bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nerve blocks in paediatric and adolescent headache disorders
Authors: Lambrinakos-Raymond Kristen , Dubrovsky Alexander Sasha 
Published: September 2018

Purpose of review
Headaches in children and adolescents are common, causing debilitating symptoms in many. Treatment of headache disorders can be complex and standard lifestyle changes as well as oral medications may offer inadequate relief. The purpose of this article is to review the mechanism of action, efficacy and technique of peripheral nerve blocks (PNBs) and the role they play in treating paediatric headache disorders.

Recent findings
Evidence for the use of PNBs in youth is limited. However, available studies show evidence of benefit in both primary and secondary headache disorders. Variability exists in the type of block, medication choice, volume infused and frequency of this treatment. There are no serious side effects associated with PNBs.

Summary
PNBs are well tolerated and effective as adjunctive therapy for many disabling paediatric headache disorders. The technique can be easily learned by frontline and specialty practitioners. Prospective placebo-controlled studies are needed to determine how to best maximize PNBs for headache management (i.e. medication choice, timing and so on).
The role of genomic approaches in diagnosis and management of primary immunodeficiency
Authors: Chinn Ivan K. , Bostwick Bret L. 
Published: September 2018

Purpose of review
Genetic testing serves an increasingly important role in the diagnosis and management of primary immunodeficiency. In this review, the strengths and limitations of various genetic testing methods are summarized, providing a foundation for the clinical approach to achieving a molecular diagnosis.

Recent findings
Rapid advances in sequencing technology have enabled the incorporation of comprehensive genetic testing into first-line clinical diagnostics. Recent articles enable comparisons of the diagnostic utility of new testing strategies while simultaneously reminding clinicians of the strengths of traditional methods.

Summary
Genetic testing in primary immunodeficiency cannot be standardized, but instead needs to be personalized based on the presenting phenotype and a basic understanding of the utility of different molecular methods. These tools, when correctly employed, can achieve a molecular diagnosis and inform the natural history, prognosis, recurrence risk, and therapeutic options.
Pediatric eosinophilic esophagitis: updates for the primary care setting
Authors: Ruffner Melanie A. , Spergel Jonathan M. 
Published: September 2018

Purpose of review
Eosinophilic esophagitis (EoE) is a multifactorial, non-IgE-mediated inflammatory disorder of the esophagus and is the most common cause of food impaction in the pediatric population. The purpose of this review is to describe the current recommendations for diagnosis and management of EoE.

Recent findings
New data has associated EoE with other allergic disorders of the atopic march as well as several risk factors, which predispose to allergic conditions. A subset of patients with esophageal eosinophilia respond to proton pump inhibitor (PPI) therapy with a partial or complete resolution of esophageal eosinophilia. Therefore, some patients can be treated with PPI alone. If this is unsuccessful, dietary elimination and swallowed steroid therapy are recommended for long-term management. There is a growing appreciation that untreated esophageal inflammation can lead to complications of fibrosis and stricture formation.

Summary
The current review will focus on the diagnosis and management of EoE in the pediatric population. Identification and diagnosis of pediatric patients with EoE is critical to prevent long-term esophageal complications.
Bioengineering the innate vasculature of complex organs: what have we learned so far
Authors: Wijesekara Piyumi , Ng Wai Hoe , Feng Minrui , Ren Xi 
Published: September 2018

Purpose of review
Engineering vasculature that meets an organ's specific physiology and function is a fundamental step in organ bioengineering. In this article, we review approaches for engineering functional vasculature for organ bioengineering, with an emphasis on the engineering of organ-specific endothelium and vasculature.

Recent findings
Recent advances in hydrogel-based engineering of vascularized organ bud enable vascular regeneration in self-assembled cellular niche containing parenchymal and stromal cells. The emerging technology of whole-organ decellularization provides scaffold materials that serve as extracellular niche guiding vascular regeneration to recapitulate native organ's vascular anatomy. Increasing morphological and molecular evidences suggest endothelial heterogeneity across different organs and across different vascular compartments within an organ. Deriving organ-specific endothelium from pluripotent stem cells has been shown to be possible by combining endothelial induction with parenchymal differentiation.

