#childrensphila

Barbara Chaiyachati, MD PhD SafePlace: The Center for Child Protection and Health Division of General Pediatrics The Children’s Hospital of Philadelphia, Center for Pediatric Clinical Effectiveness University of Pennsylvania Philadelphia, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Children in foster care have high rates of medical problems including chronic diseases. There is less known about the differences in mortality for children in foster care. Looking at national data from 2003 to 2016, this study finds that children (ages 1 to 18) in foster care have higher mortality compared to children in the general population and that the difference in mortality has increased over time.   MedicalResearch.com: What should readers take away from your report? Response: Children in foster care are a very vulnerable population. We cannot conclude that foster care is the cause of the increased mortality. Therefore, we should consider other factors that may be impacting this difference in mortality, including the experiences of children prior to foster care and children's health status when they enter foster care.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: I see two critical next steps: 1) Gaining additional information about what are the causes of mortality in foster care and how those causes may be different from children in the general population; and 2) Working with policymakers to develop evidence-based interventions that address the disparity in mortality among youth in foster care. We also did not assess mortality for children in foster care who are less than one years old; a next study may look specifically at this age group.   MedicalResearch.com: Is there anything else you would like to add?  Response: In the context of today, while children have not been shown to be at high risk for severe complications from COVID-19, we do believe that vulnerable populations may be particularly impacted by this pandemic in a variety of ways. In many jurisdictions across the nation, dependency court status hearings for children in foster care, in-person visits with biological parents, and even in-person supervision visits with foster care agency staff have been suspended because of COVID-19. Thus, this already vulnerable population of children is facing even greater challenges and isolation that we need to ensure we’re addressing. We have no disclosures.   Citations: Chaiyachati BH, Wood JN, Mitra N, Chaiyachati KH. All-Cause Mortality Among Children in the US Foster Care System, 2003-2016. JAMA Pediatr. Published online April 20, 2020. doi:10.1001/jamapediatrics.2020.0715       The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

MedicalResearch.com Interview with: Dr. Panganiban Jennifer Panganiban, MD Division of Gastroenterology, Hepatology and Nutrition Director, Non Alcoholic Fatty Liver Disease Clinic Children's Hospital of Philadelphia MedicalResearch.com: What is the background for this study? Response: Obesity now affects 1 in 5 children and adolescents in the United States with an estimated prevalence of 13.7 million. We know that this is not only an issue in the US but a worldwide epidemic. Lifestyle modification is the primary treatment of obesity, which can be successful but is limited. Off-label use of medications for weight loss in youth is increasing secondary to the limited availability of FDA approved medications for weight-loss.  MedicalResearch.com: What are the main findings? Response: Topiramate prescribed for any indication, such as migraines, resulted in weight loss or BMI stabilization in children 2-21 years of age. This was more pronounced in ages 14-21 years of age if topiramate was prescribed specifically for weight-loss for 1-3 months.  MedicalResearch.com: What should readers take away from your report?  Response: Topiramate is an effective weight loss medication and should be considered as an adjunct to lifestyle intervention, with the greatest effects noted when prescribed in adolescents. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: We recommend randomized controlled clinical trials examining the efficacy of Topiramate in childhood obesity.     MedicalResearch.com: Is there anything else you would like to add?  Response: Additional analysis has showed that Topiramate may also be beneficial in obese children with Non alcoholic fatty liver disease (NAFLD) with noted improvement in the liver enzyme, alanine aminotransferase (ALT). Any disclosures? None Citation: 2019  Obesity Week abstract: Weight-loss Effects of Topiramate in Youth With Obesity   Last Modified:       The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Silber Jeffrey H. Silber, MD, PhD Director, Center for Outcomes Research Nancy Abramson Wolfson Endowed Chair Health Services Research Children's Hospital of Philadelphia Professor of Pediatrics, Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania Professor of Health Care Management Wharton School, University of Pennsylvania  MedicalResearch.com: What is the background for this study? Response: This was a year-long randomized trial that involved 63 internal medicine residency programs from around the US.  In 2015-2016, about half of the programs were randomized to follow the existing rules about resident duty hours that included restrictions on the lengths of shifts and the rest time required between shifts (the standard arm of the trial) and the other half of the programs didn’t have those shift length or rest period rules (the flexible arm of the trial).  We measured what happened to the patients cared for in those programs (the safety study), and other studies examined how much sleep the residents received, and how alert they were at the end of shifts (the sleep study), and previously we published on the educational outcomes of the interns. To measure the impact on patient outcomes when allowing program directors the ability to use a flexible shift length for their interns, we compared patient outcomes after the flexible regimen went into place to outcomes the year before in the same program. We did the same comparison for the standard arm. Then we compared the difference between these comparisons. Comparing before and after the implementation of the trial within the same program allowed us to be more confident that a particularly strong or weak program, or a program with especially sick or healthy patients, would not throw off the results of the study. The trial was designed to determine, with 95% confidence, if the flexible arm did not do more than 1% worse than the standard arm. If this were true for the flexible arm, we could say the flexible regimen was “non-inferior” to the standard regimen. MedicalResearch.com: What are the main findings? Response: We found that for death within 30 days of admission (the primary outcome of the trial), we could say with 95% confidence that the flexible arm was non-inferior to the standard arm. We also found that for the flexible programs, complications measured by Patent Safety Indicators, and 7-day death or readmission rates also were non-inferior to the standard arm. We could not establish non-inferiority with 95% confidence for the outcome prolonged length of stay, but we also saw no evidence that one arm was statistically different from the other. In fact, for all the outcomes we studied, there was no statistical difference between the flexible or standard arms of the study. MedicalResearch.com: What should readers take away from your report? Response: The results of the iCOMPARE trial, taken as a whole, provides reassuring evidence that the more flexible approach to shift length did not pose significant risks to patients, compared to the conventional duty hours approach that was in place at the time.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: There are many questions still unanswered from this trial. Future work will need to better define the optimal shift length for specific work environments, taking into consideration patient safety as well as resident well-being and education. We need to better model the acute and chronic demands placed on residents, and we need to devise systems that track patient and resident outcomes over time, since the hospital environment is constantly changing.  Funding: We received financial support from the National Heart, Lung, and Blood Institute of NIH, as well as the ACGME, who also gave us permission to randomize programs to the flexible regimen. Citation: Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules Jeffrey H. Silber, M.D., Ph.D., Lisa M. Bellini, M.D., Judy A. Shea, Ph.D., Sanjay V. Desai, M.D., David F. Dinges, Ph.D., Mathias Basner, M.D., Ph.D., Orit Even-Shoshan, M.S., Alexander S. Hill, B.S., Lauren L. Hochman, B.A., Joel T. Katz, M.D., Richard N. Ross, M.S., David M. Shade, J.D., et alfor the iCOMPARE Research Group March 7, 2019 N Engl J Med 2019; 380:905-914 DOI: 10.1056/NEJMoa1810642 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article