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Adolescent Health, Medicine and... 2018Several countries are legalizing the use of medicinal cannabis and easing restrictions on its recreational use. While adults have been the primary target of these... (Review)
Review
PURPOSE
Several countries are legalizing the use of medicinal cannabis and easing restrictions on its recreational use. While adults have been the primary target of these initiatives, expanding access to cannabis will likely lead to increased use by children. While the effects of cannabis on pediatric neuropsychological and mental health outcomes have been broadly studied, there are limited data on the physical health effects of cannabis, including endocrine health. Animal studies have shown that chronic cannabis use leads to delayed sexual maturation; however, its effects on pubertal outcomes in children are not well studied. This systematic review aimed to assess the effect of cannabis use on pubertal timing and tempo in children.
METHODS
We conducted a systematic review with literature searches in MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central, PsycINFO, CINAHL, Web of Science, and SPORTDiscus from inception to February 2018. A gray literature search was also completed in Clinicaltrials.gov and ProQuest Dissertations and Theses A&I. The primary outcome was pubertal timing, while secondary outcomes included pubertal tempo and final height and weight. We had no restrictions on date or language of publication of papers. Two reviewers independently assessed records for eligibility, with a third reviewer resolving disagreements.
RESULTS
Our database and gray literature searches identified 759 records. A total of 29 full-text papers were assessed for eligibility. However, all studies were ultimately excluded as they did not meet the eligibility criteria.
CONCLUSION
Our results highlight a significant gap in existing literature regarding the effects of cannabis use on puberty. Adequately powered longitudinal studies are urgently needed to provide pediatricians and other health care providers with high-quality information on the potential effects of cannabis on the physical health of children.
PROSPECTIVE REGISTRAR OF SYSTEMATIC REVIEWS REGISTRATION
PROSPERO no.: CRD42018089397.
PubMed: 30349416
DOI: 10.2147/AHMT.S175864 -
International Journal of Medical... Dec 2023Medication prescription is a complex process that could benefit from current research and development in machine learning through decision support systems. Particularly... (Review)
Review
BACKGROUND
Medication prescription is a complex process that could benefit from current research and development in machine learning through decision support systems. Particularly pediatricians are forced to prescribe medications "off-label" as children are still underrepresented in clinical studies, which leads to a high risk of an incorrect dose and adverse drug effects.
METHODS
PubMed, IEEE Xplore and PROSPERO were searched for relevant studies that developed and evaluated well-performing machine learning algorithms following the PRISMA statement. Quality assessment was conducted in accordance with the IJMEDI checklist. Identified studies were reviewed in detail, including the required variables for predicting the correct dose, especially of pediatric medication prescription.
RESULTS
The search identified 656 studies, of which 64 were reviewed in detail and 36 met the inclusion criteria. According to the IJMEDI checklist, five studies were considered to be of high quality. 19 of the 36 studies dealt with the active substance warfarin. Overall, machine learning algorithms based on decision trees or regression methods performed superior regarding their predictive power than algorithms based on neural networks, support vector machines or other methods. The use of ensemble methods like bagging or boosting generally enhanced the accuracy of the dose predictions. The required input and output variables of the algorithms were considerably heterogeneous and differ strongly among the respective substance.
CONCLUSIONS
By using machine learning algorithms, the prescription process could be simplified and dosing correctness could be enhanced. Despite the heterogenous results among the different substances and cases and the lack of pediatric use cases, the identified approaches and required variables can serve as an excellent starting point for further development of algorithms predicting drug doses, particularly for children. Especially the combination of physiologically-based pharmacokinetic models with machine learning algorithms represents a great opportunity to enhance the predictive power and accuracy of the developed algorithms.
