Background Firearm-related injuries are the second leading cause of death among US children. Given this, firearm injury prevention should be a key aspect of pediatric anticipatory guidance. Objective We assessed the impact of a firearm safety counseling workshop on pediatric resident knowledge, self-efficacy, and self-reported practice patterns. Methods Sixty of 80 residents (75%) participated in a 2-hour multimodal workshop, including video, didactics with experts, and role-play scenarios. Participants were invited to complete pre-workshop, immediate post-workshop, and 3- and 6-month post-workshop self-reported questionnaires evaluating knowledge, comfort, perceived barriers, and reported practice patterns. Data comparing pre- and 6-month post-workshop practice patterns were analyzed via Fischer's exact test. Remaining statistical analysis utilized a one-sided, unpaired Mann–Whitney U test. A binomial exact proportions test was used for open-ended responses. Results After the workshop, the percentage of participants with perceived concern regarding parental barriers decreased significantly (24% to 7%, P = .001). Participants 6 months post-workshop were 5.14 times more likely to counsel their patients on firearms during more than 75% of their well visits than prior to the intervention ( P = .010). Participants reported greater comfort asking patients about firearms, with mean Likert scores increasing from 3.81 pre to 4.33 post ( P = .022), which was similar to 3-month (4.39, P = .06) and 6-month evaluations (4.54, P = .003). Conclusions Education on firearm safety counseling improved pediatric resident comfort level in discussing the topic. This impact persisted 6 months after the workshop, implying a sustained change in attitudes and behaviors.
Tumefactive demyelinating lesions are an uncommon manifestation of demyelinating disease that mimic primary central nervous system neoplasms and can pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis. Although a biopsy may be required to distinguish TDL from neoplasms or infection, certain ancillary and radiographic findings may preclude the need for invasive diagnostic procedures. We describe the case of a 15-year-old boy with a tumefactive demyelinating lesion involving the conus medullaris. An exhaustive systematic literature search of pediatric cases of TDL yielded an additional 78 cases. This review summarizes the current knowledge and recommendations for the diagnosis and management of this condition, highlighting the clinical, demographic, and radiologic features of 79 reported cases, including our own. Furthermore, it underscores areas of the literature where evidence is still lacking. Further research is needed to optimize clinical detection and medical management of this condition.
B-cell acute lymphoblastic leukemia (B-ALL) with BCR/ABL1 fusion gene is rare in patients with Down syndrome (DS), occurring in fewer than 0.7% of reported DS-ALL cases. 1 The presence of BCR/ABL1 fusion (Philadelphia chromosome-positive [Ph + ]) confers a worse prognosis due to refractory disease and increased relapse risk, 2 and patients with DS-ALL have higher rates of chemotherapy-related toxicities and relapse. 1,3 Providers are challenged with navigating toxicities by holding or reducing chemotherapy doses, knowing that each alteration may increase the chance of relapse. Therefore, new frontline therapies with less toxicity are needed. Blinatumomab, a bispecific T-cell engager targeting B-lymphocyte antigen CD19, has shown promising results in pediatric and adult patients with B-ALL. 4,5 A recent phase 2 clinical study in adults that combined blinatumomab with ponatinib, showed 1-year overall survival rates of 100% in the newly diagnosed cohort. 6 Blinatumomab is being used to treat pediatric leukemia in clinical trials. Reports of patients with DS treated with blinatumomab have shown that it is well tolerated with usual adverse events being hematologic cytopenia and cytokine release syndrome. [7][8][9] Patients older than 10 years with DS and B-ALL treated with blinatumomab have a higher incidence of seizures, and these patients are now recommended to receive seizure prophylaxis. 10 The mechanism of neurologic
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