Pediatric Obesity: Influence on Drug Dosing and Therapeutics

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of US children and adolescents. Severe obesity (³120% of the 95th percentile of BMI-for-age, or a BMI of ³35 kg/m2) is the fastest growing subgroup and now approaches 6% of all US youth. Health consequences (e.g., type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Since therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition and exercise achieve limited success. Only one drug, orlistat, is FDA-approved for long-term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity

Polypharmacy and potentially inappropriate medication use in geriatric oncology.

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods

Identifying Harm Events in Clinical Care through Medical Narratives

Preventable medical errors are estimated to be among the leading causes of injury and death in the United States. To prevent such errors, healthcare systems have implemented patient safety and incident reporting systems. These systems enable clinicians to report unsafe conditions and cases where patients have been harmed due to errors in medical care. These reports are narratives in natural language and while they provide detailed information about the situation, it is non-trivial to perform large scale analysis for identifying common causes of errors and harm to the patients. In this work, we present a method based on attentive convolutional and recurrent networks for identifying harm events in patient care and categorize the harm based on its severity level. We demonstrate that our methods can significantly improve the performance over existing methods in identifying harm in clinical care.Comment: ACM-BCB 201

The Latino Age Wave: What Changing Ethnic Demographics Mean for the Future of Aging in the U.S.

Highlights data on aging Latinos/Hispanics, trends in the assets and needs of community-based organizations serving or that could serve older Latinos, and strategies for addressing gaps in supportive policies. Outlines best practices and recommendations

Simulation Genres and Student Uptake: The Patient Health Record in Clinical Nursing Simulations

Drawing on fieldwork, this article examines nursing students’ design and use of a patient health record during clinical simulations, where small teams of students provide nursing care for a robotic patient. The student-designed patient health record provides a compelling example of how simulation genres can both authentically coordinate action within a classroom simulation and support professional genre uptake. First, the range of rhetorical choices available to students in designing their simulation health records are discussed. Then, the article draws on an extended example of how student uptake of the patient health record within a clinical simulation emphasized its intertextual relationship to other genres, its role mediating social interactions with the patient and other providers, and its coordination of embodied actions. Connections to students’ experiences with professional genres are addressed throughout. The article concludes by considering initial implications of this research for disciplinary and professional writing courses

El reto del envejecimiento y la complejidad farmacoterapéutica en el paciente VIH+

Objective: To describe the current knowledge and management of aging and pharmacotherapeutic complexity in HIV + patients. Method: A review of literature was carried out, including articles, originals or reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms «Polypharmacy»/«Polifarmacia», «Aging»/«Envejecimiento», «Frailty»/«Fragilidad», «Complejidad Farmacotera péutica»/«Medication Regimen Complexity» and «HIV»/«VIH» were combined. The review was carried out independently by two authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An aging of the population and an increase in associated comorbidities have been identified, especially over 50 years-old. Immunological changes similar to those that are generated in a non-infected elderly population have been described. These conditions influencing the prescription of antiretroviral treatment, according to studies identified. In parallel, polypharmacy is increasingly present, being defined exclusively by the concomitant use of five drugs. Pharmacotherapeutic complexity, through the Medication Regimen Complexity Index, has begun to analyse and relate to health outcomes. There has been a need to know and apply concepts already known in non-HIV-aged population, such as deprescription, potentially inappropriate medication, cholinergic risk, although few results are available. Conclusions: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new concepts that help pharmacotherapeutic optimization in this population

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Outlines a four-step approach to reducing avoidable hospital readmissions. Suggests interventions during hospitalization, at discharge, and post-discharge, including patient and caregiver education, multidisciplinary care coordination, and home visits

The Impact of Immigration Enforcement on Child Welfare

While children of immigrants have a lot at stake in the discussions surrounding U.S. immigration policy, their interests remain largely ignored in the debate. For instance, little consideration is given to the impact of immigration enforcement on the 5.5 million children, the vast majority of whom are native-born U.S. citizens, living with at least one undocumented parent.Similarly overlooked are the significant challenges experienced by public child welfare agencies that encounter children separated from their parents due to immigration enforcement measures.The U.S. child welfare system is based on the notion of ensuring the safety and best interest of the child; however, this principle is often compromised in the face of conflicting federal immigration policies and practices. This policy brief examines the intersection of immigration enforcement and child welfare and the difficulties facing immigrant families caught between the two systems. Recommendations are provided to prioritize keeping children with their families and out of the public child welfare system whenever possible and to ensure that separated children who do encounter the child welfare system receive appropriate care and parents receive due process

Optimizing outcomes in ADHD treatment: From clinical targets to novel delivery systems

Our knowledge and understanding of the underlying neurobiology and symptomatic expression of ADHD has advanced dramatically over the past decade. Associated with these advances has been a similar explosion of new treatment options to individualize treatment for our patients.This article will:∙review strategies to measure ADHD symptoms and functional difficulties while seeking to achieve full symptomatic remission throughout the day∙summarize recent findings regarding the management and prioritization of ADHD and comorbid conditions and∙discuss the various pharmacologic treatment options with a focus on recently developed molecules and novel delivery systems</jats:p