Topics: Humans; Child; Algorithms; Neural Networks, Computer; Machine Learning; Prescriptions
PubMed: 37939541
DOI: 10.1016/j.ijmedinf.2023.105241 -
Global Pediatric Health 2020. Pediatric obesity has become a significant public health concern. Pediatricians are the ideal group to help identify and treat this epidemic, but unfortunately, many... (Review)
Review
. Pediatric obesity has become a significant public health concern. Pediatricians are the ideal group to help identify and treat this epidemic, but unfortunately, many pediatricians are not trained to discuss obesity with patients and their families. Standardized training initiatives for pediatric residents on prevention and/or management of obesity are needed to equip emerging pediatricians to combat the obesity epidemic. . This systematic literature review aims to examine the effectiveness of childhood obesity prevention/counseling resident training interventions. . A comprehensive literature search was performed using preidentified search terms and limited to articles published prior to November 6, 2019. Articles were analyzed by 2 reviewers with a standardized evaluation tool. . A total of 698 articles were identified by the search. These were reduced to 111 articles after title review and 11 articles following abstract/full paper review. The 11 articles described 10 different obesity training interventions for residents. The articles varied in their size, length of training session, and study design. Despite these variations, all articles outlined positive outcomes, including an increase in physician confidence, positive changes in behavior, and/or improved electronic medical record documentation. . With the continued increase in pediatric obesity, there is a need for practical, easy-to-implement, standardized trainings for pediatric residents on obesity prevention and treatment. More investigation needs to be done to look at long-term results of current interventions as well as other outcomes such as whether physicians are correctly identifying patients who are overweight or obese and whether there is improvement in patient follow-up.
PubMed: 32637464
DOI: 10.1177/2333794X20928215 -
Canadian Medical Education Journal 2013The assessment and maintenance of competence for pediatricians has recently received increased attention. The aim of the present study was to investigate further the use... (Review)
Review
INTRODUCTION
The assessment and maintenance of competence for pediatricians has recently received increased attention. The aim of the present study was to investigate further the use of multisource feedback for assessing pediatricians in practice.
METHODS
A systematic literature review was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PUBMED, and CINAHL for English-language articles.
RESULTS
762 articles were identified with the initial search and 756 articles were excluded for a total of six studies that met the inclusion criteria for this systematic review. Internal consistency reliability was reported in five studies with α ≥ 0.95 for both subscales and full scales. Generalizability was also reported in two studies with Ep (2) generally ≥ 0.78. These adequate Ep (2) coefficients were achieved with different numbers of raters. Evidence for content, criterion-related (e.g., Pearson's r) and construct validity (e.g., principal component factor analysis) was reported in all 6 studies.
CONCLUSION
Multisource feedback is a feasible, reliable, and valid method to assess pediatricians in practice. The results indicate that multisource feedback system can be used to assess key competencies such as communication skills, interpersonal skills, collegiality, and medical expertise. Further implementation of multisource feedback is desirable.
PubMed: 26451206
DOI: No ID Found -
Nutricion Hospitalaria 2013Obesity and overweight (O/OW) in children have reached epidemic character and both are a risk factor for chronic serious health problems. This study was perfomed in... (Review)
Review
INTRODUCTION
Obesity and overweight (O/OW) in children have reached epidemic character and both are a risk factor for chronic serious health problems. This study was perfomed in order to research the relationship between O/OW and dental caries.
MATERIAL AND METHODS
[corrected] A SR was conducted between 2007-2011 in tertiary information sources (Trip, Cochrane and NGC), secondary (PubMed, IME, MEDES IBECS) and primary (reference checks).
INCLUSION CRITERIA
Patients (children 0-18 years), risk factor (O/OW) and outcomes (primary: caries, secondary: other oral pathology).
DATA COLLECTED
Author, year, country, type of study, patient age, cases (with O/OW) and controls (body mass index-BMI-normal or low), comorbidities, socioeconomic status, prevalence of caries and other results in oral health.
RESULTS
Forty-seven documents were located, 37 of them met the criteria of the RS, temporarily distributed in 2007 (6 articles), 2008 (6), 2009 (5), 2010 (11) and 2011 (9). They presented a very wide degree of heterogeneity (in patients, intervention, primary outcome and type of design), which does not allow to apply quantitative synthesis of data (meta-analysis). Studies are conflicting regarding the relationship between BMI and frequency of dental caries (DMFT, dmft).
