Royce Brunson’s Post

In California, rates for #pediatric patients developing complications in the hospital before discharge can vary substantially across hospitals. From 2021-2022, 8 hospitals (3.1 percent) were rated “Above Average,” and 11 hospitals (4.3 percent) were rated “Below Average” on at least one risk-adjusted Pediatric Quality Indicator (PDI) when compared to the state average rates. To learn more, check out our PDI data visualization: https://bit.ly/3wGi3nK Hospitals can use these findings to improve their quality of pediatric care and consumers can use them to make informed health care decisions.

Reevaluating Antenatal Steroid Practices: A Call for Evidence-Based Care Antenatal steroids have revolutionized neonatal outcomes by significantly reducing respiratory morbidity, as demonstrated by landmark trials like ALPS (Antenatal Late Preterm Steroids) and ASTEC (Antenatal Steroids for Term Elective Cesarean Section). However, emerging data suggests that the risks associated with their use beyond 34+6 weeks may outweigh the benefits, raising concerns about overuse in clinical practice What the Evidence Tells Us ALPS Trial (Gyamfi-Bannerman C, et al., NEJM, 2016): • Demonstrated reduced respiratory morbidity in late preterm neonates (34+0–36+6 weeks) • However, it also highlighted a significant increase in neonatal hypoglycemia, contributing to morbidity ASTEC Trial (Stutchfield P, et al., BMJ, 2005): • Showed reduced respiratory complications in neonates born via elective cesarean at term (37+0–37+6 weeks) • However, long-term follow-up revealed adverse impacts on intellectual ability and mathematical skills, raising concerns about cognitive outcomes Why the Concern? Despite clear guidelines and evidence, the administration of antenatal steroids beyond 34+6 weeks continues, sometimes extending up to 39 weeks This practice: • Contradicts RCOG and ACOG recommendations, which limit steroid use to pregnancies under 34+6 weeks • Exposes neonates to short-term risks such as hypoglycemia and long-term risks affecting neurodevelopment, without proven benefit Time for Change To ensure the best outcomes for mothers and newborns, it is imperative to: 1. Adhere to evidence-based guidelines: RCOG and ACOG recommend antenatal steroids only up to 34+6 weeks. Beyond this, the associated risks outweigh the benefits 2. Eliminate unnecessary steroid use beyond 34+6 weeks to avoid preventable neonatal and long-term complications 3. Promote awareness among clinicians about the emerging evidence on adverse effects, particularly on neurodevelopmental outcomes Let’s Discuss How can we work together to encourage adherence to these guidelines and standardize practices for maternal-fetal care? Have you encountered similar challenges in your clinical practice? It’s time to prioritize science, minimize unnecessary interventions, and safeguard the short- and long-term well-being of our patients #AntenatalCare #EvidenceBasedMedicine #Obstetrics #Gynecology #MaternalHealth #NeonatalCare #ClinicalGuidelines #SteroidUse #PatientSafety #MedicalResearch #OBGYNCommunity #HealthcareStandards #MedicalEducation #PerinatalCare #HealthyMothersHealthyBabies

