When is it a Dermatological Emergency?

A 9 year old girl has had a rash for a year. She has been seen by her pediatrician and a dermatologist with no sucess in treating the rash. The rash had acutley worsened over the last four days. The rash, a diffuse pustular rash, covers her whole body, it is itchy and painful, the skin sloughs off and she has a fever.

Picture of the month--quiz case. Pustular psoriasis, annular type

View my collection, "Pustular Psoriasis" from NCBI

Pustular Psoriasis 12.30.2009

Failure to Thrive by 'Spitting Up' ?

Morning Report Topic for December 28, 2009

A 2 and 1/2 month old girl presents with failure to thrive but other than starting to "spit up" three weeks prior to being seen she is normal in her history and check up...

Infantile Hypertrophic Pyloric Stenosis

A suspicious pulmonary nodule shows up on a chest film...

View my collection, "Atelectasis" from NCBI

(Topic for December 23, 2009)

Smoking Cessation

Morning Report topic for December 18, 2009 by Kevin Nelson.

Smoking Cessation 12.18.2009

It started with just a fever...

A 72 Day old presents with a fever; could it really be HSV?

View my collection, "Herpes Simplex Virus" from NCBI

Remember to Read the Growth Chart

Morning report topic for Monday, December 14, 2009.

A 9 year old boy presents with a rash on his buttocks and after treatment with two courses of antibiotics returns with two fistulas on either side of his rectum along with other symptoms, pain in sitting and diarrhea. What could be going on? After a surgical consult to find out whether he had a deeper abscess he is diagnosed with Crohn's Disease. The primary care physician had not followed the child long term and in reviewing the growth chart for this patient found the trend of growth dropping. Remember to review the growth chart!

View my collection, "Crohn's Disease" from NCBI

Useful Links
Crohn's and Colitis Foundation of America
Crohn's Disease in Medlineplus
Crohn's Disesae Interactive Tutorial for Patients

Recent Morning Report Topics

12/04/2009 Advocacy Morning Report: 504 plans in schools:
Provision of Educationally Related Services for Children and Adolescents With Chronic Diseases and Disabling Conditions

Useful links for more information on 504 plans:
Medical Home Portal
The Access Center
The Utah Parent Center
The US Dept of Ed, Office of Civil Rights
Utah State Office of Education: Educational Equity

12/07/2009 Pediatric Stroke:
View my collection, "Vertebral Artery Dissection" from NCBI

12/09/2009 Breakfast with Ed

Conjugated Hyperbilirubinemia

Conjugated hyperbilirubinemia is most often caused by ≥ 1 of the following:

* Dysfunction of hepatocytes (hepatocellular dysfunction)
* Slowing of bile egress from the liver (intrahepatic cholestasis)
* Obstruction of extrahepatic bile flow (extrahepatic cholestasis)

Conjugated Hyperbilirubinemia: Screening and Treatment in Older Infants and Children

View my collection, "Hyperbilirubinemia" from NCBI
Many of these articles come from the October 2009 issue of the journal 'Pediatrics.' You may want to refer to this specific issue...

Bleeding

Approach to the bleeding child...

View my collection, "Bleeding" from NCBI

Research articles on Childhood Leukemia can be found under the date:Friday November 13, 2009

Pubmed Search Tip

I know, I know there has not been a search tip for awhile. I will share a new one I just learned from my assistant Michelle. Related Articles link, you can love and hate it. First you find the perfect article on your topic and you want more just like it. You click on the Related Articles link and you get 463, but wait, you were searching for pain tolerance in Down's Syndrome, and you find a related article on the list titled, Effect of oxytocin on acupuncture analgesia in the rat. But you have been told you cannot place limits on related article lists. But wait! You can! Here are the steps on how to do just that.
Step 1. Find the perfect article.
Step 2. Click on the Related Article link to the right of the citation.
Step 3. Click on Advanced Search at the top of the page.
Step 4. Click on the number in your search history that shows your Related Article search, when a drop down menu shows up click on AND, the number should appear in the search box.
Step 5. Set your limits while you are on the Avanced Search page and click Search.
Step 6. View your limited Related Article list!
If you would like a demonstration of this please come in or call a librarian at Primary Children's Medical Library and we will be happy to show you.

Cyclic Vomiting and SMA Syndromes

Cyclic nausea and vomiting in childhood by David Forbes, MBBS, FRACP, gastorenterologist, School of Paediatrics & Child Health, University of Western Australia.

