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Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
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#NursesToo

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
A nurse in the operating room is the target of vulgar comments made by a surgeon over an anesthetized patient. A cardiology fellow who travels to a conference is told by an attending physician that he'll pay for one more night in the hotel if she'll share the room with him. And, after reporting the incidents to her union and to the medical center, a licensed practical nurse successfully brings legal action against a male nursing assistant who had numerous times shoved her into a closet and groped her.
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The Importance of Professional Advocacy

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
Nurse practitioners (NPs) and other advanced practice nurses are the front-line health care providers to millions of people every single day. Research demonstrates we provide high-quality care equal or superior to other health care providers, yet our restrictions in scope of practice are many. Common issues we face include difficulty achieving third-party payor designation, federal policies that ultimately are costlier to the system than a more streamlined approach, state-level limitations on practice that prevent us from working to the highest scope of our education and practice, and institutional restrictions that lead to fragmented care.
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A Review on the Use of Cystic Fibrosis Transmembrane Conductance Regulator Gene Modulators in Pediatric Patients

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
The literature surrounding the use of cystic fibrosis transmembrane conductance regulator-targeted pharmacotherapies in pediatric patients continues to evolve. These therapies represent a departure from symptom management and infection prevention, which have been the mainstay of cystic fibrosis management in pediatrics, to targeting the genetic defect present within these patients. This article reviews the clinical studies evaluating the safety and efficacy of ivacaftor, ivacaftor/lumacaftor, and ivacaftor/tezacaftor.
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Self-assessment

Paediatrics and Child Health - Tue, 04/30/2019 - 00:00
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Review of resuscitation physiology in children

Paediatrics and Child Health - Tue, 04/30/2019 - 00:00
More than one quarter of children survive to hospital discharge after in-hospital cardiac arrests, and 5–10% of children survive to hospital discharge after out-of-hospital cardiac arrests. Cardio-pulmonary resuscitation (CPR) differs in children from adults. Following the Airway, Breathing, Circulation format, this article reviews the physiology of paediatric cardio-pulmonary resuscitation. It addresses the appropriate interventions during CPR, mechanisms of action of commonly used drugs and special resuscitation circumstances: premature and newly born infants, traumatic cardiac arrest, and ECMO (Extracorporeal Membrane Oxygenation).
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Immunization-Associated Pain: Taking Research to the Bedside

Journal of Pediatric Health Care - Sat, 04/27/2019 - 00:00
Immunization-associated pain is the number one cause of pain in pediatric settings. Untreated pain has many short- and long-term detrimental effects. The purpose of this project was to implement a nonpharmaceutical immunization-associated–pain prevention program.
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Sedation and analgesia for critically ill children

Paediatrics and Child Health - Mon, 04/15/2019 - 00:00
Effective analgesia and sedation in the paediatric intensive care unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, and an ESPNIC position statement on clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children was published in 2016: Despite this, considerable variation in practice persists.
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Preterm patent ductus arteriosus: what the research tells us

Paediatrics and Child Health - Fri, 04/12/2019 - 00:00
Ductus arteriosus is a fetal blood vessel that connects two elastic arteries, pulmonary artery and aorta, with different resistances. It only becomes pathological if it fails to close after birth. The clinical features of patent ductus arteriosus (PDA) depend upon the gestation at birth, severity of lung disease and the postnatal age of the newborn. In premature infants, PDA is associated with significant morbidity and mortality. However, the current literature on treatment of PDA does not report any improvement in long-term neonatal outcomes.
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The role of ECMO in neonatal and paediatric patients

Paediatrics and Child Health - Fri, 04/12/2019 - 00:00
ECMO or extracorporeal membrane oxygenation has now been part of healthcare for over 40 years. During that time, changes in circuit technology have resulted in improved survival and have facilitated the use of ECMO in more challenging patient groups in whom ECMO was previously considered to be contraindicated. Further advances have allowed ECMO to progress out of the specialist centres and nearer to patients, in the form of mobile ECMO. Patient selection remains key to a successful outcome since ECMO is a supportive therapy utilised whilst waiting for a reversible condition to resolve through other treatment strategies.
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Mechanism of action of inotropes in neonates

Paediatrics and Child Health - Sat, 04/06/2019 - 00:00
Whilst inotropes have been used in the neonatal intensive care unit (NICU) for over 50 years, debate on the optimal management of neonatal hypotension continues. The complex biochemical processes involved often mean these medications produce effects which seem to be contrary to expectations. The changing haemodynamics during the transitional phase of the newborn period, along with the gestation related structural and functional immaturity of the cardiovascular system, makes choosing an inotrope difficult.
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Antibiotic stewardship in the neonatal intensive care unit

Paediatrics and Child Health - Fri, 04/05/2019 - 00:00
Antibiotic stewardship (ABS) refers to the coordinated interventions to appropriately prescribe and administer the most pathogen-specific, narrow-spectrum antibiotic regimens, in the correct doses, for the appropriate duration, and continually evaluate prescriber and administration compliance. The main historical driver for ABS has been antibiotic resistance, which is fuelled by antibiotic therapy. Additionally, short and long term consequences of antibiotic therapy on the developing immune system have emerged as further specific hazards of antibiotic exposure in neonates.
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Fifteen-minute consultation: The EATERS method for the diagnosis of food allergies

Mich Erlewyn-Lajeunesse
Apr 4, 2019; 0:archdischild-2018-316397v1-edpract-2018-316397
BEST PRACTICE AND FIFTEEN-MINUTE CONSULTATIONS
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Neonatal sepsis

Paediatrics and Child Health - Thu, 04/04/2019 - 00:00
Neonatal sepsis is a cause of significant mortality and morbidity. It can be early (less than 72 h) or late onset (more than 72 h age). Group B Streptococcus (GBS) is the leading cause of early onset neonatal sepsis (EONS). Risk factors include maternal sepsis, prolonged rupture of membranes, chorioamnionitis and GBS colonization. Risk-based predictive models are used to identify and screen infants. Late onset neonatal sepsis (LONS) is largely caused by gram positive organisms. Risks for LONS include prematurity, low birth weight and common neonatal interventions and procedures.
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Editorial Board

Paediatrics and Child Health - Mon, 04/01/2019 - 00:00
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Self-assessment

Paediatrics and Child Health - Sat, 03/30/2019 - 00:00
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