Atopic dermatitis (AD) is a chronic inflammatory skin disorder that requires a complex management strategy, which often involves multiple and diverse topicals and systemic treatment regimens. While topical steroids and more recently calcineurin inhibitors have been the mainstay therapy for mild-to-moderate disease, recent advances in the understanding of AD pathogenesis have led to the development of different new targets, rapidly widening our therapeutic armamentarium. This review summarizes their efficacy and safety data. We also review topical optimization strategies, including the recently published topical volume calculator, to maximize long-term disease control, especially when using multiple agents at the same time.
BACKGROUND:Although clinical trials are fundamental to advancing evidence-based practice, significant heterogeneity in outcome reporting poses a considerable challenge to the validity of systematic reviews. This inconsistency impedes the ability to compare, synthesise and interpret research findings effectively. In the field of paediatric airway management, this issue is particularly relevant because of the low incidence of critical events and the related high morbidity and mortality. The issue of inadequate and variable outcome reporting in clinical trials has been widely acknowledged, necessitating initiatives to enhance the quality of future research. OBJECTIVE:This protocol delineates the methodology used for the development of standardised, consensus-based outcome definitions and reporting items specifically tailored to paediatric airway management trials. The goal is to create guidance that will serve as an extension to the established SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) frameworks, leading to enhanced trial reproducibility and transparency and ultimately improve pediatric airway research, systematic reviews and advance patient care and safety. METHODS:This project will adhere to the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network's framework for guideline development. The methodology will be structured into four distinct phases: (1) a scoping review to comprehensively identify outcomes and variables currently reported in paediatric airway management trials; (2) a three-round Delphi process involving a multidisciplinary panel of experts to prioritise and refine outcomes and variables; (3) a consensus meeting to achieve agreement on the final set of reporting items, which will then be prepared for publication and (4) dissemination. CONCLUSIONS:The finalised outcome reporting guidelines, in the form of SPIRIT and CONSORT extensions for paediatric airway management, will be disseminated through various channels to maximise their reach and impact. These include publication in peer-reviewed journals, presentation at major international conferences and submission to relevant international reporting registries, such as the EQUATOR, SPIRIT and CONSORT registries. Active engagement with key stakeholders, including journal editors, research funders, regulatory bodies and clinician networks and national and international societies, will be a crucial component of the dissemination strategy.
OBJECTIVES:To assess the association between access challenges, measured by the Access Challenge Index (ACI), and baseline language performance in young children with hearing loss. Children with hearing loss are at increased risk of language delays, which can be influenced by access to specialized care. However, the impact of access challenges on these disparities requires further study to develop targeted interventions. DESIGN:An analysis of two prospective cohort studies' (NCT04928209) baseline assessments conducted at enrollment. This is a multicenter study, including four tertiary children's hospitals in California and Washington, with the cohort including 182 children, aged 0 to 27 months, with bilateral hearing loss, from diverse sociodemographic backgrounds. Language performance was measured using the Preschool Language Scales and Receptive-Expressive Emergent Language Scale, with scores analyzed against ACI. Expressive, receptive, and total language outcomes were included for analysis. RESULTS:Of the 182 children who met inclusion criteria, 117 (64.3%) were lower income (defined as below the 266% of the federal poverty level), 85 (46.7%) were assigned female at birth, 99 (54.4%) had public health insurance, 45 (24.7%) identified as non-Hispanic White, and 71 (39.0%) used a language other than English primarily at home. Higher ACI scores were associated with worse total language scores in both PLS (-1.25, 95% confidence interval [CI]: -2.00, -0.50, p = 0.0012) and REEL (-2.31, 95% CI: -3.36, -1.26, p < 0.0001) after inverse probability weighting of the propensity score. Subsequent analysis with ACI subscales indicated Family Support to be a strong predictor of PLS total language outcome (-4.63, 95% CI: -7.48, -1.79, p = 0.0016) and for REEL total language (-9.01, 95% CI: -12.89, -5.12, p ≤ 0.0001). CONCLUSIONS:Family support appears to be a key modifiable factor influencing language disparities for children with hearing loss. Targeted interventions to support families may improve language outcomes.
BACKGROUND:Ketorolac is a common component of multimodal analgesia protocols; however, there are concerns that it may increase the risk of pediatric fracture nonunion, particularly in femoral shaft fractures. The purpose of this study was to determine whether perioperative ketorolac administration is associated with an increased risk of nonunion in operatively treated pediatric femoral shaft fractures. METHODS:We conducted an IRB-approved retrospective review of all pediatric patients (age <18 y) who underwent operative management of femoral shaft fractures at a single institution between May 1, 2012, and December 31, 2024. Patients aged ≥18 years, those treated nonoperatively, with underlying bone pathology, inadequate follow-up, or nondiaphyseal fractures were excluded. The primary outcome was radiographic nonunion, determined by the Radiographic Union Scale for Tibia score and treating surgeon documentation. Secondary outcomes included postoperative opioid consumption, pain scores, and hospital length of stay. RESULTS:Nonunion was rare in this cohort, occurring in 1/122 patients (0.8%) who received ketorolac and 1/21 patients (4.8%) who did not receive ketorolac ( P =0.27). Patients who received ketorolac required fewer opioids, averaging 0.13±0.17 (95% CI 0.10-0.16) versus 0.23±0.28 (95% CI 0.10-0.35) MME/kg in the first 24 hours postoperatively ( P =0.047) and 0.44±0.84 (95% CI 0.29-0.59) versus 3.98±6.57 (95% CI 0.99-6.97) MME/kg cumulatively throughout admission ( P <0.001). Pain scores did not differ significantly between the ketorolac and no-ketorolac groups in the first 24 hours ( P =0.30) or cumulatively ( P =0.50). CONCLUSIONS:This comparative case series demonstrates that nonunion in operatively treated pediatric femoral fractures is rare regardless of ketorolac administration. In addition, ketorolac use appears to be associated with reduced opioid requirements without increasing pain scores. LEVEL OF EVIDENCE:Level III-therapeutic study.