Summary
Engineering organ-specific vasculature requires the combination of organ-specific endothelium with its unique cellular and extracellular niches. Future investigations are required to further delineate the mechanisms for induction and maintenance of organ-specific vascular phenotypes, and how to incorporate these mechanisms to engineering organ-specific vasculature.
What will it take before a bioengineered heart will be implanted in patients?
Authors: Taylor Doris A. , Elgalad Abdelmotagaly , Sampaio Luiz C. 
Published: September 2018

Purpose of review
Heart transplantation is the only curative treatment option for end-stage heart failure. However, a shortage of donor organs is a major limitation of this approach. Regenerative medicine targets the goal of increasing the number of available hearts for transplantation. In this review, we highlight the state of the art of building a bioartificial heart. We summarize the components needed, the hurdles, and likely translational steps to make the dream of transplanting a totally functional bioartificial heart a possibility.

Recent findings
The therapies being developed in regenerative medicine aim not only to repair, but also to regenerate or replace failing tissues and organs. The engineering of bioartificial hearts utilizing patient-derived cells could theoretically solve the two main complications of heart transplantations: graft rejection and lifelong immunosuppression. Although many hurdles remain, scientists have reached a point in which some of these hurdles have been overcome. Decellularized heart scaffolds have emerged over the past decade as one of the most promising biofabrications. Two possible options for organ scaffolds exist: nontransplantable human hearts and porcine hearts. The use of these scaffolds could lead to the availability of an unlimited number of transplantable organs. The current challenge remains improving processes required for recellularization – including those for cells, bioreactors, and physiologic conditioning. Researchers should focus to solve these hurdles and pave the way toward the dream of in-vivo bioengineered heart maturation.

Summary
Regenerative medicine has emerged as one of the most promising fields of translational research and has the potential to both minimize the need for donor organs and increase their availability. Meeting the challenge of implanting a totally functional bioengineered heart lies in solving multiple issues simultaneously. Dwarfing the technical hurdles, cost is the largest barrier to success. The scientific hurdles mainly involve scaling up and scaling out of laboratory cell processes, building bioreactors, and delivering cells into every needed region of an organ scaffold. Maintaining sterility and quantifying readiness of the nascent organs are also critical for success.
Development and Pilot Implementation of a Nutrition Curriculum and Rotation in Pediatric Gastroenterology Fellowships
Authors: Shaikhkhalil Ala , Jump Candi , Goday Praveen S. 
Published: September 2018

ABSTRACTStructured nutrition rotations are rarely offered in pediatric gastroenterology fellowships. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Nutrition Committee developed a curriculum to serve as the basis for a rotation in clinical nutrition. We worked directly with 5 fellowship programs to tailor the experience to individual institutions. As part of our pilot study, fellows completed knowledge assessments and self‐assessment of comfort level at the start and end of the experience. We saw a trend in improvement of comfort level and increase in mean score on knowledge assessments, but the differences did not meet statistical significance. Fellows who completed the rotation had an increase in comfort level in all topics with most dramatic increases in nutrition management of cystic fibrosis, refeeding syndrome, and cholestasis. Objective measures of nutrition knowledge attainment and use of programmatic feedback to continually improve the learners’ experience will help expand the nutrition curriculum to a broader audience.
Bladder Symptoms in Children With Functional Constipation
Authors: van Summeren Jojanneke J.G.T. , Holtman Gea A. , van Ommeren Sonja C. , Kollen Boudewijn J. , Dekker Janny H. , Berger Marjolein Y. 
Published: September 2018

