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In Brief

Designing a Center for Collaborative Care
 Designing a Center for Collaborative Care 150 150 Marc Levitt, MD
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Reducing Practice Variation in Pediatrics
 Reducing Practice Variation in Pediatrics 150 150 Jonathan Slaughter, MD, MPH
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With variations in practice existing even between practitioners at the same institution, research can provide the keys to standardizing care and improving outcomes. Practice variation occurs when care providers diagnose or treat patients differently, even in the setting of similar disease presentation and risk factors. Variations in care have been noted at the geographic level…

Data-Driven Health Care Delivery
 Data-Driven Health Care Delivery 150 150 Tiasha Letostak, PhD
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Health care enterprise data warehouse (EDW) technology, analytics and cross-functional teams are leading to improved quality and efficiency of patient care. Big data has big potential, but despite the value of electronic health record (EHR) systems in digitizing care at hospitals, data-driven improvements are commonly hindered by an inability to measure and analyze this data…

What Do DALYs Mean for Pediatrics?
 What Do DALYs Mean for Pediatrics? 150 150 Dave Ghose
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An emerging, innovative metric could radically change childhood health policy. A new way of looking at illness is beginning to change how public health officials view life and death. The concept — called DALYs — offers a fuller view of disease that could have a big impact on pediatrics if embraced. Unlike death tolls —…

Adolescents, Young Adults and Cancer: What Are the Issues?
 Adolescents, Young Adults and Cancer: What Are the Issues? 150 150 Abbie Miller
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Adolescents and young adults with cancer have unique needs that may explain their plateau in survival rates, despite improved survival rates in other age groups. At an age when achieving independence and experiencing life milestones are most important, adolescents and young adults facing a cancer diagnosis must meet unique challenges. These challenges may contribute to…

Talking to Adolescent Patients About Marijuana
 Talking to Adolescent Patients About Marijuana 150 150 Katie Brind'Amour, PhD, MS, CHES
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With legalization spreading across the United States, it’s hard to know what to say to teens curious about marijuana. Legal in 23 states and the District of Columbia. Renowned in pop culture. Affectionately called everything from “wacky tobaccy” to “hippie lettuce.” Marijuana isn’t going away. Despite its popularity and availability, many youths — and clinicians…

Do You Believe in Integrated Health Care?
 Do You Believe in Integrated Health Care? 150 150 Miguel Saps, MD
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Patients are more than a segregated set of organ systems. Treating them as whole beings requires the practice of integrated medicine. I believe in an integrated approach to health care. The care of patients is often envisioned as fractionated, with different specialists taking care of different organs or organ systems — a model that I…

A Watershed Moment for Cancer Virotherapy
 A Watershed Moment for Cancer Virotherapy 150 150 Timothy Cripe, MD, PhD
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A recent decision may define the future of virotherapy’s role in the clinical treatment of cancer. At 4:50 pm on Wednesday, April 29 2015, the votes were cast: 22 in favor, 1 against. With this overwhelming majority, an advisory committee sent a clear message to the FDA recommending the first marketing approval for a live virus cancer…

Crohn’s Disease Not Exempt From Racial Disparities
 Crohn’s Disease Not Exempt From Racial Disparities 150 150 Gina Bericchia
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Disparities exist among pediatric Crohn’s patients of different races for a number of health care metrics. A study published in the journal Inflammatory Bowel Diseases found significant differences in hospital readmissions, medication usage and both medical and surgical complications of children with Crohn’s disease related to race. In the study, black children had a 1.5 times higher frequency…

Prodigy and Autism Share a Common Genetic Link, Study Finds
 Prodigy and Autism Share a Common Genetic Link, Study Finds 150 150 Tiasha Letostak, PhD
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Researchers have discovered the first molecular genetic evidence for a shared etiology between prodigy and autism. A new study published in the journal of Human Heredity last month found that child prodigies share some of the same genetic variations with people who have autism. These findings could help geneticists better understand the molecular genetic underpinnings of autism and prodigy…

Patients Without Borders
 Patients Without Borders 150 150 Dave Ghose
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Immigrant children represent the fastest growing segment of the U.S. population. What can pediatricians do to help these vulnerable patients? James Duffee, MD, MPH, watched the immigrant population change dramatically during his 15 years as a community health pediatrician and child psychiatrist in Springfield, Ohio. When he founded the Rocking Horse Community Health Center in 1999,…

