Molecular Point-of-Care Testing in the Emergency Department for Group A Streptococcus Pharyngitis: A Randomized Trial.

OBJECTIVES: To compare clinical and health systems outcomes of rapid molecular testing versus throat culture recovery for the management of group A Streptococcus (GAS) pharyngitis in a pediatric emergency department (PED). METHODS: We conducted a single-center randomized trial of children (3-17 years) presenting to a PED with suspected GAS pharyngitis. A single dual-headed throat swab was collected, and participants were randomized to 1 of 2 parallel treatment groups with 1:1 allocation: point-of-care (POC) nucleic acid amplification testing or standard throat culture. The primary outcomes were time to throat pain +/- fever resolution. Secondary outcomes included absenteeism, length of stay, return visits to care, and antibiotic prescriptions and utilization. RESULTS: A total of 227 children were randomly assigned to culture (n = 115) or POC (n = 112) testing. Antibiotics were initiated earlier in the POC group by approximately 1 day (95% confidence interval, -0.40 to -1.58). No associated difference in time to throat pain or fever resolution was observed between groups. There was a decrease in the proportion of prescribed antibiotics in the POC group (0.35) compared with the culture group (0.79; P < 0.001). Otherwise, no significant differences in secondary outcomes were observed. CONCLUSIONS: Establishing a POC nucleic acid amplification testing program for GAS in a PED facilitates earlier treatment and fewer antibiotic prescriptions. Although this did not translate to improved clinical and health systems outcomes in our study, it may serve as an important tool amid evolving pediatric febrile illnesses and growing antimicrobial resistance patterns.

Pediatric Life Support Update: 2015 American Heart Association Highlights.

Despite improving survival rates for pediatric cardiac arrest victims, they remain strikingly low. Evidence for pediatric cardiopulmonary resuscitation is limited with many areas of ongoing controversy. The American Heart Association provides updated guidelines for life support based on comprehensive reviews of evidence-based recommendations and expert opinions. This facilitates the translation of scientific discoveries into daily patient care, and familiarization with these guidelines by health care providers and educators will facilitate the widespread, consistent, and effective care for patients.

The Assessment and Sustainable Management of Sickle Cell Disease in the Indigenous Tharu Population of Nepal.

Sickle cell disease is an inherited hemoglobinopathy associated with significant morbidity and mortality. Reports suggest a high sickle cell disease burden among the indigenous Tharu population of Nepal, who for centuries have inhabited regions where malaria is endemic. Unfortunately, health care resources are limited and often inaccessible for Tharu individuals suffering from sickle cell disease. We conducted a large-scale screening effort to estimate the prevalence of Hb S (HBB: c.20A>T) among the Tharu population and delivered community-based education sessions to increase sickle cell disease awareness. A total of 2899 Tharu individuals aged 6 months to 40 years in the rural district of Dang in Western Nepal were screened using a sickling test, of whom, 271 [9.3%; 95% confidence interval (95% CI): 8.3-10.4%] screened positive for Hb S. Those who screened positive were offered diagnostic gel electrophoresis testing. Of the 133 individuals who underwent diagnostic testing, 75.9% (n = 101) were confirmed to be Hb AS heterozygotes, 4.5% (n = 6) were confirmed to be Hb SS homozygotes and 19.5% (n = 26) were false positives. These findings support a large burden of sickle cell disease among the Tharu population and highlight the importance of appropriate resource allocation and management. With a positive predictive value of 80.0% (95% CI: 73.0-87.0%), the sickling test in conjunction with raising local sickle cell disease awareness may be a simple and sustainable way to promote access to health resources.

Paediatric patient family engagement with clinical research at a tertiary care paediatric hospital.

BACKGROUND: Subject recruitment is essential for conducting clinical research; however, there are very few studies evaluating research uptake by families in a paediatric setting. OBJECTIVES: To determine how frequently paediatric patients and their families receiving care at a tertiary paediatric hospital participated in research. The secondary objectives were to explore factors that influence patient families' decisions to participate in research and how they perceived their experiences. METHODS: A cross-sectional study surveying families of children receiving care in a sample of clinical areas at a tertiary care paediatric hospital in British Columbia was conducted. A self-administered questionnaire was used, and was facilitated by trained interviewers. Descriptive statistics were used to report the proportion of patient families that have previously been invited to participate in research and, among these, the proportion who had agreed to participate. Patient families' perceptions of research and their past experiences therein were also reported. RESULTS: A total of 657 families were approached, of which 543 were enrolled (82.6% response rate). Among the 439 families that had visited the hospital previously, 114 (26.0%) had been invited to participate in research and 99 (87%) had consented to participate. Of these 99 families, only one had a negative experience, and 84 (85%) of these participant families were at least somewhat likely to participate in research again in the future. CONCLUSIONS: Only one-quarter of families that had previously visited the hospital had been invited to participate in a research project. Of the families approached previously, there was a high rate of participation and willingness to participate in future research.

