A Mock Telephone Triage Experience for Nurse Practitioner Students

The ability to manage patient telephone calls competently and confidently is an important skill for nurse practitioners (NPs). A curriculum intervention was implemented in a pediatric NP program to promote this skill. Thirty-nine NP students participated in a mock telephone triage experience to determine whether triage, involving student/faculty mock parent telephone calls, would increase the student’s confidence and competence. A Likert scale pre/post questionnaire surveying perceived confidence, competence, and readiness to practice revealed an increase in students’ confidence in decision making, assessing the patient, and making a diagnosis over the phone.     

Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review

One of the most widely used options for minimal/moderate sedation in pediatric patients is oral midazolam, as it presents an alternative to less well‐accepted routes of administration (eg, intravenous or intranasal) of this well‐known efficacious and well‐tolerated short‐acting benzodiazepine. A systematic review of the literature was conducted in order to identify clinical studies evaluating the effectiveness of oral midazolam for sedation in pediatric patients in the context of premedication before anesthesia or during diagnostic/treatment procedures. The percentage of responders (response rate) after single administration of oral midazolam was evaluated and compared versus placebo in a subset of placebo‐controlled studies. The range of oral midazolam doses providing effective sedation in the different pediatric age subsets was analyzed in order to assess optimum dosing strategies. A total of 25 pediatric clinical studies, utilizing a variety of measures of sedation effectiveness, were selected. These studies included a total of 1472 patients (aged 4 months‐18 years) treated with midazolam (0.25‐1.5 mg/kg) and 138 patients treated with placebo. The response rates [95% confidence interval] with oral midazolam ranged from 36.7% [21.6%, 54.9%] to 97.8% [86.1%, 99.7%], while with placebo response rates ranged from 4.0% [0.6%, 23.5%] to 41.0% [29.4%, 53.6%]. When considering the 4 placebo‐controlled studies, the odds ratios [95% confidence interval] for the comparison of midazolam vs. placebo ranged from 13.4 [5.0, 36.0] to 25.9 [6.7, 100.6]. The analysis of subgroups by context of sedation showed response rates [95% confidence interval] with oral midazolam ranging from 36.7% [21.6%, 54.9%] to 97.0% [94.8%, 98.3%] for anesthetic premedication and from 56.1% [43.1%, 68.4] to 97.8% [86.1%, 99.7%] for medical procedures. The efficacy of midazolam for pediatric minimal/moderate sedation from a dose of 0.25 mg/kg and above was demonstrated. The probability of occurrence of adverse events and over‐sedation increases with increasing doses.     

Effect of patent ductus arteriosus on the heart in preterm infants

There continues to be controversy on the long‐term effects of a patent ductus arteriosus (PDA) and its management. However, the hemodynamic effects of a large PDA in a preterm infant are well known. This article aims to provide insight into the adaptive changes and remodeling effects of a PDA on the myocardium in preterm infants.     

Myocarditis in the pediatric population: A review

Myocarditis has a variable clinical presentation and there is still debate regarding accurate diagnostic criteria. Adding to the controversy surrounding this diagnosis, there is no clear consensus for the treatment or ongoing follow‐up of patients with myocarditis. All of this makes the diagnosis and management of myocarditis a particular challenge in the pediatric population. Furthermore, the literature with respect to this topic is dynamic and ever‐changing. In this review article, we aim to review and summarize the common clinical presentations of myocarditis, along with the latest recommendations for diagnostic criteria, treatment, and follow‐up of patients with myocarditis.