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In Brief

Family Focus Restructures Single Ventricle Care
 Family Focus Restructures Single Ventricle Care 150 150 Brianne Moore
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Standardize, connected care in a multidisciplinary team environment aims to improve outcomes and quality of life for patients born with single ventricle heart anatomy. Children with single ventricle anatomy, one of the most harrowing of congenital heart defects, face unique challenges that require multiple procedures and hospital admissions to treat. In most institutions, each admittance…

Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm?
 Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm? 150 150 Rachael Hardison
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Supplementing with omega-3 and -6 fatty acids impacts language development in preterm toddlers at risk for developing autism. Delay in language development is often an early indicator in children at risk for developing autism spectrum disorder (ASD), yet clinicians are still trying to understand the best practices for how and when to implement early intervention…

“Impatient” Therapy: Physicians Too Aggressive in Treatment of ITP
 “Impatient” Therapy: Physicians Too Aggressive in Treatment of ITP 150 150 Brianne Moore
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Despite guidelines that advocate watching and waiting, physicians are still treating most patients with immune thrombocytopenia. When a child presents with easy bruising or bleeding, red skin spots and fatigue – symptoms similar to those for leukemia – families seek evaluation immediately. However, more often these cases are pediatric immune thrombocytopenia (ITP), an acquired disorder…

How to Improve Apparent Cause Analyses and Reduce Error Recurrence
 How to Improve Apparent Cause Analyses and Reduce Error Recurrence 150 150 Brianne Moore
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A quality improvement team embarks on a project focused on the accuracy of future quality improvement initiatives. An apparent cause analysis (ACA) is a process used to investigate the cause or causes of a medium or low-risk safety event. Designed as a quality improvement measure, ACAs are used to explain in detail why an issue…

Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles
 Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles 150 150 Kevin Mayhood
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The microbiome may harbor causes of abdominal and behavioral issues and potential targets for relief. Children with autism spectrum disorder (ASD) and functional abdominal pain may have a distinct microbiome-neuroimmune profile compared to kids with gastrointestinal disorders (GI) and those with no GI illness. Building on others’ research showing that Clostridia bacteria in the gut are altered…

Combining Quality Measures to Improve Surgical Outcomes
 Combining Quality Measures to Improve Surgical Outcomes 150 150 Kevin Mayhood
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Use a refined morbidity and mortality conference with a national database, a new study suggests. A pediatric surgery morbidity and mortality (M&M) conference that applies quality improvement practices borrowed from industry can be a significantly more effective tool for learning from mistakes and making corrections, researchers from Nationwide Children’s Hospital show in a new study.…

How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares
 How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares 150 150 Jeb Phillips
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A quality improvement project shows children with negative urine cultures take antibiotics they don’t need. Even before a urine culture confirms the diagnosis, urgent care physicians often prescribe antibiotics when children present with symptoms of urinary tract infection (UTI). Early treatment is important for relief of symptoms and prevention of complications. But what if the…

Emergency Departments Can Help Prevent Suicide
 Emergency Departments Can Help Prevent Suicide 150 150 Brianne Moore
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Secondary screenings, safety plans and phone follow-ups are key to reducing death by suicide. Suicide is the tenth leading cause of death in the United States and has increased in incidence 27 percent from 1999 to 2015. Interestingly, up to 40 percent of individuals who die by suicide visit an emergency department (ED) in the…

Cannabidiol May Reduce Drug-Resistant Seizures by Half
 Cannabidiol May Reduce Drug-Resistant Seizures by Half 150 150 Brianne Moore
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Two studies demonstrate clinically significant response to oral liquid cannabidiol over placebo. Two recent studies – one published in The New England Journal of Medicine and one presented at the 2017 American Academy of Neurology annual meeting – indicate that a new plant-based, cannabis-derived treatment may be able to decrease the incidence of seizures in two complex…

Specialists Collaborate to Improve Ovary Preservation
 Specialists Collaborate to Improve Ovary Preservation 150 150 Brianne Moore
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A weekend case inspires an investigation into how pediatric surgeons and gynecologists treat the same patient differently. When lesions persist on a patient’s ovary, there are two options for treatment: oophorectomy, which removes the entire ovary, and ovarian sparing surgery (OSS). Depending on referral patterns and access to specialists, either a pediatric surgeon or a…

Mechanism for Expulsion of DNA from NTHI Described
 Mechanism for Expulsion of DNA from NTHI Described 150 150 Abbie Miller
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Researchers at Nationwide Children’s publish breakthrough discovery revealing how DNA and DNABII proteins are released into the biofilm matrix. Nontypeable Haemophilus influenzae (NTHI) bacteria, a common culprit in otitis media, are known for their ability to create dense biofilms. As the subject of much biofilm and vaccine research, they are increasingly understood as complex and surprising organisms.…

Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures
 Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures 150 150 Brianne Moore
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The seemingly infinite indicators large pediatric systems use to measure children’s health often fall short in determining patient outcomes and quality of care. In an editorial published in JAMA Pediatrics, Kelly Kelleher, MD, director of the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital, and co-author William Gardner from the Children’s Hospital of Eastern Ontario, call for…

Math Model Reveals Immune System Secrets
 Math Model Reveals Immune System Secrets 150 150 Brianne Moore
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Natural killer (NK) cells are a key part of the innate immune system, activating to destroy virally infected cells or tumor cells detected in the body. While the mechanism of detection of infected cells by NK cells is well understood, some aspects of how NK cells communicate with other immune cells are not. Due to…

How to Advocate for Patients with Legislators
 How to Advocate for Patients with Legislators 150 150 Steve Allen, MD
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Perhaps more this year than any other in recent memory, the health care community has come together against a proposed piece of federal legislation. While opposition to the American Health Care Act/Better Care Reconciliation Act has been particularly urgent, hospitals and medical associations regularly engage in government advocacy work. At Nationwide Children’s Hospital, for example,…

Different Patterns of Executive Function Deficits in Different Pediatric Brain Disorders
 Different Patterns of Executive Function Deficits in Different Pediatric Brain Disorders 150 150 Mary Bates, PhD
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Clinical implications include specialized testing for deficits in executive function as these may not be apparent at a routine exam. A large group of researchers, including many from Nationwide Children’s Hospital, recently looked at whether children with different brain disorders show diverse patterns of strengths and weaknesses in executive functions. Children with traumatic brain injuries…

Immune Profiling Leads to Implications for Immunotherapy for NF1-Associated Tumors
 Immune Profiling Leads to Implications for Immunotherapy for NF1-Associated Tumors 150 150 Abbie Miller
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Profiling reveals histologic subtype distinctions and heterogeneity of neurofibromatosis type 1-associated tumors. Neurofibromatosis type 1 (NF1) — an autosomal dominant disorder affecting approximately one in every 3,500 people — results in dysfunctional neurofibromin, a protein expressed throughout the body and involved in the RAS signaling pathway. Virtually all patients with NF1 develop benign peripheral nerve…

Hepatitis E Persists and Self-Limits Due to Novel Mechanism, Study Finds
 Hepatitis E Persists and Self-Limits Due to Novel Mechanism, Study Finds 150 150 Brianne Moore
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A team of researchers finds that Hepatitis E behaves uniquely compared other hepatitis viruses and hopes to pave the way for future investigation. Hepatitis E virus (HEV) is one of five known human hepatitis viruses and infects approximately 20 million people annually. HEV causes significant morbidity and mortality around the world, causing acute hepatitis in…

Combining Immunotherapies Effective Against Mouse Model of Cancer
 Combining Immunotherapies Effective Against Mouse Model of Cancer 150 150 Mary Bates, PhD
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Recent study results suggest that combining virotherapy and PD-1 blockades may be more effective than either approach alone. Rhabdomyosarcoma, a cancer made up of cells that normally develop into skeletal muscles, is the most common soft tissue cancer in children. If it is detected early and localized in certain areas, rhabdomyosarcoma is usually curable with…

Sweat Chloride Should Be the First-Line CF Test, but Often Isn’t
 Sweat Chloride Should Be the First-Line CF Test, but Often Isn’t 150 150 Jeb Phillips
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A study finds that CFTR mutation analysis is being ordered before (or without) sweat chloride in some cases, potentially leading to missed diagnoses, increased patient anxiety and unnecessary costs. The Cystic Fibrosis Foundation is clear in its diagnostic guidelines: sweat chloride needs to be the first test ordered after a positive newborn screening for cystic…

Needle-free Immunization Prevents Experimental Otitis Media
 Needle-free Immunization Prevents Experimental Otitis Media 1024 575 Tiasha Letostak, PhD
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Close up, color image of someone extending a gloved hand with a small patch face up on their pointer finger that resembles a circular adhesive bandage that has a smaller, blue square patch on its center

The first data to demonstrate the efficacy of a simple, needle-free vaccine delivery system for middle ear infections. Otitis media (OM), or middle ear infection, accounts for approximately 30 million doctor visits a year in the U.S. The pathogen nontypeable Haemophilus influenzae (NTHI) causes the majority of cases of ear infection, including chronic OM, recurrent OM, and…