Treating children's cyclic vomiting by Shirley Chow and Ran D. Goldman MD, at the Hospital for Sick Children in Toronto, Ont.

View my collection, "Cyclic Vomiting Syndrome" from NCBI

SMA & Cyclic Vomiting 11.23.09

Celiac Disease

Celiac

Celiac Disease Foundation

Celiac.com

View related Morning Report post:
How Common is Celiac's Disease?

Mitochondrial Deletion Syndrome

Mitochondrial DNA (mtDNA) deletions have been identified in patients with progressive external ophthalmoplegia (PEO), Kearns-Sayre syndrome (KSS), Pearson syndrome and mitochondrial myopathies (MM).

Mitochondrial Deletion Syndrome

View my collection, "Mitochondrial deletion syndrome" from NCBI

Bereavement

When Children Die, this book is available for check out from Primary Children's Medical Library or may be viewed online.

An article with a good overview on bereavement, Pediatrics in Review, Coping with Death, by Jennifer S. Linebarger, Olle Jane Z. Sahler, and Kelsey A. Egan. September 2009, p. 350-356.

The Private Worlds of Dying Children a book by Myra Bluebond-Langner, view online at Google books.

The Sharing Place A grief support program for children in Salt Lake City, Utah.

Bereavement 11.16

Leukemia

View my collection, "Leukemia" from NCBI

History of Medicine--Images

The National Library of Medicine has an image database with more than 70,000 images from the History of Medicine collection. Some images are public domain and may be useful for presentations. Visit the Images from the History of Medicine and browse the collection.

Concise Reviews Extra

The Pediatric Infectious Disease Journal has a section every issue called Concise Reviews of Pediatric Infectious Diseases. Two of these Concise Reviews have been recommended; see the link to the citations in PubMed below.

Infectious Pericarditis in Children, Gail J. Demmler, MD

Management of Parapneumonic Empyema, Krow Ampofo, MD, and Carrie Byington, MD (free through PubMed Central)

Ludwig's Angina

Ludwig's angina is a bacterial infection on the floor of the mouth. It is a serious and potentionally life-threatening cellulitis. Alternative names for the condition are, submandibular or sublingual space infection. To check for sublingual space infection push hard in the middle of the tongue, it will feel firm vs. the more spongey give of a normal tongue.

Wilhelm Friedrich von Ludwig first described this condition in 1836. His first patient presenting with this condition was Queen Catherine of Wurttemberg.

Angina is from anchone, the Greek word for strangulation, and was taken to connote throat pain and infection. Until the advent of antibiotics Ludwig's angina was almost always fatal.

View my collection, "Ludwig's Angina" from NCBI

Chronic Hepatitis B

Kevin Nelson presented Chronic Hepatitis B on Friday, November 6. His article recommendations on the topic are found with the link below.
View my collection, "Hepatitis B" from NCBI
Useful link:
Hepatitis Treatment, Research and Education Center: Hepatitis B

Chronic Hepatitis B

Properly used car seats are 71% effective at preventing fatalities

View my collection, "Car Seat" from NCBI

Buckle_Up

Schistosomiasis

Monday, November 2, morning report topic.

View my collection, "schistosomiasis" from NCBI

PubMed search tip: Take a Coffee Break that is a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that show how bioinformatics tools are used as a part of the research process.

Frankenstein: Penetrating the Secrets of Nature

Happy Halloween! Visit the National Library of Medicine's Frankenstein online exhibit.

Physicians’ Relationships with Pharmaceutical Representatives

Jeff Botkin and Armand Antommaria presented a noon conference on the relationship between physicians and pharmaceutical representatives. Below is a summary of the discussion and links to articles for further reading.

Physicians’ primary duty is to provide care to their patients. Pharmaceutical companies’ primary obligation is to increase shareholder return. These disparate goals create the opportunity for conflicts of interest. The following readings augment the discussion we had during noon conference:

“The Company We Keep”
A general overview of the physician and pharmaceutical representative relationship.

“Physicians and the Pharmaceutical Industry”
Evidence that such relationships influence physician behavior.

“A Social Science Perspective on Gifts to Physicians From Industry”
Evidence regarding the actual mechanisms through which influence occurs, supporting the claim that such relationships should be avoided.

It all started with a sunburn...

View my collection, "Neonatal Lupus Syndrome" from NCBI

Lymphatic Malformation

Check out this case report of this 4 year old who presents with a giant lymphatic malformation of the tongue and neck. Pretty amazing…
Management of a Giant Lymphatic Malformation of the Tongue


View my collection, "Lymphatic malformation" from NCBI

Orange Juice Can Be Deadly

View my collection, "Hyperkalemia" from NCBI

Your patient presents with respiratory depression, altered mental status, and miosis…Is it head trauma, an epilectic seizure?

