ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting.

Background: COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence.

Methods: A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children's Hospital of The King's Daughters (CHKD) were included in the study.

Faster discharge with lactated ringers than normal saline in first 72 h of acute pancreatitis: A multicenter randomized trial.

Objectives: Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS.

Study Design: A multisite randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.

Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma.

Importance: Vital signs are essential components in the triage of injured children. The Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS) physiologic criteria are frequently used for trauma assessments.

Objective: To evaluate the performance of ATLS and PALS criteria vs empirically derived criteria for identifying major trauma in children.

Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value.

Unnecessary diagnostic tests and treatments in children cared for in emergency departments (EDs) do not benefit patients, increase costs, and may result in harm. To address this low-value care, a taskforce of pediatric emergency medicine (PEM) physicians was formed to create the first PEM Choosing Wisely recommendations. Using a systematic, iterative process, the taskforce collected suggested items from an interprofessional group of 33 ED clinicians from 6 academic pediatric EDs.

Secondhand Smoke Exposure Measured in Urinary Cotinine Levels and Severity of Pediatric Sleep Apnea.

Importance: Exposure to secondhand smoke has been associated with numerous health problems in children, including obstructive sleep apnea. Secondhand smoke exposure may be a risk factor for increased pediatric sleep apnea severity.

Objectives: To assess the association of secondhand smoke exposure (SHSe), quantified by urinary cotinine levels, with severity of obstructive sleep apnea (OSA) in children.

Clonal Diversity, Antibiotic Resistance, and Virulence Factor Prevalence of Community Associated in Southeastern Virginia.

is a significant human pathogen with a formidable propensity for antibiotic resistance. Worldwide, it is the leading cause of skin and soft tissue infections (SSTI), septic arthritis, osteomyelitis, and infective endocarditis originating from both community- and healthcare-associated settings. Although often grouped by methicillin resistance, both methicillin-resistant (MRSA) and methicillin-sensitive (MSSA) strains are known to cause significant pathologies and injuries.

Overuse Injuries, Overtraining, and Burnout in Young Athletes.

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage.

ARID2, a milder cause of Coffin-Siris Syndrome? Broadening the phenotype with 17 additional individuals.

Coffin-Siris Syndrome (CSS, MIM 135900) is now a well-described genetic condition caused by pathogenic variants in the Bromocriptine activating factor (BAF) complex, including ARID1B, ARID1A, ARID2, SMARCA4, SMARCE1, SMARCB1, SOX11, SMARCC2, DPF2, and more recently, BICRA. Individuals with CSS have a spectrum of various medical challenges, most often evident at birth, including feeding difficulties, hypotonia, organ-system anomalies, and learning and developmental differences. The classic finding of fifth digit hypo- or aplasia is seen variably.

Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing.

Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied. To evaluate associations between ND with SDB symptom burden and QOL.

Pediatric Down Syndrome Upper Airway Stimulation: Patient Selection and Post-Implantation Optimization.

Objective: The Food and Drug Administration recently approved upper airway stimulation (UAS) for children with Down Syndrome and persistent obstructive sleep apnea who meet certain inclusion and exclusion criteria. Although there is a robust experience with this therapy in the adult population, established protocols used in adults are not directly transferrable to a complex pediatric population. This review aims to combine the protocols from several institutions for patient selection and postimplantation optimization, including a protocol for Drug-Induced Sleep Endoscopy in children with Down Syndrome, preactivation threshold measurements, device titration, and follow-up sleep studies.

Prostate-specific membrane antigen (PSMA) glycoforms in prostate cancer patients seminal plasma.

Introduction: Prostate-specific membrane antigen (PSMA) is a US Food and Drug Administration-approved theranostic target for prostate cancer (PCa). Although PSMA is known to be glycosylated, the composition and functional roles of its N-linked glycoforms have not been fully characterized.

Methods: PSMA was isolated from pooled seminal plasma from low-risk grade Groups 1 and 2 PCa patients.

Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children: Analysis of the Pediatric Adenotonsillectomy for Snoring (PATS) Randomized Clinical Trial.

Importance: It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT).

Objective: To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA.

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial.

Importance: The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown.

Objectives: To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB.

Design, Setting, And Participants: Randomized clinical trial enrolling 459 children aged 3 to 12.

Reducing physical restraints in pediatrics: A quality improvement mixed-methods analysis of implementing a clinical debriefing process after behavioural health emergencies in a Children's Hospital.

Introduction: An increasing number of pediatric patients with mental and behavioral health (MBH) conditions present to Emergency Department (ED) and inpatient settings with behavioral events that require physical restraint (PR). PR usage is associated with adverse outcomes. Clinical debriefing (CD) programs have been associated with improved performance but have not been studied in this population.

Navigating quality and safety in your health system: understanding the alphabet soup.

Entering any new healthcare system today requires thorough knowledge about its quality and safety structure and culture. Learning that language is generally the first step in gaining a better understanding of how systems function. This overview of common mnemonics in the quality and safety world will provide the reader with better comprehension of their quality systems within their institutions.

A theoretical and practical approach to quality improvement education.

Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems' emphases on QI result in the need for QI curricula that meet the needs of diverse learners.

Establishing outcome-driven vital signs ranges for children in the prehospital setting.

Background: Vital signs are frequently used in pediatric prehospital assessments and guide protocol utilization. Common pediatric vital sign classification criteria identify >80% of children in the prehospital setting as having abnormal vital signs, though few receive lifesaving interventions (LSIs). We sought to identify data-driven thresholds for abnormal vital signs by evaluating their association with prehospital LSIs.

Mindfulness for Young Athletes.

Mindfulness has been around for centuries and a significant amount of research has been published in the past 6 years. Mindfulness has been shown to be helpful to improve overall well-being and sports performance. There has been a large increase in anxiety, depression, and overall stress in the pediatric, adolescent, and young adult population.

Correlation of vital sign centiles with in-hospital outcomes among adults encountered by emergency medical services.

Background: Vital signs are a critical component of the prehospital assessment. Prior work has suggested that vital signs may vary in their distribution by age. These differences in vital signs may have implications on in-hospital outcomes or be utilized within prediction models.

Does a Preoperative Mental Health Diagnosis Affect Pain Management in Patients With Adolescent Idiopathic Scoliosis Undergoing Surgery?

Background: Patients with adolescent idiopathic scoliosis (AIS) are typically treated surgically with posterior spinal fusion (PSF) when the curve continues to progress beyond 45 to 50 degrees. In adult patients, studies have shown that preoperative psychiatric diagnoses are associated with poorer clinical outcomes after lumbar spine surgery. This study aims to address whether a preoperative mental health disorder affects outcomes in pediatric patients with AIS treated with PSF.