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Management of Shock in Infants and Children

    • Extracorporeal membrane oxygenation (ECMO) is a modified method of cardiopulmonary bypass that is used as a last resort modality for support of the pediatric patient in cardiac and/or respiratory failure. 
    • VADs are a newer, alternative method of mechanical circulatory support for children in refractory heart failure or cardiogenic shock who are awaiting transplantation. VAD use in adults is well established, and its use in children has been steadily increasing over the last decade.
    • Lactate is a by-product of anaerobic metabolism and is often used to diagnose and monitor the progression of shock. Although lactate is less frequently elevated in pediatric patients, an initial elevated lactate level has been found to be associated with increased risk of organ dysfunction in pediatric sepsis and can be followed as a marker of resuscitation.

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Classification Systems for Lower Extremity Occlusive Disease

    • The SVS runoff score provides a method for giving weight to those vessels contributing to the runoff. It was developed to anatomically stratify patients when designing studies to compare the outcome of lower extremity arterial bypass.
    • The TASC classification system guides the clinical management of a patient by providing vascular specialists with a basic framework for determining whether the patient’s vascular disease pattern is best treated with endovascular intervention or with surgical revascularization. The TASC classification is also used to stratify cohorts in research studies evaluating treatment modalities.
    • The Finnvasc score, Project of Ex-Vivo graft Engineering via Transfection (PREVENT) III (PIII) score, and BASIL Mortality Index are three tools designed to aid in decision making between open surgical revascularization and endovascular intervention. These tools stratify the risk of periprocedural morbidity and/or predict a patient’s probability for short-term, medium-term, and long-term survival.

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Neck Dissection

    • The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
    • Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter. 

Classification Systems for Lower Extremity Occlusive Disease

    • The SVS runoff score provides a method for giving weight to those vessels contributing to the runoff. It was developed to anatomically stratify patients when designing studies to compare the outcome of lower extremity arterial bypass.
    • The TASC classification system guides the clinical management of a patient by providing vascular specialists with a basic framework for determining whether the patient’s vascular disease pattern is best treated with endovascular intervention or with surgical revascularization. The TASC classification is also used to stratify cohorts in research studies evaluating treatment modalities.
    • The Finnvasc score, Project of Ex-Vivo graft Engineering via Transfection (PREVENT) III (PIII) score, and BASIL Mortality Index are three tools designed to aid in decision making between open surgical revascularization and endovascular intervention. These tools stratify the risk of periprocedural morbidity and/or predict a patient’s probability for short-term, medium-term, and long-term survival.

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability
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