Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference.

Endoscopy plays a critical role in caring for and evaluating the patient with eosinophilic esophagitis (EoE). Endoscopy is essential for diagnosis, assessment of response to therapy, treatment of esophageal strictures, and ongoing monitoring of patients in histologic remission. To date, less-invasive testing for identifying or grading EoE severity has not been established, whereas diagnostic endoscopy as integral to both remains the criterion standard. Therapeutic endoscopy in patients with adverse events of EoE may also be required. In particular, dilation may be essential to treat and attenuate progression of the disease in select patients to minimize further fibrosis and stricture formation. Using a modified Delphi consensus process, a group of 20 expert clinicians and investigators in EoE were assembled to provide guidance for the use of endoscopy in EoE. Through an iterative process, the group achieved consensus on 20 statements yielding comprehensive advice on tissue-sampling standards, gross assessment of disease activity, use and performance of endoscopic dilation, and monitoring of disease, despite an absence of high-quality evidence. Key areas of controversy were identified when discussions yielded an inability to reach agreement on the merit of a statement. We expect that with ongoing research, higher-quality evidence will be obtained to enable creation of a guideline for these issues. We further anticipate that forthcoming expert-generated and agreed-on statements will provide valuable practice advice on the role and use of endoscopy in patients with EoE.

The Impact of Visiting Restrictions During the COVID-19 Pandemic on Pediatric Patients.

Visitor restriction policies have been implemented on many hospital units as a result of the Covid-19 pandemic. These policies are integral to the strategies that hospitals are using to limit exposure risks during the pandemic. However, visitor restriction policies disproportionally affect hospitalized children. The trauma caused by lack of family at the bedside of adult patients during the Covid-19 pandemic has been studied but there is a lack of primary research on the impact of the Covid-19 visiting policy restrictions on pediatric patients. Long term studies are needed to understand the effect of this separation on children and their caregivers.

Protecting Children from Wildfire Smoke.

The impacts of wildfires on the health of children are becoming a more urgent matter as wildfires become more frequent, intense and affecting, not only forested areas, but also urban locations. It is important that medical professionals be prepared to provide information to patients and families on how to minimize the adverse health effects on children of wildfire smoke and ash from wildfires.

New Guidelines for Children Returning to Sports after Covid-19.

Approximately 45 million children participate in some form of athletics. The COVID-19 pandemic has affected many aspects of their lives, including sports activities. Families are asking care givers questions about how best to ensure the safety of their children when returning to sports activities. The American Academy of Pediatrics has issued revised guidelines for children returning to athletic activities after COVID-19. These include strengthening the recommendations for cloth mask wearing for all children engaging in vigorous sports and clarifications of cardiac risks to children who have had COVID-19.

Exchange of medicinal plant information in California missions.

BACKGROUND: Missions were established in California in the eighteenth and nineteenth centuries to convert Native Americans to Christianity and enculturate them into a class of laborers for Californios (Spanish/Mexican settler). The concentration of large numbers of Native Americans at the Missions, along with the introduction of European diseases, led to serious disease problems. Medicinal supplies brought to California by the missionaries were limited in quantity. This situation resulted in an opportunity for the sharing of knowledge of medicinal plants between the Native Americans and the Mission priests. The purpose of this study is to examine the degree to which such sharing of knowledge took place and to understand factors that may have influenced the sharing of medicinal knowledge. The study also examines the sharing of medicinal knowledge between the Native Americans and the Californios following the demise of the California Missions. METHODS: Two methods were employed in the study: (1) a comparison of lists of medicinal plants used by various groups (e.g., Native American, Mission priests, Californios) prior to, during, and after the Mission period and (2) a close reading of diaries, reports, and books written by first-hand observers and modern authorities to find accounts of and identify factors influencing the exchange of medicinal information. RESULTS: A comparison of the lists of medicinal plants use by various groups indicated that only a small percentage of medicinal plants were shared by two or more groups. For example, none of the 265 taxa of species used by the Native Americans in pre-Mission times were imported into Spain for medicinal use and only 16 taxa were reported to have been used at the Missions. A larger sharing of information of medicinal plants took place in the post-Mission period when Native Americans were dispersed from the Missions and worked as laborers on the ranches of the Californios. CONCLUSIONS: Sharing of information concerning medicinal plants did occur during the Mission period, but the number of documented species was limited. A number of possible factors discouraged this exchange. These include (1) imbalance of power between the priests and the Native Americans, (2) suppression of indigenous knowledge and medical practices by the Mission priests, (3) language barriers, (4) reduction of availability of medicinal herbs around the Mission due to introduced agricultural practices, (5) desire to protect knowledge of medicinal herbs by Native American shaman, (6) administrative structure at the Missions which left little time for direct interaction between the priests and individual Native Americans, (7) loss of knowledge of herbal medicine by the Native Americans over time at the Missions, and (8) limited transportation opportunities for reciprocal the shipment of medicinal plants between California and Spain. Three possible factors were identified that contributed to a greater sharing of information between the Native Americans and the Californios in the post-Mission period. These were (1) more one-to-one interactions between the Californios and the Native Americans, (2) many of the Californios were mestizos whose mothers or grandmothers were Native Americans, and (3) lack of pressure on the part of the Californios to suppress Native American beliefs and medicinal practices.

Large Genetic Study Uncovers 14 New Genes Responsible for Developmental Disorders in Children.

The exomes of 4293 families with individuals with undiagnosed developmental disorders were sequenced to identify de novo mutations. The researchers identified 14 new genetic disorders.

Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential.

BACKGROUND: Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. OBJECTIVE: Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care. METHODS: A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues' work. RESULTS: Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse's use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work. CONCLUSIONS: The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes.