BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions.

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Geocoded emergency department (ED) data have allowed for the development and evaluation of novel interventions for the prevention of violence in cities outside of the United States. First implemented in Cardiff, United Kingdom, collection of these data provides public health agencies, community organizations, and law enforcement with place-based information on assaults. The purpose of this study was to assess the feasibility of translating this model within the electronic medical record (EMR) in the United States. A new EMR module based on the Cardiff Model was developed and integrated into the existing ED EMR. Data were collected for all patients reporting an assaultive injury upon arrival to the ED. Emergency department nurses were subsequently recruited to participate in 2 surveys and a focus group to evaluate the implementation and to provide qualitative feedback to enhance integration. Nurses completed EMR questions in 98.2% of patients reporting to the ED over the study period. More than 90% of survey respondents were satisfied with their participation, and most felt that the questions were useful for clinical care (79/70%), were integrated well into workflow (89/90%), and were congruent with the ED and hospital goals and mission (93/98%). Focus group themes centered on ED culture, external factors, and internal workflow. It is feasible to implement place-based, assault-related injury-specific questions into the EMR with minimal disruption of workflow and triage times. Nurses, as key members of the ED team, are receptive to participating in the collection of population health data that may inform community violence prevention activities.

Background The J tip uses air instead of a needle to push lidocaine into the skin. No studies have investigated its use for venipuncture in young children. Objective Determine if J tip decreased venipuncture pain in young children compared to vapocoolant spray. Methods Children ages 1 to 6 years were randomized into 3 groups: Intervention – J tip, Control –vapocoolant spray, and Sham –vapocoolant spray and “pop” of an empty J tip. The procedure was videotaped and scored using the FLACC tool at three times; Baseline - before approach, Device - J tip deployment and Venipuncture - venipuncture. The FLACC tool was scored 0(none) to 10(severe). Comparisons of pain scores over time were made using the Generalized Estimating Equation. Venipuncture success and adverse effects were assessed and compared using Χ2. Results 205 children enrolled; Intervention=96, Control=53, Sham=56. There were no between group differences in baseline characteristics. There was no mean change in pain scores from Device to Venipuncture in the Intervention group (0.25, 95% CI (−0.31, 0.82) but there was an increase in pain in the Control (2.82, 95% CI (1.91, 3.74) and Sham (1.68, 95% CI (0.83, 2.52) groups. This change was greater for the Control and Sham compared to the Intervention group. There was no difference in venipuncture success between groups. No severe adverse events occurred. Minor adverse events were the same between groups. Conclusion Use of the J tip for children ages 1 to 6 years reduced venipuncture pain compared to vapocoolant spray or sham treatment.