To Rest or Not To Rest?
 To Rest or Not To Rest? 150 150 Kevin Mayhood
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Ebola in Children Creates Ethical Quandary
 Ebola in Children Creates Ethical Quandary 150 150 Kevin Mayhood
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Do you keep a parent in the room while the virus rages inside a child? The Ebola outbreak in Guinea, Liberia and Sierra Leone has challenged emergency preparedness at Children’s Hospitals and Clinics of Minnesota like nothing before — even more than the early days of AIDS and outbreaks of measles and H1N1 flu, says Infection Prevention…

A Shift in the Antibiotic Prophylaxis Debate?
 A Shift in the Antibiotic Prophylaxis Debate? 150 150 Katie Brind'Amour, PhD, MS, CHES
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The RIVUR trial laid to rest certain questions surrounding antimicrobial prophylaxis in children with vesicoureteral reflux. But it also launched a new debate. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trialwas supposed to provide clear direction for pediatric urologists. To date, it is the largest double-blind, placebo-controlled, randomized, multicenter study examining urinary tract infection…

Conflicting Directions for BPD Treatment
 Conflicting Directions for BPD Treatment 150 150 Katie Brind'Amour, PhD, MS, CHES
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Treatment of bronchopulmonary dysplasia differs dramatically among institutions. But why does variation matter? Recent studies report extreme variation among hospitals ordering three common medications for chronic lung disease, or bronchopulmonary dysplasia, calling into question the appropriateness of their use and the reason for their prescription. “In the use of diuretics, inhaled bronchodilators and inhaled corticosteroids,…

Placental Transfusion Confusion
 Placental Transfusion Confusion 150 150 Katie Brind'Amour, PhD, MS, CHES
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Medical professional organizations cannot reach consensus regarding delayed cord clamping and umbilical cord “milking.” Nearly every relevant professional organization has its own recommendations for placental transfusion techniques known as delayed umbilical cord clamping and milking. But it’s unclear whether additional research will lead to consensus. The American Congress of Obstetricians and Gynecologists and American Academy of Pediatrics say there’s…

Study Finds Cow’s Milk is Added to Breast Milk and Sold to Parents Online
 Study Finds Cow’s Milk is Added to Breast Milk and Sold to Parents Online 150 150 Katie Brind'Amour, PhD, MS, CHES
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Deceptive Internet advertisements for human breast milk may put infants at risk. What do parents (and doctors) need to know about milk sharing? A study published yesterday on the safety of human breast milk bought over the Internet found that 10 percent of samples contained added cow’s milk. The discovery that purchased samples of human milk may…

The Continence Predictor Index
 The Continence Predictor Index 150 150 Marc Levitt, MD
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Are We Properly Capturing the Maternal-Child Health Continuum?
 Are We Properly Capturing the Maternal-Child Health Continuum? 150 150 Irina Buhimschi
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An obstetrician doing research at a children’s hospital may seem out of place. But not according to one clinician-scientist, who believes that maternal health and child health are inextricably intertwined. Traditionally, doctors divide into those who practice adult medicine and those who practice pediatrics. With the exception of family physicians, there is little crossover in…

Advancing Pediatric Anesthesiology Through Research
 Advancing Pediatric Anesthesiology Through Research 150 150 Joseph Tobias, MD
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Pediatric anesthesiology research is a relatively new phenomenon. But one clinician-scientist believes it is the key to bringing the field into the “big leagues” of evidence-based medicine. Over the past 30 years, the field of pediatric anesthesiology has expanded with the recognition of the need for specialized training, the development of fellowship programs and, most…

Big Data: Ride the Bandwagon, Sell Hot Dogs at the Show, or Jump Out of the Way?
 Big Data: Ride the Bandwagon, Sell Hot Dogs at the Show, or Jump Out of the Way? 150 150 William Ray, PhD
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Big Data has big potential. But can it truly tell you what you want to know? Big Data. It’s all the rage, and if you listen to the hype, you might get the impression that it’s going to cure cancer, bring about world peace and clean your kitchen while it’s at it. All the cool…