ABSTRACTObjective:The aim of the review is to perform a systematic review of the literature examining the prevalence of bladder symptoms in children with functional constipation (FC) and to compare the prevalence of those symptoms between children with and without FC.Methods:In this systematic review 4 databases were searched to July 2018. Studies investigating the prevalence of bladder symptoms in children aged 4 to 17 years with FC were included. There was no language restriction. Two reviewers independently extracted data and assessed study quality. Clinical heterogeneity between studies was investigated. Prevalence rates of bladder symptoms in children with FC were calculated. Relative risks were calculated to compare the prevalence of bladder symptoms between children with and without FC.Results:Among 23 studies of children with FC, 22 reported the prevalence bladder symptoms (12,281 children) and 7 reported the prevalence of urinary tract infections (UTIs) (687 children). The prevalence rates of single bladder symptoms, lower urinary tract symptoms (LUTS), and UTI varied between 2% to 47%, 37% to 64%, and 6% to 53%. The relative risks were 1.24 to 6.73 for 20 single bladder symptoms (12 studies) and 2.18 to 6.55 for UTI (2 studies). The 95% confidence intervals indicated significance in 14 of 20 single bladder symptoms.Conclusions:Bladder symptoms seem common in children with FC, but the reported prevalence varies greatly. Children with FC are more likely to have bladder symptoms than children without FC. We recommend that clinicians be aware of concomitant bladder symptoms in children presenting with FC.
Classification and Nutrition Management of Acute Pancreatitis in the Pediatric Intensive Care Unit
Authors: Cole Sarah , Wakeham Martin , Werlin Steven , Goday Praveen S. 
Published: September 2018

ABSTRACTThe aims of this retrospective cohort study were to classify the severity of patients admitted to the pediatric intensive care unit (PICU) with acute pancreatitis (AP) and to identify how many patients received appropriate nutritional management in accordance with more recent guidelines and the outcomes of those patients. Of the 54 children with AP, 12 (22.2%) had a primary diagnosis of AP (50% severe, 17% moderate) whereas 42 (77.8%) had a secondary diagnosis of AP (81% severe, 11.9% moderate). Just under half of the patients (48.1%) had enteral nutrition commenced before the third day of admission (50% with primary AP, 47.6% with secondary AP). The average time to initiation of enteral feeds was 2.3 days for those that received enteral nutrition. 51.8% of patients received parenteral nutrition (25% with primary AP, 59.5% with secondary AP). Most patients received enteral nutrition late and parenteral nutrition was overused in patients with AP admitted to the PICU.
Assessing Severity of Psychological Distress Among Refugees With the Refugee Health Screener, 13-Item Version
Authors: Bjärtå Anna , Leiler Anna , Ekdahl Johanna , Wasteson Elisabet 
Published: September 2018

Abstract
The recent inflow of refugees to Sweden has put pressure on health care as well as revealing a need for methods regarding assessment of refugees' mental health status. The present study investigated the use of the Refugee Health Screener (RHS; Hollifield et al., 2013) to distinguish among severity levels of symptoms of psychological distress in refugees. Refugees residing in asylum accommodations (n = 510) were screened with RHS-13, together with screeners for depression, anxiety, and posttraumatic stress disorder (PTSD). Risk for mild, moderate, or severe levels of depression, anxiety, or/and PTSD was used as screening proxy. Receiver operating characteristic analysis rendered cutoff scores of 11, 18, and 25, for mild, moderate, and severe symptoms, respectively. Evaluated against each symptom scale separately, cutoffs performed well. Cutoff 11, previously identified by Hollifield et al. (2016), was also confirmed. However, utilization of additional cutoffs could improve refugee mental health by guiding clinical decision making.
Measuring Community Prevalence of Trichomonas vaginalis Infection to Guide Local Screening Practices: A Process Improvement Project
Authors: Weger Benjamin O. , Klein David A. , Bowsher Barbara L. , Weir Larissa F. , Roberts Timothy A. 
Published: September 2018

Abstract
The Centers for Disease Control and Prevention suggests screening for Trichomonas vaginalis infection might be considered in high-prevalence populations. High asymptomatic infection rates and poor sensitivity of clinical diagnosis make it difficult to estimate local prevalence. Testing of ThinPrep samples can provide an estimate of local Trichomonas vaginalis infection rates and guide screening practices.
Pediatric Conditions Requiring Interfacility Transport From Emergency Departments
Authors: Aledhaim Ali , Fishe Jennifer N. , Hirshon Jon Mark , Anders Jennifer F. 
Published: September 2018

Objectives
Pediatric care is increasingly regionalized, increasing rates of interfacility transport (IFT). However, it is unknown what conditions most frequently require IFT. This study's objective was to identify high-frequency pediatric conditions requiring IFT.

