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Mehta N.M.,Pain and Perioperative Medicine | Corkins M.R.,University of Tennessee Health Science Center | Lyman B.,Childrens Mercy Hospital | Malone A.,Mt. Carmel West Hospital | And 5 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2013

Lack of a uniform definition is responsible for underrecognition of the prevalence of malnutrition and its impact on outcomes in children. A pediatric malnutrition definitions workgroup reviewed existing pediatric age group English-language literature from 1955 to 2011, for relevant references related to 5 domains of the definition of malnutrition that were a priori identified: anthropometric parameters, growth, chronicity of malnutrition, etiology and pathogenesis, and developmental/ functional outcomes. Based on available evidence and an iterative process to arrive at multidisciplinary consensus in the group, these domains were included in the overall construct of a new definition. Pediatric malnutrition (undernutrition) is defined as an imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. A summary of the literature is presented and a new classification scheme is proposed that incorporates chronicity, etiology, mechanisms of nutrient imbalance, severity of malnutrition, and its impact on outcomes. Based on its etiology, malnutrition is either illness related (secondary to 1 or more diseases/injury) or non-illness related, (caused by environmental/behavioral factors), or both. Future research must focus on the relationship between inflammation and illness-related malnutrition. We anticipate that the definition of malnutrition will continue to evolve with improved understanding of the processes that lead to and complicate the treatment of this condition. A uniform definition should permit future research to focus on the impact of pediatric malnutrition on functional outcomes and help solidify the scientific basis for evidence-based nutrition practices. © 2013 American Society for Parenteral and Enteral Nutrition. Source


Chulani V.L.,Arnold Palmer Hospital for Children | Chulani V.L.,Florida State University | Gordon L.P.,Mount Sinai School of Medicine
Primary Care - Clinics in Office Practice | Year: 2014

Adolescence is a developmental stage defined by physical and psychosocial maturation. This article reviews normal pubertal development and the evaluation and management of adolescents with suspected pubertal abnormalities and provides an overview of adolescent psychosocial development. © 2014 Elsevier Inc. Source


Joseph B.,Kasturba Medical College | Price C.T.,Arnold Palmer Hospital for Children | Price C.T.,University of Central Florida
Orthopedic Clinics of North America | Year: 2011

The aim of treatment of Perthes in the early part of the disease is to prevent the femoral head from getting deformed by muscular forces and weight-bearing stresses transmitted across the acetabular margin. To achieve this, femoral head extrusion must be preempted in children who are older than 8 years at onset of the disease by ensuring containment as soon as the disease is diagnosed. In children younger than 8 years in whom femoral head extrusion occurs, containment must be obtained by the early stage of fragmentation. © 2011 Elsevier Inc. Source


Wiemann J.M.,Spinal USA | Shah S.A.,DuPont Company | Price C.T.,Arnold Palmer Hospital for Children
Journal of Pediatric Orthopaedics | Year: 2014

BACKGROUND:: Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees). METHODS:: Premenarchal, Risser 0 female patients presenting to 2 pediatric orthopaedic specialty practices for evaluation of idiopathic scoliosis with Cobb angle measurements between 15 and 25 degrees were selected. They were randomized by location to receive nighttime bending brace treatment or observation. Patients in the observation group were converted to fulltime TLSO wear if they progressed to >25 degrees primary curve Cobb angle. Curve progression was monitored with minimum 2-year follow-up. RESULTS:: Sixteen patients in the observation group and 21 patients in the bracing group completed 2-year follow-up. All patients in the observation group progressed to fulltime bracing threshold. In the nighttime bracing group, 29% of the patients did not progress to 25 degrees primary curve magnitude. Rate of progression to surgical magnitude was similar in the 2 groups. CONCLUSIONS:: Risser 0 patients presenting with mild idiopathic scoliosis are at high risk for progression to >25 degrees primary curve magnitude. Treatment with the Charleston nighttime bending brace may reduce progression to full-time bracing threshold. No difference in progression to surgical intervention was shown between nighttime bracing and observation for small curves. Copyright © 2014 by Lippincott Williams & Wilkins. Source


Ruiz R.L.,Arnold Palmer Hospital for Children | Ruiz R.L.,University of Central Florida
Oral and Maxillofacial Surgery Clinics of North America | Year: 2010

The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data. © 2010 Elsevier Inc. All rights reserved. Source

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