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Proton pump inhibitor (PPI) use in young children is associated with risk of serious infection. It’s best to avoid PPI use in the absence of a very clear indication.
Source
Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children. JAMA Pediatr. 2023 Aug 14;e232900. doi: 10.1001/jamapediatrics.2023.2900. Online ahead of print.
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Prophylactic treatment of patients with severe alcohol-related hepatitis with amoxicillin-clavulanate did not reduce all-cause mortality when compared to placebo.
Source
Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA. 2023 May 9;329(18):1558-1566. doi: 10.1001/jama.2023.4902.
Spoon Feed
Patients who are discharged from the emergency department after presenting with abdominal pain and receiving opioids have 57% greater odds of return within 30 days. This population is also at higher risk for adverse effects from these medications.
Source
Return Rates for Opioid versus Nonopioid Management of Patients with Abdominal Pain in the Emergency Department. J Emerg Med. 2023 Apr;64(4):471-475. doi: 10.1016/j.jemermed.2023.01.008. Epub 2023 Mar 28.
Spoon Feed
Patients with alcohol-associated hepatitis have a high rate of complications and short-term mortality of 20-50%. Prompt recognition and treatment, including initiation of treatment for alcohol use disorder, is important to improve patient outcomes.
Source
Alcohol-Associated Hepatitis. NEJM. 2022 Dec 29; 387 (26): 2436-2448.
Spoon Feed
In patients with a gastrointestinal bleed (GIB), CT imaging was more often diagnostic when the specific indication (GIB) was listed within the requisition order and multiphase studies were ordered.
Source
Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed. Am J Emerg Med. 2022 Dec 5;64:101-105. doi: 10.1016/j.ajem.2022.12.003. Online ahead of print.
Spoon Feed
Esophageal bougienage is an underutilized bedside technique for managing retained esophageal coins.
Source
Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused. Pediatr Emerg Care. 2022 Sep 30. doi: 10.1097/PEC.0000000000002849. Online ahead of print.
Spoon Feed
Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload.
Source
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884.
Spoon Feed
Legalization of cannabis in Ontario was not associated with an increase in ED visits for cannabis hyperemesis syndrome (CHS); however, after legislation passed allowing commercialization of cannabis, there was a large increase in visits for CHS.
Source
Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada. JAMA Netw Open. 2022 Sep 16. Doi:10.1001/jamanetworkopen.2022.31937
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Children with functional abdominal pain and irritable bowel syndrome taking an open-label placebo reported significantly less pain and took fewer rescue pain medications.
Source
Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2022 Apr 1;176(4):349-356. doi: 10.1001/jamapediatrics.2021.5750. Erratum in: doi: 10.1001/jamapediatrics.2022.0359.
Spoon Feed
A new, rare form of acute hepatitis has been seen in children, mostly under age 5 years, that presents with vomiting, diarrhea, and abdominal pain, followed by acute hepatitis with jaundice. If you see a child with a “stomach virus” who has jaundice – check labs!
Source
Acute hepatitis is identified in more children, but cause remains elusive. BMJ. 2022 May 6;377:o1156. doi: 10.1136/bmj.o1156.
