Initiative Cuts Overuse of Tests, Treatments for Bronchiolitis

Reductions in ordering of chest radiographs, respiratory viral testing, bronchodilators
Source: Pulmonary Medicine News - Doctors Lounge - Category: Respiratory Medicine Tags: Family Medicine, Infections, Nursing, Pediatrics, Pulmonology, Radiology, Emergency Medicine, Journal, Source Type: news

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Objectives: New definitions of pediatric acute respiratory distress syndrome include criteria to identify a subset of children “at risk for pediatric acute respiratory distress syndrome.” We hypothesized that, among PICU patients with bronchiolitis not immediately requiring invasive mechanical ventilation, those meeting at risk for pediatric acute respiratory distress syndrome criteria would have worse clinical outcomes, including higher rates of pediatric acute respiratory distress syndrome development. Design: Single-center, retrospective chart review. Setting: Mixed medical-surgical PICU within a ter...
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
Conclusions: CAP patients with negative CR findings are characterized by lower blood levels of inflammatory markers, a higher incidence of aspiration pneumonia, and a lower incidence of complicated para ­pneumonic effusion or empyema than those with positive CR findings. Chest CT scan should be considered in suspected CAP patients with a negative CR, especially in bedridden patients.Respiration
Source: Respiration - Category: Respiratory Medicine Source Type: research
There have been a few case reports of eosinophilic bronchiolitis that is characterized by radiographic findings showing diffuse bronchiolitis plus massive accumulation of eosinophils in the airways. Systemic steroid therapy has been suggested to be effective for this disorder, although the precise pathogenesis in unknown. Here, we report a case of severe asthma complicated with eosinophilic pneumonia and eosinophilic bronchiolitis, all of which were alleviated by anti ‐interleukin 5 (IL‐5) antibody. A 60 ‐year‐old female with severe bronchial asthma developed persistent dyspnoea and an abnormal lung shadow. High‐...
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: Case Report Source Type: research
​I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134[5]:e1474; Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mostly cau...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Conclusion Among pediatric patients with croup, bronchiolitis, and febrile and afebrile seizure, higher resource utilization and admissions were observed in NA-EDs. These preliminary findings from a national survey require a more detailed investigation into the variation in care between A-ED and NA-ED settings.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Original Articles Source Type: research
CONCLUSIONSIn this largest case series to date of histopathologic ALI after allo-HCT, biopsy does not appear to meaningfully change management in the majority of patients, and is associated with substantial procedural risk. Histopathologic findings do not clearly correlate with the clinical and radiographic picture in a sizeable proportion of the patients. PFT results, BAL findings, the timing of the onset of respiratory failure after HCT, and the response to steroids seem to be of greater diagnostic and/or prognostic value.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 722. Clinical Allogeneic Transplantation: Acute and Chronic GVHD, Immune Reconstitution: Poster I Source Type: research
Introduction: The presence of potentially pathogenic microorganisms (PPM) in Non-CFBQ is frequent and determines prognostic and therapeutic aspects. Our objective has been to know what factors are associated with the isolation of PPM in this type of bronchiectasis.Methods: Prospective observational study of patients with Non-CFBQ (2006-2014). We collected all the PPM isolates at the time of inclusion establishing three groups (A: absence of PPM, B: isolates other than Pseudomonas and C: isolates of Pseudomonas). A comparative analysis of the differential characteristics between these groups was carried out.Results: We incl...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections Source Type: research
Radiography use similar between patients admitted versus discharged from the ED
Source: Pulmonary Medicine News - Doctors Lounge - Category: Respiratory Medicine Tags: Infections, Pediatrics, Pulmonology, Radiology, Emergency Medicine, Journal, Source Type: news
Despite recommendations against radiography for suspected bronchiolitis, patients continued to receive unnecessary imaging, a study found.Medscape Medical News
Source: Medscape Medical News Headlines - Category: Consumer Health News Tags: Emergency Medicine News Source Type: news
This epidemiology study uses National Hospital Ambulatory Medical Care Survey data to characterize trends in use of radiography to diagnose bronchiolitis in children younger than 24 months evaluated in emergency departments between 2007 and 2015.
Source: JAMA - Category: General Medicine Source Type: research
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