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The objective of this literature review was to evaluate multimodal therapies and interventions that help prevent progression and manage pain in children with OI. A systematic review of literature utilizing PRISMA guidelines. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, PubMed, PsycINFO, UpToDate, and ProQuest Nursing & Allied Health Source. Existing literature on pain management in pediatric patients diagnosed with OI was reviewed and appraised. Fifteen studies met the criteria for review. Results indicated that therapies addressing pain management are most effective when they use a multimodal approach that promotes bone strength, psychological support, reduces the risk of fractures, increases bone stability, and maintains physiological function. Four multimodal treatments for pain management in children with OI were identified including bisphosphonate therapy, surgical intervention, physical therapy, and psychosocial support. Developing a finite understanding of the utilization of multimodal therapies to manage and treat pain can assist in engineering treatments that improve the quality of life for children diagnosed with OI. [ABSTRACT FROM AUTHOR]

Pediatric obesity has reached an epidemic status. The purpose of this study was to examine the prevalence of overweight and obesity in patients and how often and how accurately a diagnosis was coded. The population for this study included children aged 3–18 years. This cohort presented to retail health clinics in a large urban health system for school or sports physicals from June 1, 2017, to November 30, 2017. A retrospective chart review was conducted. Statistical analysis was performed to determine if there was a relationship between obesity and age, ethnicity, race, and sex. The study identified that 15.9% of patients were overweight and 16.5% were obese. In practice, 99% of patients lacked a formal diagnosis of overweight or obesity; in addition, appropriate screening measures reflecting nutrition and physical activity were found to be lacking in 99% of cases. Strategies are needed to improve efforts to diagnose and manage overweight and obesity in pediatric population in the retail health setting. Organizational recommendations for change are suggested based on guidelines for childhood obesity. [ABSTRACT FROM AUTHOR]

The subcutaneous implantable cardioverter defibrillator (S-ICD) is a new device used for the prevention of sudden cardiac death. Best practices in the perioperative management of the S-ICD are not established; therefore, clinicians typically deactivate the device during surgery, with reinterrogation and activation postoperatively. This could put the patient at risk for being discharged with the device "off' We present two cases where electromagnetic interference was appropriately detected by the S-ICD and filtered. These cases present an important clinical finding that could lead to less deactivation of devices during surgery. Further research will be required to define which surgical procedures require magnet, reprogramming, or no changes. [ABSTRACT FROM AUTHOR]

LINK-HF study has shown that multivariate physiological telemetry from a wearable sensor combined with machine learning can provide accurate early detection of impending heart failure (HF) hospitalization. Whether early intervention based on predictive data generated through artificial intelligence (AI) analytical methods could improve outcomes in HF is not known. The LINK-HF2 study consists of two phases. The completed, non-randomized vanguard phase enrolled 27 patients with HF at 2 VA sites, and the ongoing main randomized phase will enroll 240 patients at 5 VA sites. The predictive AI system used in this study is a cloud-based analytic platform that generates a multivariate change index (MCI) to identify changes in observed physiological patterns that deviate from the expected normal behavior. In the vanguard phase, comprehensive implementation program was developed and examined integration of non-invasive remote monitoring and subsequent algorithmic response to the clinical workflow. Clinicians responded to notifications within 24 hours in 95% of instances and clinical action was taken in 25% of instances. Challenges included over-alerting, time needed for data review, staffing, and deference to other providers. The results of the vanguard phase were used to make the following protocol adjustments: 1. Refinement of the algorithmic response to predictive alerts (Figure 1); 2. Expansion of clinician education; 3. Improved education of study subjects on the meaning of predictive notifications; and 4. Aggregating repeated MCI alerts within 72 hours into a single event.In the randomized phase of LINK-HF2, 240 subjects with HF will be fitted with the non-invasive monitor and randomized to either an active arm, in which notifications will be communicated to clinical providers and followed by an algorithmic response, or to a control arm where notifications will not be communicated to the clinical team. Study outcomes will be: 1. HF hospitalization, 2. All-cause hospitalization, 3. Hospitalization length, 4. Health-related quality of life (KCCQ-12, VAS), 5. Cost of medical care. The LINK-HF2 study will provide clinical utility data for and approach where algorithmic response will be taken to AI predictive analytics derived from multivariate physiological telemetry from a wearable sensor [ABSTRACT FROM AUTHOR]