Or is it an opiate ingestion??

**US Poison Centers receive 1.5 million calls a year regarding pediatric ingestions and 79% (!!) of these calls involve children younger than age six.

View my collection, "Poisonings" from NCBI

Pediatric Poisoning Powerpoint

The Yellow Wallpaper

Sometimes rest is not a cure. If you have not read, "The Yellow Wallpaper" by Charlotte Perkins Gliman, published in 1892, I highly recommend it. It is a short story about a young woman driven mad by the perscription of rest for her health, happy Tuesday!

Management of Pediatric Depression

Information for parents:
Understanding Depression
Antidepressant Medication
National Institute of Mental Health (NIMH)
Child & Adolescent Mental Health NIMH
National Mental Health Information Center

A presentation by Welby Nielsen, DO.


Depression Presentation

Advocacy Morning Report

A Culturally Sensitive Approach to Diarrhea Associated Mild-Moderate Dehydration, presented by, Lindsay Hatzenbuehler MD MPH.

Rehydrate.org

Advocacy Morning Report 10.15

Legg-Calve-Perthes' Disease

This was the topic for Monday, October 12 presented by Andy Rose.

View my collection, "Legg-Calve-Perthes " from NCBI

PubMed search tip: A new feature is available with the search box in PubMed. As you begin a search you will notice suggested terms to use. These are not Medical Subject Heading terms or MeSH terms. The suggested terms are taken from popular searches that have been performed by others using PubMed.

How common is Celiac's Disease?

Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder. More than 2 million people in the United States have the disease, or about 1 in 133 people. Among people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, as many as 1 in 22 people may have the disease.

View my collection, "Celiac Disease" from NCBI

Other resources:
Celiac Disease Foundation KidsKorner
Gluten Free Resources
Quick Start Diet Guide

10.09.2009

Five Specialists and What is the Diagnosis?

A 7 month old girl with failure to thrive and developmental delay. Five specialist were involved and everyone was a bit confused. Did she have a syndrome? What was that renal mass?

View my collection, "Noonan, Turner's and Wilm's" from NCBI

Morning Report 10-07-2009

Myasthenia Gravis

The patient presented and the topic discussed Monday, October 5.

View my collection, "Myasthenia Gravis" from NCBI

Subacute Osteomyelitis (Brodie's Abcess)

Amputate the leg?! View the first link for a good history and overview of Brodie's Abcess.


Subacute Osteomyelitis (Brodie Abscess)

View my collection, "Osteomyelitis" from NCBI


PubMed search tip: PubMed has a redesign link to try out. Click on the image below or use the image on PubMed's homepage.

Intussusception

Peak age 6-12 months
80% occur by the age of 24 months
Diagnosis by ultrasound

Treatment
Air Enema Reduction
80% reduced non-operationally
10% recurrence in 72 hours
Pathological lead point more prone to recurrence

View my collection, "Intussusception" from NCBI

The Machine is Us

Citrobacter Meningitis

View my collection, "Citrobacter Meningitis" from NCBI

PubMed Search tip: Even if you have closed PubMed, a search history will remain available for eight hours on the computer used to perform the search, unless it is manually cleared by a PubMed user. If you click on the "History" tab right below the search box you will have the your post search documentation to remember how you searched.

Hypoparathyroidism in a Newborn

This topic was discussed on Friday, September 25. Some of the articles in the PubMed collection below are not available as free full-text online. The library at Primary Children's would be happy to obtain the full-text for you.

View my collection, "Hypoparathyroidism in a Newborn " from NCBI

Morning Report 9-25

PubMed Search tip: Found the perfect article after a PubMed search? Take a second look at the title of that perfect article you found. Is the title in brackets [ ]? This indicates that the article is only available in the language noted in the article citation even though the abstract is in English.

Syphilis & TORCH

CDC Treatment Guidelines for Congenital Syphilis

View my collection, "Congenital Syphilis" from NCBI The article "Congenital Syphilis--Persisting Pestilence" is a very good concise review in The Pediatric Infectious Disease Journal it is not free online but is available in print at the library.

View my collection, "TORCH" from NCBI The "Blueberry Muffin Baby" article is free full-text however the other citations are not, but you may request them through Primary Children's Medical Library.

