Vulnerability and Agency across Treatment-Seeking Journeys for Acutely Ill Children: How Family Members Navigate Complex Healthcare Before, During and After Hospitalisation in A Rural Kenyan Setting
Adult; Child Preschool; Cohort Studies; Female; Humans; Infant; Male; Qualitative Research; Prospective Studies; Family; Continuity of Patient Care; Hospitalization; Child Mortality; Social Support; Acute Disease; Caregivers; Health Facilities; Family Characteristics; Vulnerable Populations; Rural Population; Kenya/epidemiology; Agency; Child Health; Childhood acute illness; Delivery of Health Care/standards; Treatment-seeking; Vulnerability
BACKGROUND: Child mortality rates during hospitalisation for acute illness and after discharge are unacceptably high in many under-resourced settings. Childhood vulnerability to recurrent illness, and death, is linked to their families' situations and ability to make choices and act (their agency). We examined vulnerability and agency across treatment-seeking journeys for acutely ill children and considered the implications for policy and practice. METHOD: A qualitative sub-study was embedded within the prospective CHAIN Network cohort study, which is investigating mechanisms of inpatient and post-hospital discharge mortality among acutely ill young children across a spectrum of nutritional status. Primary data were collected from household members of 20 purposively selected cohort children over 18 months through formal interviews (total n = 74), complemented by informal discussions and observations. Data were analysed using narrative and thematic approaches. RESULTS: Treatment-seeking pathways were often long and complex, particularly for children diagnosed as severely malnourished. Family members' stories reveal that children's carers, usually mothers, navigate diverse challenges related to intersecting vulnerabilities at individual, household and facility levels. Specific challenges include the costs of treatment-seeking, confusing and conflicting messaging on appropriate care and nutrition, and poor continuity of care. Strong power inequities were observed between family members and health staff, with many mothers feeling blamed for their child's condition. Caregivers' agency, as demonstrated in decision-making and actions, often drew on the social support of others but was significantly constrained by their situation and broader structural drivers. CONCLUSION: To support children's care and recovery, health systems must be more responsive to the needs of families facing multiple and interacting vulnerabilities. Reducing incurred treatment costs, improving interpersonal quality of care, and strengthening continuity of care across facilities is essential. Promising interventions need to be co-designed with community representatives and health providers and carefully tested for unintended negative consequences and potential for sustainable scale-up.
Zakayo SM; Njeru RW; Sanga G; Kimani MN; Charo A; Muraya K; Sarma H; Uddin MF; Berkley JA; Walson JL; Kelley M; Marsh V; Molyneux S
International Journal for Equity in Health
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s12939-020-01252-x" target="_blank" rel="noreferrer noopener">10.1186/s12939-020-01252-x</a>
Nursing Care at End of Life in Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation
Acute Disease; Child; Death; Humans; Intensive Care Units Pediatric; Neoplasms; Pain; Respiration Artificial
BACKGROUND: Parents' perceptions of critical care during the final days of their child's life shape their grief for decades. Little is known about nursing care needs of children actively dying in the pediatric intensive care unit (PICU). OBJECTIVES: To examine associations between patient characteristics, circumstances of death, and nursing care requirements for children who died in the PICU. METHODS: A secondary analysis of the data set from the Randomized Evaluation of Sedation Titration for Respiratory Failure trial was conducted. RESULTS: This analysis included 104 children; 67 died after withdrawal of life-sustaining treatments; 21, after failed resuscitation; and 16, after brain death. Patients had a median age of 7.5 years, were cognitively appropriate, and were intubated for acute respiratory failure. Daily pain and sedation scores indicated patients' comfort was well managed (mean pain scores: modal, 0; peak, 2; mean sedation scores: modal, -2; peak, -1). Patients with longer PICU stays more often experienced pain and agitation on the day of death. Illness trajectory (acute, complex chronic condition, or cancer) was associated with pain scores (P = .04). Specifically, children with cancer had higher pain scores than children with acute illness trajectories (P = .01). Many patients (62%) had no change in critical care devices in their last days of life (median, 5 devices). Patterns of pain, sedation, comfort medications, and nursing care requirements did not differ by circumstances of death. CONCLUSION: Children with cancer and longer PICU stays may need comprehensive comfort management. Invasive devices left in place during withdrawal of life support may have inhibited parents' ability to connect with their child. Future research should incorporate parents' perspectives.
Broden EG; Hinds PS; Werner-Lin A; Quinn R; Asaro LA; Curley MAQ
American Journal of Critical Care
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4037/ajcc2022294" target="_blank" rel="noreferrer noopener">10.4037/ajcc2022294</a>
Communicating death and dying through simulation: A project with pediatric residents
acute disease; child; clergy; comfort; communication skill; conference abstract; conversation; curriculum; emergency treatment; human; Likert scale; pain; palliative therapy; residency education; resident; simulation; teaching; terminal care
Program Goals Pediatric residentscare for a wide spectrum of children with acute and chronic disease processes. They are often the first to communicate with families, yet receive little formal training in conveying difficult information. In 2014, during this author's chief resident academic year, many residents expressed feelings of frustration and inadequacy when caring for children at end-of-life, and also reported a lack of opportunities to process their patients' deaths. To address these needs, we partnered with an interdisciplinary team to create an end-of-life communications-based curriculum that was integrated into our existing resident simulation program. We aimed to provide communication opportunities for our residents in a safe, structured, and directly observed environment where they could practice communication skills and reflect on their experiences. We hypothesized that residents would value these simulations as part of their residency training, and would feel more comfortable communicating difficult news after practicing such skills. Evaluation The end-of-life simulation curriculum was developed by an interdisciplinary team of ICU and hospitalist physicians, pediatric palliative care professionals, child life specialists, and hospital chaplains. Over two years, all residents participated in simulations that focused on communicating with parents (standardized actors) in pediatric death and dying situations. Three pausing points were included during the simulation, offering residents the unique opportunity to discuss together how best to approach the next conversation with the standardized parent-actor. Following the simulations, the interdisciplinary team debriefed with the residents, allowing opportunity for reflection and addressing questions and concerns. After each simulation/debriefing cycle, educational resources were provided through an electronic teaching file, as well as opportunities to meet oneon- one with members of the interdisciplinary team for further processing. Pre-tests and post-tests were used to evaluate residents comfort with end-of-life communication and pediatric palliative care provision. A 5-point Likert scale was used to evaluate residents' level of comfort with a variety of skills/topics, including: discussing end-of-life care options with parents, limiting emergency treatment, managing pain/symptoms, pronouncing death, and coping with one's own responses to a child's death. Discussion Pediatric residents feel unprepared to communicate with families in end-of-life situations. Through this innovated simulation curriculum, we have been able to better understand the needs of our resident trainees and by providing exposure to these complex situations in a safe, empowering environment. Following our first year of data collection, we found that 92% of residents reported feeling more comfortable communicating with families in end-of-life situations after participating in a two hour simulation. The residents reported benefitting from these experiences; 100% of residents requested additional training in palliative care. We anticipate having second cycle data available for presentation in Fall, 2016 to further demonstrate the how this innovative simulation enhances pediatric resident education.
