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Sample records for paediatric practice impact

  1. Azithromycin use in paediatrics: A practical overview

    PubMed Central

    Ovetchkine, Philippe; Rieder, Michael J

    2013-01-01

    Azithromycin is an antibiotic that is commonly prescribed for upper and lower respiratory tract infections in children. While it has proven benefits, some concerns regarding azithromycin use have arisen in recent years. This practice point considers azithromycin therapy for acute respiratory infections in otherwise healthy children. Pharmacokinetics, spectrum of activity, the problem of resistant bacteria and clinical aspects are considered, along with recommendations for use and contraindications. Azithromycin should be avoided in patients with a significant risk of bacteremia. It is associated with pneumococcal resistance and, with stated exceptions, is generally not recommended for the treatment of acute pharyngitis, acute otitis media or pneumococcal community-acquired pneumonia in the paediatric population. PMID:24421702

  2. Impact of the European paediatric legislation in paediatric rheumatology: past, present and future.

    PubMed

    Ruperto, Nicolino; Vesely, Richard; Saint-Raymond, Agnes; Martini, Alberto

    2013-12-01

    Conducting clinical trials in paediatric rheumatology has been difficult mainly because of the lack of funding for academic studies and the lack of interest by pharmaceutical companies in the small and non-rewarding paediatric market. The situation changed dramatically a few years ago with the introduction of the Best Pharmaceuticals for Children Act in the USA and of specific legislation for the development of paediatric medicines (Paediatric Regulation) in the European Union (EU). The EU Paediatric Regulation had a positive impact in paediatric rheumatology-in particular, on the development of new treatments for children with juvenile idiopathic arthritis (JIA). Some problems remain, however, such as greater harmonisation of the regulatory aspects of medicines, how to handle me-too agents, how to conduct adequate pharmacokinetic studies and develop age-appropriate formulations, ethical problems in study review and implementation, and a change in the current JIA classification. The introduction of specific legislation, coupled with the existence of large international networks such as the Pediatric Rheumatology Collaborative Study Group (PRCSG at http://www.prcsg.org), covering North America, and the Paediatric Rheumatology International Trials Organisation (PRINTO at http://www.printo.it), covering more than 50 countries, has led to great advances in paediatric rheumatology. Future changes might increase the possibility of conducting trials with similar approaches in other paediatric rheumatological conditions and provide evidence-based treatments for children affected by rheumatic diseases. PMID:23962457

  3. Medicolegal issues in paediatric practice: proceedings of the 4th Northern Regional Paediatric Colloquium.

    PubMed

    Cousins, D A; Barrett, I; Kaplan, C A

    2004-01-01

    Ethical dilemmas frequently arise in paediatric practice. Given the nature of the speciality, these issues are pertinent to both the medical and legal professions. It is of potential benefit for the professions to meet and discuss such cases outwith the immediate clinical setting. A series of such meetings have been held in the Northern region. We report the proceedings of the fourth meeting. Four cases were presented and the issues arising were debated. The key points from each discussion are described. PMID:14984219

  4. Clinical practice: immune thrombocytopenia in paediatrics.

    PubMed

    Labarque, Veerle; Van Geet, Chris

    2014-02-01

    Immune thrombocytopenia (ITP) is a disease affecting both children and adults. It is defined as acquired isolated thrombocytopenia caused by the autoimmune production of anti-platelet antibodies. Childhood ITP most frequently occurs in young children who have been previously well, although a viral respiratory tract infection often precedes thrombocytopenia. A benign and self-limiting course is common, but major bleeding complications such as intracranial haemorrhage may occur. Yet one cannot predict which child will have a prolonged course of thrombocytopenia and who will develop an intracranial haemorrhage. In children without atypical characteristics, only minimal diagnostic investigations are needed, and most paediatric ITP patients do not need platelet-enhancing therapy even though various treatment options are available. A "watch and wait" strategy should be considered in paediatric patients with mild disease. Steroids, intravenous immunoglobulin G or anti-D immunoglobulin are the current first-line therapeutic measures for children at risk for severe bleeding. When life-threatening bleeding occurs, a combination of therapies is needed. In this review, we summarise the current knowledge on primary ITP in children and adolescents. PMID:24390128

  5. Thomas Willis's practice of paediatric neurology and neurodisability.

    PubMed

    Williams, A N

    2003-12-01

    Thomas Willis (1621-1675) is regarded as a founder of modern clinical neuroscience. He conceived the word "neurology" and left a body of work that defined mid-seventeenth-century medicine. Recent interpretations of Willis's work have led to a growing appreciation of his significant contributions to paediatric neurology, a speciality founded properly some three centuries after his death. This paper presents abstracts and plates taken from Willis's major published works, together with student notes by John Locke (1632-1704) and Robert Boyle (1627-1691) taken from lectures delivered by Willis in Oxford in the 1660s. The material embraces a wide variety of conditions now managed within modern paediatric neurology and neurodisability. In several cases, these are the first descriptions recorded in the medical literature. Willis fused astute history taking and clinical observation (sometimes supported by subsequent post-mortem studies) into a structured medical intervention. Willis's practice was state of the art, being based on acceptance of Harvey, a traditional Galenic infrastructure, iatrochemistry and Gassendi's "psychology". Although Willis's discoveries became a cornerstone of modern medical science, his medical practice did not lead to any therapeutic advances. However, up to the mid-eighteenth century his works were internationally accepted for their practical usefulness. The corpus of material left by Willis affords a fascinating insight into the clinical rationale of a seventeenth century physician in his management of paediatric cases. PMID:15069866

  6. The impact of paediatric early warning systems.

    PubMed

    Naddy, Catherine

    2012-10-01

    The child who is ill enough to be admitted to a children's ward has the potential to deteriorate rapidly. If this deterioration is not recognised and acted on in a timely manner, such children may require cardiopulmonary resuscitation, high dependency or intensive care. A paediatric early warning tool used with routine nursing observations will alert staff to the need for increased monitoring, the support of an associated outreach team or emergency medical attention. If the tool is used, a nurse can provide objective, transparent evidence of the child's condition to experienced clinicians. Appropriate education and supervision of staff should be ensured through the use of an outreach team. PMID:23167014

  7. Paediatric nursing in Europe: influencing policy and practice.

    PubMed

    Smith, Fiona

    2007-12-01

    The WHO European Health Report 2005 called for significant efforts from all countries to protect and promote children's health. Nurses across Europe have a major role to play in this effort but in many countries they lack the appropriate education and organisational support to make a meaningful contribution. A network of paediatric nursing associations in Europe was formed in 2003 to strengthen nurses' voices in child health policy and improve the potential of nurses to contribute to protecting and promoting the health of children and young people. Based on a consensus definition of the European paediatric nurse, the Paediatric Nursing Associations of Europe has developed consensus position statements on issues such as regulation and educational preparation. These have been used to lobby at national levels with positive results such as new mechanisms for identifying paediatric nurses on some national nursing registers, legislation to protect the use of the title 'paediatric nurse' and consideration of the reintroduction of specific programmes at both pre and post registration level for preparation of paediatric nurses. PMID:18196854

  8. Paediatric drug development: the impact of evolving regulations.

    PubMed

    Turner, M A; Catapano, M; Hirschfeld, S; Giaquinto, C

    2014-06-01

    Children deserve medicines that are adapted to their needs. The need to include children in drug development has been recognised increasingly over the past few decades. Legal and regulatory frameworks are well established in the EU and US. The amount of work done to study medicines for children is significantly greater than it was 10 years go. Proof-of-concept has been demonstrated for all segments of the paediatric drug development pipeline. It is now time to examine how the practice of developing medicines for children has evolved within those frameworks and to determine how that work should be generalised. This review describes the development of medicines for children and critically appraises the work that has been done within those frameworks. Significant effort is needed to realize the potential provided by the current regulatory framework. Using the work programme of the Global Research in Paediatrics (GRiP) Network of Excellence as a template we outline current work and future growing points. PMID:24556465

  9. Maintenance Intravenous Fluid Prescribing Practices Among Paediatric Residents

    PubMed Central

    Freeman, Michael A; Ayus, Juan C; Moritz, Michael L

    2014-01-01

    Aim To investigate the sodium composition of maintenance intravenous fluids used by paediatric residents throughout the United States in common clinical scenarios of arginine vasopressin excess. Methods We distributed an online survey to paediatric residency programs asking what type of maintenance intravenous fluids (0.2%, 0.45%, 0.9% NaCl or Lactated Ringers) they would administer in four common clinical scenarios of arginine vasopressin excess (gastroenteritis, pneumonia, meningitis and post-operative) in both a 6-month-old (mo) and a 13-year-old (yo) child. Results We had 472 responses, representing 5% of the total paediatric residency population in the US. Hypotonic maintenance intravenous fluids were selected in 78% of children (88.2% of 6 mo and 68.5% of 13 yo). Isotonic maintenance intravenous fluids were selected approximately twice as often for patients with meningitis as for those without (21.4% vs 8.7% 6 mo and 42.8% vs 27.7% 13 yo; p <.0.001). Conclusions The majority of US paediatric residents would prescribe hypotonic maintenance intravenous fluids in disease states associated with arginine vasopressin excess. However, a significant number of residents are using isotonic maintenance intravenous fluids. Isotonic fluids are more likely to be prescribed in older children and children with meningitis. PMID:22765308

  10. Paediatric Interventional Uroradiology

    SciTech Connect

    Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.

    2011-04-15

    Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.

  11. The impact of electronic cigarettes on the paediatric population

    PubMed Central

    Durmowicz, Elizabeth L

    2014-01-01

    Objective To review the impact of electronic cigarettes (e-cigarettes) on children. Methods Five electronic databases were searched through 31 December 2013. Studies in English that included data for children younger than 18 years of age were included. In addition, relevant data from articles identified during searches of the e-cigarette literature, relevant state survey data and paediatric voluntary adverse event reports submitted to the US Food and Drug Administration (FDA) were reviewed and included. Results Use of e-cigarettes by youth is increasing and is not limited to traditional cigarette smokers. Data regarding the reasons for youth e-cigarette initiation and ongoing use are limited. The effects of e-cigarette marketing and the availability of flavoured e-liquids on youth use are unknown. The abuse liability of e-cigarettes in youth is also not known. Unintentional exposures to e-cigarettes and e-liquids have been reported in children. The number of e-cigarette-related reports received by poison centres is increasing. No data are available on secondhand and thirdhand e-cigarette aerosol exposures in children. Conclusions Data on the impact of e-cigarettes on children are extremely limited. The available data indicate that youth awareness is high and use is increasing rapidly. The extent to which e-cigarette use in youth will result in nicotine dependence and subsequent use of other tobacco products is unknown. e-cigarettes present risks of unintentional nicotine exposure and are potential choking hazards. A greater understanding of the impact of e-cigarettes on children is needed and will be important in the evaluation of the effects of these products on the public health. PMID:24732163

  12. Professional and organizational commitment in paediatric occupational therapists: the influence of practice setting.

    PubMed

    Seruya, Francine M; Hinojosa, Jim

    2010-09-01

    The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web-based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty-seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school-based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web-based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale. PMID:20806287

  13. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

    PubMed Central

    Peters, Mark J.

    2016-01-01

    Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension. PMID:27516901

  14. Discussing patient management online: the impact of roles on knowledge construction for students interning at the paediatric ward.

    PubMed

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-03-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection and critical thinking on patient management and treatment, and to offer an exercise in evidence-based medical practice. Groups of approximately 4-5 students were asked to discuss 4 authentic cases during clinical rotation in paediatrics. 49 students interning at the paediatric ward participated in this study. With respect to role assignment, differences between groups (1) with a student or an instructor as moderator and (2) with or without a developer of alternatives for patient management were explored. A content analysis was performed to explore the different levels of social construction of knowledge. The results of multilevel logit analyses show a significant difference in knowledge construction through social negotiation between conditions with a student moderator and conditions where the instructor is moderating, but only when a developer of alternatives is involved. No significant difference was revealed between student-moderated and instructor-moderator groups without a developer of alternatives. It can be concluded that when both the moderator and developer role are assigned to students, their contributions are more likely to reflect a high level of knowledge construction. PMID:16841238

  15. Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes

    PubMed Central

    Cowan, F; Warner, J; Lowes, L; Riberio, J; Gregory, J

    1997-01-01

    Accepted 13 May 1997
 AIMS—To define outcome measures for auditing the clinical care of children and adolescents with insulin dependent diabetes mellitus (IDDM) and to assess the benefit of appointing a dedicated paediatric trained diabetes specialist nurse (PDSN).
METHODS—Retrospective analysis of medical notes and hospital records. Glycaemic control, growth, weight gain, microvascular complications, school absence, and the proportion of children undergoing an annual clinical review and diabetes education session were assessed. The effect of the appointment of a PDSN on the frequency of hospital admission, length of inpatient stay, and outpatient attendance was evaluated.
RESULTS—Children with IDDM were of normal height and grew well for three years after diagnosis, but grew suboptimally thereafter. Weight gain was above average every year after diagnosis. Glycaemic control was poor at all ages with only 16% of children having an acceptable glycated haemoglobin. Eighty five per cent of patients underwent a formal annual clinical review, of whom 16% had background retinopathy and 20% microalbuminuria in one or more samples. After appointing the PDSN the median length of hospital stay for newly diagnosed patients decreased from five days to one day, with 10of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median of 19 to 10%.
CONCLUSIONS—Outcome measures for evaluating the care of children with IDDM can be defined and evaluated. Specialist nursing support markedly reduces the length of hospital stay of newly diagnosed patients without sacrificing the quality of care.

 PMID:9301347

  16. Beyond counting cases: public health impacts of national Paediatric Surveillance Units

    PubMed Central

    Grenier, D; Elliott, E J; Zurynski, Y; Pereira, R Rodrigues; Preece, M; Lynn, R; von Kries, R; Zimmermann, H; Dickson, N P; Virella, D

    2007-01-01

    Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and facilitates international collaboration among member PSUs and allows for sharing of resources, simultaneous data collection and hence comparison of data from different geographical regions. The impact of data collected by PSUs, both individually and collectively as members of INoPSU, on public health outcomes, clinical care and research is described. PMID:17158859

  17. Developing a culture to facilitate research capacity building for clinical nurse consultants in generalist paediatric practice.

    PubMed

    Wilkes, Lesley; Cummings, Joanne; McKay, Nicola

    2013-01-01

    This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW), Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT) was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge. PMID:23956854

  18. Practising what we preach: A look at healthy active living policy and practice in Canadian paediatric hospitals

    PubMed Central

    Solh, Ziad; Adamo, Kristi B; Platt, Jennica L; Ambler, Kathryn; Boyd, Erin; Orrbine, Elaine; Cummings, Elizabeth; LeBlanc, Claire MA

    2010-01-01

    BACKGROUND: In the past 30 years, the rate of obesity has risen considerably among Canadian children. Paediatric hospitals are in a unique position to model healthy environments to Canadian children. OBJECTIVE: To obtain an overview of healthy active living (HAL) policy and practice in Canadian paediatric hospitals. METHODS: Working in partnership with the local Canadian Paediatric Society HAL champions and the Canadian Association of Paediatric Health Centres liaisons, a nationwide survey was conducted in 2006/2007 to identify healthy eating, physical activity and smoking cessation practices in all 16 Canadian paediatric academic hospitals. RESULTS: Policies addressing healthy eating and/or physical activity promotion were present in 50% of hospitals with a greater focus on nutrition. Wellness committees were created in 50% of the hospitals, most of which were recently established. Healthy food options were available in cafeterias, although they were often more expensive. Fast food outlets were present in 75% of hospitals. Although inpatient meals were designed by dietitians, 50% offered less nutritious replacement kids meals (ie, meal substitutions) on request. Options for play available to inpatients and outpatients were primarily sedentary, with screen-based activities and crafts predominating over active play. Physical activity promotion for staff focused on reduced membership fees to fitness centres and classes. CONCLUSION: Canadian paediatric hospitals do not adequately promote HAL for patients and staff. The present study findings suggest further effort is required to create necessary healthy lifestyle modifications in these institutions through Canadian Paediatric Society/Canadian Association of Paediatric Health Centres-led policy development and implementation initiatives. A national-level policy framework is required to regulate interhospital variability in policies and practices. PMID:22131867

  19. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    PubMed Central

    Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

    2016-01-01

    Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

  20. The Clinical Impact of Chromosomal Microarray on Paediatric Care in Hong Kong

    PubMed Central

    Tao, Victoria Q.; Chan, Kelvin Y. K.; Chu, Yoyo W. Y.; Mok, Gary T. K.; Tan, Tiong Y.; Yang, Wanling; Lee, So Lun; Tang, Wing Fai; Tso, Winnie W. Y.; Lau, Elizabeth T.; Kan, Anita S. Y.; Tang, Mary H.; Lau, Yu-lung; Chung, Brian H. Y.

    2014-01-01

    Objective To evaluate the clinical impact of chromosomal microarray (CMA) on the management of paediatric patients in Hong Kong. Methods We performed NimbleGen 135k oligonucleotide array on 327 children with intellectual disability (ID)/developmental delay (DD), autism spectrum disorders (ASD), and/or multiple congenital anomalies (MCAs) in a university-affiliated paediatric unit from January 2011 to May 2013. The medical records of patients were reviewed in September 2013, focusing on the pathogenic/likely pathogenic CMA findings and their “clinical actionability” based on established criteria. Results Thirty-seven patients were reported to have pathogenic/likely pathogenic results, while 40 had findings of unknown significance. This gives a detection rate of 11% for clinically significant (pathogenic/likely pathogenic) findings. The significant findings have prompted clinical actions in 28 out of 37 patients (75.7%), while the findings with unknown significance have led to further management recommendation in only 1 patient (p<0.001). Nineteen out of the 28 management recommendations are “evidence-based” on either practice guidelines endorsed by a professional society (n = 9, Level 1) or peer-reviewed publications making medical management recommendation (n = 10, Level 2). CMA results impact medical management by precipitating referral to a specialist (n = 24); diagnostic testing (n = 25), surveillance of complications (n = 19), interventional procedure (n = 7), medication (n = 15) or lifestyle modification (n = 12). Conclusion The application of CMA in children with ID/DD, ASD, and/or MCAs in Hong Kong results in a diagnostic yield of ∼11% for pathogenic/likely pathogenic results. Importantly the yield for clinically actionable results is 8.6%. We advocate using diagnostic yield of clinically actionable results to evaluate CMA as it provides information of both clinical validity and clinical utility. Furthermore, it

  1. Manipulation of drugs to achieve the required dose is intrinsic to paediatric practice but is not supported by guidelines or evidence

    PubMed Central

    2013-01-01

    Background A lack of age-appropriate formulations can make it difficult to administer medicines to children. A manipulation of the dosage form may be required to achieve the required dose. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice. Method A structured, undisguised observational study and postal survey. The observational study investigated drug manipulations occurring in clinical practice across three sites. The questionnaire, administered to a sample of paediatric nurses throughout the UK, surveyed manipulations conducted and nurses’ experiences and views. Results The observational study identified 310 manipulations, of which 62% involved tablets, 21% were intravenous drugs and 10% were sachets. Of the 54 observed manipulations 40 involved tablets with 65% of the tablets being cut and 30% dispersed to obtain a smaller dose. 188 manipulations were reported by questionnaire respondents, of these 46% involved tablets, 12% were intravenous drugs, and 12% were nebuliser solutions. Manipulations were predominantly, but not exclusively, identified in specialist clinical areas with more highly dependent patients. Questionnaire respondents were concerned about the accuracy of the dose achieved following manipulations and the lack of practice guidance. Conclusion Manipulations to achieve the required dose occur throughout paediatric in-patient settings. The impact of manipulations on the efficacy of the drugs, the accuracy of the dose and any adverse effects on patients is not known. There is a need to develop evidence-based guidance for manipulations of medicines in children. PMID:23688279

  2. Handwashing practice and policy variability when caring for central venous catheters in paediatric intensive care.

    PubMed

    Morritt, Mary Lou; Harrod, Mary Ellen; Crisp, Jackie; Senner, Anne; Galway, Robyn; Petty, Sheila; Maurice, Lucy; Harvey, Alice; Hardy, Jan; Donnellan, Robyn

    2006-02-01

    It has been estimated that there may be as many as 150,000 healthcare associated infections (HCAI) in Australia each year, contributing to 7,000 deaths, many of which could be prevented through the implementation of appropriate infection control practices. Contact with contaminated hands is a primary source of HCAI. Intensive care staff have been identified as one of the least adherent groups of health care professionals with handwashing; they are less likely to practise hand antisepsis before invasive procedures than staff working in other patient care specialties. The study examined the self-reported clean and aseptic handwashing practices of nurses working in paediatric intensive care units (PICUs) across Australia and New Zealand, the patterns in variation between nurses' reported handwashing practices and the local policies, and patterns in the duration of procedural handwashing for specific procedures. A survey was undertaken in 2001 in which participating tertiary paediatric hospitals provided copies of their infection control policies pertaining to central venous catheter (CVC) management; five nurses on each unit were asked to provide information in relation to their handwashing practices. Seven hospitals agreed to participate and 30 nurses completed the survey. The study found an enormous level of variation among and between nurses' reported practices and local policies. This variation extended across all aspects of handwashing practices - duration and extent of handwash, type of solution and drying method used. The rigour of handwashing varied according to the procedure undertaken, with some evidence that nurses made their own risk assessments based on the proximity of the procedure to the patient. In conclusion, this study's findings substantiate the need for standardisation of practice in line with the current Centers for Disease Control and Prevention Guidelines, including the introduction of alcohol handrub. PMID:16544674

  3. The future potential of eicosanoids and their inhibitors in paediatric practice.

    PubMed

    Shimizu, T

    1998-08-01

    Eicosanoids may have many potential uses in paediatric practice. Since E-type prostaglandins were first applied to treat ductus-dependent congenital heart diseases in paediatric practice, many eicosanoid-related drugs have been examined for the treatment of pathophysiological conditions in children. Prostaglandins (PG), thromboxane (TX) and leukotrienes (LT), produced from arachidonic acid in the phospholipids of cell membranes, are considered to be biologically active eicosanoids. Corticosteroids reduce eicosanoid production by impairing phospholipase A2 activation, while cyclo-oxygenase inhibiting drugs such as the nonsteroidal anti-inflammatory drugs (NSAID) suppress PG and TX production. PGE1 (alprostadil) and PGE2 (dinoprostone) therapy has been shown to improve oxygenation in neonates whose pulmonary and systemic blood flow are dependent on a patent ductus arteriosus, while epoprostenol (prostacyclin, PGI2) and beraprost (beraprost sodium), another PGI2 analogue, are often effective as acute vasodilators in paediatric pulmonary hypertension. Synthetic PGE analogues such as misoprostol have gastric antisecretory and cytoprotective effects, and are effective in both prophylaxis and treatment of NSAID-induced gastroduodenal mucosal lesions. Both alprostadil and epoprostenol have been shown to be effective in treating peripheral vascular and skin diseases. Since TX, a platelet aggregator and vasoconstrictor, has been implicated as a potential mediator of asthma, its inhibition by agents such as seratrodast (AA-2414) and ozagrel (OKY-046) has proven effective in the treatment of adult patients with asthma; studies of these agents in paediatric patients is awaited with interest. Developing the clinical use of eicosanoid-related drugs and assessing the potential use of these drugs requires a 3-phase approach: reducing the complications in the treatment of neonates with ductus-dependent congenital heart diseases and primary pulmonary hypertension requiring PGE1, PGE2

  4. Paediatric manpower.

    PubMed Central

    Liberman, M M; Bellman, M H

    1982-01-01

    Two investigations of paediatric manpower in England, Wales, and Northern Ireland were carried out, each using a different method. The first survey located registrars and senior registrars and checked on their occupational status 3 years later in order to see which ones had been promoted. Loss factors--such as emigration, retirement for personal reasons, part-time training, or transfer to general practice, community paediatrics, or other medical specialties--were examined closely. The second survey was a cross-sectional analysis of the entire paediatric establishment. It examined in particular the distribution of consultants and registrars. Using figures from survey 2 and loss factors from survey 1, a model of the paediatric career structure could be constructed. This showed that the present career pyramid would be unable to absorb the current number of registrars in training. There is an urgent need for a comprehensive registration scheme for registrars, especially those with honorary contracts, who are not currently included in official records. Paediatrics is unique in having a high proportion of women for whom there is little opportunity of reconciling career aspirations with family commitments. PMID:7125690

  5. The evolution of paediatrics from archaeological times to the mid-nineteenth century and the historical influence on present day practice.

    PubMed

    Rangroo, Vinita

    2008-05-01

    The history of childcare dates back to the beginning of time. This article critically analyses the history of paediatrics from its roots to mid-nineteenth century with the view to examine its evolution and influence on today's practice. Paediatrics as a sub-speciality of medicine only began in the fifteenth century when the Four Incunabula were published in the West. This was the first attempt at producing a comprehensive and accessible reference paediatric text. However, long before the Incunabula, early traces of childcare are found in different cultures like Egyptian, Indian and Chinese. Modern paediatrics is a highly advanced field of medicine that relies on many recent technological innovations. In spite of these, this paper concludes that paediatrics today is very much based on concepts, such as observation and clinical skills, introduced many centuries ago. The basic approach used in everyday clinical practice owes more to century-old ideas of scientists. PMID:18394119

  6. The world's longest surviving paediatric practices: some themes of Aboriginal medical ethnobotany in Australia.

    PubMed

    Pearn, John

    2005-01-01

    Contemporary paediatric practices of Australian Aboriginal men and women, in more than 100 Aboriginal Language Groups, comprise a living discipline whose origins predate Western medicine by tens of millennia. The history of paediatrics acknowledges this surviving continuum of the world's oldest child-care practices. Because of the inextricable nexus between Aboriginal men and women and the land in which they live, medical ethnobotany forms a major part of the medical aspects of Aboriginal child care. Traditional tribal healers, called 'Nungungi' in some language groups of Central Australia, are identified as such whilst still young children and are given special education in the healing arts, especially that of medical ethnobotany, by older healers. Distinct from this specialized role, all Aboriginal men and women (and in particular grandmothers) in traditional communities use a sophisticated botanical materia medica in the treatment of sick and injured children. In cultures in transition, medical ethnobotanical practices may persist long after the local use of flora as sources of traditional food, weaponry, totemic identity and religious rites have disappeared. Some selected botanical 'cures' were adopted by early European settlers and a number of such relict uses have become part of mainstream Western life today, particularly as this applies to self-medication. Drugs and medicaments used in the treatment of children are obtained from leaves, bark, roots and flowers, usually as fresh preparations. They are prepared as infusions, decoctions and macerations and may be enjoined with emollients such as emu or kangaroo fat for topical application. Botanical drugs and medicaments are usually prepared fresh for each administration and are rarely stored. Contemporary Australian ethnobotany exploits the medicinal properties of more than 100 genera - using such extracts as antiseptics, analgesics, astringents, antipyretics, sedatives, hypnotics, expectorants and

  7. Neurodevelopmental and behavioural paediatrics.

    PubMed

    McDowell, Michael

    2015-01-01

    One of the notable shifts in Paediatrics across the last 50 years has been towards disorders that are chronic and qualitative in nature. In addition to physical health, these impact on childhood development, behaviour and wellbeing. Understanding and management of these problems extends the traditional biological toolkit of paediatrics into the complexities of uncertainties of psychological and social context. In Australasia, the profession has responded with the development of Community Paediatrics as a recognised sub-specialty, of which Neurodevelopmental and Behavioural Paediatrics is an important component. These developments are reviewed along with consideration of future challenges for this field of health care. PMID:25586854

  8. The Impact and Successes of a Paediatric Endocrinology Fellowship Program in Africa.

    PubMed

    Odundo, Gordon Otieno; Ngwiri, Thomas; Otuoma, Olivia; Laigong, Paul; Mukhwana, Renson; Limbe, Mary Slessor; Chanzu, Nadia Musimbi

    2016-01-01

    Background. The prevalence and distribution of endocrine disorders in children in Africa are not well known because most cases are often undiagnosed or diagnosed too late. The awareness of this led to the launch of the Paediatric Endocrinology Training Center for Africa (PETCA) designed to improve quality and access to health care by training paediatricians from Africa in paediatric endocrinology. Methods. The fellowship is undertaken over an 18-month period: six months of clinical and theoretical training in Kenya, nine months of project research at the fellow's home country, and three months of consolidation in Kenya. Upon completion, certified paediatricians are expected to set up centers of excellence. Results. There have been two phases, phase I from January 2008 to October 2012 and phase II from January 2012 to April 2015. Fifty-four fellows from 12 African countries have been certified, 34 (phase I) and 20 (phase II). Over 1,000 patients with wide ranging diabetes and endocrine disorders have been diagnosed and treated and are being followed up at the centers of excellence. Conclusion. The successes of the PETCA initiative demonstrate the impact a capacity building and knowledge transfer model can have on people in resource-poor settings using limited resources. PMID:26904118

  9. The Impact and Successes of a Paediatric Endocrinology Fellowship Program in Africa

    PubMed Central

    Odundo, Gordon Otieno; Ngwiri, Thomas; Otuoma, Olivia; Laigong, Paul; Mukhwana, Renson; Limbe, Mary Slessor; Chanzu, Nadia Musimbi

    2016-01-01

    Background. The prevalence and distribution of endocrine disorders in children in Africa are not well known because most cases are often undiagnosed or diagnosed too late. The awareness of this led to the launch of the Paediatric Endocrinology Training Center for Africa (PETCA) designed to improve quality and access to health care by training paediatricians from Africa in paediatric endocrinology. Methods. The fellowship is undertaken over an 18-month period: six months of clinical and theoretical training in Kenya, nine months of project research at the fellow's home country, and three months of consolidation in Kenya. Upon completion, certified paediatricians are expected to set up centers of excellence. Results. There have been two phases, phase I from January 2008 to October 2012 and phase II from January 2012 to April 2015. Fifty-four fellows from 12 African countries have been certified, 34 (phase I) and 20 (phase II). Over 1,000 patients with wide ranging diabetes and endocrine disorders have been diagnosed and treated and are being followed up at the centers of excellence. Conclusion. The successes of the PETCA initiative demonstrate the impact a capacity building and knowledge transfer model can have on people in resource-poor settings using limited resources. PMID:26904118

  10. The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey

    ERIC Educational Resources Information Center

    Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

    2012-01-01

    Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

  11. Discussing Patient Management Online: The Impact of Roles on Knowledge Construction for Students Interning at the Paediatric Ward

    ERIC Educational Resources Information Center

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-01-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection…

  12. Organisation of workplace learning: a case study of paediatric residents' and consultants' beliefs and practices.

    PubMed

    Skipper, Mads; Nøhr, Susanne Backman; Jacobsen, Tine Klitgaard; Musaeus, Peter

    2016-08-01

    Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of medical specialist training. An explorative case study in three paediatric departments in Denmark including 9 days of field observations and focus group interviews with 9 consultants responsible for medical education and 16 residents. The study aimed to identify factors in work organisation facilitating and hindering residents' learning. Data were coded through an iterative process guided by thematic analysis. Findings illustrate three main themes: (1) Learning beliefs about patient care and apprenticeship learning as inseparable in medical practice. Beliefs about training and patient care expressed in terms of training versus production caused a potential conflict. (2) Learning context. Continuity over time in tasks and care for patients is important, but continuity is challenged by the organisation of daily work routines. (3) Organisational culture and regulations were found to be encouraging as well inhibiting to a successful organisation of the work in regards to learning. Our findings stress the importance of consultants' and residents' beliefs about workplace learning as these agents handle the potential conflict between patient care and training of health professionals. The structuring of daily work tasks is a key factor in workplace learning as is an understanding of underlying relations and organisational culture in the clinical departments. PMID:26696031