10 Reseaons Why EM is extremely Important : 1.Immediate Care for Acute Conditions - The ER is often the first point of contact for patients experiencing acute and life-threatening conditions, such as heart attacks, strokes, trauma, and severe infections. The ability to provide immediate care can be the difference between life and death. 2.Broad Scope of Practice - Emergency physicians must be skilled in a wide range of medical fields, including internal medicine, surgery, pediatrics, and obstetrics. This broad knowledge allows them to treat a diverse array of conditions quickly and efficiently. 3.Critical Decision-Making - ER physicians are trained to make rapid, high-stakes decisions with limited information. They often have to diagnose and stabilize patients within minutes, which requires strong clinical judgment and the ability to work under pressure. 4.24/7 Accessibility - The ER is open 24/7, providing access to medical care at any time. This is especially crucial for individuals who cannot wait for a regular appointment or who experience medical emergencies outside of regular office hours. 5.Public Health Role - ERs often serve as the front line in public health crises, such as pandemics, natural disasters, and mass casualty incidents. They play a key role in identifying and managing outbreaks and other large-scale health emergencies. 6.Interdisciplinary Collaboration - The ER is a hub of interdisciplinary teamwork, involving nurses, paramedics, surgeons, specialists, and other healthcare professionals. This collaboration ensures that patients receive comprehensive and coordinated care. 7.Gateway to Further Treatment - The ER often acts as a gateway to further treatment, with many patients being admitted to the hospital for additional care or referred to specialists for ongoing treatment. This initial assessment and stabilization are crucial for guiding the next steps in patient care. 8.Patient Advocacy - ER physicians often advocate for patients who might not have access to regular healthcare. They provide care regardless of a patient's ability to pay, and they often connect patients with resources and follow-up care that they might not otherwise receive. 9.High Impact on Healthcare Outcomes - Effective emergency care can significantly reduce morbidity and mortality rates. Early intervention in critical cases, such as trauma or sepsis, can dramatically improve patient outcomes. 10.Dynamic and Rewarding Field - The dynamic nature of ER work, where no two days are the same, can be highly rewarding for those who thrive in fast-paced environments. The immediate impact on patient outcomes provides a deep sense of professional fulfillment. The ER specialty is vital not only for the immediate care it provides but also for its role in the broader healthcare system, ensuring that patients receive timely and appropriate care when they need it most.

🚑 Pediatric out-of-hospital cardiac arrest (POHCA) is one of the most challenging situations EMS teams face. There aren't many POHCA publications so this is a good one to dig into. 🌟 The study came out of the Portland area and it's worth the read. Kudos to the research team of Sunhee Chung, Asia Wooten, Matt Hansen, Matthew Neth & Joshua Lupton. 📝 Study Breakdown: ➊ Over 5 years, researchers reviewed 112 cases of POHCA where EMS attempted resuscitation. ➋ The majority of these arrests (81%) occurred at home, with 73% being unwitnessed. ➌ The most common initial rhythm was asystole, found in 70% of cases. ⚡ Key Findings: ⦿ Out of 112 cases, 26.7% achieved ROSC at any time. 14.4% survived to hospital discharge. ⦿ Infants (under 1 YR) made up over half of the cases. ⦿ Advanced airway management was successful in 68% of patients. ⦿ The tibial IO was the preferred route for access (78) vs IV (13). ⦿ Epinephrine administration was utilized in 80% of cases, with an average first dose given 14 minutes after the 911 call. 🔍 A deeper dive showed that those without Online Medical Control (OLMC) had better outcomes: ⦿ This is because the call was likely for TOR. ⦿ ROSC on ED arrival was 23% for non-OLMC cases compared to 4.5% with OLMC. ⦿ The no-OLMC group had a 14% survival-to-discharge rate, while none in the OLMC group survived to discharge. 📊 What does this mean? ➡ The study suggests that cases involving OLMC are often initiated late in the resuscitation process and tend to involve patients with poorer prognostic factors. ➡ This underscores the need for earlier interventions and perhaps more standardized protocols to improve outcomes for pediatric cardiac arrests. 💡 Takeaway: Pediatric OHCA cases are rare, but when they occur, they are often unwitnessed with poor survival rates. Early intervention, quicker response times, and consistent communication protocols could be crucial to improving these outcomes. 📚 Read the full study here: https://lnkd.in/eiQbn7xM #PediatricCare #EMS #CardiacArrest #OnlineConsultation #PrehospitalCare