CONCLUSIONS
Systematic review allows dentists and pediatricians to know the relationship between O/OW and dental caries.
Topics: Adolescent; Child; Dental Caries; Humans; Obesity; Overweight
PubMed: 24160190
DOI: 10.3305/nh.2013.28.5.6674 -
The Cochrane Database of Systematic... Aug 2021There is presently no certainty about the ideal feeding intervals for preterm infants. Shorter feeding intervals of, for example, two hours, have the theoretical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is presently no certainty about the ideal feeding intervals for preterm infants. Shorter feeding intervals of, for example, two hours, have the theoretical advantage of allowing smaller volumes of milk. This may have the potential to reduce the incidence and severity of gastro-oesophageal reflux. Longer feeding intervals have the theoretical advantage of allowing more gastric emptying between two feeds. This potentially provides periods of rest (and thus less hyperaemia) for an immature digestive tract.
OBJECTIVES
To determine the safety of shorter feeding intervals (two hours or shorter) versus longer feeding intervals (three hours or more) and to compare the effects in terms of days taken to regain birth weight and to achieve full feeding.
SEARCH METHODS
We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in CENTRAL (2020, Issue 6) and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions, and CINAHL on 25 June 2020. We searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs.
SELECTION CRITERIA
We included RCTs and quasi-RCTs comparing short (e.g. one or two hours) versus long (e.g. three or four hours) feeding intervals in preterm infants of any birth weight, all or most of whom were less than 32 weeks' gestation. Infants could be of any postnatal age at trial entry, but eligible infants should not have received feeds before study entry, with the exception of minimal enteral feeding. We included studies of nasogastric or orogastric bolus feeding, breast milk or formula, in which the feeding interval is the intervention.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were days taken to achieve full enteral feeding and days to regain birth weight. Our other outcomes were duration of hospital stay, episodes of necrotising enterocolitis (NEC) and growth during hospital stay (weight, length and head circumference).
MAIN RESULTS
We included four RCTs, involving 417 infants in the review. One study involving 350 infants is awaiting classification. All studies compared two-hourly versus three-hourly feeding interval. The risk of bias of the included studies was generally low, but all studies had high risk of performance bias due to lack of blinding of the intervention. Three studies were included in meta-analysis for the number of days taken to achieve full enteral feeding (351 participants). The mean days to achieve full feeds was between eight and 11 days. There was little or no difference in days taken to achieve full enteral feeding between two-hourly and three-hourly feeding, but this finding was of low certainty (mean difference (MD) ‒0.62, 95% confidence interval (CI) ‒1.60 to 0.36). There was low-certainty evidence that the days taken to regain birth weight may be slightly longer in infants receiving two-hourly feeding than in those receiving three-hourly feeding (MD 1.15, 95% CI 0.11 to 2.20; 3 studies, 350 participants). We are uncertain whether shorter feeding intervals have any effect on any of our secondary outcomes including the duration of hospital stay (MD ‒3.36, 95% CI ‒9.18 to 2.46; 2 studies, 207 participants; very low-certainty evidence) and the risk of NEC (typical risk ratio 1.07, 95% CI 0.54 to 2.11; 4 studies, 417 participants; low-certainty evidence). No study reported growth during hospital stay.
AUTHORS' CONCLUSIONS
The low-certainty evidence we found in this review suggests that there may be no clinically important differences between two- and three-hourly feeding intervals. There is insufficient information about potential feeding complications and in particular NEC. No studies have looked at the effect of other feeding intervals and there is no long-term data on neurodevelopment or growth.
Topics: Birth Weight; Enteral Nutrition; Enterocolitis, Necrotizing; Humans; Infant; Infant Formula; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Milk, Human; Time Factors; Treatment Outcome; Weight Gain
PubMed: 34415568
DOI: 10.1002/14651858.CD012322.pub2 -
Jornal de Pediatria May 2003To critically review recent medical literature, focusing on practical features that are relevant for diagnosis and outpatient treatment of pediatric hypertension. (Review)
Review
OBJECTIVE
To critically review recent medical literature, focusing on practical features that are relevant for diagnosis and outpatient treatment of pediatric hypertension.