  13. How have the past 5 years of research changed clinical practice in paediatric nephrology?

    PubMed Central

    Marks, Stephen D

    2007-01-01

    Clinical practice in paediatric nephrology is continuously evolving to mirror the research output of the 21st century. The management of antenatally diagnosed renal anomalies, urinary tract infections, nephrotic syndrome and hypertension is becoming more evidence based. Obesity and related hypertension is being targeted at primary and secondary care. The evolving field of molecular and cytogenetics is discovering genes that are facilitating clinicians and families with prenatal diagnoses and understanding of disease processes. The progression of chronic kidney disease in childhood to end‐stage renal failure (ESRF) can be delayed using medical treatment to reduce proteinuria and treat hypertension. Pre‐emptive living‐related renal transplantation has become the treatment of choice for children with ESRF, thereby reducing the morbidity and mortality associated with peritoneal and haemodialysis. Although peritoneal dialysis, which is performed in the patient's home, is the preferred modality for children for whom there is no living or deceased donor for transplantation, home nocturnal haemodialysis is becoming a feasible option. Imaging modalities with the use of magnetic resonance and computerised tomography are continuously improving. As mortality for renal and vasculitic diseases improves, the gauntlet is now thrown down to reduce morbidity with secondary prevention of longer‐term complications such as atherosclerosis and hyperlipidaemia. Clinical and drug trials in the fields of hypertension, nephrotic syndrome, systemic lupus erythematosus, vasculitis and transplantation are producing more effective treatments, thereby reducing the morbidity resulting from the disease processes and the side effects of drugs. PMID:17376945

  14. What Evidence Underlies Clinical Practice in Paediatric Surgery? A Systematic Review Assessing Choice of Study Design

    PubMed Central

    Allin, Benjamin; Knight, Marian

    2016-01-01

    Objective Identify every paediatric surgical article published in 1998 and every paediatric surgical article published in 2013, and determine which study designs were used and whether they were appropriate for robustly assessing interventions in surgical conditions. Methods A systematic review was conducted according to a pre-specified protocol (CRD42014007629), using EMBASE and Medline. Non-English language studies were excluded. Studies were included if meeting population criteria and either condition or intervention criteria. Population: Children under the age of 18, or adults who underwent intervention for a condition managed by paediatric surgeons when they were under 18 years of age. Condition: One managed by general paediatric surgeons. Intervention: Used for treatment of a condition managed by general paediatric surgeons. Main Outcome Measure Studies were classified according to whether the IDEAL collaboration recommended their design for assessing surgical interventions or not. Change in proportions between 1998 and 2013 was calculated. Results 1581 paediatric surgical articles were published in 1998, and 3453 in 2013. The most commonly used design, accounting for 45% of studies in 1998 and 46.8% in 2013, was the retrospective case series. Only 1.8% of studies were RCTs in 1998, and 1.9% in 2013. Overall, in 1998, 9.8% of studies used a recommended design. In 2013, 11.9% used a recommended design (proportion increase 2.3%, 95% confidence interval 0.5% increase to 4% increase, p = 0.017). Conclusions and Relevance A low proportion of published paediatric surgical manuscripts utilise a design that is recommended for assessing surgical interventions. RCTs represent fewer than 1 in 50 studies. In 2013, 88.1% of studies used a less robust design, suggesting the need for a new way of approaching paediatric surgical research. PMID:26959824

  15. Early impact of rotavirus vaccination in a large paediatric hospital in the UK.

    PubMed

    Hungerford, D; Read, J M; Cooke, R P D; Vivancos, R; Iturriza-Gómara, M; Allen, D J; French, N; Cunliffe, N

    2016-06-01

    The impact of routine rotavirus vaccination on community-acquired (CA) and healthcare-associated (HA) rotavirus gastroenteritis (RVGE) at a large paediatric hospital, UK, was investigated over a 13-year period. A total of 1644 hospitalized children aged 0-15 years tested positive for rotavirus between July 2002 and June 2015. Interrupted time-series analysis demonstrated that, post vaccine introduction (July 2013 to June 2015), CA- and HA-RVGE hospitalizations were 83% [95% confidence interval (CI): 72-90%) and 83% (95% CI: 66-92%] lower than expected, respectively. Rotavirus vaccination has rapidly reduced the hospital rotavirus disease burden among both CA- and HA-RVGE cases. PMID:26876744

  16. Off-label use of maraviroc in HIV-1-infected paediatric patients in clinical practice.

    PubMed

    Palladino, Claudia; Gómez, María Luisa Navarro; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Espiau, María; Hoyos, Santiago Pérez; León-Leal, Juan Antonio; Méndez, María; Moreno-Pérez, David; Guasch, Claudia Fortuny; Sierra, Antoni Mur; Guruceta, Itziar Pocheville; Guillén, Santiago Moreno; Briz, Verónica

    2015-10-23

    Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs. PMID:26544580

  17. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement.

    PubMed

    Patel, Sanjay; Abrahamson, Ed; Goldring, Stephen; Green, Helen; Wickens, Hayley; Laundy, Matt

    2015-02-01

    There is compelling evidence to support the rationale for managing children on intravenous antimicrobial therapy at home whenever possible, including parent and patient satisfaction, psychological well-being, return to school/employment, reductions in healthcare-associated infection and cost savings. As a joint collaboration between the BSAC and the British Paediatric Allergy, Immunity and Infection Group, we have developed good practice recommendations to highlight good clinical practice and governance within paediatric outpatient parenteral antibiotic therapy (p-OPAT) services across the UK. These guidelines provide a practical approach for safely delivering a p-OPAT service in both secondary care and tertiary care settings, in terms of the roles and responsibilities of members of the p-OPAT team, the structure required to deliver the service, identifying patients and pathologies that are suitable for p-OPAT, ensuring appropriate vascular access, antimicrobial choice and delivery and the clinical governance aspects of delivering a p-OPAT service. The process of writing a business case to support the introduction of a p-OPAT service is also addressed. PMID:25331058

  18. The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective

    PubMed Central

    2014-01-01

    Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has been done on parental presence it often focuses primarily on the parents or staff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the emotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping with post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental accompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether accompaniment would be of benefit to their patient population. The lack of published data does not enable a formal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the preference in land based conveyance. Future research is needed into the emotional recovery of children after trauma, as well as the experiences of patient, parent and staff during conveyance. PMID:24887082

  19. Impact of complex NOTCH1 mutations on survival in paediatric T-cell leukaemia

    PubMed Central

    2012-01-01

    Background Molecular alterations occur frequently in T-ALL and the potential impact of those abnormalities on outcome is still controversial. The current study aimed to test whether NOTCH1 mutations and additional molecular abnormalities would impact T-ALL outcome in a series of 138 T-ALL paediatric cases. Methods T-ALL subtypes, status of SIL-TAL1 fusion, ectopic expression of TLX3, and mutations in FBXW7, KRAS, PTEN and NOTCH1 were assessed as overall survival (OS) and event-free survival (EFS) prognostic factors. OS and EFS were determined using the Kaplan-Meier method and compared using the log-rank test. Results The frequencies of mutations were 43.5% for NOTCH1, while FBXW7, KRAS and PTEN exhibited frequencies of 19.1%, 9.5% and 9.4%, respectively. In 78.3% of cases, the coexistence of NOTCH1 mutations and other molecular alterations was observed. In multivariate analysis no statistical association was revealed between NOTCH1 mutations and any other variable analyzed. The mean length of the follow-up was 68.4 months and the OS was 50.7%. SIL-TAL1 was identified as an adverse prognostic factor. NOTCH1 mutation status was not associated with outcome, while the presence of NOTCH1 complex mutations (indels) were associated with a longer overall survival (p = 0.031) than point mutations. Conclusion NOTCH1 mutations alone or in combination with FBXW7 did not impact T-ALL prognosis. Nevertheless, complex NOTCH1 mutations appear to have a positive impact on OS and the SIL-TAL1 fusion was validated as a negative prognostic marker in our series of T-ALL. PMID:22225590

  20. Impact of a Virtual Clinic in a Paediatric Cardiology Network on Northeast Brazil.

    PubMed

    de Araújo, Juliana Sousa Soares; Dias Filho, Adalberto Vieira; Silva Gomes, Renata Grigório; Regis, Cláudio Teixeira; Rodrigues, Klecida Nunes; Siqueira, Nicoly Negreiros; Albuquerque, Fernanda Cruz de Lira; Mourato, Felipe Alves; Mattos, Sandra da Silva

    2015-01-01

    Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals. PMID:26265913

  1. Impact of a Virtual Clinic in a Paediatric Cardiology Network on Northeast Brazil

    PubMed Central

    de Araújo, Juliana Sousa Soares; Dias Filho, Adalberto Vieira; Silva Gomes, Renata Grigório; Regis, Cláudio Teixeira; Rodrigues, Klecida Nunes; Siqueira, Nicoly Negreiros; Albuquerque, Fernanda Cruz de Lira; Mourato, Felipe Alves; Mattos, Sandra da Silva

    2015-01-01

    Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals. PMID:26265913

  2. The impact of early viral infections and graft-versus-host disease on immune reconstitution following paediatric stem cell transplantation.

    PubMed

    Olkinuora, H; von Willebrand, E; Kantele, J M; Vainio, O; Talvensaari, K; Saarinen-Pihkala, U; Siitonen, S; Vettenranta, K

    2011-06-01

    Viral infections and graft-versus-host disease (GVHD) render an impact on both the clinical and immunological recovery following allogeneic hematopoietic stem cell transplantation (HSCT). We studied the recuperation of the immune defence after transplant in the paediatric setting and assessed the impact of early (<100 days post-HSCT) viral [cytomegalovirus (CMV), Ebstein-Barr virus (EBV) and adenovirus] reactivations/infections and GVHD. Fifty-one paediatric recipients of HSCT were enrolled. T cell recovery was evaluated on lymphocyte subpopulations using flow cytometry and functionally by measuring T cell excision circles (TRECs) and through the analysis of T lymphocyte responses to mitogens. B cell recovery was studied by flow cytometry and functionally by ELISPOT. Acute and mild chronic GVHD allowed for a brisk recovery of both cellular and humoral immunity while moderate to severe chronic graft-versus-host disease (cGVHD) associated with a significant, tampering effect on the immunological recovery after transplant. In the former group, the early viral reactivations/infections seemingly linked with a delayed recovery of T lymphocytes and low TRECs values. Moderate to severe cGVHD appears to associate with an impaired immunological recovery after HSCT. Early viral infections linked with prolonged T cell immunodeficiency and thymic dysfunction may be indicative of the presence of subclinical GVHD. PMID:21323694