🚨 Study on Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers 🚨 A significant study by James Marcin, Hadley Sauers-Ford, Jamie L Mouzoon, Sarah C Haynes, Parul Dayal, Ilana Sigal, Daniel Tancredi, Monica Lieng, Nathan Kuppermann has shown that telemedicine consultations for pediatric patients in rural and community emergency departments (EDs) can effectively reduce interfacility transfers compared to telephone consultations. 📉 🔍 Key Findings: ➔Reduction in Transfers: Telemedicine consultations led to fewer transfers of acutely ill children from rural EDs than telephone consultations, optimizing care delivery and resource use. ➔Risk Rate Analysis: Adjusted risk of transfer was significantly lower in the telemedicine group across all analyses: Intention-to-treat: RR = 0.93 Treatment-received: RR = 0.81 Per-protocol: RR = 0.79 This study emphasizes the value of telemedicine in enhancing decision-making and improving patient outcomes in rural and community settings. 🌐👩⚕️👨⚕️ https://lnkd.in/d6rssq57 #Telemedicine #PediatricCare #EmergencyMedicine #MedicalResearch #PhysicianInsights #CME #HealthcareInnovation

🌟 Revolutionizing Pediatric Burn Care: SuprathelA Shines Bright! 🌟 Recent research reveals that SuprathelA is a game-changer for treating partial-thickness burns in children. A comprehensive study involving 378 pediatric patients over six years demonstrates significant advantages of SuprathelA compared to traditional treatments like EZ-dermA and BiobraneA. 🔍 Key Findings: - Shorter Hospital Stays: Patients using SuprathelA had a median stay of just 4 days, compared to 9 days for others. - Fewer Invasive Procedures: Reduced rates of escharectomy and grafting during initial treatment. - Improved Long-Term Outcomes: Less need for reinterventions post-treatment. These results highlight not only the efficacy of SuprathelA but also its potential to enhance patient comfort and optimize healthcare resources. 🏥 As healthcare providers, it’s crucial to consider adopting this innovative approach in pediatric burn management! For more insights on this pivotal study, click the link below! 👇 #BurnTreatment #ClinicalResearches #HealthcareInnovation #PatientOutcomes #PediatricCare #Publications #SuprathelA #MarketAccess #MarketAccessToday

More than 400 delegates – including researchers, scientists, doctors, nurses, therapists and members of staff – joined together for the Royal Free London’s (RFL’s) second research symposium. We caught up with Professor Derralynn Hughes, clinical director of research and innovation at the RFL, to share some highlights from the event. New and improved treatments, clinical trials and qualitative research and case studies were all on the agenda at this week’s two-day event. A wide variety of topics included the impact of new liver cancer treatments, the positive results of a trial for people with Neimann-Pick disease and evaluation of an early pregnancy loss support clinic. Delegates to the symposium were welcomed by Professor Derralynn Hughes and Lucy Parker, research and development directors. The event also included an evening reception and a prize-giving ceremony. Professor Derralynn Hughes, clinical director of research and innovation at the RFL, said: “Clinical research is usually considered to be how we understand more about conditions and ways of treating them, but research for a large organisation like the Royal Free London is about so much more – it is about our place in science and how we work with universities, and about how we do research to make services better for patients and staff experience. Lucy Parker, interim research and development director, said: “By collaborating and sharing our experiences and stories at events like this, we can all grow in our own areas of research which ultimately helps our patients.” The RFL’s ambition is to be among the NHS’ top ten 10 research trusts, achieving the best access, experience and outcomes for patients and staff.