Assessing Romantic Lives of Adult Survivors of Childhood Cancer
 Assessing Romantic Lives of Adult Survivors of Childhood Cancer 150 150 Kevin Mayhood
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In some ways, the group appears more resilient than survivors of adult-onset cancer or those with other childhood-onset diseases. Adult survivors of childhood cancer appear, on the whole, to have comparable romantic lives to others their age, new studies show. Surprisingly, the group doesn’t seem to carry the same burdens as men and women with…

When Talking About Birth Control, Don’t Leave Boys Out of the Conversation
 When Talking About Birth Control, Don’t Leave Boys Out of the Conversation 150 150 Sarah Saxbe, MS, MSW, LISW-S
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Sex education for boys should include information about all forms of birth control, even those for females. When a child arrives in his or her pediatrician’s office each year for their well visit, the nurse and provider often go over a long list of questions for the parents and child. Many are related to daily…

The First Study of Oncolytic HSV-1 in Children and Young Adults With Cancer Indicates Safety and Tolerability
 The First Study of Oncolytic HSV-1 in Children and Young Adults With Cancer Indicates Safety and Tolerability 1024 575 Abbie Miller
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The phase 1 trial shows safety and tolerance of HSV1716 in the pediatric population; evidence of viral replication in the blood and acute inflammation on PET/CT scans suggest a phase 2 trial for dosage and efficacy is warranted. HSV1716 – an oncolytic herpes simplex virus-1 – has been studied in adults via injection into the…

Secondary Findings: What Should Be Reported?
 Secondary Findings: What Should Be Reported? 150 150 Brianne Moore
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With the growing use of exome and genome sequencing in research and diagnosis, the ACMG has recently released a policy update on the reporting of secondary findings. Genomic sequencing is instrumental in identifying many diseases. It can also reveal disease causing variants in our genetic code unrelated to the reason the clinical exome or genome…

In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10
 In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10 150 150 Kevin Mayhood
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Measures taken in first 12 hours of life are associated with a host of deficits. Children born extremely preterm are known to be at increased risk of neurodevelopmental impairments, but not all babies born the same early date and weight are equal. Researchers have found that for children born at less than 28 weeks, a…

The Maternal Microbiome: How Stress During Pregnancy Impacts Female Offspring in Adulthood
 The Maternal Microbiome: How Stress During Pregnancy Impacts Female Offspring in Adulthood 150 150 Tiasha Letostak, PhD
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A recent study suggests a critical window of pregnancy where stress is able to influence the microbiome and intrauterine environment, with lasting behavioral consequences. Previous research has demonstrated that stress during pregnancy changes the composition of the intestinal microbiota and is related to the emergence of behavioral disorders such as anxiety and depression. A new…

Balancing Immune Activation and Suppression After Cardiopulmonary Bypass
 Balancing Immune Activation and Suppression After Cardiopulmonary Bypass 150 150 Mary Bates, PhD
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Understanding how the immune system responds to CPB could dramatically impact postsurgical outcomes. Cardiopulmonary bypass (CPB) is a relatively routine procedure, generally with favorable outcomes. However, among the risks posed to patients is the over- or under-activation of the immune system following the surgery. Mark Hall, MD, FCCM, division chief of Critical Care at Nationwide Children’s Hospital,…

Bracing for Buckle Fractures
 Bracing for Buckle Fractures 150 150 Jeb Phillips
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Shifting from casts to splints for distal radius buckle fractures has saved time and money for providers and families. The traditional treatment for distal radius buckle fractures involves immobilization in a short- or longarm cast. A 2015 multi-institutional study found that more than 70 percent of pediatric orthopedic specialists use this as their standard of…

Survey: Physical Barriers, Not Fear, Keep Homeless Youth From Receiving Care
 Survey: Physical Barriers, Not Fear, Keep Homeless Youth From Receiving Care 150 150 Brianne Moore
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Research survey investigates barriers to care in unstably-housed youth. Every year, an estimated 1.6 to 1.7 million youth in the United States are living on the streets, in shelters or in other temporary living situations. Earlier studies have suggested that homeless youth do not seek medical services because of fear-based barriers – distrust of doctors,…

Best Practices in Severe BPD Treatment
 Best Practices in Severe BPD Treatment 150 150 Jeb Phillips
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To help standardize care, the Bronchopulmonary Dysplasia Collaborative has published a comprehensive review of evidence-based approaches for treatment of patients with severe forms of the disease. Infants with severe bronchopulmonary dysplasia (BPD) have high risks of late morbidities and mortality, but the best ways to manage these vulnerable patients are still debated. In fact, it’s…