Greening H G; Havalad V; Kobler K
Pediatrics
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Challenges and 'obstacles': reframing our perspective on the transition into adulthood for young people with life-limiting and life-threatening conditions
Patient Transfer; Acute Disease; Adolescent; Humans; Young Adult
BACKGROUND: The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. AIM: To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. DESIGN: A systematic literature review and analysis of psychometric properties. DATA SOURCES: PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. RESULTS: From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. CONCLUSION: There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.
Pritchard AW; Rees SA
Journal of the Royal College of Physicians of Edinburgh
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4997/JRCPE.2016.402" target="_blank" rel="noreferrer noopener">10.4997/JRCPE.2016.402</a>
Harnessing the power of telemedicine in palliative care from childhood to adulthood: The why and how
acute disease
Objectives *Explain the rationale for incorporating telemedicine into the care of palliative care patients and its associated benefits. *Describe common challenges, proven strategies, and best practice recommendations for successful and sustainable integration of a telemedicine program into palliative medicine programs. *Appreciate the ease of telemedicine and discuss patient-centered benefits of implementing telemedicine into palliative care practice. Although Pediatric Palliative Care (PC) Programs are increasing in number across the country, "deserts" still exist in which access to PC interdisciplinary teams is challenged. Many families elect home-based PC, and the expectation of travel to a clinic or hospital for appointments is not universally appropriate, practical or patient-centered. Many children who receive PC are medically fragile and dependent on technology. Transporting these patients can increase stress, adversely impact quality of life, and increase caregiver burden and the risk of infectious exposure. The result is poor adherence with follow-up and, at times, delays in seeking care during acute illness. In this presentation we will propose a concise, evidence-based, and patient-tailored approach to overcoming these obstacles through the utilization of telemedicine (TM) encounters. Common challenges in the development and implementation of PC TM programs will be shared. Two pediatric institutions will compare and contrast the evolution of their TM programs, describe strategies employed to overcome challenges, and share outcomes. Through a casebased approach we will address billing, technological aspects, privacy and security of data, team engagement and program sustainability. We will demonstrate the ease of a TM encounter live during the session, and explore the perspective of a young adult PC patient in how TM has enhanced his care. A panel discussion will focus on successful and collaborative solutions to optimize care for children at home through TM and invite questions, success stories and challenges in the use of TM from attendees. Audience members will gain insight and appreciation for how TM can broaden and improve patient care, and will obtain concrete ideas for overcoming challenges in developing PC TM programs in their home institutions.
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Ajayi T; Doshi A; Thienprayoon R; Bower K; Tate M; Short R
Journal of Pain and Symptom Management
2018
<a href="http://doi.org/10.1016/j.jpainsymman.2017.12.003" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2017.12.003</a>
Good-parent beliefs of parents of seriously ill children
adolescent; Child; Cross-Sectional Studies; Female; Humans; infant; Male; Parent-Child Relations; Parents; Questionnaires; Chronic disease; Child welfare; Acute Disease; Stress; Practice; Preschool; Adaptation; Psychological; Attitudes; Newborn; Health Knowledge; Philadelphia
IMPORTANCE: Parents' beliefs about what they need to do to be a good parent when their children are seriously ill influence their medical decisions, and better understanding of these beliefs may improve decision support. OBJECTIVE: To assess parents' perceptions regarding the relative importance of 12 good-parent attributes. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, discrete-choice experiment was conducted at a children's hospital. Participants included 200 parents of children with serious illness. MAIN OUTCOMES AND MEASURES: Ratings of 12 good-parent attributes, with subsequent use of latent class analysis to identify groups of parents with similar ratings of attributes, and ascertainment of whether membership in a particular group was associated with demographic or clinical characteristics. RESULTS: The highest-ranked good-parent attribute was making sure that my child feels loved, followed by focusing on my child's health, making informed medical care decisions, and advocating for my child with medical staff. We identified 4 groups of parents with similar patterns of good-parent-attribute ratings, which we labeled as: child feels loved (n=68), child's health (n=56), advocacy and informed (n=55), and spiritual well-being (n=21). Compared with the other groups, the child's health group reported more financial difficulties, was less educated, and had a higher proportion of children with new complex, chronic conditions. CONCLUSIONS AND RELEVANCE: Parents endorse a broad range of beliefs that represent what they perceive they should do to be a good parent for their seriously ill child. Common patterns of how parents prioritize these attributes exist, suggesting future research to better understand the origins and development of good-parent beliefs among these parents. More important, engaging parents individually regarding what they perceive to be the core duties they must fulfill to be a good parent may enable more customized and effective decision support.