PubMed Search tip: Have you seen this at the end of a citation in PubMed: PMID: 18700111 [PubMed - indexed for MEDLINE] ? Each citation in PubMed is assigned a unique PMID # and you can pull up the citation again in PubMed by using only this number in the search box. Or you may share this number with your colleagues and they will be able to pull up the referenced citation easily.

Recurrent/Chronic Pain

Recurrent pain is defined as discrete episodes of pain that are generally of brief duration with complete recovery between episodes.

Chronic pain persists on a daily basis for longer than what would be expected for healing of the underlying physical pathology. It may or may not be associated with tissue damage.

• Estimates show that the prevalence of recurrent and chronic pain in children is 15% to 30%
• 8% have severe and frequent pain
• Most common locations for pain: head, abdomen, limbs/musculoskeletal

• Previous study found that 60% of children with chornic and recurrent pain have a psychiatric diagnosis as well.
• Anxiety disorders and Depressive disorders are most common in this population.
• In patients with RAP- depression has been reported in 9%-40% and anxiety has been reported in 33%-70%.

View my collection, "Recurrent/Chronic Pain" from NCBI

Shaken Baby Syndrome

SBS/AHT (shaken baby syndrome/abusive head trauma) is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.

View my collection, "Shaken Baby Syndrome" from NCBI

To learn more on Shaken Baby Syndrome, please go to: http://www.dontshake.org/ and http://www.shakenbaby.org/.

The Period of PURPLE Crying program is the name given to the National Center on Shaken Baby Syndrome's evidence-based SBS prevention program. The following article describing the randomized controlled trial of the Period of PURPLE Crying materials in Seattle, Washington has been published in the March issue of Pediatrics. To view this article please go to: http://pediatrics.aappublications.org/cgi/content/full/123/3/972

View my collection, "Dysautonomia/POTS" from NCBI

Dysautonomia: What does it mean? What are the symptoms? Is it curable?

Dysautonomia is a medical term often used to describe a group of complex conditions that are caused by a dysfunction of the autonomic nervous system (ANS). The ANS regulates all of the unconscious functions of the body, including the cardiovascular system, gastrointestinal system, metabolic system, and endocrine system. Symptoms of dysautonomia may include: Tachycardia (extremely fast heart rate), bradycardia (slow heart rate), palpitations, chest pain, dangerously low blood pressure, wide swings/sudden drops in blood pressure, orthostatic intolerance (the inability to remain upright), excessive fatigue, exercise intolerance, dizziness, fainting/near fainting, gastrointestinal problems, nausea, insomnia, shortness of breath, anxiety, tremulousness, frequent urination, convulsions, cognitive impairment, visual blurring or tunneling, and migraines. It is a chronic disease and is not curable.

Postural Orthostatic Tachycardia Syndrome (POTS): (often referred to as just postural tachycardia syndrome or POTS) is a condition of dysautonomia, and more specifically, orthostatic intolerance, in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia. This is often, but not always, accompanied by a fall in blood pressure.

The Plague

View my collection, "Black Death" from NCBI

Circumcision

An infant recently circumcised won't stop bleeding. What are the causes? What are the risks with circumcision? What is Christmas disease? Review the list below...really there is a Christmas disease.

View my collection, "Circumcision" from NCBI

PubMed search tip: If you want to find an article in PubMed but don't have the full citation or a librarian handy. Use the link in the left hand navigation called "Single Citation Matcher". You can put in only the page number if you have it, or the year and words in the title. Trust me, sometimes it is magic.

Esophogeal Atresia

View my collection, "Esophogeal Atresia" from NCBI

Non-ketotic Hypoglycemia

Case Report: Hypoglycemic Coma in a Young Girl, Kuwait Medical Journal 2005

View my collection, "Non-ketonic Hypoglycemia" from NCBI

PubMed search tip: If you use the "Details" tab after preforming a keyword search you will be shown how PubMed translated your search using automatic term mapping and search rules. For example, if you search the morning report topic "Non-ketotic Hypoglycemia" you will see this result when you view the details page,

non-ketotic[All Fields] AND ("hypoglycaemia"[All Fields] OR "hypoglycemia"[MeSH Terms] OR "hypoglycemia"[All Fields])

You will then have an idea what is a Medical Subject Heading and what is not. This may help you narrow your search or understand why you retrieved the resulting list of citations.

Hirschsprung's Disease

View my collection, "Hirschsprung's Disease" from NCBI

Pulmonary Renal Syndrome

View my collection, "Pulmonary renal syndrome" from NCBI

Anemia

View my collection, "Anemia" from NCBI

NOTE: If you open the citation list to Abstract view you will then have full-text icons for most of the articles in the collection within Primary Children's network. Outside of Primary Children's computer network you will need to have an individual subscription to access the full-text articles.