Cognitive Behavioral Therapy Can Help Children With Persistent Post-Concussive Symptoms
 Cognitive Behavioral Therapy Can Help Children With Persistent Post-Concussive Symptoms 150 150 Mary Bates, PhD
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A psychological intervention improves kids’ function and quality of life even years after a concussion. For most children and adolescents that experience concussions, symptoms resolve after a week or two. However, a small subset of kids has persistent symptoms lasting for months or even years after the injury. These symptoms can be disruptive and stressful,…

How a QI Intervention Lowered Breast Milk Errors in a Busy NICU
 How a QI Intervention Lowered Breast Milk Errors in a Busy NICU 150 150 Kevin Mayhood
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Bedside barcode scanners and dedicated milk preparation technicians helped drive the decline. A quality improvement (QI) initiative in the Neonatal Intensive Care Unit (NICU) at Nationwide Children’s Hospital has been associated with a substantial reduction in errors administering mother’s milk to these vulnerable infants. The total number of scanned errors declined from 97.1 per 1,000…

U.S. Poison Control Centers Receive 32 Calls a Day About Pediatric Exposures to Prescription Opioids
 U.S. Poison Control Centers Receive 32 Calls a Day About Pediatric Exposures to Prescription Opioids 150 150 Tracy Mehan, MA
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Researchers call for changes to prescribing practices and increased education about safe storage at home. A new study published online today by Pediatrics and conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital found that there were more than 188,000 calls to U.S. Poison Control Centers for…

Teens With Asthma: A High School Diploma Does Not Equal Readiness for Self-Management
 Teens With Asthma: A High School Diploma Does Not Equal Readiness for Self-Management 150 150 David Stukus, MD
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Poorly controlled asthma takes a toll on numerous aspects of health and life. Asthma is the leading pediatric chronic health condition, affecting approximately 10 percent of children and adolescents. Uncontrolled asthma can lead to acute exacerbations and need for emergency department visits or hospitalizations. A frequently unrecognized toll of poorly controlled asthma is the impact…

Mechanism of Bacterial Adhesion to Platelets Revealed
 Mechanism of Bacterial Adhesion to Platelets Revealed 150 150 Tiasha Letostak, PhD
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Researchers investigate a key protein required to bind two distinct receptors on the bacteria Streptococcus oralis involved in infective endocarditis. Infective endocarditis (IE) is an infection of the endocardium, usually of the valves, and is caused by infectious agents that are typically bacterial. Understanding how these bacterial infections occur is important to the prevention, treatment…

ANH Preserves Platelet Count and Function Regardless of Storage Method and Time
 ANH Preserves Platelet Count and Function Regardless of Storage Method and Time 150 150 Kevin Mayhood
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Length of storage during cardiac surgeries appears to have no detrimental effects on blood. Across the United States, transfusions are standard in cardiac operating rooms, but at Nationwide Children’s Hospital, a practice geared toward limiting blood transfusion has been established and finely honed. According to a recent study from The Heart Center at Nationwide Children’s, more than…

How a QI Project Dramatically Increased Pediatric Survival After Cardiopulmonary Arrest
 How a QI Project Dramatically Increased Pediatric Survival After Cardiopulmonary Arrest 150 150 Jeb Phillips
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A survival rate of 37-48 percent among young heart surgery patients who experience code events is the norm. A multidisciplinary review process helped achieve an 81 percent rate at Nationwide Children’s Hospital. Survival rates have remained stubbornly low for young heart surgery patients who experience cardiopulmonary arrest; critical care literature reports that fewer than 50…

There’s No Place Like Home (Depending on Which State You Live In…..)
 There’s No Place Like Home (Depending on Which State You Live In…..) 150 150 Kelly Kelleher, MD, MPH
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Researchers find wide variation in how federal entitlement and benefit programs are implemented from state to state. Over the past five decades, the health of America’s children has improved considerably. Unfortunately, those improvements were not evenly distributed. Most American children are healthy and have promising futures. Children in poverty, on the other hand, infrequently move…

Two Investigational Antitumor Agents Work Better Together Against MPNST and Neuroblastoma
 Two Investigational Antitumor Agents Work Better Together Against MPNST and Neuroblastoma 150 150 Abbie Miller
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The synergistic effects of a kinase inhibitor and an oncolytic herpes virus show promise for difficult-to-treat neuroblastomas and malignant peripheral nerve sheath tumors. Two investigational agents, Aurora A kinase inhibitor (alisertib) and HSV1716, a virus derived from HSV-1 and attenuated by the deletion of RL1, have shown some antitumor efficacy in early clinical trials as…