2015-01
Feudtner C; Walter JK; Faerber JA; Hill DL; Carroll KW; Mollen CJ; Miller VA; Morrison WE; Munson DA; Kang T; Hinds PS
Jama Pediatrics
2015
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/jamapediatrics.2014.2341" target="_blank" rel="noreferrer">10.1001/jamapediatrics.2014.2341</a>
Beta-Endorphin Response to an Acute Pain Stimulus
Male; Pain Measurement; Time Factors; Reproducibility of Results; Animals; Mice; Acute Disease; Biomarkers of Pain; Physical Stimulation; Animal; beta-Endorphin/analysis/metabolism/secretion; Biological Markers/analysis/blood; Disease Models; Inbred DBA; Neurochemistry/methods; Pain/blood/physiopathology; Radioimmunoassay/methods; Up-Regulation/physiology
The timing of the measurement of biological samples (e.g. biomarkers) is not always standardized. Biomarkers are the focus of many recent studies and treatments. The purpose of this study was to determine the timing of the release of beta-endorphin (BE), a possible biomarker, after exposure to pain and/or handling stress in order to standardize measurements. Mouse plasma was collected for BE analysis following handling i.e. being picked up by the investigator, exposure to a painful (55 degrees C hot-plate), or exposure to a nonpainful stimulus (room temperature hot-plate). The groups exposed to either a painful or nonpainful stimulus released BE in response to the stimulus, but the duration of the response was longer in mice exposed to a painful stimulus than in mice exposed to a nonpainful stimulus. The BE in the mice exposed to a nonpainful stimulus peaked at 1 min and returned to baseline levels by 5 min while the BE response of the mice exposed to a painful stimulus peaked at 10 min and remained elevated for 25 min. The results of this study indicate that BE can be a biomarker for pain and handling stress, however, the timing of the measurement should differ.
Rasmussen NA; Farr LA
Journal Of Neuroscience Methods
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jneumeth.2008.10.013" target="_blank" rel="noreferrer noopener">10.1016/j.jneumeth.2008.10.013</a>
Acute colonic pseudo-obstruction in postchemotherapy complication of brain tumor treated with neostigmine
Child; Humans; Male; Acute Disease; Neostigmine/therapeutic use; Antineoplastic Combined Chemotherapy Protocols/adverse effects/therapeutic use; Brain Neoplasms/drug therapy; Cecum/pathology; Colon/pathology; Colonic Pseudo-Obstruction/chemically induced/drug therapy
Acute colonic pseudo-obstruction is characterized by dilatation of the large bowel without mechanical obstruction. Although the first step of the treatment is conservative management, mechanical decompression should be performed when symptoms persist. Recently, the efficacy of pharmacologic treatment has been reported in adults, but no such data have yet been reported in children for treatment of acute colonic pseudo-obstruction resulting from chemotherapy. We report a 9-year-old boy with acute colonic pseudo-obstruction caused by chemotherapy for brain tumor who did not respond to initial supportive therapy, but who was successfully treated with neostigmine.
2007
Kim TS; Lee JW; Kim MJ; Park YS; Lee DH; Chung NG; Cho B; Lee S; Kim HK
Journal Of Pediatric Hematology/oncology
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/MPH.0b013e318063ef4b" target="_blank" rel="noreferrer">10.1097/MPH.0b013e318063ef4b</a>
Role of systemic steroids in acute preschool wheeze
Child; Humans; Acute Disease; Randomized Controlled Trials as Topic; Emergency Service; Preschool; infant; Hospital; Glucocorticoids/pharmacology; Respiratory Sounds/drug effects
2010
Grigg J
Archives Of Disease In Childhood
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/adc.2009.160994" target="_blank" rel="noreferrer">10.1136/adc.2009.160994</a>
Direct measurement of intracranial pressure at high altitude and correlation of ventricular size with acute mountain sickness: Brian Cummins' results from the 1985 Kishtwar expedition
Humans; Male; Young Adult; Adult; Middle Aged; Severity of Illness Index; Intracranial Pressure; Acute Disease; adolescent; Tomography; X-Ray Computed; India; Altitude Sickness/diagnosis/etiology/physiopathology; Brain/complications/physiopathology; Cerebral Ventricles/physiopathology; Expeditions; Experimental; Headache/etiology; Hypoxia; Implants; Intracranial Hypertension/diagnosis/etiology; Physical Exertion; Telemetry/instrumentation
OBJECTIVE AND IMPORTANCE: The "tight-fit" hypothesis and subsequent current understanding of acute mountain sickness (AMS) is that individuals with less compliant cerebrospinal fluid systems (smaller ventricles and cerebrospinal fluid spaces) have a greater increase in intracranial pressure (ICP) for a given increase in brain volume as a result of hypoxic cerebral edema. There has only been 1 study of direct (telemetric) ICP measurement at high altitude. This was performed in 1985 on 3 subjects by Brian Cummins up to a maximum height of 16,500 ft (5030 m). The group also investigated the "tight-fit" hypothesis by correlating computed tomographic scans that measured ventricular size (read blindly) with headache score and AMS symptomatology in 10 subjects. Unfortunately, the data were thought to have been destroyed by fire, and, hence, the findings were not published. The data have now been rediscovered, and this article reviews the methodology and findings of this unique piece of work. RESULTS: The ICP monitoring study demonstrated that ICP remained normal at rest at all altitudes; however, in the single subject with AMS, there was a dramatic increase in ICP even on minimal exertion. The computed tomographic scan analysis of brain compliance demonstrated an inverse correlation between ventricular size and headache score. CONCLUSION: This unique research, which is unlikely to ever be repeated, is the only report of direct ICP measurement at high altitude. This and the computed tomographic study provide the first objective evidence supporting the "tight-fit" hypothesis of AMS.
2008
Wilson MH; Milledge J
Neurosurgery
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1227/01.NEU.0000327885.15132.CA" target="_blank" rel="noreferrer">10.1227/01.NEU.0000327885.15132.CA</a>
Management of acute asthma in adults in the emergency department: nonventilatory management
Female; Humans; Pregnancy; Adult; Risk Factors; Acute Disease; Oxygen Inhalation Therapy; Patient Admission; Emergency Service; decision making; Radiography; Thoracic; Hospital; Blood Gas Analysis; Oxygen/blood; Airway Obstruction/diagnosis; Forced Expiratory Volume; Recurrence/prevention & control; Adrenal Cortex Hormones/therapeutic use; Asthma/diagnosis/therapy; Bronchodilator Agents/therapeutic use; Magnesium Sulfate/therapeutic use; Oximetry; Peak Expiratory Flow Rate
2010
Hodder R; Lougheed MD; Rowe BH; FitzGerald JM; Kaplan AG; McIvor RA
Canadian Medical Association Journal
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1503/cmaj.080072" target="_blank" rel="noreferrer">10.1503/cmaj.080072</a>
A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma
Child; Female; Humans; Male; Pain Measurement; Analgesics; Treatment Outcome; Patient Satisfaction; Acute Disease; adolescent; Administration; Oral; Non-Narcotic/therapeutic use; Dose-Response Relationship; Drug; Opioid/therapeutic use; Pain/diagnosis/drug therapy/etiology; Codeine/therapeutic use; Acetaminophen/therapeutic use; Ibuprofen/therapeutic use; Wounds and Injuries/complications
OBJECTIVE: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries. PATIENTS AND METHODS: Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. RESULTS: A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale <30 mm) than the other 2 groups. There was no significant difference between patients in the codeine and acetaminophen groups in the change in pain score at any time period or in the number of patients achieving adequate analgesia. CONCLUSIONS: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.