  3. Media Coverage of Youth Suicides and Its Impact on Paediatric Mental Health Emergency Department Presentations

    PubMed Central

    Leon, Stephanie L.; Cloutier, Paula; BéLair, Marc-André; Cappelli, Mario

    2014-01-01

    Background: To examine mental health (MH) presentations to the emergency department (ED) of a paediatric hospital following two highly publicized local teen suicides. Methods: Youths aged 12–18 years with a MH chief complaint and/or diagnosis were included. Differences in frequencies were analyzed using chi-square tests, and relative risks were evaluated using generalized linear modelling. Results: Significant increases in the number of ED presentations were found within the months of the publicized suicides compared to the same months of previous years. No differences were found in symptom acuity, suicidal status and psychiatric hospitalization rates. Significant increases were found in relative risk of presenting to the ED 28 and 90 days post both publicized suicides. Conclusions: Results suggest there was an association between highly publicized suicides and an increase in the number of MH presentations to the local paediatric ED. Considerations of media's potentially positive role in MH awareness are needed. PMID:25410699

  4. Impacted Sharp Oesophageal Foreign Bodies--A Novel Technique of Removal with the Paediatric Bronchoscope.

    PubMed

    Mitra, Aparajita; Bajpai, Minu

    2016-04-01

    Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl. PMID:26851436

  5. The impact of injury severity on long-term social outcome following paediatric traumatic brain injury.

    PubMed

    Muscara, Frank; Catroppa, Cathy; Eren, Senem; Anderson, Vicki

    2009-08-01

    Despite suggestions that paediatric traumatic brain injury (TBI) disrupts social skill development, few studies have investigated long-term social outcome following the transition into adulthood. The current study aimed to investigate long-term social outcome, in a sample of 36 survivors who suffered a mild, moderate or severe TBI between 8 and 12 years of age. At 7-10 years post-injury, the age of participants ranged between 16 and 22 years. Social outcome was assessed using a number of self-rated and parent-rated questionnaires, in order to obtain self- and other-rated accounts of the groups' current social functioning. Predictors of long-term social outcome were also explored, with findings suggesting that young people who suffered mild TBI during childhood tended to be functioning at a higher level on some measures of social functioning, compared to those that suffered a moderate and severe injury. Further, results suggested that pre-injury adaptive functioning and socio-economic status predicted long-term functioning for some measures of social outcome. Finally, social problem-solving skills predicted the success of social reintegration post-TBI. These preliminary findings indicate that there is a risk of social difficulties following paediatric TBI continuing into adulthood, and that a number of demographic, social, and neuropsychological variables continue to predict social outcome even at this late stage post-injury. PMID:18839384

  6. Paediatric diabetes.

    PubMed

    Kalra, Sanjay

    2013-09-01

    Diabetes does not spare any section of society, and its prevalence in the paediatric and adolescent age group is rising. This review highlights the etiological and clinical features of childhood diabetes, including secular changes in epidemiology. It discusses the aspects of non pharmacological and pharmacological therapy which are unique to the paediatric age group, and explores current use of novel therapeutic modalities. The article calls for modulation of the psychological environment of the child with diabetes, to help improve his or her quality of life, and sensitizes physicians to take proactive, affirmative action to address the special needs of children with type1 diabetes. PMID:24601207

  7. The reduction of dose in paediatric panoramic radiography: the impact of collimator height and programme selection

    PubMed Central

    Safi, H; Maddison, S M

    2015-01-01

    Objectives: The aim of this work was to estimate the doses to radiosensitive organs in the head of a young child undergoing panoramic radiography and to establish the effectiveness of a short collimator in reducing dose. Methods: Thermoluminescent dosemeters were used in a paediatric head phantom to simulate an examination on a 5-year-old child. The panoramic system used was an Instrumentarium OP200 D (Instrumentarium Dental, Tuusula, Finland). The collimator height options were 110 and 140 mm. Organ doses were measured using exposure programmes intended for use with adult and child size heads. The performance of the automatic exposure control (AEC) system was also assessed. Results: The short collimator reduced the dose to the brain and the eyes by 57% and 41%, respectively. The dose to the submandibular and sublingual glands increased by 32% and 20%, respectively, when using a programme with a narrower focal trough intended for a small jaw. The effective dose measured with the short collimator and paediatric programme was 7.7 μSv. The dose to the lens of the eye was 17 μGy. When used, the AEC system produced some asymmetry in the dose distribution across the head. Conclusions: Panoramic systems when used to frequently image children should have programmes specifically designed for imaging small heads. There should be a shorter collimator available and programmes that deliver a reduced exposure time and allow reduction of tube current. Programme selection should also provide flexibility for focal trough size, shape and position to match the smaller head size. PMID:25352427

  8. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    PubMed

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level. PMID:26924486

  9. "Age-Appropriate Development" as Measure and Norm: An Ethnographic Study of the Practical Anthropology of Routine Paediatric Checkups

    ERIC Educational Resources Information Center

    Kelle, Helga

    2010-01-01

    The article provides an ethnographic study of the logic of conducting routine paediatric checkups in children from birth to the age of 5 in Germany (U1 to U9). These checkups are meant as a continual evaluation of a child's developmental process and progress, and their outcomes inform decisions on children's careers in educational institutions.…

  10. [The Appointment of Paediatric Professorships in the Soviet Occupation Zone and the early GDR. The Impact of the Political System Change after 1945].

    PubMed

    Hinz-Wessels, Annette

    2016-01-01

    This paper examines the impact of the political system change after 1945 on the appointment of paediatric professorships in the Soviet Occupation Zone and the GDR up until the time the Wall was built in 1961. It can be demonstrated that the political purge in the post-war period had only minor impact on the appointment of professorships and the National Socialist past no longer mattered after the conclusion of denazification. In 1957, the proportion of former NSDAP members among East German university professors of paediatrics was 100 per cent. When it came to new appointments, both members of the "bourgeois" academic non-professorial teaching staff from the GDR as well as paediatricians from West Germany, who had largely gained their scientifically qualifications under National Socialism, were in the running. A politically-controlled elite exchange did not take place until the construction of the Wall. State and party organs generally followed the personnel proposals of the universities since an insufficient number of qualified candidates was available for the systematic appointment of ,,progressive" paediatricians. Given the lack of staff, the SED personnel policy was aimed at the integration of previous elites, as long as they behaved loyally towards the new state. Since the East German faculties continued to make the questioning of the professionally competent professors in West Germany and East Germany the basis for their appointment lists, West German university paediatricians were able to exert considerable influence on the appointment of East German paediatric professorship until 1960s. PMID:27476257

  11. Paediatric blood pressure and anaesthesia.

    PubMed

    Mather, C M

    1991-05-01

    One percent of children have appreciably and consistently raised arterial blood pressure. A 7-year-old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures? PMID:2035786

  12. Whole-genome sequencing as standard practice for the analysis of clonality in outbreaks of meticillin-resistant Staphylococcus aureus in a paediatric setting.

    PubMed

    Ugolotti, E; Larghero, P; Vanni, I; Bandettini, R; Tripodi, G; Melioli, G; Di Marco, E; Raso, A; Biassoni, R

    2016-08-01

    Meticillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital-associated infections. This study investigated the potential use of whole-genome sequencing (WGS) for surveillance purposes by re-examining MRSA strains related to past outbreaks among hospitalized paediatric patients. WGS data ameliorated the genotypic profile previously obtained with Sanger sequencing and pulsed-field gel electrophoresis typing, and discriminated between strains that were related and unrelated to the outbreaks. This allowed strain clonality to be defined with a higher level of resolution than achieved previously. This study demonstrates the potential of WGS to trace hospital outbreaks, which may lead to WGS becoming standard practice in outbreak investigations. PMID:27184087

  13. Surgical strategies in paediatric inflammatory bowel disease

    PubMed Central

    Baillie, Colin T; Smith, Jennifer A

    2015-01-01

    Inflammatory bowel disease (IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn’s disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid (distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum (pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice. PMID:26034347

  14. JACIE accreditation in paediatric haemopoietic SCT.

    PubMed

    Cornish, J M

    2008-10-01

    The Joint Accreditation Committee of the International Society for Cellular Therapy (ISCT) and European Group for Blood and Marrow Transplantation (EBMT), known as JACIE, is a nonprofit body established for the purposes of assessment and accreditation in the field of haemopoietic SCT (HSCT). The committee was established in 1999 with the aim of creating a standardized system of accreditation officially recognized across Europe and based on the accreditation standards established by the US-based Foundation for the Accreditation of Cellular Therapy (FACT). The major objectives of JACIE are to improve the quality of HSCT in Europe by providing a means whereby transplant centres, cell collection facilities and processing facilities can demonstrate high-quality practice. JACIE launched its official inspection programme in January 2004, and since then more than 35 centres in Europe have been inspected. The history of paediatric-specific accreditation guidelines has lagged behind the overall development but is now incorporated within the standards. There is now acknowledgement that a paediatric transplant team will be headed by a paediatric programme director, that an independent paediatric unit will perform no less than 10 allogeneic transplants in children under the age of 18 per year, be looked after by nurses and junior doctors specifically trained in paediatric practice and have access to paediatric subspecialties with an intensive care unit on site. Paediatric units will be examined by a paediatric-trained inspector. Remaining issues of difference with the guidelines relate to the numbers required for accreditation in combined units. Overall, the paediatric community in Europe has embraced the JACIE guidelines. JACIE is working more closely with other international organizations in cellular therapy to develop international standards for all aspects of SCT. The recent implementation of Directive 2004/23/EC has provided an impetus for the implementation of JACIE in

  15. Impact of 24 hour critical care physician staffing on case-mix adjusted mortality in paediatric intensive care.

    PubMed

    Goh, A Y; Lum, L C; Abdel-Latif, M E

    2001-02-10

    The 24 h availability of intensive care consultants (intensivists) has been shown to improve outcomes in adult intensive care units (ICU) in the UK. We tested whether such availability would improve standardised mortality ratios when compared to out-of-hours cover by general paediatricians in the paediatric ICU setting of a medium-income developing country. The standardised mortality ratio (SMR) improved significantly from 1.57 (95%CI 1.25-1.95) with non-specialist care to 0.88 (95%CI 0.63-1.19) with intensivist care (rate ratio 0.56, 95% CI 0.47-0.67). Mortality odds ratio decreased by 0.234, 0.246 and 0.266 in the low, moderate and high-risk patients. 24 h availability of intensivists was associated with improved outcomes and use of resources in paediatric intensive care in a developing country. PMID:11273070

  16. Practical Collaborations for Positive Impact

    ERIC Educational Resources Information Center

    Newton, Andrew R.; Maher, Michelle A.; Smith, Douglas A.

    2015-01-01

    Assessment has assumed an increasingly prominent place in academic and student affairs practice. Yet, in smaller student affairs departments with limited staffing and resources, how might a department identify the resources or time to thoroughly assess student learning outcomes? This Notes in Brief details the partnership between the University of…

  17. Understanding and evaluating the effects of implementing an electronic paediatric prescribing system on care provision and hospital work in paediatric hospital ward settings: a qualitatively driven mixed-method study protocol

    PubMed Central

    Farre, Albert; Cummins, Carole

    2016-01-01

    Introduction Electronic prescribing systems can improve the quality and safety of healthcare services, but their implementation is not straightforward and may create unexpected change. However, the added complexity of paediatric prescribing (eg, dose calculations, dilutions, manipulations) may pose additional challenges. This study will aim to (1) understand the complex organisational reality of a paediatric hospital in which a new electronic paediatric prescribing (ePP) system will be introduced; (2) describe ePP-related change, over time, in paediatric hospital ward settings; (3) explore staff perspectives in relation to currently established practices and processes; and (4) assess the impact of ePP on care provision and hospital work from the perspective of paediatricians, paediatric nurses and managers. Methods and analysis A qualitatively driven mixed-method approach will be adopted, including 3 inter-related substudies. The core component of the study will be qualitative (substudy 1): we will use ethnographic research methods, including non-participant observation in wards and informal conversational interviews with members of staff. In addition, the design will include 2 embedded supplementary components: a qualitative 1 (substudy 2) based on in-depth interviews and/or focus groups with paediatricians, paediatric nurses, paediatric pharmacists/pharmacy technicians and managers; and a quantitative 1 (substudy 3) in which a staff survey will be developed and administered before and after the ePP implementation. Analytic themes will be identified from ethnographic field notes and interview data. Survey data will be analysed using descriptive statistics and baseline and follow-up data compared to establish impact evaluation measures. Ethics and dissemination A favourable ethical opinion has been obtained from a National Health Service (NHS) Research Ethics Committee (15/SS/0157). NHS research governance approval has been obtained at the relevant hospital site

  18. Paediatric cardiac nursing education: a national collaboration.

    PubMed

    Cook, Kerry; Daniels, Amanda; Sheehan, Karen; Langton, Helen

    2006-02-01

    Educational courses for staff working in paediatric specialties may not be financially viable because of the small numbers involved and the difficulties that potential students have in getting released from their units. The UK Paediatric Cardiac Nurses Association worked with other groups to explore the feasibility of a national multi-professional paediatric cardiac education pathway. Three options were identified, including the continuation of local in-house provision with its associated variation in standards. The relative benefits and resource implications of each option were explored and approaches made to educational institutions for support in developing the pathway. A university with an established reputation for e-learning undertook this development and a post graduate certificate in Paediatric Cardiothoracic Practice will soon be available. PMID:16518954

  19. Diagnostic paediatric imaging

    SciTech Connect

    Hall, C.M.; Lingam, S.

    1986-01-01

    This book is a case study teaching manual presenting radiographs and examples of other imaging modalities from 100 paediatric patients. The material comes from the radiological teaching collection at the Hospital for Sick Children at Great Ormond Street in London and was compiled over a ten year period. With each case a short clinical history is given and a series of questions posed, similar to those encountered in postgraduate medical examinations. Sample answers with comments and more illustrations are presented on the following page. The last decade has seen a rapid expansion in the range and sophistication of diagnostic imaging modalities which are available to clinicians. Since it is impossible to achieve comprehensive coverage in a book of this size, the authors have selected examples of cases which illustrate the range of imaging modalities currently available and which may be encountered in both clinical practice and in examinations.

  20. Paediatric anaesthesia: an overview.

    PubMed

    Langton, Helen Elizabeth

    2015-10-28

    This article provides an overview of the nursing considerations for paediatric anaesthesia. It is aimed at newly qualified operating department practitioners and anaesthetic nurses, and those with limited experience in the care of paediatric patients. It explores the ways in which paediatric anatomy and physiology differ from those of adults and looks at the implications for treatment in the anaesthetic environment. It also discusses the equipment required and the rationale for its use. PMID:26508256

  1. What's new in paediatric dentistry?

    NASA Astrophysics Data System (ADS)

    Vitale, M. C.

    2016-03-01

    Since the early 80's, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner. In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a "micro-invasive" dentistry and a "clean" surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.

  2. Where should paediatric surgery be performed?

    PubMed

    Arul, G S; Spicer, R D

    1998-07-01

    evidence that all neonatal surgery and anaesthesia should be conducted only by specialists. The debate now centres around the number of complex surgical cases a unit should treat to maintain its specialist status. The NHS executive, in its guidelines on contracting for specialist services, emphasises that "Sensible contracting needs to take into account the optimum population size not only for the stability of contracted referrals but also to give sufficient 'critical mass' for clinical effectiveness." Achieving this balance has consequences, not just for the maintenance of surgical expertise, but for the essential ancilliary services. There is clear evidence in anaesthesia that anaesthetists doing small numbers of neonatal procedures had significantly worse results. The same seems to be true in the fields of oncology, radiology, pathology, and intensive care. The reasons why the results of management of certain paediatric conditions are better at specialist centres are open to speculation. Presumably greater exposure to rare complex cases, concentration of expertise, more peer review, and a trickle down effect of the multidisciplinary approach all help to keep health care workers up to date with current world practice. In addition, it allows for appropriate specialist on call rotas and dedicated junior staff. If insufficient numbers of specialist surgical cases are being treated at a centre then the whole multidisciplinary team suffers. The 1989 NCEPOD report states "that paediatricians and general surgeons must recognise that small babies differ from other patients not only in size, and that they pose quite separate problems of pathology and management." The need for large centres of paediatric surgical expertise is now accepted by the Royal College of Surgeons of England, the British Association of Paediatric Surgeons, the Senate of Surgery of Great Britain and Ireland, the Royal College of Paediatrics and Child Health, the Royal College of Anaesthetists, the Audit PMID

  3. Measuring the Expertise of Paediatric Rehabilitation Therapists

    ERIC Educational Resources Information Center

    King, Gillian; Bartlett, Doreen J.; Currie, Melissa; Gilpin, Michelle; Baxter, Donna; Willoughby, Colleen; Tucker, Mary Ann; Strachan, Deborah

    2008-01-01

    This article describes the development of a classification system to measure the expertise levels of practicing paediatric rehabilitation therapists. Seventy-five therapists from five disciplines (physical, occupational, speech-language, behaviour, and recreational therapy) were involved, along with 170 peers, and 188 parents of children with…

  4. Use of smartphone apps by paediatric trainees.

    PubMed

    Jyothi, Srinivas; Halton, Fiona; Goodyear, Helen

    2015-08-01

    Over 70% of the population owns a smartphone and there are now millions of apps available. This study looks at smartphone and app use among paediatric trainees, in particular whether they are accessing medical apps to help with clinical practice. PMID:26255919

  5. Gene therapy for paediatric leukaemia.

    PubMed

    Rousseau, R F; Bollard, C M; Heslop, H E

    2001-07-01

    Improvements in the chemotherapeutic and transplant regimens have had a significant impact in improving survival rates for paediatric leukaemia. However, there are still important problems to address including what options are available for patients with chemoresistant disease and what strategies are available to avoid the concerns regarding the toxicity associated with highly cytotoxic treatment regimens. Gene therapy and immunotherapy protocols hold great promise. Using gene transfer of a marker gene, a number of biological issues in the therapy of leukaemia have been addressed. For example, by gene marking autologous bone marrow grafts it has been possible to demonstrate that infused marrow contributes to relapse in acute and chronic myeloid leukaemias. In the allogeneic transplant setting, genetically modified T-cells have proven valuable for the prophylaxis and treatment of viral diseases and may have an important role in preventing or treating disease relapse. Gene transfer is also being used to modify tumour function, enhance immunogenicity, and confer drug-resistance to normal haematopoietic stem cells. With the continued scientific advancements in this field, gene therapy will almost certainly have a major impact on the treatment of paediatric leukaemia in the future. PMID:11727502

  6. Paediatric asthma and obesity.

    PubMed

    Lucas, Sean R; Platts-Mills, Thomas A E

    2006-12-01

    None of the explanations proposed for the increase in paediatric asthma have been adequate. It is becoming apparent that the cause of the increase in asthma must be multi-factorial. Increasing attention has been focused on the role of lifestyle in the development of asthma. Lifestyle changes that have occurred in children are those in diet and decreased physical activity, with obesity being the product of these changes. The increase in asthma, obesity and a sedentary lifestyle have occurred together. However, a temporal relationship between asthma, obesity and decreased physical activity has not been determined in the paediatric literature. Limited data suggest that decreased physical activity could be playing a role in the aetiology of asthma independent of obesity. Furthermore, there has been substantial research on the benefits of exercise programmes for paediatric patients with asthma. Longitudinal trials monitoring physical activity, obesity and the development of asthma are needed. PMID:17098637

  7. Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England

    PubMed Central

    Harron, Katie; Mok, Quen; Hughes, Dyfrig; Muller-Pebody, Berit; Parslow, Roger; Ramnarayan, Padmanabhan; Gilbert, Ruth

    2016-01-01

    Background We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). Methods BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. Results The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. Conclusions The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates. PMID:26999045

  8. Impact of paediatric human immunodeficiency virus infection on children's and caregivers' daily functioning and well-being: a qualitative study

    PubMed Central

    Punpanich, W.; Gorbach, P. M.; Detels, R.

    2012-01-01

    Background Human immunodeficiency virus (HIV) infection impacts not only upon the physical health of affected children, but also their psychosocial functions, family relationships and economical status. Caregivers are confronted with complex challenges related to the physical, emotional and financial demands of raising these children.The purpose of this study was to enhance our understanding of the impact of HIV disease on both children's and caregivers' well-being, using a qualitative inquiry approach. Methods A total of 35 primary caregivers of HIV-infected children participated in in-depth interviews. The issues discussed included the major negative impacts on children's daily functioning and well-being, and the perceived caregiver/parental burden. Participants included parents (40%), grandparents (22.8%), other relatives (e.g. uncles, aunts) (34.3%) and one foster parent (2.8%). Results Qualitative analysis revealed that the major negative impacts of HIV/AIDS included physical symptoms, school performance and relationship changes. The major negative impacts on caregivers' well-being included acceptance of the diagnosis, dealing with the financial burden and keeping the diagnosis private. Conclusions Approaches are needed to address these challenges by enhancing families' coping skills and building supportive networks. PMID:21851376

  9. Paediatric obesity and renal transplantation: current challenges and solutions.

    PubMed

    Terrace, John D; Oniscu, Gabriel C

    2016-04-01

    The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with life-style and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation. PMID:26018121