Early Detection of Bipolar Spectrum Disorders in High-Risk Children
 Early Detection of Bipolar Spectrum Disorders in High-Risk Children 150 150 Abbie Miller
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A new study finds key symptoms are associated with the development of bipolar disorder among children of parents with the condition. New research published today in the American Journal of Psychiatry indicates a strong link between subthreshold manic episodes and likelihood of developing bipolar disorder in children of parents with bipolar disorder. The study’s findings could…

Illuminating Vasospasm in Children with Traumatic Brain Injury
 Illuminating Vasospasm in Children with Traumatic Brain Injury 150 150 Jan Arthur
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Understanding reasons for dangerous vessel constriction following brain injury may help define treatment or prevention options. Vasospasm, or severe narrowing of blood vessels, is a dangerous complication observed in children with moderate to severe traumatic brain injury. In a paper recently published in Critical Care Medicine, investigators at Nationwide Children’s Hospital have further defined the prevalence,…

Bacterial or Viral? New Technique to Clear Muddy Waters
 Bacterial or Viral? New Technique to Clear Muddy Waters 150 150 Jan Arthur
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Transcriptional profiling could help reduce inappropriate administration of antibiotics for lower respiratory infections in hospitalized patients. Lower respiratory tract infections (LRTIs) are one of the most frequent reasons for hospitalization in adults and children worldwide. However, in most cases, establishing the cause of the infection is challenging and many patients undergo unnecessary treatment with antibiotics…

Speeding Up the Genome Analysis Process
 Speeding Up the Genome Analysis Process 150 150 Jan Arthur
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New software analyzes human genomes faster than other available technologies, empowering population-scale genomic analysis. Investigators at Nationwide Children’s Hospital have developed an analysis “pipeline” that slashes the time it takes to search a person’s genome for disease-causing variations from weeks to hours. An article describing the ultra-fast, highly scalable software was published in the latest…

Cholesterol Screening: What’s the Right Approach?
 Cholesterol Screening: What’s the Right Approach? 150 150 Dave Ghose
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The jury is still out on whether universal testing of children is a good thing. To screen or not to screen? For pediatricians, that question is far from answered when it comes to universal cholesterol testing. Despite an endorsement of the practice from an expert panel at the end of 2011, controversy continues to shroud…

How to Build and Lead a Successful Medical Department
 How to Build and Lead a Successful Medical Department 150 150 V. Rama Jayanthi, MD
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Fostering an environment that supports evidence-based medicine, professional development and equal footing for clinician-researchers is a critical challenge for medical leadership. You can spot the collaborative leader because he’s rejected the heroic, solitary model of leadership. He doesn’t try to dominate his organization as its all-seeing visionary, leading idea generator and controlling intelligence. Instead, he…

Be Your Own Career Advocate
 Be Your Own Career Advocate 150 150 Linda Cripe, MD
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A successful cardiologist and neuromuscular disorders researcher shares her hard-won tips for getting what you want out of your career in academic medicine. The road to securing your first faculty position is long and frequently marked with significant personal and financial sacrifice. It is a rare individual who at some point does not ask the…

Probing for Links Between Psychotropic Drugs and Severe Liver Disease
 Probing for Links Between Psychotropic Drugs and Severe Liver Disease 150 150 Kevin Mayhood
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Drugs that help minors with severe mental health disorders may put overweight and obese patients at risk for severe liver disease. In a paper that appears to be the first to suggest the connection, the authors point out that youths who suffer from psychiatric illnesses are already at greater risk for obesity and its comorbidities.…

Digital Education for Patients and Families
 Digital Education for Patients and Families 150 150 Mike Patrick, MD
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When patients and parents want health information, they often turn to the Internet. Let’s make sure they’re finding the right sources. In the digital age, young patients and their parents have an encyclopedic world of health information at their fingertips. Answers are available on demand, and most people find them. In fact, according to recent…

The High Cost of Antibiotic Redundancy
 The High Cost of Antibiotic Redundancy 150 150 Katie Brind'Amour, PhD, MS, CHES
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As many as 78 percent of non-federal U.S. hospitals frequently prescribe redundant antibiotics, according to a study appearing in the journal Infection Control and Hospital Epidemiology. Over a four-year period, these hospitals accounted for 32,507 cases of antibiotic regimens with overlapping antimicrobial spectra, resulting in more than $12 million in avoidable health care expenses. There are very few clinical…

