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Diurnal Cortisol Rhythms in Children
Parental maltreatment can disrupt normative developmental processes in children through chronic activation of physiological stress systems. Bernard and colleagues report the 3-year follow-up results of a randomized clinical trial using an attachment and behavioral intervention for children involved with child protective services following allegations of neglect. Children in the intervention group showed more typical patterns of cortisol production than children in the control group, who showed a blunted cortisol rhythm. The active parenting intervention may have long-lasting effects on a physiological stress system critical for health and adjustment.
Postdischarge Treatment of Acute Osteomyelitis
Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). Keren and colleagues in the Pediatric Research in Inpatient Settings Network conducted a cohort study on 2060 children admitted with acute osteomyelitis in 36 children’s hospitals. Children treated with antibiotics via the oral route did not experience more treatment failures than those treated with antibiotics via the PICC route, but 15% of the PICC group had a catheter-related complication. The editorial by Tamma and Milstone discusses the implications for the future care of children with osteomyelitis.
Continuing Medical Education and Journal Club
Improving CPR With a Feedback Device
Most health care professionals fail to perform cardiopulmonary resuscitation (CPR) within established American Heart Association guidelines. Cheng and colleagues in the International Network for Simulation-Based Pediatric Innovation, Research, and Education conducted a randomized trial of 324 health care professionals in which they compared just-in-time training, visual feedback of adequacy of efforts, and combinations of these 2 interventions. Just-in-time training before CPR or real-time visual feedback during CPR, alone or in combination, improved compliance with American Heart Association guidelines for CPR that are associated with better outcomes. In their accompanying editorial, Cook and Beckman discuss a focus on high-value, cost-conscious education benefiting educators, students, patients, and society.
Clinical Review & Education
Electronic Cigarette Use and Exposure
Electronic cigarette (e-cigarette) use has gained widespread popularity and acceptance in the general population. Collaco and colleagues review the history of e-cigarettes, user demographics, known health effects, and current legislative efforts to protect minors from exposure. Currently, 10% of high school students have tried e-cigarettes, with a 3-fold increase between 2011 and 2013 among adolescents who have never smoked. Few studies have examined the short- and long-term health effects of e-cigarettes on primary users. Randomized clinical trials have not established an overwhelming benefit to recommend e-cigarettes as a superior method for smoking cessation.
Author Audio Interview
Highlights. JAMA Pediatr. 2015;169(2):101. doi:10.1001/jamapediatrics.2014.2106
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