  10. Effects of anaesthesia on paediatric lung function.

    PubMed

    Trachsel, D; Svendsen, J; Erb, T O; von Ungern-Sternberg, B S

    2016-08-01

    Respiratory adverse events are one of the major causes of morbidity and mortality in paediatric anaesthesia. Aside from predisposing conditions associated with an increased risk of respiratory incidents in children such as concurrent infections and chronic airway irritation, there are adverse respiratory events directly attributable to the impact of anaesthesia on the respiratory system. Anaesthesia can negatively affect respiratory drive, ventilation/perfusion (V/Q) matching and tidal breathing, all resulting in potentially devastating hypoxaemia. Understanding paediatric respiratory physiology and its changes during anaesthesia will enable anaesthetists to anticipate, recognize and prevent deterioration that can lead to respiratory failure. This review aims to give a comprehensive overview of the effects of anaesthesia on respiration in children. It focuses on the impact of the different components of anaesthesia, patient positioning and procedure-related changes on respiratory physiology. PMID:27440626

  11. How small is small enough? Role of robotics in paediatric urology.

    PubMed

    Ganpule, Arvind P; Sripathi, Venkat

    2015-01-01

    The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series. PMID:25598599

  12. How small is small enough? Role of robotics in paediatric urology

    PubMed Central

    Ganpule, Arvind P.; Sripathi, Venkat

    2015-01-01

    The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series. PMID:25598599

  13. Salbutamol in paediatrics: pharmacology, prescribing and controversies.

    PubMed

    Andrzejowski, Paul; Carroll, Will

    2016-08-01

    Salbutamol has become a key drug in respiratory medicine since it was first developed by Sir David Jack et al in 1968, 5000 years after the β agonist ephedrine was first used in its raw form, as the Ma Huang herb in Chinese medicine to treat asthma. It is one of the most commonly encountered medicines in paediatric practice and the authors have found that an understanding of its pharmacology in clinical practice is incredibly helpful. In this article, we discuss its pharmacology and pharmacodynamics, practical prescribing points and some unresolved issues surrounding its use, which should serve to provide an essential working knowledge for the busy paediatrician. PMID:27059284

  14. [New analgesics in paediatrics].

    PubMed

    Avez-Couturier, Justine; Wood, Chantal

    2016-01-01

    There are a number of different types of analgesics in paediatrics. They must be used in accordance with the situation, the type of pain and the characteristics of the child. In all cases, strict compliance with the posology and the instructions for use is essential to avoid any risk of error. Finally, pharmacological, physical and psychological treatments are employed in a complementary manner, for the biopsychosocial management of the child's care. PMID:27177483

  15. Swearing: its prevalence in healthcare settings and impact on nursing practice.

    PubMed

    Stone, T E; McMillan, M; Hazelton, M

    2010-08-01

    Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nurses and nursing practice. Nurses are, of all health workers, most likely to be targets of verbal aggression, and up to 100% of nurses in mental health settings report verbal abuse. The literature contains no reference to the effects on nurses of exposure to swearing. This paper reports the findings of a questionnaire study of 107 nurses working in three clinical settings, which used a mixed methods approach. Participants reported high levels of swearing by patients, 32% citing its occurrence from one to five times per week and 7% 'continuously'; a similar incidence arose across the nursing teams at all sites, but being sworn at in anger by another staff member happened rarely. The study failed to show significant differences in the frequency of swearing between mental health and paediatric settings, but did find gender-based differences in both frequency of use and offendedness. High degrees of distress among nurses subjected to swearing were evident; moreover, respondents appeared to have only a limited range of interventions to draw upon in dealing with exposure to such treatment. PMID:20633080

  16. High magnitude head impacts experienced during youth football practices.

    PubMed

    Young, Tyler; Rowson, Steven; Duma, Stefan M

    2014-01-01

    To reduce the risk of concussion in the 3.5 million youth athletes who participate in organized football leagues in the United States each year, practice structure can be modified to decrease impact frequency and magnitude. The objective of this study is to identify activities that result in high magnitude head impacts in youth football players during practice. The HIT System was used to record the head acceleration magnitude, impact location on the helmet, and time of each impact for each game and practice players participated in. These data were used to quantify the head impact exposure associated with players between the ages of 9 and 11 years. Video footage recorded during each practice and game session was used to identify the activity associated with any impact above 45 g. The incidence rate of high magnitude impacts in various activities were compared by normalizing by the amount of time associated with each activity. It was determined that scrimmages accounted for 0.094 impacts greater than 45 g per minute in practices while contact drills contributed to 0.102 impacts greater than 45 g per minute during practices. The results of this study indicate future youth football practice modifications should focus on both scrimmages and contact drills. PMID:25405410

  17. Theory and Practice of Environmental Impact Analysis

    ERIC Educational Resources Information Center

    Mason, Peter F.

    1974-01-01

    Preliminary assessment of Environmental Impact Statements in California indicate that their effectiveness is directly related to the local political structure. Environmental planning is expected to improve as environmental impact reports gain more credence as an information base for city planners. The need for uniform impact guidelines are…

  18. Training Research: Practical Recommendations for Maximum Impact

    PubMed Central

    Beidas, Rinad S.; Koerner, Kelly; Weingardt, Kenneth R.; Kendall, Philip C.

    2011-01-01

    This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations. PMID:21380792

  19. Paediatric radiation oncology in the care of childhood cancer: A position paper by the International Paediatric Radiation Oncology Society (PROS).

    PubMed

    Kortmann, Rolf-Dieter; Freeman, Carolyn; Marcus, Karen; Claude, Line; Dieckmann, Karin; Halperin, Edward; Esiashvili, Natia; Paulino, Arnold; Mahajan, Anita; Seiersen, Klaus; Ahern, Verity; Ricardi, Umberto; Carrie, Christian

    2016-05-01

    Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities. PMID:27106553

  20. Theatre of paediatric surgery.

    PubMed

    McBride, Craig A; Holland, Andrew J A

    2015-01-01

    In the 50 years since the first edition of this journal, operative paediatric surgery has undergone radical change. Many of the most common instruments are unchanged, both as a testament to their utility and in recognition of past surgeons remembered eponymously. Surrounding that basic core of instruments, theatre has changed radically as new tools and techniques have arisen. Surgeons have come down from their pedestals, recognising surgery as a team sport rather than a solo performance. More than half of the current paediatric surgical trainees are women, a higher proportion than in any other craft group of the Royal Australasian College of Surgeons. The appearance, and rapid development, of laparoscopy is to many observers the most notable change in surgery over the last 50 years. Placed in its context though, it is simply the most prominent example of a frameshift in surgical thinking. The patient as a whole is now the focus, rather than just the disease. Recent developments are as much about minimising harm to normal tissues as they are about extirpating pathology. As a surgical maxim, 'Primum non nocere' is even more in evidence in 2015 than it was in 1965. PMID:25586851

  1. Impact of Biotechnology on Pharmacy Practice.

    ERIC Educational Resources Information Center

    Black, Curtis D.; And Others

    1990-01-01

    Discussed is the role of schools of pharmacy in (1) preparing future practitioners to assimilate and shape the impact of biotechnology; (2) establish graduate and research programs to enhance and apply products of biotechnology; and (3) identify manpower needs to fully realize potential advances caused by biotechnology. (DB)

  2. Examining Internships as a High-Impact Educational Practice

    ERIC Educational Resources Information Center

    Keller, Kerri Day

    2012-01-01

    Colleges and universities across the United States seek new, creative, and impactful ways to enhance student engagement. The study of student engagement has led to the identification of several "high-impact" educational practices that appear to generate higher levels of student performance, learning, and development than the traditional…

  3. Hospital Based Prospective Observational Study to Audit the Prescription Practices and Outcomes of Paediatric Patients (6 months to 5 years age group) Presenting with Acute Diarrhea

    PubMed Central

    Kondekar, Santosh; Rathi, Surbhi

    2016-01-01

    Introduction Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons. Aim To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome. Materials and Methods This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome. Results In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery. Conclusion In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery. PMID:27437317

  4. [Paediatric simulation today and tomorrow. Perspectives and concepts].

    PubMed

    Jordi Ritz, E-M; Eich, C; Gisin, S; Heinzel, O; Hüpfl, M; Erb, T O

    2009-12-01

    The confrontation with critically ill newborns, infants and small children is rare and poses a particular challenge for the medical team. Confident technical and non-technical skills are essential for successful emergency treatment. Paediatric simulators facilitate a didactic infrastructure, linking textbook theory with experience-based practice. To summarize the current status of paediatric simulation in Germany, Austria and Switzerland an online survey of all associated centres was conducted. Paediatric simulation is currently available at 24 centres, which have 39 paediatric simulators available, including 8 for newborns, 26 for infants and 5 for children. A certain congruence of standards is detectable among these centres and most instructors have completed a specialized instructor training. Of the instructors 26% are specialized nursing personnel and 67% are physicians of which most are paediatricians and anaesthesiologists. Many centres (38%) operate solely by means of the enthusiastic dedication of the employees who organize various activities during their free time. Nearly all centres (92%) place particular emphasis on non-technical skills which include the interpersonal aspects of crisis resource management. Video-supported debriefing is considered to be the basis for effective training. Within the scope of the recently established PaedSim project the curricula of paediatric simulation courses should be more structured and internationally standardized, thereby increasing both efficacy and sustainability of these training programs. PMID:20012246

  5. Infection control in paediatric office settings

    PubMed Central

    2008-01-01

    Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies. PMID:19412374

  6. Paediatric procedural sedation within the emergency department.

    PubMed

    Krieser, David; Kochar, Amit

    2016-02-01

    Procedural sedation and analgesia in children requires the use of non-pharmacological and pharmacological approaches to facilitate the management of painful procedures. The development of skills in such techniques has mirrored the development of paediatric emergency medicine as a subspecialty. Governance, education and credentialing must facilitate safe sedation practice, using a structured approach, as sedating children in the busy environment of an emergency department is not without risk. Emergency clinicians, patients and caregivers all have a role to play in developing a safe, effective sedation plan. PMID:27062624

  7. Potential for optimisation of paediatric chest X-ray examination.

    PubMed

    Kostova-Lefterova, D; Taseva, D; Ingilizova, K; Hristova-Popova, J; Vassileva, J

    2011-09-01

    The purpose of this study was to compare the important aspects of paediatric radiological practice and the patient doses from chest X-ray examinations performed in three hospitals in Bulgaria. Data from 163 paediatric patients were recorded using a standardised form. Entrance surface air kerma (ESAK) to patient was calculated from the air-kerma air product (KAP) and field size measurements. Large variations were found for KAP and ESAK. Inappropriate film size and insufficient collimation were often used. Inappropriate use of automatic exposure control and antiscatter grid was found. In most cases, no attention was paid to reduce dose to sensitive organs by means of shielding or proper collimation. Recommendations were given to the hospitals on how to reduce patient doses in paediatric chest radiography. PMID:21824872

  8. Drug discovery in paediatric oncology: roadblocks to progress

    PubMed Central

    Adamson, Peter C.; Houghton, Peter J.; Perilongo, Giorgio; Pritchard-Jones, Kathy

    2015-01-01

    Approval of new cancer drugs for paediatric patients generally occurs after their development and approval for treating adult cancers. As most drug development occurs in the industry setting, the relatively small market of paediatric oncology does not provide the financial incentives for companies to actively pursue paediatric oncology solutions. Indeed, between 1948 and January 2003 the FDA approved 120 new cancer drugs, of which only 30 have been used in children. This slow rate of development must be addressed in a meaningful way if we are to make progress in the most pressing settings in childhood cancer. In this Viewpoint article, the key opinion leaders in the field weigh in and offer practical advice on how to address this issue. PMID:25223555

  9. [Toxicology screening in paediatrics].