Methods
This is a statewide retrospective observational study from 2010 to 2012 of pediatric patients (<18 years of age) who underwent IFT in Maryland. Patients were identified from the Health Care Utilization Project's database using probabilistic linkage. This study identified the 20 most common pediatric IFT conditions, and the conditions with the highest IFT rates.

Results
Probabilistic linkage was successful for 2254 records. The largest age category was 0 to 4 years (43%). The top 3 IFT conditions were asthma (13.5%), epilepsy (8.5%), and diabetes mellitus (6.6%). Diabetes mellitus had the highest IFT rate (24%), followed by appendicitis (15.5%) and internal obstruction (14.4%).

Conclusions
Specific pediatric conditions commonly require IFT and had high IFT rates in this statewide study. In addition, the largest age group undergoing IFT was young children (0 to 4 years of age). This study provides specific detail regarding conditions and ages impacted by IFT, and emergency medical services should consider incorporating these findings into transport destination algorithms. In addition, public health stakeholders should address implications of the concentration of care for these common pediatric conditions and younger age groups.
Lazarus Syndrome — Challenges Created by Pediatric Autoresuscitation
Authors: Mullen Stephen , Roberts Zöe , Tuthill David , Owens Laura , Te Water Naude Johann , Maguire Sabine 
Published: September 2018

Abstract
Pediatric autoresuscitation is extremely rare, with only 4 documented cases in the literature. The longest recorded time between stopping cardio pulmonary resuscitation (CPR) and return of spontaneous circulation is 2 minutes. We report a previously well 18-month-old who attended the emergency department after an unexplained cardiac arrest. After 10 cycles of CPR, resuscitation was stopped; 6 minutes later, the patient had a return of spontaneous circulation and was transferred to the pediatric intensive care unit. The patient remains alive but with significant neurological impairment. There are a variety of theories regarding the pathology of pediatric autoresuscitation. The most commonly accepted model is that there is a degree of autopositive end-expiratory pressure impending venous return as a consequence of vigorous ventilation during CPR. This case challenges clinicians to reassess our current definition of death and reaffirms the need for clearer guidelines surrounding the certification of death.
Repeat Laboratory Testing in the Pediatric Emergency Department
Authors: Fieldston Evan S. , Fakeye Oludolapo A. , Friedman David F. 
Published: September 2018

Background
Little is known about repeat testing for patients admitted to children's hospitals from the emergency department (ED).

Objective
The objective of this study was to describe the trend of repeat laboratory testing from a children's hospital ED.

Methods
Laboratory studies were analyzed for July 2002 to June 2010 for complete blood counts (CBCs; 7 years), basic metabolic panels (BMPs; 2.5 years), and coagulation studies (7 years) ordered and reordered in the ED within 8 hours for patients admitted to the hospital. Results for tests were generated and classified into high, low, and normal based on reference ranges. To reflect actual practice, we expanded the normal range from 95% of lower bound to 105% of upper bound.

Results
A total of 37,035 CBCs, 11,414 BMPs, and 3903 coagulation studies were ordered. Proportions of these tests repeated were 0.9%, 1.9%, and 1.9%, respectively. Mean time to repeat was 2 hours. For CBCs, 25% of repeats were for a missing component; 35% were for low platelet counts. Sixty-eight percent of initial BMPs were repeated for high potassium. Half of coagulation studies were repeated for high prothrombin time; 36% were repeated for a missing component. On repeat, 75% of BMPs with high potassium levels and 65% of CBCs with low platelet count returned normal values, but 16% of coagulation studies repeated for high prothrombin time returned normal values.

