Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses.

Background: Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees.

Family Presence During Pediatric Tracheal Intubations.

Importance: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated.

Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children.

Objective: The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children.

Materials And Methods: Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected.

Innovation in Pediatric Cardiac Intensive Care: An Exponential Convergence Toward Transformation of Care.

The word innovation is derived from the Latin noun innovatus, meaning renewal or change. Although companies such as Google and Apple are nearly synonymous with innovation, virtually all sectors in our current lives are imbued with yearn for innovation. This has led to organizational focus on innovative strategies as well as recruitment of chief innovation officers and teams in a myriad of organizations.

Epidural Baclofen for the Management of Postoperative Pain in Children With Cerebral Palsy.

Introduction: Children with cerebral palsy undergoing soft tissue and bony procedures often experience pain and spasticity postoperatively. Differentiation of pain from spasticity complicates management, so controlling spasticity with a continuous infusion of baclofen, an antispasmodic, through an already present indwelling epidural catheter holds interest.

Methods: A retrospective chart review was performed of patients with cerebral palsy undergoing single event, multilevel lower extremity surgery at a single institution who received epidural analgesia with or without continuous baclofen infusion.

Recombinant Salmonella Expressing Burkholderia mallei LPS O Antigen Provides Protection in a Murine Model of Melioidosis and Glanders.

Burkholderia pseudomallei and Burkholderia mallei are the etiologic agents of melioidosis and glanders, respectively. These bacteria are highly infectious via the respiratory route and can cause severe and often fatal diseases in humans and animals. Both species are considered potential agents of biological warfare; they are classified as category B priority pathogens.

Does timing of neonatal inguinal hernia repair affect outcomes?

Purpose: The purpose of this study was to examine practice variability and compare outcomes between early and delayed neonatal inguinal hernia repair (IHR).

Methods: Patients admitted to neonatal intensive care units with a diagnosis of IH who underwent IHR by age 1 year in the Pediatric Health Information System from 1999 to 2011 were included. IHR after the index hospitalization was considered delayed.

Early versus delayed surgical correction of malrotation in children with critical congenital heart disease.

Purpose: The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD).

Methods: Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed.

Contribution of copy-number variation to Down syndrome-associated atrioventricular septal defects.

Purpose: The goal of this study was to identify the contribution of large copy-number variants to Down syndrome-associated atrioventricular septal defects, the risk for which in the trisomic population is 2,000-fold more as compared with that of the general disomic population.

Methods: Genome-wide copy-number variant analysis was performed on 452 individuals with Down syndrome (210 cases with complete atrioventricular septal defects; 242 controls with structurally normal hearts) using Affymetrix SNP 6.0 arrays, making this the largest heart study conducted to date on a trisomic background.

ACR Appropriateness Criteria head trauma--child.

Head trauma is a frequent indication for cranial imaging in children. CT is considered the first line of study for suspected intracranial injury because of its wide availability and rapid detection of acute hemorrhage. However, the majority of childhood head injuries occur without neurologic complications, and particular consideration should be given to the greater risks of ionizing radiation in young patients in the decision to use CT for those with mild head trauma.

Intracranial Mycobacterium abscessus infection in a healthy toddler.

We present the first case of pediatric intracranial Mycobacterium abscessus infection in a 16-month-old female with neurofibromatosis type 1. We describe a successful treatment regimen including excisional biopsy combined with high-dose steroids and 16 weeks of triple antimicrobial therapy that resulted in clinical cure and an excellent neurologic outcome.

Radiation safety knowledge and perceptions among residents: a potential improvement opportunity for graduate medical education in the United States.

Rationale And Objectives: To investigate residents' knowledge of adverse effects of ionizing radiation, frequency of their education on radiation safety, and their use of radioprotective equipment.

Materials And Methods: Residents from 15/16 residency programs at Emory University were asked to complete a resident radiation safety survey through SurveyMonkey(®). The associations between the residents' knowledge and use of radioprotective equipment with residents' specialty and year of training were investigated.

Comparative accuracy of intravenous contrast-enhanced CT versus noncontrast CT plus intravenous contrast-enhanced CT in the detection and characterization of patients with hypervascular liver metastases: a critically appraised topic.

Rational And Objectives: To evaluate whether addition of nonenhanced computed tomography (NECT) to intravenous contrast-enhanced (CE) abdominal CT improves detection or characterization of hypervascular liver masses. Patients were referred for initial staging or follow-up with known breast, melanoma, neuroendocrine, or thyroid cancer.

Material And Methods: The literature was searched using the patient, intervention, comparison, and outcome (PICO) method.

Image Gently: a campaign to reduce children's and adolescents' risk for cancer during adulthood.

Recently, the Cancer Prevention Across the Lifespan workgroup at the Centers for Disease Control held a workshop entitled "Identifying Opportunities for Cancer Prevention During Pre-Adolescence and Adolescence." With the goal of raising awareness and developing community and policy interventions to decrease risk factors for cancer, one session highlighted the danger of ionizing radiation exposure from diagnostic medical imaging. This session focused on the Image Gently campaign, which is a multidisciplinary partnership focused on increasing awareness, developing education materials, and advocating for children to protect them from unnecessary radiation.

Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses.

Background: Children with inflammatory bowel disease (IBD) undergo imaging using ionizing radiation and may be exposed to high cumulative radiation. We hypothesized that children with IBD have high exposure to radiation from medical imaging.

Methods: An Institutional Review Board (IRB)-approved retrospective chart review from 2002-2008 was performed on all patients with IBD.

The role of prophylaxis in the management of von Willebrand disease: today and tomorrow.

Some patients with von Willebrand disease (VWD) will experience severe bleeding complications requiring intensive treatment. Up to 40% of patients with type 3 VWD experience joint bleeding, which can lead to haemophilic arthropathy. Patients with type 2A or 2B VWD are at risk of developing recurrent gastrointestinal bleeding, which is associated with angiodysplasia.

Torsion of an indirect hernia sac within a hydrocele causing acute scrotum: case report and review of the literature.

We report a case of acute scrotum in a 2-year-old child caused by torsion of an indirect hernia sac within a hydrocele. This is an extremely rare cause of acute scrotal swelling and pain in the pediatric population, with this case representing only the eighth instance reported in the literature. Despite the scarcity with which this diagnosis has been encountered, clinicians should include torsion of an indirect hernia sac on the differential diagnosis for acute scrotum in a child.

Non-Wilms' renal tumors in children.

Renal tumors other than Wilms' tumors are infrequent in childhood. Wilms' tumors account for 6% to 7% of childhood cancer, whereas the remaining renal tumors account for less than 1%. The most common non-Wilms' tumors are clear cell sarcoma of the kidney, rhabdoid tumor of the kidney, renal cell carcinoma, mesoblastic nephroma, and multilocular cystic nephroma.