We need to help babies breathe... when they are premature and unable to do so on their own... but this help disrupts lung development and causes lung injury and inflammation which causes BPD. BPD not only causes short and long term issues with pulmonary function, but is associated with worse neurodevelopment outcomes (CP). We have long sought to prevent BPD or decrease the associated co-morbidities. Steroids, mainly dexamethasone, have been used to prevent BPD or to limit the progression of BPD and its associated morbidities in babies while they are receiving assisted ventilation. Here is a new and important study by Lex Doyle, a pioneer in neonatal research, and others evaluating systemic corticosteroids and BPD (https://lnkd.in/gaChD6fg). This study, of 3700 preterm infants at risk of BPD from neonatal intensive care units in 10 countries, employed a comparative effectiveness research approach, utilizing weighted meta-regression analysis of 26 randomized clinical trials (RCTs) conducted between June 1989 and March 2022 (NICU care has changed dramatically in this time period and there has been significant concerns about the safety and efficacy of dexamethasone use in premature babies over these 3+ decades). They found; dexamethasone was associated with improved survival free of cerebral palsy when the risk of BPD was greater than 70%. Conversely, it was associated with harm when the risk of BPD was less than 30%. Here is what I wish we knew (but still do not): 1- what are all the modifiable and non-modifiable factors associated with BPD? 2-what are the different phenotypes that exist within our current definition of BPD (so that we could develop better, individualized prevention and treatment strategies for BPD)? 3-what developmental window (brain and lung) is a safe and/or effective time to provide an intervention to prevent or treat BPD? 4-we need to stop searching for a single intervention and more closely look at bundled approaches of care that are focused on brain and lung development that start before and continue after birth. What are those bundles and when should we provide them? 5-when will we start leveraging the enormous amount of data that we have in the neonatal ICU in real-time to provide more precise and timely care (like that which could be leveraged from continuous physiological monitoring, assisted ventilation devices....)? RCTs are the gold standard for generating evidence in medicine. However, using their results to guide the care of an individual patient requires careful consideration because RCTs are designed to provide population-level insights, not necessarily provide answers on how an individual patient should be managed as each have unique clinical circumstances.  I can list on a single hand, the single interventions that have made a difference in the care of NICU patients... I wish it were more, but it is not. #UsingWhatWeHaveBetter

👏 We are glad to announce the launch of #i4KIDS4RARE by i4KIDS I i4KIDS-EUROPE 👏  🤔 What is #i4KIDS4RARE? It’s a new European project born as a specific program of i4KIDS I i4KIDS-EUROPE, Hospital Sant Joan de Déu Barcelona and #IRSJD focused on rare diseases and orphan medical devices for pediatric patients.  🚀 The main objective of this accelerator is to promote and guide the development of #innovative solutions for #pediatric patients suffering from #rarediseases. Want to learn more about this innovative project? Read the full article here! https://lnkd.in/dNi3AdSA #i4KIDS #i4KIDS4RARE #PediatricInnovation #RareDiseases #HealthcareInnovation #ChildrenHealth #EUProject #MedicalDevices #SJDBarcelona

Diagnostic Challenges of Long COVID in Children: A Survey of Pediatric Health Care Providers' Preferences and Practices Given the challenges in diagnosing children with long COVID, we sought to explore diagnostic practices and preferences among clinicians. A ten-question survey assessed pediatric providers' clinical decision making for identifying and evaluating long COVID in children. Of the 120 survey respondents, 84 (70%) were physicians, 31 (26%) nurse practitioners, and 5 (4%) physician assistants. The most common categories of symptoms identified as raising suspicion for long COVID in children included cardiopulmonary symptoms, selected by 119 (99%) of pediatric providers, and neurocognitive symptoms, selected by 118 (98%) of providers. However, there was more ambiguity on the primary feature of long COVID, with providers selecting a range of key symptoms. Of all physical exam findings, postural orthostatic tachycardia, was most suggestive of long COVID (identified by 49 [41%] of pediatric providers), whereas one-third of providers reported no specific identifiable exam finding. Pediatric providers report variable decision making in the clinical evaluation of long COVID, with patient demographics and clinical factors impacting whether a diagnosis of long COVID is considered. This variation in diagnosing pediatric long COVID reflects ambiguity in the definition of long COVID in children and the absence of clinical guidelines to support providers in the identification of disease and treatment. This study highlights an area of need for future clinical advances in pediatric long COVID. ***Click on banner below to access entire study. Posted by Larry Cole Executive Director - Covid Impact 360