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Perioperative Transfusions and Venous Thromboembolism

BACKGROUND AND OBJECTIVES:

Annual incidence of venous thromboembolism (VTE) including postoperative VTE in hospitalized children is rising significantly. A growing body of evidence supports the role of red blood cells (RBCs) in pathologic thrombosis. In this study, we examined the association of perioperative RBC transfusion with postoperative VTE in pediatric patients.

METHODS:

The pediatric databases of the American College of Surgeons’ National Surgical Quality Improvement Project from 2012 to 2017 were used. Multivariable logistic regression was used to examine the association between perioperative RBC transfusion status and the development of new or progressive VTE within 30 days of surgery. The analyses were age stratified, as follows: neonates (≤28 days), infants (>28 days and <1 year), and children (≥1 year).

RESULTS:

In this study, we included 20 492 neonates, 79 744 infants, and 382 862 children. Postoperative development of VTE was reported in 99 (0.48%) neonates, 147 (0.2%) infants, and 374 (0.1%) children. In all age groups, development of VTE was significantly more common among patients with a perioperative RBC transfusion than patients without a perioperative RBC transfusion (neonates: adjusted odds ratio [aOR] = 4.1, 95% confidence interval [CI] = 2.5–6.7; infants: aOR = 2.4, 95% CI = 1.7–3.6; children: aOR = 2.2, 95% CI = 1.7–2.9). Among children who received an intra- or postoperative transfusion, the weight-based volume of RBCs (mL/kg) transfused was associated with postoperative VTE in a dose-dependent manner: second tertile (odds ratio = 2.3, 95% CI = 1.3–4.1) and third tertile (odds ratio = 4.1, 95% CI = 2.3–7.4) versus first tertile.

CONCLUSIONS:

Perioperative RBC transfusions are independently associated with development of new or progressive postoperative VTE in children, infants, and neonates. These findings need further validation in prospective studies and emphasize the need for evidence-based perioperative pediatric blood transfusion decisions.




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The Infantile Hemangioma Referral Score: A Validated Tool for Physicians

OBJECTIVES:

Infantile hemangiomas (IHs) are common; some cases require timely referral and treatment to prevent complications. We developed and validated a reliable instrument for timely and adequate referral of patients with IH to experts by nonexpert primary physicians.

METHODS:

In this multicenter, cross-sectional, observational study, we used a 3-stage process: (1) development of the Infantile Hemangioma Referral Score (IHReS) tool by IH experts who selected a representative set of 42 IH cases comprising images and a short clinical history, (2) definition of the gold standard for the 42 cases by a second independent committee of IH experts, and (3) IHReS validation by nonexpert primary physicians using the 42 gold standard cases.

RESULTS:

A total of 60 primary physicians from 7 different countries evaluated the 42 gold standard cases (without reference to the IHReS tool); 45 primary physicians evaluated these cases using the IHReS questionnaire, and 44 completed retesting using the instrument. IHReS had a sensitivity of 96.9% (95% confidence interval 96.1%–97.8%) and a specificity of 55.0% (95% confidence interval 51.0%–59.0%). The positive predictive value and negative predictive value were 40.5% and 98.3%, respectively. Validation by experts and primary physicians revealed substantial agreement for interrater reliability and intrarater repeatability.

CONCLUSIONS:

IHReS, a 2-part algorithm with a total of 12 questions, is an easy-to-use tool for primary physicians for the purpose of facilitating correct and timely referral of patients with IH. IHReS may help practitioners in their decision to refer patients to expert centers.




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Infusionsoft by Keap

Infusionsoft by Keap combines robust analytics with an intuitive interface and easily customizable dashboards to help you track your customers and email marketing campaigns.




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Champions League Fantasy: Inside info

Who takes the penalties? Who can't you afford to ignore? And who are the bargain signings that could make all the difference?




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Champions League Fantasy: Bargain signings

Players who provide excellent value for money are a key component of successful Fantasy sides; check out our suggestions.




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An architect explores using his passion in missions

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.




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Not your stereotypical missionary

From age 17, Ana Maria prayed to serve God in Switzerland. While she waited, she became a dance instructor with no idea dance would become her ministry.




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The God of India, Singapore and the Middle East

Doron's experience on Logos Hope shows him God's faithfulness and uncovers leadership abilities he is using today in a new role.




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Visiting an underground church

Despite being aware of the need for discretion when talking about Jesus, Argentinian Cecilia felt no fear while she was in Central Asia.




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Tech Company Wins Ed. Dept Award to Create Accessible Books

Benetech, a Palo Alto, Calif. based software company, is embarking on is third 5-year award with the U.S. Department of Education to create books for students with print disabilities.




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Penn State Smeal panel explores pandemic's effects on sustainability, business

The Penn State Smeal College of Business Center for the Business of Sustainability recently hosted the first in a series of virtual fireside discussions titled “The Impact of Coronavirus on Sustainability and Social Impact,” to explore how recent momentum in sustainability efforts has been altered.




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Penn State Health selects president for its new Hampden Medical Center

Penn State Health has appointed Don McKenna as president of Penn State Health Hampden Medical Center.




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Hershey Medical Center joins clinical trial evaluating antiviral drug remdesivir

Penn State Health Milton S. Hershey Medical Center has begun enrolling participants in an international clinical trial evaluating an investigational antiviral drug, remdesivir, for treatment of coronavirus disease 2019 (COVID-19).




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Practical Nursing Program moves clinicals to virtual simulations

Lehigh Valley's Practical Nursing Program has moved to the Shadow Health Digital Clinical Experience so students can continue clinical rotations through virtual simulations.




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Fin24.com | SIM-swap scams: How Vodacom protects you

SIM-swap fraud complaints seem to be on the rise with a growing number of victims coming forward to share their dreadful experiences. Vodacom offers some helpful tips.




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Casio ProTrek WSD-F30

The Casio ProTrek WSD-F30 smartwatch has a ton of useful features and a super-durable build for outdoor adventurers, but we expect a bit more for its high price.




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Fossil Gen 5 Smartwatch

The Fossil Gen 5 Smartwatch features an attractive design and smooth performance, but its size isn't suitable for all wrists.




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The Best Tech Gifts for Fitness Enthusiasts

If you're buying for someone who lives by the SoulCycle schedule, or wants to get in shape in 2020, this is the gift guide for you.




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Benign Neonatal Shudders, Shivers, Jitteriness, or Tremors: Early Signs of Vitamin D Deficiency

Millicent Collins
Aug 1, 2017; 140:e20160719-e20160719
CASE REPORTS




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Fin24.com | 3 'practicalities' to consider before investing in property in Africa – expert

Africa can be a challenging place to do business and property investment is not exempt from some, often unique, challenges, says a Nedbank expert.




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Like College Athletes, These High School Players Get an Assist on Academics

An unusual program in Cincinnati provides academic coaches to help high school players meet eligibility requirements to stay in the game.




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Cybersecurity professional speaks to students via Zoom

Penn State Greater Allegheny’s current students recently joined a virtual conversation about Cybersecurity Analytics and Operations, Greater Allegheny’s newest 4-year program starting this fall.




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Virtual tutoring and parent sessions available for local school district

Community and university leaders collaborate to help students and parents residing in the McKeesport Area School District.




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Spain, Italy, Russia among qualifiers as main round ends

Italy, Azerbaijan, Ukraine, Portugal, Spain, Kazakhstan and Russia joined hosts Slovenia in the finals by winning their main round groups while the eight play-off contenders are confirmed.




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An architect explores using his passion in missions

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.




si

Not your stereotypical missionary

From age 17, Ana Maria prayed to serve God in Switzerland. While she waited, she became a dance instructor with no idea dance would become her ministry.




si

The God of India, Singapore and the Middle East

Doron's experience on Logos Hope shows him God's faithfulness and uncovers leadership abilities he is using today in a new role.