2007
Clark E; Plint AC; Correll R; Gaboury I; Passi B
Pediatrics
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2006-1347" target="_blank" rel="noreferrer">10.1542/peds.2006-1347</a>
The course of high-sensitive C-reactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain - a 6 months prospective longitudinal study
Female; Humans; Male; Pain Measurement; Cohort Studies; Adult; Middle Aged; Time Factors; Acute Disease; Chronic disease; C-Reactive Protein/metabolism; Low Back Pain/blood/physiopathology/therapy; Recovery of Function/physiology; Sciatica/blood/physiopathology/therapy
In this prospective longitudinal study with a follow-up of 6 months, the course of serum concentration of C-reactive protein was measured by an ultrasensitive immunoassay in 31 patients with acute lumbosciatic pain and 41 patients with chronic low back pain. High-sensitive CRP (hsCRP), pain and clinical function were assessed at ten fixed time-points during follow-up. The course of hsCRP values was assessed in relation to the course of pain and clinical function adjusting for possible confounding factors. At the beginning of the study, there were no statistically significant differences in mean hsCRP levels in patients with acute lumbosciatic pain (1.49mg/l) compared to the levels obtained in patients with chronic low back pain (1.30mg/l) and those in a control group from the general population (1.26mg/l). In patients with acute lumbosciatic pain, hsCRP declined significantly in the initial period of 3 weeks with a corresponding decrease in pain and improvement in function and clinical evaluation as assessed with the straight leg raising test (SLR), whereas after this period, the course of the hsCRP did not correspond with the clinical parameters. In patients with chronic low back pain, hsCRP remained approximately constant throughout the whole period with no correlation with pain or function. As a conclusion, according to this study levels of hsCRP do not have a major clinical relevance when evaluating the long-term course of patients with acute lumbosciatic pain and chronic low back pain and therefore should not be taken into primary consideration when decisions on therapy are made.
2006
Gebhardt K; Brenner H; Sturmer T; Raum E; Richter W; Schiltenwolf M; Buchner M
European Journal Of Pain
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.ejpain.2005.11.005" target="_blank" rel="noreferrer">10.1016/j.ejpain.2005.11.005</a>
Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory ('triple-agent') therapy for episodes of acute on chronic pain
Humans; Adult; Analgesics; Prospective Studies; Aged; Middle Aged; Acute Disease; 80 and over; Oxycodone/administration & Pain/drug therapy; Analgesics/administration & dosage; Combination; Dexamethasone/administration & Drug Therapy; Hydromorphone/administration & Ketamine/administration & Ketorolac/administration & Male; Non-Steroidal/administration & Chronic Disease; Opioid/administration & Anti-Inflammatory Agents
AIM: This prospective audit was undertaken in order to document the analgesic response and adverse effects of concurrent short-term ('burst') triple-agent analgesic (ketamine, an opioid and an anti-inflammatory agent--either steroidal or non-steroidal) administration, for episodes of acute on chronic pain. The clinical hypothesis in this study is that better pain control may be obtained by simultaneous multiple target receptor blockade. METHOD: The response of 18 patients is reported. The pain and analgesic requirement data for the 24 h before starting triple-agent therapy were compared with the last 24 h on the triple-agent therapy. Patients were then classified as responders or non-responders. RESULTS : According to stringent clinical criteria, 12 out of the 18 patients were classified as responders. The response rate was highest for somatic pain (7/9) and appeared to decrease with duration of prior uncontrolled pain. Only four out of the 18 patients reported adverse effects and all of these were minor. CONCLUSIONS: The results suggest that this 'burst' triple-agent approach is safe and effective in an inpatient palliative care population during episodes of poorly controlled acute on chronic pain, and warrants further investigation to ascertain whether it gives superior results compared to the 'gold-standard' WHO ladder approach.
2005
Good P; Tullio F; Jackson K; Goodchild C; Ashby M
Internal Medicine Journal
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1445-5994.2004.00727.x" target="_blank" rel="noreferrer">10.1111/j.1445-5994.2004.00727.x</a>
The natural history of juvenile or subacute GM2 gangliosidosis: 21 new cases and literature review of 134 previously reported.
