98. improving bronchiolitis management with a care path
Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Ripal Patel, Melissa Schafer, Heidi Ochs, John Andrake, John Pires Ervoes, Eric GershonBackgroundBronchiolitis is the number one cause of hospitalization in children under 2 years of age. AAP guidelines emphasize that only supportive care is needed for bronchiolitis. Data obtained from our institution showed poor adherence to AAP guidelines. This project was undertaken with the goal of improving compliance with these guidelines.Aim StatementOur aim was to reduce length of stay (LOS) for admitted low risk patients with bronchiolitis, age 1-24 months, from 67 hours to
A long-term goal of clinical care has always been to fit the specific treatment to the individual patient —what we would now call personalized medicine. However, the ability to predict which patient will best respond to which treatment has historically been nearly impossible. Accordingly, personalized medicine has typically involved significant trial and error with different therapies until desired cl inical results are achieved. Fortunately for both patients and physicians, this paradigm has begun to change.
Environmental nonallergenic exposures, such as microbes and air pollutants, are thought to influence the clinical manifestations of allergic and atopic disease. However, as patterns of urbanization, climate change, and socioeconomic health disparities persist, the health effects of the envirome are increasingly relevant to practitioners and policymakers. In this issue of Annals, Peden1 outlines the influence of pollutant, infectious, and psychosocial conditions on the incidence and severity of allergic disease.
The goal of personalized medicine is arguably as old as medicine itself,1 and the promise of using simultaneously broad (all genes and all exposures), precise (single molecules or cells), and unbiased (not dependent on prior knowledge) data sets to tailor clinical care is the compelling objective of systems biology as applied to medicine. In this issue, Virkud et al2 present a useful and informative overview of the “big data” domains, including genomics, epigenomics, transcriptomics, and proteomics along with the microbiome and exposome and their integrated effects on the metabolome, which are the grist f...
Urticaria is characterized by the appearance of hives or angioedema.1 Chronic urticaria is defined by urticarial episodes that last more than 6 weeks, occurring daily or several times per week.2 Although acute urticaria is commonly associated with infections,3 most cases of chronic urticaria have no identifiable cause. Nevertheless, several reports documented chronic urticaria from infectious causes including Helicobacter pylori.4 Studies show association of upper respiratory infections, including sinusitis, with chronic urticaria with remission after antibiotic therapy.
This article evaluates the cost-effectiveness of allergy immunotherapy (AIT) in the treatment of allergic rhinitis, asthma, and other allergic conditions. An extensive search of the PubMed and Medline databases (up to December 2018) was conducted. There is strong evidence in the collective literature, which included individual studies and systematic reviews, that AIT is cost-effective in the management of allergic rhinitis and asthma as compared with standard drug treatment alone. The magnitude of AIT ’s cost-effectiveness is likely underestimated because most of the studies considered during-treatment costs and not ...
Subcutaneous immunotherapy (SCIT) is effective for allergic rhinitis and conjunctivitis, asthma, and insect venom hypersensitivity. The risk of severe allergic reactions induced by SCIT remains low, and mild systemic reactions have recently shown a tendency to decline. However, near-fatal and fatal anaphylactic reactions may occur. Clinicians administering allergen-specific immunotherapy should receive specialized training and be aware of risk factors and preventive measures to avoid severe allergic reactions induced by SCIT.