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Visiting an underground church

Despite being aware of the need for discretion when talking about Jesus, Argentinian Cecilia felt no fear while she was in Central Asia.




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Virtual services keeping Hazleton students, campus connected during crisis

Penn State Hazleton’s Student Services and Engagement team is continuing to forge personal connections with students while operating under the restrictions in the virtual environment created by the COVID-19 crisis.




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Hacked and Cut Off From the Public: This Is School Board Business in the Coronavirus Crisis

Social distancing is forcing school business to be conducted virtually, putting school boards in the difficult spot of making crucial decisions on spending and other issues without the same level of public input.




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Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis

CONTEXT:

Several antiemetics have been used in children with acute gastroenteritis. However, there is still controversy over their use.

OBJECTIVE:

To determine the effectiveness and safety of antiemetics for controlling vomiting in children with acute gastroenteritis.

DATA SOURCES:

Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Latin America and the Caribbean Literature on Health Sciences, and gray literature, until December 2018.

STUDY SELECTION:

We selected randomized clinical trials comparing metoclopramide, ondansetron, domperidone, dexamethasone, dimenhydrinate, and granisetron.

DATA EXTRACTION:

Two reviewers independently screened abstracts and full texts, extracted the data, and assessed the risk of bias. We performed pairwise and network meta-analysis using the random-effects model.

RESULTS:

Twenty-four studies were included (3482 children). Ondansetron revealed the largest effect in comparison to placebo for cessation of vomiting (odds ratio = 0.28 [95% credible interval = 0.16 to 0.46]; quality of evidence: high) and for hospitalization (odds ratio = 2.93 [95% credible interval = 1.69 to 6.18]; quality of evidence: moderate). Ondansetron was the only intervention that reduced the need for intravenous rehydration and the number of vomiting episodes. When considering side effects, dimenhydrinate was the only intervention that was worse than placebo.

LIMITATIONS:

Most treatment comparisons had low- or very low–quality evidence, because of risk of biases and imprecise estimates.

CONCLUSIONS:

Ondansetron is the only intervention that revealed an effect on the cessation of vomiting, on preventing hospitalizations, and in reducing the need for intravenous rehydration. Ondansetron was also considered a safe intervention.




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Efficacy and Effectiveness of the PCV-10 and PCV-13 Vaccines Against Invasive Pneumococcal Disease

CONTEXT:

Pneumococcal conjugate vaccines (PCVs) (pneumococcal 13-valent conjugate vaccine [PCV-13] and pneumococcal 10-valent conjugate vaccine [PCV-10]) are available for prevention of pneumococcal infections in children.

OBJECTIVE:

To determine the vaccine effectiveness (VE) of PCV-13 and PCV-10 in preventing invasive pneumococcal disease (IPD) and acute otitis media (AOM) in children <5 years.

DATA SOURCES:

Systematic searches of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Cochrane.

STUDY SELECTION:

Eligible studies examined the direct effectiveness and/or efficacy of PCV-10 and PCV-13 in reducing the incidence of disease in healthy children <5 years.

DATA EXTRACTION:

Two reviewers independently conducted data extraction and methodologic quality assessment.

RESULTS:

Significant effectiveness against vaccine-type IPD in children ≤5 years was reported for ≥1 dose of PCV-13 in the 3 + 1 (86%–96%) and 2 + 1 schedule (67.2%–86%) and for PCV-10 for the 3 + 1 (72.8%–100%) and 2 + 1 schedules (92%–97%). In children <12 months of age, PCV-13 VE against serotype 19A post–primary series was significant for the 3 + 1 but not the 2 + 1 schedule. PCV-10 crossprotection against 19A was significant in children ≤5 years with ≥1 dose (82.2% and 71%). Neither PCVs were found effective against serotype 3. PCV-13 was effective against AOM (86%; 95% confidence interval [CI]: 61 to 94). PCV-10 was effective against clinically defined (26.9%; 95% CI: 5.9 to 43.3) and bacteriologically confirmed AOM (43.3%; 95% CI: 1.7 to 67.3).