SOURCES
Classic articles and systematic review of recent literature through electronic search of Medline and Lilacs databases over the last 10 years, using the key words arterial hypertension, newborns, infants, preschool, children and adolescents. Those articles containing relevant information were selected.
SUMMARY OF THE FINDINGS
Arterial hypertension and obesity are public health problems all over the world. Essential arterial hypertension in adults begins in childhood and can also be secondary to several diseases. Pediatricians must measure the arterial pressure of the patients in a proper manner. When arterial hypertension is detected, it must be investigated in order to be adequately treated. The investigation depends on the age and the rising degree of the arterial pressure, taking into consideration the cause of hypertension, as well as its effects on target organs.
CONCLUSIONS
The early recognition of an abnormal arterial pressure followed by adequate investigation and treatment are required to reduce the cardiovascular and renal morbidity/mortality.
Topics: Blood Pressure Determination; Child; Diet; Humans; Hypertension; Prevalence; Risk Factors
PubMed: 14506524
DOI: 10.2223/jped.1006 -
Children (Basel, Switzerland) Feb 2023The objective of this review is to assess and synthesize the role of the maternal and child health (MCH) handbook on improving healthcare service utilization, behavior... (Review)
Review
The objective of this review is to assess and synthesize the role of the maternal and child health (MCH) handbook on improving healthcare service utilization, behavior change, and health outcomes for women and children. A systematic search of all relevant existing reports was conducted on 14 January 2021, using the following online bibliographic databases: PubMed, EMBASE, MEDLINE, The Cochrane Library, Academic Search Premier, Emcare, APA PsycINFO, and Web of Science. Two reviewers independently performed study selection, data extraction, and quality assessment. We included 7 trials from 1430 articles, and a total of 2643 women. As overall risk of bias assessment, most domains of the Cochrane risk-of-bias assessment tool showed a high or unclear risk of bias. The risk of ≥6 antenatal care (ANC) visits was 19% higher (RR 1.19, 95% CI 1.09 to 1.30, I2 = 47%, 2 studies, 955 women, moderate certainty of evidence) and skilled birth attendants during delivery was 13% higher (RR 1.13, 95% CI 1.04 to 1.24, I2 = 0%, 2 studies, 1094 women, low certainty of the evidence) in the intervention group than in the control group. The MCH handbook can increase maternal health service utilization and early breastfeeding practice. It also leads to a sense of autonomy during ANC, better communication with healthcare providers, and support from family members.
PubMed: 36979993
DOI: 10.3390/children10030435 -
The Cochrane Database of Systematic... Jan 2023Postoperative pain clinical management in neonates has always been a challenging medical issue. Worldwide, several systemic opioid regimens are available for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative pain clinical management in neonates has always been a challenging medical issue. Worldwide, several systemic opioid regimens are available for pediatricians, neonatologists, and general practitioners to control pain in neonates undergoing surgical procedures. However, the most effective and safe regimen is still unknown in the current body of literature.
OBJECTIVES
To determine the effects of different regimens of systemic opioid analgesics in neonates submitted to surgery on all-cause mortality, pain, and significant neurodevelopmental disability. Potentially assessed regimens might include: different doses of the same opioid, different routes of administration of the same opioid, continuous infusion versus bolus administration, or 'as needed' administration versus 'as scheduled' administration.
SEARCH METHODS
Searches were conducted in June 2022 using the following databases: Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, and CINAHL. Trial registration records were identified via CENTRAL and an independent search of the ISRCTN registry.
SELECTION CRITERIA
We included randomized controlled trials (RCTs), quasi-randomized, cluster-randomized, and cross-over controlled trials evaluating systemic opioid regimens' effects on postoperative pain in neonates (pre-term or full-term). We considered suitable for inclusion: I) studies evaluating different doses of the same opioid; 2) studies evaluating different routes of administration of the same opioid; 3) studies evaluating the effectiveness of continuous infusion versus bolus infusion; and 4) studies establishing an assessment of an 'as needed' administration versus 'as scheduled' administration.