Child; Female; Humans; Male; Adult; Prospective Studies; Longitudinal Studies; Acute Disease; adolescent; Preschool; infant; Q3 Literature Search; retrospective studies; Gangliosidoses; GM2/diagnosis
OBJECTIVE: Juvenile GM2 gangliosidosis is a group of inherited neurodegenerative diseases caused by deficiency of lysosomal beta-hexosaminidase resulting in GM2 ganglioside accumulation in brain. The purpose of this study was to delineate the natural history of the condition and identify genotype-phenotype correlations that might be helpful in predicting the course of the disease in individual patients. METHODS: A cohort of 21 patients with juvenile GM2 gangliosidosis, 15 with the Tay-Sachs variant and 6 with the Sandhoff variant, was studied prospectively in 2 centers. Our experience was compared with previously published reports on 134 patients. Information about clinical features, beta-hexosaminidase enzyme activity, and mutation analysis was collected. RESULTS: In our cohort of patients, the mean (+/-SD) age of onset of symptoms was 5.3 +/- 4.1 years, with a mean follow-up time of 8.4 years. The most common symptoms at onset were gait disturbances (66.7%), incoordination (52.4%), speech problems (28.6%), and developmental delay (28.6%). The age of onset of gait disturbances was 7.1 +/- 5.6 years. The mean time for progression to becoming wheelchair-bound was 6.2 +/- 5.5 years. The mean age of onset of speech problems was 7.0 +/- 5.6 years, with a mean time of progression to anarthria of 5.6 +/- 5.3 years. Muscle wasting (10.6 +/- 7.4 years), proximal weakness (11.1 +/- 7.7 years), and incontinence of sphincters (14.6 +/- 9.7 years) appeared later in the course of the disease. Psychiatric disturbances and neuropathy were more prevalent in patients with the Sandhoff variant than in those with the Tay-Sachs variant. However, dysphagia, sphincter incontinence, and sleep problems occurred earlier in those with the Tay-Sachs variant. Cerebellar atrophy was the most common finding on brain MRI (52.9%). The median survival time among the studied and reviewed patients was 14.5 years. The genotype-phenotype correlation revealed that in patients with the Tay-Sachs variant, the presence of R178H and R499H mutations was predictive of an early onset and rapidly progressive course. The presence of either G269S or W474C mutations was associated with a later onset of symptoms along with a more slowly progressive disease course. CONCLUSIONS: Juvenile GM2 gangliosidosis is clinically heterogeneous, not only in terms of age of onset and clinical features but also with regard to the course of the disease. In general, the earlier the onset of symptoms, the more rapidly the disease progresses. The Tay-Sachs and Sandhoff variants differed somewhat in the frequency of specific clinical characteristics. Speech deterioration progressed more rapidly than gait abnormalities in both the Tay-Sachs variant and Sandhoff variant groups. Among patients with the Tay-Sachs variant, the HEXA genotype showed a significant correlation with the clinical course.
2006
Maegawa GH; Stockley T; Tropak M; Banwell B; Blaser S; Kok F; Giugliani R; Mahuran D; Clarke JT
Pediatrics
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2006-0588" target="_blank" rel="noreferrer">10.1542/peds.2006-0588</a>
Managing children's pain
Child; Humans; Adolescent Psychology; Age Factors; Nurse's Role; Child Psychology; Cognition; Child Development; Nursing Assessment; Acute Disease; Primary Health Care; adolescent; Preschool; PedPal Lit; infant; Parents/education/psychology; Cognitive Therapy; Patient Education; Pediatric Nursing/methods; Analgesia/methods/nursing; Communication Disorders/complications; Pain Measurement/methods/nursing; Pain/diagnosis/psychology/therapy
2006
Savory J; Bennett M
Nursing Times
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Quantitative and qualitative analysis of gastroesophageal reflux after percutaneous endoscopic gastrostomy
Child; Female; Humans; Male; Hydrogen-Ion Concentration; Acute Disease; quality of life; Preschool; Enteral Nutrition/methods; Weight Gain; Monitoring; Endoscopy; Airway Obstruction/diagnosis; Gastroesophageal Reflux/epidemiology/etiology/therapy; Gastrointestinal/adverse effects/methods; Gastrostomy/adverse effects/methods; Nervous System Diseases/rehabilitation; Physiologic/methods/statistics & numerical data; Postoperative Complications/diagnosis/epidemiology/etiology; Vomiting/diagnosis
BACKGROUND/PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is of great benefit to a defined population of children, but gastrostomy has been implicated in causation or exacerbation of gastroesophageal reflux (GER). The aim of this study was to quantitatively and qualitatively analyze the effect of PEG on GER. METHODS AND MATERIAL: Sixty-four children mean age 6.7 +/- 4.2 years, most of whom were impaired neurologically were evaluated for GER after PEG between 1998 and 2000. Twenty-four-hour pH monitoring was used for quantitative assessment. Qualitative analysis was by interview to record the following: vomiting, choking, chest infection, and weight gain. RESULTS: Twenty-four hour pH monitoring was performed 9.4 +/- 1.2 weeks after PEG. Patients underwent follow-up for 18 +/- 6 months. Seventy-two percent who did not have reflux before PEG remained reflux free. Fourteen percent who had GER before PEG continued to have reflux (P .05). Six percent of patients with preexisting GER improved post-PEG. Of the 14 patients (22%) who had or continued to have reflux after PEG, 11 of 14 (79%) underwent antireflux surgery, and 21% were managed successfully by intensive medical treatment and change of feeding regimen. Only 6% experienced difficulties and complications with the device. Forty-eight percent of patients did not vomit pre- or postoperation. In 16%, vomiting improved post-PEG, whereas 14% experienced minor deterioration (1 to 2 vomits per month). Major deterioration was experienced by 22%. Weight gain occurred in 77%, and in 23% there was no loss of weight. There was an overall improvement in quality of life in 88% after PEG. Overall improvement in quality of life post-PEG, post-antireflux surgery and post-intensive medical management for pathologic GER was 94%. CONCLUSIONS: (1) PEG did not precipitate or exacerbate GER quantitatively or qualitatively in the majority of children. (2) A normal 24-hour pH study predicted a favourable outcome after PEG. (3) An abnormal preoperation pH study predicted persistence or worsening reflux after PEG, but not all of these patients required an antireflux procedure. (4) GER is not a contraindication to PEG, the overall benefits of which outweigh the risks.
2002
Samuel M; Holmes K
Journal Of Pediatric Surgery
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1053/jpsu.2002.30267" target="_blank" rel="noreferrer">10.1053/jpsu.2002.30267</a>
Pain, anxiety, distress, and suffering: interrelated, but not interchangeable
Child; Humans; Age Factors; Severity of Illness Index; Acute Disease; Stress; Chronic disease; Analgesics/administration & dosage/therapeutic use; Anxiety/drug therapy/etiology/psychology; Catheterization; Central Venous/adverse effects/psychology; Neoplasms/complications/drug therapy/psychology; Pain/complications/drug therapy/psychology; Psychological/drug therapy/etiology/psychology
2003
Berde C; Wolfe J
The Journal Of Pediatrics
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1067/mpd.2003.194" target="_blank" rel="noreferrer">10.1067/mpd.2003.194</a>
Does an acute pain service improve postoperative outcome?
