antibiotics and resistance in dermatology: focus on treating the elderly.

Although elderly patients are at an increased risk for skin infections, the chief culprits are no different than in younger patients. However, many of these organisms have developed resistance to antibiotics. Resistance increases the morbidity, mortality, and cost of treating infections.