Conclusions
Repeat ED laboratory testing occurs infrequently at a children's hospital, and a large proportion of repeats is attributed to missing results. When repeated, abnormal results on initial studies are often returned as normal.
What Do We Know About Pediatric Palliative Care Patients Consulting to the Pediatric Emergency Department?
Authors: Gaucher Nathalie , Humbert Nago , Gauvin France 
Published: September 2018

Objectives
The objective of this study was to describe the characteristics of pediatric palliative care (PPC) patients presenting to a pediatric emergency department (ED) and these patients' ED visits.

Methods
This retrospective chart review was conducted from April 1, 2007, to March 31, 2012, in a tertiary care pediatric university-affiliated hospital. Eligible patients had initial PPC consultations during the study period; all ED visits by these patients were included. Data were drawn from the ED's electronic data system and patient's medical chart.

Results
A total of 290 new patients were followed by the PPC team, and 94 (32.4%) consulted the ED. Pediatric palliative care patients who consulted the ED had a median age of 7 years and baseline diagnoses of cancer (39.4%) or encephalopathy (27.7%). No patients died in the ED, but 36 (38.3%) died in hospital after an ED visit and 18 (19.1%) within 72 hours of admission. Pediatric palliative care patients consulted 219 times, with a median number of visits per patient of 2 (range, 1–8). They presented acutely ill as per triage scales. Reasons for consultation included respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), and fever (9.1%). Patients were often admitted to wards (61.2%) and the pediatric intensive care unit (7.3%). Two thirds (65.7%) of patients had signed an advanced care directive at the time of their visit. Discussions about goals of care occurred in 37.4% of visits.

Conclusions
Pediatric palliative care patients present to the ED acutely ill, often at their end of life, and goals of care are not always discussed. This is a first step toward understanding how to improve PPC patients' ED care.
Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails
Authors: McNeely Clea A. , Hutson Sadie , Sturdivant Tara L. , Jabson Jennifer M. , Isabell Brittany S. 
Published: September 2018

Context:
Law enforcement has been the primary strategy for addressing the opioid epidemic. As a result, the incarceration rate for women in county jails has increased more than 800% since 1980, and most women inmates struggle with substance use disorders. There is a large unmet need for contraception among women in county jails.

Program:
The East Region of the Tennessee Department of Health partnered with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception (LARC) to women in 15 jails.

Implementation:
Incarcerated women were invited to attend a comprehensive family planning education session conducted in the jail by health department nurses. The sessions included information on neonatal abstinence syndrome. The nurses explained that the women could receive intrauterine devices, implants, and injectable progesterone while incarcerated and come to the health department for all contraceptive methods upon release. Between January 2014 and June 2017, nurses conducted 182 education sessions, and 794 women received a LARC. Method placement occurred in the jails or at the local health department. No adverse effects were known to have occurred.

Evaluation:
We collected pilot data to explore the accuracy and the comprehensiveness of the family planning education session and whether the incarcerated women experienced the program as voluntary. All 18 women inmates interviewed reported experiencing the program as voluntary. Using published and administrative data, we roughly estimated that the program prevented between 270 and 460 unintended pregnancies and between 40 and 52 cases of neonatal abstinence syndrome in the first year after the women received a method. This represents a cost savings to Medicaid of $1.4 million.

Discussion:
The partnership demonstrated the feasibility of providing voluntary comprehensive family planning education and access to highly effective contraception for women inmates who, as a group, face a host of political, socioeconomic, and personal barriers to reproductive health care.
Surgical Treatment of Migraine Headache: Back to the Future
Authors: Gfrerer Lisa , Raposio Edoardo , Ortiz Ricardo , Austen William Gerald 
Published: September 2018

Summary:Understanding the history and evolution of ideas is key to developing an understanding of complex phenomena and is the foundation for surgical innovation. This historical review on migraine surgery takes us back to the beginnings of interventional management for migraine centuries ago, and reflects on present practices to highlight how far we have come. From Al-Zahrawi and Ambroise Paré to Bahman Guyuron, two common themes of the past and present have emerged in the treatment of migraine headache. Extracranial treatment of both nerves and vessels is being performed and analyzed, with no consensus among current practitioners as to which structure is involved. Knowledge of past theories and new insights will help guide our efforts in the future. One thing is clear: Where we are going, there are no roads. At least not yet.