HISTORIQUE: Il est essentiel de recruter des sujets pour mener des recherches cliniques. Cependant, il existe très peu d'études sur les familles qui acceptent de participer à des recherches en milieu pédiatrique. OBJECTIFS: Déterminer la fréquence à laquelle des patients d'âge pédiatrique et leur famille soignés à un hôpital pédiatrique de soins tertiaires participent à la recherche. Les objectifs secondaires consistaient à explorer des facteurs qui influent sur la décision des familles de patients de participer à la recherche ainsi que leur perception de ces expériences. MÉTHODOLOGIE: Des chercheurs ont mené une étude transversale auprès de familles d'enfants soignés dans un échantillon de secteurs cliniques d'un hôpital pédiatrique de soins tertiaires de la Colombie-Britannique. Ils ont utilisé un questionnaire autoadministré, facilité par des intervieweurs formés. Ils ont utilisé des statistiques descriptives pour rendre compte de la proportion de familles de patients qui avaient déjà été invitées à participer à une recherche et, de ce nombre, la proportion qui avait accepté d'y participer. Ils ont également rendu compte de la perception des familles des patients à l'égard de la recherche et de leur expérience. RÉSULTATS: Au total, 657 familles ont été invitées, et 543 ont participé (taux de réponse de 82,6 %). Des 439 familles qui avaient déjà eu rendez-vous à l'hôpital, 114 (26,0 %) avaient été invitées à participer à une recherche et 99 (87 %) y avaient consenti. De ces 99 familles, une seule a vécu une expérience négative, et 84 (85 %) étaient au moins quelque peu susceptibles de participer de nouveau à une recherche. CONCLUSIONS: Seul le quart des familles qui avaient eu rendezvous à l'hôpital avait été invité à participer à un projet de recherche. Au sein des familles déjà invitées, le taux de participation et la dispositions à participer à une future recherche étaient élevés.

A Toddler With Prolonged Fever and Intermittent Cough.

Fever of unknown origin is an important diagnostic challenge in pediatrics that requires a thoughtful approach. The differential diagnosis is broad and includes infectious, autoimmune, oncologic, neurologic, genetic, and iatrogenic causes. Infection remains the most common etiology, and uncommon presentations of infections are still more likely than classic presentations of rare conditions. We report a case of a retropharyngeal abscess in a toddler whose presentation is marked by a prolonged fever (>3 weeks). This case highlights the importance of close follow-up with serially repeated history and physical examinations to guide the evaluation of a patient with fever of unknown origin.

Reliability of HEARTSMAP as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments for Pediatric Mental Health Complaints.

OBJECTIVES: The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health (MH) presentations to the emergency department (ED). In addition, we report on current documentation practices. METHODS: We conducted a retrospective cross-sectional study of pediatric (up to age 17) MH-related visits to four EDs between April 1, 2013, and March 31, 2014. The primary outcome was the inter-rater agreement when evaluating the completeness of pediatric emergency psychosocial assessments using the HEARTSMAP tool. The secondary outcome was to describe the adequacy of documentation of emergency pediatric MH assessments, using HEARTSMAP as a guide for a complete assessment. RESULTS: A total of 400 medical records (100 from each site) were reviewed. We observed near-perfect inter-rater agreement (κ = 0.99-1.00) regarding the presence of documentation and good-to-perfect agreement (κ = 0.71-1.00) regarding whether sufficient information was documented to score a severity level for every component of an emergency psychosocial assessment. Inter-rater agreement regarding whether referrals or resources were documented for identified needs was observed to be good to very good (κ = 0.62-0.98). Current psychosocial documentation practices were found to be inconsistent with significant variability in the presence of documentation pertaining to HEARTSMAP sections between medical centers and initial clinician assessor and whether specialized MH services were involved prior to discharge. CONCLUSIONS: The HEARTSMAP tool can be reliably used to assess pediatric psychosocial assessment documentation across a diverse range of EDs. Current documentation practices are variable and often inadequate, and the HEARTSMAP tool can aid in quality improvement initiatives to standardize and optimize care for the growing burden of pediatric mental illness.

Campylobacter jejuni in Musca domestica: An examination of survival and transmission potential in light of the innate immune responses of the house flies.

The house fly, Musca domestica, has been implicated as a vector of Campylobacter spp., a major cause of human disease. Little is known whether house flies serve as biological amplifying hosts or mechanical vectors for Campylobacter jejuni. We investigated the period after C. jejuni had been ingested by house flies in which viable C. jejuni colonies could be isolated from whole bodies, the vomitus and the excreta of adult M. domestica and evaluated the activation of innate immune responses of house flies to ingested C. jejuni over time. C. jejuni could be cultured from infected houseflies soon after ingestion but no countable C. jejuni colonies were observed > 24 h postingestion. We detected viable C. jejuni in house fly vomitus and excreta up to 4 h after ingestion, but no viable bacteria were detected ≥ 8 h. Suppression subtractive hybridization identified pathogen-induced gene expression in the intestinal tracts of adult house flies 4-24 h after ingesting C. jejuni. We measured the expression of immune regulatory (thor, JNK, and spheroide) and effector (cecropin, diptericin, attacin, defensing, and lysozyme) genes in C. jejuni-infected and -uninfected house flies using quantitative real time PCR. Some house fly factor, or combination of factors, eliminates C. jejuni within 24 h postingestion. Because C. jejuni is not amplified within the body of the housefly, this insect likely serves as a mechanical vector rather than as a true biological, amplifying vector for C. jejuni, and adds to our understanding of insect-pathogen interactions.