Humans; Pain; Pain Measurement; Treatment Outcome; Cost-Benefit Analysis; Patient Satisfaction; Acute Disease; Non-U.S. Gov't; Research Support; Analgesics/administration & dosage/adverse effects/therapeutic use; Anesthesia Department; Hospital/economics/organization & administration; Postoperative/drug therapy/economics
2002
Werner MU; Soholm L; Rotboll-Nielsen P; Kehlet H
Anesthesia & Analgesia
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00000539-200211000-00049" target="_blank" rel="noreferrer">10.1097/00000539-200211000-00049</a>
Use of patient-controlled analgesia for management of acute pain
Humans; Acute Disease; Pain/drug therapy; Analgesics/administration & dosage/adverse effects; Infusion Pumps; Infusions; Injections; Intravenous; Self Administration/adverse effects/instrumentation
Patient-controlled analgesia (PCA) provides improved titration of analgesic drugs, thereby minimizing individual pharmacokinetic and pharmacodynamic differences. Patient-controlled analgesia decreases patient anxiety resulting from delays in receiving pain-relieving medication and from the slow onset of analgesic action when these drugs are administered either intramuscularly or in the extradural space. With PCA therapy, patients are reportedly able to maintain a near optimal state of analgesia with minimal sedation and few side effects. The potential for overdose can be minimized if small bolus doses are used with a mandatory lockout interval between successive doses. Finally, studies of the cost-effectiveness of PCA therapy are important if this therapeutic approach is to achieve more widespread acceptance.
1988
White PF
Jama
1988
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/jama.259.2.243" target="_blank" rel="noreferrer">10.1001/jama.259.2.243</a>
Beta-endorphin levels of children in acute stress
Child; Humans; infant; Prognosis; Follow-Up Studies; Acute Disease; Preschool; infant; beta-Endorphin/blood; Biomarkers of Pain; Newborn; Biomarkers Reference List; Blood Glucose/analysis; Hyperglycemia/blood/epidemiology/pathology; Insulin/blood; Stress/blood/epidemiology
In this study aiming to clarify the relationships between beta-endorphin and glucose levels, beta-endorphin levels were determined in children in acute stress. The study was carried out on 32 critically ill children between 5 days and 12 years presenting with clinical symptoms of acute infectious conditions. 11 healthy children were taken as controls. The results showed that although beta-endorphin levels were elevated in all critically ill patients, these levels were significantly higher than control values in hyperglycaemic cases. The insulin levels were also elevated. A follow-up of nine of the hyperglycaemic cases showed a significant decline in beta-endorphin and insulin levels with recovery. Glucose tolerance was also normal. These results confirm the reports of many other studies on the role of beta-endorphin as a stress hormone.
1990
Dindar A; Gunoz H; Neyzi O
Diabetes Research And Clinical Practice
1990
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/0168-8227(90)90052-u" target="_blank" rel="noreferrer">10.1016/0168-8227(90)90052-u</a>
Hospital care of patients with dementia.
Hospitalization; Humans; Palliative Care; Advance Directives; Prognosis; Acute Disease; Double Effect Principle; advance care planning; Dementia/co [Complications]; Dementia/mo [Mortality]; Hip Fractures/co [Complications]; Hip Fractures/th [Therapy]; Patient Care; Pneumonia/co [Complications]; Pneumonia/th [Therapy]; DNAR
2000
Riesenberg D
Jama
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/jama.284.1.87" target="_blank" rel="noreferrer">10.1001/jama.284.1.87</a>
A report of four cases of acute, severe pulmonary hemorrhage in infancy and support with extracorporeal membrane oxygenation
Female; Humans; Male; Extracorporeal Membrane Oxygenation; Respiration; Severity of Illness Index; Acute Disease; infant; Artificial; Hemorrhage/complications/therapy; Lung Diseases/complications/therapy; Respiratory Insufficiency/etiology/therapy
Introduction
Pulmonary hemorrhage is an uncommon event in infants. It has been described most commonly in the sick premature neonate, older child, or adolescent with chronic cardiopulmonary disease. Acute idiopathic pulmonary hemorrhage in previously healthy infants has, to our knowledge, been reported only rarely. During the past 5 years we have successfully treated 4 infants with sever respiratory failure secondary to acute idiopathic pulmonary hemorrhage. Two of these patients were managed with the conventional therapy of mechanical ventilation, while the other two were successfully managed with extracorporeal membrane oxygenation (ECMO) after failure of conventional mechanical ventilation. In this report we review the current literature on this unusual pediatric problem and describe the use of ECMO as a modality in supporting patients after an acute pulmonary hemorrhage.
Siden HB; Sanders GM; Moler FW
Pediatric Pulmonology
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/ppul.1950180512" target="_blank" rel="noreferrer noopener">10.1002/ppul.1950180512</a>
Intermittent but not continuous inescapable footshock stress affects immune responses and immunocyte beta-endorphin concentrations in the rat
Male; Time Factors; Animals; Acute Disease; Rats; Comparative Study; Receptors; beta-Endorphin/analysis; Corticosterone/blood; Corticotropin-Releasing Hormone/antagonists & inhibitors; Corticotropin-Releasing Hormone/blood/pharmacology/physiology; Electroshock/adverse effects; Foot; Helplessness; Killer Cells; Learned; Lymphocyte Activation; Lymphoid Tissue/chemistry; Natural/immunology; Neuroimmunomodulation/physiology; Peptide Fragments/pharmacology; Spleen/immunology; Sprague-Dawley; Stress/etiology/immunology
It is well known that a variety of stressors influence immune responses. The opioid peptide-beta-endorphin (BE) is deeply involved in stress responses, is synthesized in cells of the immune system, and participates in the modulation of immune function. We analyzed the ability of two different stress paradigms to modulate the beta-endorphin concentrations in the immune cells and the immune response in the rat. Two and 24 h after the exposure to inescapable intermittent footshock (1.6 mA, 60 Hz, 1 s, every 5 s for 20 min) the concentrations of beta-endorphin in splenocytes, peripheral blood mononuclear cells and lymph node cells were significantly increased. In contrast, the exposure to a continuous footshock for 3 min did not affect the concentrations of the opioid peptide. Similarly, phytohemoagglutinin-induced proliferation of splenocytes and natural killer activity were significantly impaired only after the exposure to intermittent footshock stress. On the contrary, plasma corticosterone levels were similarly elevated after both paradigms of stress. The pretreatment with the corticotropin-releasing hormone (CRH) receptor antagonist prevented both the stress-induced increase of immunocyte BE and immunosuppression. In conclusion, our data suggest that intermittent and continuous footshock stressors activate different neuroendocrine responses and that CRH plays a central role in mediating the immune effects of the intermittent footshock stress. The possible relationship between the beta-endorphin changes and immunosuppression is discussed.
