Search

Objective Previous research has suggested an association between plagiocephaly and developmental delay. However, study samples drawn from children seen in subspecialty clinics increase the potential for selection and referral bias. Our study evaluates the association between plagiocephaly and developmental delay and the timing of these diagnoses in a primary care setting, where plagiocephaly is commonly diagnosed and managed. Methods Our retrospective analysis used electronic medical record data from 45 primary care sites within a children's health system from 1999 to 2017, including children aged 0 to 5 years with diagnoses determined by physician diagnosis codes at primary care visits. Children were classified in the plagiocephaly group if diagnosis occurred by 12 months of age. Primary outcome was any developmental delay. Pearson χ2 test, Fisher exact test, and logistic regression analyses were conducted, with multivariable models adjusted for sex, race, ethnicity, insurance, prematurity status (22-36 weeks' gestation), primary care sites, birth year, and diagnoses of abnormal tone and torticollis. Results Of 77,108 patients seen by 12 months, 2315 (3.0%) were diagnosed with plagiocephaly, with an increase in diagnosis prevalence over the study time frame. Plagiocephaly was independently associated with an increased odds of any developmental delay diagnosis (adjusted odds ratio 1.50, 95% confidence interval 1.32-1.70). The diagnosis of plagiocephaly was recorded before the diagnosis of developmental delay in most cases when both diagnoses were present (374 of 404, 92.6%). Conclusion Data from a large primary care cohort demonstrate an association between plagiocephaly and developmental delay, affirming findings in previous subspecialty literature.

Background: A hypercoagulable state is reported in obese children and adolescents. Fish oil may reduce the propensity for thrombosis by favorably impacting coagulation and fibrinolysis. We hypothesized that pharmacologic fish oil supplementation would reduce the concentration of coagulation factors such as total-fibrinogen (T-Fib) and gamma prime fibrinogen (γ’-Fib) and fibrinolysis factors such as plasminogen activator inhibitor-1 (PAI-1) in obese dyslipidemic adolescents. Methods: Participants (n=42, age 14±2 years) with hypertriglyceridemia and low-density lipoprotein (LDL) cholesterol Results: PAI-1 significantly decreased (p = 0.03) with a trend towards a decrease in T-Fib in the fish oil group. Fish oil treatment group also showed significant decrease in γ’-Fib, but not in the placebo group; mean change (95% CI): -0.11 (-0.16, -0.06) vs -0.03 (-0.08, 0.02). The difference in the mean change in γ’-Fib concentration from baseline or washout measures between fish oil treatment and placebo was significant; reg coeff (SE):0.08 (0.03); p=0.02. The change in γ’-Fib was related to the change in log transformed PAI-1 (reg coeff (SE): -0.09 (.041); p=0.03). Further, log-transformed CRP and IL-6 (reg coeff (SE): 0.064 (.030), p=0.04) and 0.10 (.04); p=0.03 respectively) showed significant correlations with baseline or washout baseline γ’ fibrinogen, but there were no such relationships for mean changes. Conclusions: Fish oil-induced synchronized reduction of γ’-Fib, T-Fib and PAI-1 suggests attenuation of the obesity-related alterations in coagulation and fibrinolysis in adolescents. Intriguingly, these changes are independent of changes in other inflammatory factors. The reduction in elevated concentration of γ’-Fib is remarkable as it forms clots that are more fibrinolysis resistant. Further evaluation is warranted on the specific beneficial effect of fish oil on the obesity-related hypercoagulant-/hypofibrinolytic-state and the potential for thrombosis later in life.

Introduction: Encouraged by evidence suggesting that simulation-based educational programs can translate to improved patient care, interest and investment in medical simulation have grown considerably in the past decade. Despite such growth, simulation is still a developing field, and little is known of the perceived needs for simulation training among practicing clinicians. This study describes medical simulation interests among clinicians in a pediatric health care system. Methods: A web-based survey addressing previous medical simulation experience, medical simulation interests, and demographics was distributed to physicians, nurses, and respiratory therapists within a pediatric healthcare system in the Delaware Valley. Results: All three groups expressed the highest level of interest in simulated resuscitation events (“mock codes”) and the least interest in simulations involving communication and electronic medical records. “Airway problems” was identified as the most popular medical simulation topic of interest. Although the rank order of interest in medical simulation categories was similar across groups, physicians reported the lowest levels of interest in all simulation categories. Characteristics such as previous simulation experience and group (eg, nurses and respiratory therapists) were associated with medical simulation interests. Years in practice did not impact interest. Conclusions: For adult learners, educational experiences should be targeted to the learners' perceived needs but should also address unrecognized deficits. Collectively, physicians, nurses, and respiratory therapists were most interested in participating in simulations addressing “codes” (emergency resuscitations) and airway management; these perceptions may provide a focus for designing simulation events that appeal to diverse learning styles. Prior experience with medical simulation seems to increase interest in subsequent simulation activities and offers the optimistic possibility that first-hand experience with simulation may help overcome structural and cultural barriers. Future research should seek to better understand potential obstacles for the participation of healthcare providers, especially physicians, in simulation-enhanced learning.

18.6% (5.9% observation, 12.7% readmission), revisions had a rate of 26.5% (10.2% observation and 16.3 % readmission) and LGB had a rate of 13.9% (5.6% observation, 8.3% readmission). Most common reasons for readmission was abdominal pain 34.2%, nausea and vomiting 17.1%, 7.9% for chest pain.15.1% were causes unrelated to the original surgery. The average patient arrived at the ER 15 days after surgery (20 mean,17 mode) for observation and 13 days for readmission (7 mode,13 median).