Disparities in Care: Beyond Insurance
 Disparities in Care: Beyond Insurance 150 150 Dave Ghose
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A Minnesota study suggests the ACA’s Medicaid expansion won’t be enough to reduce persistent health care disparities among minority groups. The health care gap isn’t just about insurance. A variety of barriers — including transportation, inconvenient office hours, cultural biases and confusing information — prevent minorities from accessing health care. In a paper published in the August issue…

Colorectal Cancer Screening and the Pediatric Subspecialist
 Colorectal Cancer Screening and the Pediatric Subspecialist 150 150 Katie Brind'Amour, PhD, MS, CHES
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Screening a 15-year-old for pre-cancerous polyps may seem a bit unusual, as colon cancer is widely considered an adult disease. But for children with a family history of Lynch syndrome, a hereditary condition that increases the risk of colon and other cancers, life-threatening malignancies can develop as early as the mid-teens. Fewer than one in…

Survivors of Congenital Heart Disease Report Poor Risk Knowledge and High-Fat Diets
 Survivors of Congenital Heart Disease Report Poor Risk Knowledge and High-Fat Diets 150 150 Tiasha Letostak, PhD
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A new study suggests that CHD survivors may lack knowledge about their disease and would benefit from education about future risks and health behaviors. Over 1 million adults with congenital heart disease (CHD) currently reside in the United States. These individuals are at heightened risk for numerous health concerns, including endocarditis, pregnancy complications and life-threatening…

A New Take on Obesity Prevention: The Maternal-Child Relationship
 A New Take on Obesity Prevention: The Maternal-Child Relationship 150 150 Tiasha Letostak, PhD
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In the past 30 years, obesity has quadrupled in adolescents and more than doubled in children, affecting even preschool-aged children. The majority of childhood obesity prevention strategies focus on energy balance, targeting behaviors and environmental changes to increase physical activity, decrease sedentary behavior or limit intake of energy-dense foods and beverages. However, the limited success…

Mystery Rising: Why is T1D Incidence Rising Globally?
 Mystery Rising: Why is T1D Incidence Rising Globally? 150 150 Katie Brind'Amour, PhD, MS, CHES
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Type 1 diabetes used to be rare. Late 19th-century estimates put its incidence at about 0.004 percent of the world’s population. But by the end of the 20th century, most nations reported a number 350 times that rate. With many countries continuing to experience a steady rise in new cases of up to 4 percent…

Stressed Out: Toxic Stress and Child Brain Development
 Stressed Out: Toxic Stress and Child Brain Development 150 150 Dave Ghose
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Stress, in small doses, can be good for children. When they argue with another child over a toy or attend a new school or daycare, the experience can teach them valuable coping skills. Even a more intense event, such as the death of a loved one or a frightening accident, can be beneficial developmentally with…

Getting to the Point: Are Safety Needles Really Safe?
 Getting to the Point: Are Safety Needles Really Safe? 150 150 Kelli Whitlock Burton
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Sharp hypodermic needles are, as the name implies, sharp. Just ask the nearly 400,000 U.S. health care workers who are accidentally pricked each year. Most needle sticks aren’t serious, but the potential for exposure to bloodborne diseases has led many hospitals to discontinue the use of sharp needles in certain areas, including the operating room.…

Delays and Difficulties: Fecal Microbiota Transplants as Therapy
 Delays and Difficulties: Fecal Microbiota Transplants as Therapy 150 150 Katie Brind'Amour, PhD, MS, CHES
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Use of fecal microbiota transplantation to treat a wide range of disorders is in limbo while the FDA decides how to regulate the therapy. Between 1997 and 2007, Clostridium difficile bacterial infections among U.S. children more than doubled and its mortality rate among all U.S. cases more than quadrupled. Clinicians are turning to a number of treatment…

An Unwelcome Blast from the Past: Vitamin K Deficiency Bleeding
 An Unwelcome Blast from the Past: Vitamin K Deficiency Bleeding 150 150 Kelli Whitlock Burton
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Most pediatric specialists who began practicing medicine in the mid-1960s have probably never seen a case of vitamin K deficiency bleeding. Robert Sidonio, MD, had seen just one, and that was during his fellowship. And then, in February 2013, an infant came in to the emergency room with bleeding in the brain, one of the most…