1994
Sacerdote P; Manfredi B; Bianchi M; Panerai AE
Brain, Behavior, And Immunity
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1006/brbi.1994.1023" target="_blank" rel="noreferrer">10.1006/brbi.1994.1023</a>
Acute onset of X-linked adrenoleukodystrophy mimicking encephalitis
Humans; Male; Acute Disease; infant; Q3 Literature Search; Tomography; Diagnosis; Differential; X-Ray Computed; Adrenoleukodystrophy/diagnosis/drug therapy/genetics; Encephalitis/diagnosis; Erucic Acids/therapeutic use; Fatty Acids/blood; Linkage (Genetics); X Chromosome
We report the case of a 6-year-old boy with X-linked adrenoleukodystrophy (ALD). In view of the acute onset of vomiting, fever, and coma, encephalitis was initially suspected. However, brain magnetic resonance imaging demonstrated a pattern of demyelination that was consistent with ALD; this diagnosis was confirmed by the finding of elevated plasma very long-chain fatty acids levels. At presentation, the patient was hyponatremic. That this metabolic disturbance and the coma resolved within hours of the initiation of corticosteroid therapy suggests that the presenting symptoms were secondary to adrenal cortical insufficiency. Primary adrenal failure was confirmed by endocrinologic evaluation. Thrombocytopenia, hepatic transaminase abnormalities, anemia and leukopenia developed during the subsequent course of therapy with oleic acid and erucic acid.
1994
Zammarchi E; Donati MA; Tucci F; Fonda C; Fanelli F; Pazzaglia R
Brain & Development
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/0387-7604(94)90077-9" target="_blank" rel="noreferrer">10.1016/0387-7604(94)90077-9</a>
Pediatric acute pain management
Child; infant; Analgesics; Time Factors; Acute Disease; Nebulizers and Vaporizers; Anesthetics; Preschool; infant; Chronic disease; Newborn; Infusions; Intravenous; Human; Local/therapeutic use; Nerve Block/methods; Non-Narcotic/administration & dosage/therapeutic use; Opioid/administration & dosage/blood/therapeutic use; Pain/drug therapy/physiopathology
The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
2000
Golianu B; Krane EJ; Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0031-3955(05)70226-1" target="_blank" rel="noreferrer">10.1016/s0031-3955(05)70226-1</a>
Efficacy and complications of morphine infusions in postoperative paediatric patients
Child; Female; Humans; Male; Pain; Analgesics; Follow-Up Studies; Confidence Intervals; Incidence; Acute Disease; adolescent; Preschool; infant; retrospective studies; Infusions; Intravenous; Opioid/administration & dosage/adverse effects/therapeutic use; Morphine/administration & dosage/adverse effects/therapeutic use; Postoperative/prevention & control; Respiration/drug effects; Akathisia; Analgesia/nursing; Anesthesia Recovery Period; Anoxemia/chemically induced; Arousal/drug effects; Drug-Induced/etiology; Postoperative Nausea and Vomiting/chemically induced; Pruritus/chemically induced; Urinary Retention/chemically induced
The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.
1999
Esmail Z; Montgomery C; Courtrn C; Hamilton D; Kestle J
Paediatric Anaesthesia
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1046/j.1460-9592.1999.00384.x" target="_blank" rel="noreferrer">10.1046/j.1460-9592.1999.00384.x</a>
Neostigmine for the treatment of acute colonic pseudo-obstruction
Female; Humans; Male; Adult; Aged; Middle Aged; Acute Disease; Double-Blind Method; 80 and over; Recurrence; Abdominal Pain/chemically induced; Cholinesterase Inhibitors/adverse effects/therapeutic use; Colonic Pseudo-Obstruction/drug therapy; Neostigmine/adverse effects/therapeutic use
BACKGROUND: Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment. METHODS: We studied 21 patients with acute colonic pseudo-obstruction. All had abdominal distention and radiographic evidence of colonic dilation, with a cecal diameter of at least 10 cm, and had had no response to at least 24 hours of conservative treatment. We randomly assigned 11 to receive 2.0 mg of neostigmine intravenously and 10 to receive intravenous saline. A physician who was unaware of the patients' treatment assignments recorded clinical response (defined as prompt evacuation of flatus or stool and a reduction in abdominal distention), abdominal circumference, and measurements of the colon on radiographs. Patients who had no response to the initial injection were eligible to receive open-label neostigmine three hours later. RESULTS: Ten of the 11 patients who received neostigmine had prompt colonic decompression, as compared with none of the 10 patients who received placebo (P<0.001). The median time to response was 4 minutes (range, 3 to 30). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Two patients who had an initial response to neostigmine required colonoscopic decompression for recurrence of colonic distention; one eventually underwent subtotal colectomy. Side effects of neostigmine included abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine. CONCLUSIONS: In patients with acute colonic pseudo-obstruction who have not had a response to conservative therapy, treatment with neostigmine rapidly decompresses the colon.
1999
Ponec RJ; Saunders MD; Kimmey MB
The New England Journal Of Medicine
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00006254-200002000-00010" target="_blank" rel="noreferrer">10.1097/00006254-200002000-00010</a>
Pediatric utilization of rapamycin for severe cardiac allograft rejection
Child; Female; Humans; Adult; Animals; Acute Disease; Rabbits; Safety; Platelet Count; dosage; Antilymphocyte Serum/administration &; Cyclosporine/administration &; derivatives; dosage/adverse effects/therapeutic use; dosage/analogs &; Graft Rejection/drug therapy/etiology/pathology; Heart Transplantation/adverse effects; Immunosuppressive Agents/administration &; Methotrexate/administration &; Methylprednisolone/administration &; Mycophenolic Acid/administration &; Prednisone/administration &; Sirolimus/administration &; T-Lymphocytes/immunology; Tacrolimus/administration &
BACKGROUND: Rapamycin is a new immunosuppressive agent that has been shown to be effective in the treatment of acute cardiac rejection in the adult population. METHODS: This case documents a pediatric patient with ongoing cardiac rejection that did not abate despite treatment with antithymocyte serum (RATS), corticosteroid pulses, and methotrexate in addition to daily prednisone, mycophenolate mofetil, and tacrolimus. RESULTS: Initiation of therapy with rapamycin resulted in a rapid resolution of cardiac rejection and reduction of concomitant immunosuppressive agents and few side effects. CONCLUSIONS: This case illustrated the utilization of rapamycin in a pediatric patient with ongoing acute rejection despite several modifications in treatment.