Cerebral Sinovenous Thrombosis in Children: Another Reason to Treat Iron Deficiency Anemia
Susan L. Benedict, MD, et. al.
(This article is available full-text only within Primary Children's computer network).

As mentioned today in morning report, Oski is the leader in pediatric anemia and nutrition research. I have included his latest article cited in PubMed on the subject even though it is dated 1993.

PubMed search tip: Search "Anemia" in the MeSH (Medical Subject Headings) Database. When you look at the top result, "Anemia", you will see that below the term there are many different sub-categories. If you do not want your results to pull from all of the different types of anemia then you can use the "Do Not Explode this term" box. Once "Anemia" and "Do Not Explode this term" are selected in the MeSH Database click the "Send to" drop down menu and select "search box with and". You may then search PubMed by clicking the link under the search box or add more search terms from the MeSH database.

Autism Spectrum Disorders

Autism Spectrum Disorders This link will take you to the medhomeportal page on the topic.

Medhomeportal.org is an excellent information resource to refer to when providing for the care of children with chronic conditions. It was started in Utah for pediatricians under the direction of Chuck Norlin, MD.

Learn more about the Medical Home Portal by clicking the link below.

"The Aims of the Medical Home Portal
The Medical Home Portal aims to provide ready access to reliable and useful information for professionals and families to help them care and advocate for children and youth with special health care needs (CYSHCN), as partners in the Medical Home model. The long-range goal is to improve outcomes for CYSHCN and their families by enhancing the availability and quality of healthcare, related services, and coordination of care." (directly taken from the about page)

Myocarditis

View my collection, "Myocarditis" from NCBI

PubMed Search Tip: Using the term "Pediatrics" in your search will not narrow your search to the pediatric population, but will limit it to the practice of pediatrics in medicine. If you would like to limit your search to the pediatric population, use the "Limits" tab right below the search box. On the "Limits" page you may select various age ranges for your search.

ADHD

Below is the PowerPoint presentation on ADHD by Jeremy Kendrick, this is a very informational document. Also included in this blog are informational links on the topic of ADHD. The AAP Policy Publications link will not link directly to ADHD. However, you may use the search box on the page to find policy statements on ADHD and many other subjects. The policy statements page may be a good resource for other morning report topics.

AAP Policy Publications

AAP Chilren's Health Topic on ADHD

View my collection, "ADHD" from NCBI

ADHD Packet

MSSA Bacteremia and Staph Scalded Skin Syndrome

Even though the case presented today was not infective endocarditis, Dr Beth Justice recommeded the article linked to below. The article "Infective Endocarditis" presents the issue of using gentamicin with staph infections and in the literature on the subject is the basis about this particular issue.

Infective Endocarditis (this is a link to the full-text article)

View my collection, "MSSA Bacteremia and Staph Scalded Skin Syndrome" from NCBI



PubMed search tip: Getting full-text articles can be frustrating. If you are using an Intermountain computer to search PubMed (a few in Primary Children's are on the U of U network) , and you look at the citation results in abstract format you may see an icon that is blue-green with yellow words "Online Full-text". This icon indicates we have an electronic subscription to access that particular journal. Click it to get the full-text.

If you see the blue icon with "Primary Children's Medical Center Print Collection" the article is available from the library and you may make a copy or request that one be sent to your email as a PDF.

Late-onset Group B Streptococcal (GBS)

See a list of articles about Late-onset Group B Stretococccal by following the link below. If you would like help locating the full-text of a particular article please contact Primary Children's Medical Library.

View my collection, "Late-onset Group B Strep. (GBS)" from NCBI

Searching for Late-onset Group B Streptococcal Infections is a bit tricky in PubMed. The best term for searching is the medical subject heading (MeSH), "Streptococcal Infections"[Mesh]. Group B is not a MeSH term, but you may combine the terms as shown below to retrieve search results with a concentrate of GBS.

"Streptococcal Infections"[Mesh] AND "group b"
"Streptococcal Infections"[Mesh] AND group b[tw]


PubMed search tip: if you add [tw] to the end of a string of terms it will be searched as a phrase.

Morning Report Collaboration For Better Learning

Practice-Based Learning and Improvement, Morning Report Makes Outpatients Safer
You can view the full article on page 5 in this newsletter from the National Patient Safety Foundation.