The End of “Under 12″
 The End of “Under 12″ 150 150 Kelli Whitlock Burton
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UNOS board eliminates age classification for child lung transplant candidates and alters rules for pediatric heart transplants. Many in the pediatric field were surprised last year when a federal judge ordered that a 10-year-old Pennsylvania girl with cystic fibrosis be added to the national adult waiting list for a double-lung transplant. She had spent 18 months…

Mock MRI Scanners to Reduce Anesthesia Use
 Mock MRI Scanners to Reduce Anesthesia Use 150 150 Katie Brind'Amour, PhD, MS, CHES
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Initial research supports the use of MRI practice sessions and mock scanners to avoid sedation and alleviate patient and parent anxiety before an MRI. Studies exist for populations such as patients with ADHD and diabetes, but to date no studies appear to investigate the use of a mock MRI machine for young children with a wide range of…

Using Zinc for Growth Delays in Babies Born Preterm
 Using Zinc for Growth Delays in Babies Born Preterm 150 150 Katie Brind'Amour, PhD, MS, CHES
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Zinc supplementation in extremely low birth-weight (ELBW) infants with chronic lung disease improves weight gain and linear growth, according to a retrospective study performed at Nationwide Children’s Hospital. The study is one of the first to look at the association between zinc supplementation and growth in ELBW babies with chronic lung disease, also known as bronchopulmonary dysplasia.…

Do Your Patients Understand You? Strategies to Improve Patient-Provider Communication
 Do Your Patients Understand You? Strategies to Improve Patient-Provider Communication 150 150 Tiasha Letostak, PhD
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The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions. However, over a third of patients in the United States — or 77 million adults…

The Dilemma of Undertriaged Trauma Cases
 The Dilemma of Undertriaged Trauma Cases 150 150 Katie Brind'Amour, PhD, MS, CHES
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Nationally, at least one in three children ages 5 and under with major trauma receive their definitive care at a level III trauma center or non-trauma center, according to arecent study in the American Journal of Emergency Medicine. Among children ages 6 to 17, the frequency of undertriage decreases to one in every four major trauma…

Out of Drugs: Planning for the Unthinkable
 Out of Drugs: Planning for the Unthinkable 150 150 Dave Ghose
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Pediatric cancer specialists have faced an enormous challenge in recent years. With critical chemotherapy drugs often in short supply, they’ve been forced to improvise alternative treatments or purchase medicine from questionable secondary sources. These practices raise safety and ethical concerns. Emerging evidence indicates that shortages are harming patients in some instances, exposing them to more…

ADHD Medications Do Not Curb Adult Height
 ADHD Medications Do Not Curb Adult Height 150 150 Tiasha Letostak, PhD
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According to the Centers for Disease Control and Prevention, the number of children being diagnosed with attention deficit hyperactivity disorder (ADHD) has increased from 7.8 percent to 11 percent in the last decade. Specifically, approximately 2 million more U.S. children between the ages of 4 and 17 had been diagnosed with ADHD in 2011 than in…

AAP Statement on School Start Times May Be Challenging to Implement
 AAP Statement on School Start Times May Be Challenging to Implement 150 150 Katie Brind'Amour, PhD, MS, CHES
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The American Academy of Pediatrics published a statement in August supporting delayed start times for middle and high schools to help combat chronic sleep deprivation. Research indicates adolescents naturally experience a shift in their circadian rhythm that makes sleep difficult prior to 11 PM. But since many middle and high schools begin classes before 8:30 AM, teens…

Sinus Infection Test Could Curb Antibiotic Overuse
 Sinus Infection Test Could Curb Antibiotic Overuse 150 150 Tiasha Letostak, PhD
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Antibiotic misuse, overuse and resistance have significant consequences for patients and hospitals, but determining the primary cause of sinusitis remains a clinical challenge for physicians. Now, diagnostic technology co-invented by researchers at The Ohio State University and Nationwide Children’s Hospital will better equip physicians with additional information needed to make a bacterial sinusitis diagnosis. Subinoy…

Reframing Hope in Pediatric End-of-Life Care
 Reframing Hope in Pediatric End-of-Life Care 150 150 Tiasha Letostak, PhD
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As physicians, you want to do more good than harm. And it is often believed that telling the truth about poor end-of-life expectations will lead to hopelessness in patients and families, causing more harm than good. But study after study on prognostication has shown that patients and their families prefer more honest and accurate communication.…