2000
Straatman LP; Coles JG
Transplantation
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00007890-200008150-00025" target="_blank" rel="noreferrer">10.1097/00007890-200008150-00025</a>
Increased concentration of beta-endorphin in sera of patients with psoriasis and other inflammatory dermatoses
Female; Humans; Male; Adult; Aged; Middle Aged; Acute Disease; adolescent; Comparative Study; beta-Endorphin/blood; Radioimmunoassay; Atopic/blood; Dermatitis; Psoriasis/blood; Scleroderma; Systemic/blood
Serum beta-endorphin was quantified by radioimmunoassay in 71 patients with psoriasis vulgaris, other chronic inflammatory skin diseases with T-cell infiltrates [atopic dermatitis (n = 25), and systemic sclerosis (n = 34)], and 100 healthy subjects. The neuropeptide was found to be markedly (P 60% body surface; 16.2 pg/ml), which lasted longer than 3 months (15.8 pg/ml), whereas neither the presence of stress nor itching correlated with the serum peptide concentration. Our data suggest that beta-endorphin is produced in psoriatic lesions by inflammatory cells, rather than the increased levels being the result of activation of the pituitary-adrenal axis by chronic stress. The generation of neuropeptide in psoriatic lesions and its antinociceptive effect on the peripheral sensory nerves might explain why pruritus is a relatively rare phenomenon in psoriasis.
1994
Glinski W; Brodecka H; Glinska-Ferenz M; Kowalski D
The British Journal Of Dermatology
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1365-2133.1994.tb08502.x" target="_blank" rel="noreferrer">10.1111/j.1365-2133.1994.tb08502.x</a>
Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases
Child; Humans; Acute Disease; Preschool; infant; Nutritional Status; retrospective studies; Enteral Nutrition/adverse effects; Nervous System Diseases/metabolism/therapy; Nitrogen/urine; Urea/urine
OBJECTIVE: To report on acquired experience of metabolic support for children with acute neurological diseases, emphasizing enteral tube feeding usage and metabolic assessment, and also to recommend policies aimed towards improving its implementation. DESIGN: Retrospective analysis. SETTING: Pediatric Intensive Care Unit of Hospital do Servidor Publico Estadual de Sao Paulo. SUBJECTS: 44 patients consecutively admitted to the Pediatric ICU over a period of 3 years who were given nutrition and metabolic support for at least 72 hours. Head trauma, CNS infections and craniotomy post-operative period following tumor exeresis were the main diagnoses. MEASUREMENTS: Records of protein-energy intake, nutrient supply route, nitrogen balance and length of therapy. RESULTS: From a total of 527 days of therapy, single parenteral nutrition was utilized for 34.3% and single enteral tube feeding for 79.1% of that period. 61.4% of the children were fed exclusively via enteral tube feeding, 9.1% via parenteral and 39.5% by both routes. The enteral tube feeding was introduced upon admission and transpyloric placement was successful in 90% of the cases. Feeding was started 48 hours after ICU admission. The caloric goal was achieved on the 7th day after admission, and thereafter parenteral nutrition was interrupted. The maximum energy supply was 104.2 +/- 23.15 kcal/kg. The median length of therapy was 11 days (range 4-38). None of the patients on tube feeding developed GI tract bleeding, pneumonia or bronchoaspiration episodes and, of the 4 patients who were given exclusive TPN, 2 developed peptic ulcer. The initial urinary urea nitrogen was 7.11 g/m2 and at discharge 6.44 g/m2. The protein supply increased from 1.49 g/kg to 3.65 g/kg (p < 0.01). The nitrogen balance increased from--7.05 to 2.2 g (p < 0.01). CONCLUSIONS: Children with acute neurological diseases are hypercatabolic and have high urinary nitrogen losses. The initial negative nitrogen balance can be increased by more aggressive feeding regimes than the usual ones. Early tube feeding was well tolerated, which permits the conclusion that it is a safe and effective method for nutrition support. Recommendations of basic rules for metabolic support are made.
1998
Leite HP; Fantozzi G
Sao Paulo Medical Journal = Revista Paulista De Medicina
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1590/s1516-31801998000600006" target="_blank" rel="noreferrer">10.1590/s1516-31801998000600006</a>
Association between opioid prescribing patterns and opioid overdose-related deaths
Female; Humans; Male; Young Adult; Cohort Studies; Adult; Analgesics; Aged; Middle Aged; Risk; Acute Disease; Case-Control Studies; adolescent; Physician's Practice Patterns/statistics & numerical data; Chronic disease; United States/epidemiology; Drug Prescriptions/statistics & numerical data; Opioid/administration & dosage/poisoning; Overdose/epidemiology; Pain/drug therapy; Veterans/statistics & numerical data
CONTEXT: The rate of prescription opioid-related overdose death increased substantially in the United States over the past decade. Patterns of opioid prescribing may be related to risk of overdose mortality. OBJECTIVE: To examine the association of maximum prescribed daily opioid dose and dosing schedule ("as needed," regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders. DESIGN: Case-cohort study. SETTING: Veterans Health Administration (VHA), 2004 through 2008. PARTICIPANTS: All unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain. Main Outcome Measure Associations of opioid regimens (dose and schedule) with death by unintentional prescription opioid overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions. RESULTS: The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment. CONCLUSION: Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.
Bohnert AS; Valenstein M; Bair MJ; Ganoczy D; McCarthy JF; Ilgen MA; Blow FC
Jama
2011
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/jama.2011.370" target="_blank" rel="noreferrer">10.1001/jama.2011.370</a>