Stories about: Pediatric Dose October 2015

Challenging Case: A child with a Monteggia fracture

Monteggia fracture X-ray

A six-year-old boy presented to the Orthopedic Center at Boston Children’s Hospital in July 2014 having sustained an injury during a fall that spring. The treating physician did not initially recognize the injury as a Monteggia fracture, a fairly uncommon and often unrecognized injury. …Read More

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Much ado about (almost) nothing: Revisiting Paxil in adolescents

adolescent brain Paxil

BMJ recently published a re-analysis of a 2001 study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), evaluating the use of paroxetine (Paxil) to treat teens with depression. This re-analysis falls under the RIAT (restoring invisible and abandoned trials) initiative that encourages companies and researchers to update findings from past clinical trials.

This news is essentially “much ado about nothing,” because no one was doing anything based upon the 2001 study. But it is worth noting because it was not the best moment for the JAACAP and the authors of the original article. …Read More

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Clinical informatics: Medicine’s oldest new frontier

tablet stethoscope clinical informatics

Clinical Informatics has been around for over forty years, though it remains a relatively new concept to most clinicians. But it touches nearly everything we do as medical providers each day.

As a field, clinical informatics aims to harness the power of information technology for the betterment of patient care through innovative care delivery systems. And by nature a multi-disciplinary practice, it affects all areas of patient care. For instance, electronic health records (EHRs) allow providers to communicate patient information seamlessly between outpatient clinics, emergency departments, the peri-operative space and the inpatient floors.

While the EHR may be the most recognized example of clinical informatics in action in today’s world, health information technology (HIT) is present everywhere you look in the healthcare system. …Read More

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Expert’s Corner: Consider autism in children with ADHD-like symptoms

autism spectrum disorder ADHD crossword diagnosis

Children with autism spectrum disorder (ASD) often have symptoms that look like those of attention-deficit/hyperactivity disorder (ADHD). Could this similarity delay an ASD diagnosis in some children? A national study last month in Pediatrics, involving nearly 1,500 children with an ASD diagnosis, found the answer is yes.

Of the 1,500 children, about 20 percent were initially diagnosed with ADHD. On average, they received their ASD diagnosis about three years later than those who were first diagnosed with ASD or with both ASD and ADHD simultaneously. This made them 30 times more likely to be over the age of 6 when diagnosed with ASD, missing a vital intervention window.

Notes talked to the paper’s first author, Amir Miodovnik, MD, MPH, of Boston Children’s Hospital’s Division of Developmental Medicine. (Miodovnik currently practices at The Maimonides Infants & Children’s Hospital in Brooklyn, NY.) …Read More

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