LIMITATIONS:

Because of the large heterogeneity in studies, a meta-analysis for pooled estimates was not done.

CONCLUSIONS:

Both PCVs afford protection against pneumococcal infections, with PCV-10 protecting against 19A IPD, but this VE has not been verified in the youngest age groups.




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Abusive Head Trauma in Infants and Children

Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.




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Visit an Indian Paradise, and You’ll Never Want to Leave

India, this magical land, has irresistibly captivated crowds of visitors because of definite motives: incredible Indian charms, numerous residues of past ages, and various sacred points for pilgrimage. Tourism in India has always been among the most full-blown spheres of the state's politics. India tourism allows traveling to all the most famous places, you may wish to visit. Among them, there are illustrious palaces and groves, forts built in both oriental and English colonial manners, and...




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3 Ways to Translate Conversations in Real Time With Google Assistant

Google Translate is not the only app that can help you converse with someone speaking a different language. Here's how to translate real-time conversations with the Google Assistant.




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How to Restore Music on Your iPhone or iPad

Is your favorite music missing on your iPhone or iPad? Maybe you inadvertently turned off syncing or accidentally deleted those tunes. All is not lost; here's how to recover your music.




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Rumor: No Free Version of Apple's Streaming Service

You'll get a trial, but that's it. If you want any kind of free music, you'll have to stick with iTunes Radio.




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Apple Music vs. Spotify: Which Is Best?

Today, Apple takes on the biggest name in music streaming, Spotify. How do they measure up to each other?




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Apple Needs New iPods, But Not for Music

New iPods can be a critical part of Apple's strategy. Just don't think of them as music players.




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Amazon Music Unlimited vs. Spotify: How Do They Compare?

The big difference between Spotify and Amazon Music Unlimited is Amazon offers an affordable tier of service available on just one Echo device. Here's how else they differ.




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Apple Music

Apple Music boasts a deep music well Siri and Apple Watch compatibility, but this well-rounded streaming music service falls just short of joining LiveXLive and Spotify as the best in class.




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Get a Free Echo Dot With Any Toshiba, Insignia Fire TV Edition

That free Echo Dot will let you launch apps, search for titles, and switch inputs on your TV with just your voice.




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Amid Confusion, Feds Seek to Clarify Online Learning for Special Education Students

The Education Department says federal law should not be used to prevent schools from offering online learning to all students, including those with disabilities.




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How to Handle IEPs During the Coronavirus Crisis? Some Expert Advice

Very carefully, experts say, while understanding that federal laws governing special education were not written with online education in mind.




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10 Ways to Boost Your Wi-Fi Signal

Check out these quick tips to boost your wireless signal from your router, extend and optimize your Wi-Fi coverage, and speed up your surfing.




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Basic Tech Skills? Many Americans Have Room for Improvement

991 people in the US were asked about their mastery of three common tech tasks; the results aren't too encouraging.




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Alison McConnell: Rangers went in too hard on SPFL... now dossier let-down may cost them vote

Perhaps there were some who had hoped for a dossier of lurid juiciness.




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Rangers vice-chairman John Bennett criticises 'cynical tactics' of SPFL and insists issue not just Gers vs governing body

Rangers vice-chairman John Bennett has criticised the SPFL for their 'cynical tactics' over their labelling of the club's dossier as a "smoking gun" - and insists the issue is not merely Gers vs the governing body.




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Alistair Grant: We need clear messaging, not lockdown confusion

IT’S a bank holiday weekend and we are now several weeks into a gruelling lockdown.




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Sixth resident dies from Covid-19 at Skye Home Farm care home where more than 50 have tested positive

A sixth resident has died from coronavirus in a care home on Skye.