Evaluating and Treating Pediatric Lower Back Pain in the Primary Care Setting
 Evaluating and Treating Pediatric Lower Back Pain in the Primary Care Setting 150 150 Jeb Phillips
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While pediatric training often focuses on etiology, recent studies have found that most cases of lower back pain in school-aged children have no definitive diagnosis and are benign and self-limiting. Primary care pediatricians are often taught that lower back pain in school-aged children has a definitive cause. As a recent review published in JAMA Pediatrics highlights, studies conducted over…

Hormonal Contraception Safer Than Expected For Women With Diabetes
 Hormonal Contraception Safer Than Expected For Women With Diabetes 150 150 Abbie Miller
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Women with diabetes often fall through the cracks when it comes to prescription contraception. A new study illuminates the issues and highlights safe options. The use of contraception to prevent unplanned pregnancies is an important aspect of women’s health. For women with chronic health conditions, family planning has important implications for the health of the…

Subclinical Muscle Involvement May be Missed With Amyopathic Juvenile Dermatomyositis Diagnosis
 Subclinical Muscle Involvement May be Missed With Amyopathic Juvenile Dermatomyositis Diagnosis 150 150 Abbie Miller
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Study shows that some children diagnosed with amyopathic dermatomyositis have subclinical muscle involvement, highlighting the need for standardized workup and treatment protocols. Juvenile dermatomyositis (JDM) is an autoimmune disease that classically presents in preschool to school aged children with a rash and muscle weakness. In some cases, children may present with the rash, but no muscle…

For AYA Females With Rhabdomyosarcoma, Consider Routine Examination or Imaging of Breasts
 For AYA Females With Rhabdomyosarcoma, Consider Routine Examination or Imaging of Breasts 150 150 Abbie Miller
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Rhabdomyosarcoma with breast involvement is found almost exclusively in females. A recent case series highlights the need for guidelines for follow-up imaging. Rhabdomyosarcoma (RMS) is a soft tissue sarcoma associated with metastasis and inferior outcomes in adolescent and young adult (AYA) patients (those with cancer diagnosis at age 15-39 years). Metastases to the breast have…

Hospitals Should Use Genotyping to Monitor Bacterial Infections
 Hospitals Should Use Genotyping to Monitor Bacterial Infections 150 150 Kevin Mayhood
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A team led by a pulmonologist-researcher found that in a children’s hospital, an unexpected pathogen emerges as a common cause of infection. The bacteria Acinetobacter baumannii is a widely-reported cause of healthcare-associated infections, particularly in adult intensive care units in developing countries. But a retrospective study of isolated cases at Nationwide Children’s Hospital found that Acinetobacter pittii recently emerged…

Why Patients With Diabetes Have More UTIs
 Why Patients With Diabetes Have More UTIs 150 150 Mary Bates, PhD
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Insulin regulates an antimicrobial peptide that is suppressed in patients with diabetes. A recent study led by clinicians and researchers at Nationwide Children’s Hospital reports a potential explanation for why urinary tract infections (UTIs) are so common in patients with diabetes – insulin regulates an antimicrobial peptide (AMP) that is suppressed in those patients. Patients…

Local Learning Health System Model Demonstrates High-Quality Patient Care While Reducing Costs
 Local Learning Health System Model Demonstrates High-Quality Patient Care While Reducing Costs 150 150 Jan Arthur
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Providing high-quality patient care while reducing costs is a significant goal in the current health care reform environment. The Institute of Medicine has specifically called for the establishment of “learning health systems” to address this challenge. In a learning health system, the electronic health record is utilized to drive research and personalized treatments based on…

Many Respiratory Pathogens, One Test: The Respiratory Infection Array
 Many Respiratory Pathogens, One Test: The Respiratory Infection Array 150 150 Jeb Phillips
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A multiplex polymerase chain reaction assay newly available for outpatients is faster and more comprehensive than conventional testing for causes of upper respiratory infection. ‘Tis the season for coughs, runny noses and the challenge of trying to pinpoint which pathogen is causing your patient’s particular upper respiratory infection. Clinical presentations are similar for a number…

Promising Practices and Patient-Centered Medical Neighborhoods for Childhood Obesity
 Promising Practices and Patient-Centered Medical Neighborhoods for Childhood Obesity 150 150 Tiasha Letostak, PhD
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An algorithm for assessment and management of childhood obesity, along with patient-centered medical neighborhoods, provides avenues for comprehensive weight management for children 2 years and older. Although childhood obesity affects 17 percent of children in the United States, and nearly one-quarter of these children are overweight, only a few centers in the country provide evidence-based…