DATA COLLECTION AND ANALYSIS
According to Cochrane methods, two investigators independently screened retrieved records, extracted data, and appraised the risk of bias. We stratified meta-analysis by the type of intervention: studies evaluating the use of opioids for postoperative pain in neonates through continuous infusion versus bolus infusion and studies assessing the 'as needed' administration versus 'as scheduled' administration. We used the fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD), standardized mean difference (SMD), median, and interquartile range (IQR) for continuous data. Finally, we used the GRADEpro approach for primary outcomes to evaluate the quality of the evidence across included studies.
MAIN RESULTS
In this review, we included seven randomized controlled clinical trials (504 infants) from 1996 to 2020. We identified no studies comparing different doses of the same opioid, or different routes. The administration of continuous opioid infusion versus bolus administration of opioids was evaluated in six studies, while one study compared 'as needed' versus 'as scheduled' administration of morphine given by parents or nurses. Overall, the effectiveness of continuous infusion of opioids over bolus infusion as measured by the visual analog scale (MD 0.00, 95% confidence interval (CI) -0.23 to 0.23; 133 participants, 2 studies; I² = 0); or using the COMFORT scale (MD -0.07, 95% CI -0.89 to 0.75; 133 participants, 2 studies; I² = 0), remains unclear due to study designs' limitations, such as the unclear risk of attrition, reporting bias, and imprecision among reported results (very low certainty of the evidence). None of the included studies reported data on other clinically important outcomes such as all-cause mortality rate during hospitalization, major neurodevelopmental disability, the incidence of severe retinopathy of prematurity or intraventricular hemorrhage, and cognitive- and educational-related outcomes. AUTHORS' CONCLUSIONS: Limited evidence is available on continuous infusion compared to intermittent boluses of systemic opioids. We are uncertain whether continuous opioid infusion reduces pain compared with intermittent opioid boluses; none of the studies reported the other primary outcomes of this review, i.e. all-cause mortality during initial hospitalization, significant neurodevelopmental disability, or cognitive and educational outcomes among children older than five years old. Only one small study reported on morphine infusion with parent- or nurse-controlled analgesia.
Topics: Humans; Infant, Newborn; Analgesia; Analgesics, Opioid; Clinical Protocols; Morphine; Pain, Postoperative
PubMed: 36645224
DOI: 10.1002/14651858.CD015016.pub2 -
International Journal of Environmental... Nov 2021Fever is a common symptom in children that nurses and pediatricians treat. Although it is a common sign in clinical practice, fever instills irrational fears in parents... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Fever is a common symptom in children that nurses and pediatricians treat. Although it is a common sign in clinical practice, fever instills irrational fears in parents that health professionals share.
OBJECTIVE
To investigate whether doctors' and nurses' knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children's fever.
DATA SOURCES
A systematic review with meta-analysis was conducted with PRISMA international standards and the Cochrane recommendations.
STUDY SELECTION
Articles examining health professionals' (doctors and/or nurses) knowledge, perceptions, and/or attitudes toward fever in children and the use of antipyretics were selected for the study.
DATA EXTRACTION
The qualitative analysis was carried out by classifying the articles according to the applied educational programs for nurses related to fever care for children that evaluated different outcomes to determine their efficacies.
RESULTS
For the qualitative synthesis, 41 articles were included, and 5 of these were taken in meta-analysis, which measured the effectiveness of educational programs for fever management in nurses.
LIMITATIONS
All of the included studies generally had a high risk of bias.
CONCLUSION
According to the evidence reviewed, nurses' and physicians' perceptions and attitudes regarding fever management in children indicate an overtreatment of this sign. We can give a recommendation grade of D on the use of educational programs to modify attitudes, perceptions, and knowledge about fever in children and improve clinical practice in nurses.
Topics: Attitude of Health Personnel; Child; Clinical Competence; Fever; Health Knowledge, Attitudes, Practice; Humans; Overtreatment; Physicians
PubMed: 34886174
DOI: 10.3390/ijerph182312444