    PubMed

    Garcia-Algar, Óscar; Cuadrado González, Ainoha; Falcon, María

    2016-09-01

    The prevalence of acute or chronic exposure to substances of abuse in paediatric patients, from the neonatal period to adolescence, is not well established as most cases go unnoticed. Regardless of clinical cases of acute poisoning leading to visits to emergency room, the exposure is usually detected by a questionnaire to the parents or children. In the last few years, new validated analytical methodologies have been developed in order to detect parent drugs and their metabolites in different biological matrices. These biological matrices have different time windows for detection of the exposure: acute (i.e., urine, blood, oral fluid), and chronic (i.e., hair, meconium or teeth). The aim of this paper was to review the scenarios where the use of biological matrices is indicated for the detection of acute or chronic exposure to substances of abuse. PMID:26458521

  10. Paediatric Blunt Torso Trauma

    PubMed Central

    Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.

    2016-01-01

    Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913

  11. The practical impact of elastohydrodynamic lubrication

    NASA Technical Reports Server (NTRS)

    Anderson, W. J.

    1978-01-01

    Elastohydrodynamic lubrication has had its most significant impact on, among all the types of concentrated contact mechanisms, rolling element bearings. EHL technology, through its inclusion in computer codes, now provides us with more effective methods for optimizing bearing design and for predicting bearing life, power loss, temperature and dynamic behavior. Bearing life prediction has advanced to a much more sophisticated level as compared to the calculation of fatigue life based on Lundberg-Palmgren theory. Application of elastohydrodynamics to gearing has, more or less, been limited to the calculation of pitch point film thicknesses. Techniques for calculating film thicknesses over the entire range of tooth meshes for arbitrarily shaped gear teeth (noninvolute, spur, helical, etc.) need to be developed. Elastomer seals with both unidirectional and reciprocating motion offer a fruitful application for the elastohydrodynamics of low modulus materials.

  12. The impact of globalisation on teleradiology practice.

    PubMed

    Shieh, Yao Y; Tsai, Fong Y; Shieh, Mengkai

    2008-01-01

    Some advocates of globalisation argue that a free market with little regulation is the best approach for achieving cost-effective healthcare. Healthcare, however, is different from other business activities in that it is typically less profit-driven; instead, it often involves the goal of providing equitable care to the underprivileged. Traditionally, the government has subsidised the expenses of delivering affordable healthcare to underserved communities. Because of the many recent advances in telecommunications technology, telemedicine has gained increasing attention. Teleradiology, in particular, is by far the maturest of all telemedicine disciplines and, thus, it may serve as a pivotal indicator of whether telemedicine on a global scale is feasible or not. In this paper, a prediction of the future landscape of globalised teleradiology operations is attempted based on the extrapolation of the historical trends in teleradiology practice as well as the growing pressure on federal and local governments to reduce their regulatory power under the General Agreement on Trade in Services (GATS). PMID:19174364

  13. Possible global environmental impacts of solid waste practices

    SciTech Connect

    Davis, M.M.; Holter, G.M.; DeForest, T.J.; Stapp, D.C.; Dibari, J.C.

    1994-09-01

    Pollutants resulting from the management of solid waste have been shown to affect the air, land, oceans, and waterways. In addition, solid wastes have other, more indirect impacts such as reduction in feedstocks of natural resources, because useful materials are disposed of rather than recycled. The objective of this study is to evaluate solid waste management practices that have negative implications on the global environment and develop recommendations for reducing such impacts. Recommendations identifying needed changes are identified that will reduce global impacts of solid waste practices in the future. The scope of this study includes the range of non-hazardous solid wastes produced within our society, including municipal solid waste (MSW) and industrial solid waste (ISW), as well as industry-specific wastes from activities such as construction, demolition, and landclearing. Most solid waste management decisions continue to be made and implemented at very local levels, predominantly with a short-term focus to respond to relatively immediate pressures of landfill shortages, funding problems, political considerations, and the like. In this rush to address immediate local problems, little consideration is being given to potential impacts, either short- or long-term, at the national or global level resulting from solid waste management practices. More and more, the cumulative impacts from local decisions concerning solid waste management are beginning to manifest themselves in broader, longer-term impacts than are being addressed by the decision-makers or, at the very least, are presenting a greater and greater potential for such impacts.

  14. PGD training and its impact on general dentist practice patterns.

    PubMed

    Atchison, Kathryn A; Mito, Ronald S; Rosenberg, Dara Jean; Lefever, Karen H; Lin, Sylvia; Engelhardt, Rita

    2002-12-01

    This study compares the practice patterns of general dentists with and without formal advanced training in AGED or GPR programs. The UCLA School of Dentistry surveyed a random selection of dentists from graduating years 1989, 1993, and 1997 as part of a Health Resources Services Administration (HRSA)-supported evaluation of the impact of federal funding on postgraduate general dentistry (PGD) programs. Using a sample drawn by the American Dental Association (ADA), 6,725 dentists were surveyed about their practice, advanced training, patients served, and services provided. Of the 2,029 dentists (30 percent) who responded, 49 percent were practicing dentists with no formal advanced training in general dentistry or one of the eight ADA specialties; 7 percent had Advanced Education in General Dentistry (AEGD) experience; 20 percent trained in a General Practice Residency (GPR); and 24 percent were specialists. Additionally, 7 percent of respondents had PGD training and a clinical specialty. GPR-trained dentists were significantly more likely to be on a hospital staff and to treat medically compromised patients even after ten years of practice. PGD dentists were less likely to seek specialty training. Major reasons for seeking PGD training were increasing treatment speed, learning to treat medically compromised patients, and wanting hospital experience. Primary reasons for not selecting training were starting a practice and having a great practice opportunity. Our conclusion is that PGD training has an enduring impact on practice patterns and improves access to dental care for underserved populations. PMID:12521061

  15. Paediatric personnel extremity dose study.

    PubMed

    Gallet, J M C; Reed, M H

    2002-03-01

    Concern has been expressed in paediatric radiology regarding the magnitude of the extremity dose received by attending personnel during routine fluoroscopic procedures and CT. Common procedures that may be of short duration in adults can be quite the opposite in paediatric patients. The extremities of attending personnel are more likely to be exposed to the primary beam and for a longer period of time owing to a variety of reasons such as assisting in the procedure or physically restraining the patient during the examination. During the period mid 1998 to mid 2000, two paediatric radiologists, four senior radiographers and two paediatric nurses were monitored using ring thermoluminescent dosemeters (TLDs). Each participant wore the ring TLD on either the left or right ring finger, depending on which hand the individual favoured. Left/right asymmetrical studies were not conducted, nor were records kept of whether an examination used a grid or gridless technique. Initial apprehension about higher paediatric fluoroscopic and CT extremity doses was dispelled as a result of this quantitative dosimetric study. PMID:11932219

  16. Management of paediatric GERD.

    PubMed

    Vandenplas, Yvan

    2014-03-01

    Paediatric GERD is complicated to manage, as symptoms are diverse and often difficult to interpret. In infants, regurgitation is a common physiological condition. Nevertheless, when it occurs frequently (>4 times per day) and causes the infant distress, parents often seek medical help. In children 2-10 years of age, GERD is often considered to cause extra-oesophageal symptoms, despite the absence of hard evidence. Diagnostic investigations often lack solid validation and the signs and symptoms of GERD overlap with those of cow's milk protein allergy and eosinophillic oesophagitis. Reassurance, dietary treatment and positional adaptations are recommended for troublesome infant reflux. Anti-acid medication, mainly PPIs, is over-used in infants even though, in many children, reflux is not an acid-related condition. Moreover, evidence is increasing that PPIs cause adverse events such as gastroenteritis and respiratory tract infections. Management in children older than 10 years is similar to that in adults. Using prokinetics to treat nonerosive reflux disease remains only a promising theoretical concept, as no such molecule is currently available. Today, the adverse effects of each prokinetic molecule largely outweigh its potential benefit. Laparoscopic surgery is indicated in children who have life-threatening symptoms or in cases of drug dependence. PMID:24126561

  17. High-Impact Practices and the First-Year Student

    ERIC Educational Resources Information Center

    Tukibayeva, Malika; Gonyea, Robert M.

    2014-01-01

    High-impact practices, programs, and activities where students commit considerable time and effort in different settings can help to define the first-year college experience and are likely to increase success in areas like persistence, deep learning, and self-reported gains.

  18. The Impact of Action Learning Experience on Reflective Practice

    ERIC Educational Resources Information Center

    Harris, Nicole S.

    2012-01-01

    This case study examines the changes that occur with respect to reflective practices as a result of participating in an action learning group through the identification of aspects/activities of action learning that contribute to such changes and the impact these aspects/activities had on the program participants at a department of the federal…

  19. Study motives, career choices and interest in paediatric dentistry among final year dental students in Nigeria

    PubMed Central

    2014-01-01

    Background Students’ motives for studying Dentistry have been a subject of interest for years because of the potential for understanding the psychological makeup and subsequent job satisfaction for the dentist. It is also useful in identifying expectations of the profession. This study therefore tried to identify study motives and career preferences of dental students especially with respect to the practice of paediatric dentistry. Methods This was a cross-sectional study using a self-administered questionnaire. The final year students in six dental schools in Nigeria were required to fill the questionnaire. Students were asked to rank their motives and career preferences on a Likert like scale with points ranging from 0–5 where 0 represented a factor that had no influence on their decision and 5 represented a very influential factor. The underlying dimensions for study motives, career preference, impression about and motive for interest in the practice of paediatric dentistry were identified using factor analysis. Results One hundred and seventy nine of 223 students (80.3%) participated in this study. Motives for the practice of dentistry included characteristics of the profession, altruism and intellectual challenges, existence of artistic theme in dentistry and parent’s recommendation. Overall, 67.1% of respondents indicated interest in postgraduate studies and 50.8% were interested in paediatric dentistry practice. The main motives for showing interest in the practice of paediatric dentistry were ‘personal interest, professional interest and interest of significant others in children’, and ‘family influence’. Significantly more males than females were interested in the practice of paediatric dentistry though the motives for interest in the practice of paediatric dentistry did not differ significantly by sex or age. Conclusion The non-significant sex difference in the motives for interest in the practice of paediatric dentistry is a possible

  20. Electronic nursing documentation in a paediatrics hospital: impact on quality of care by using OpenEHR, IHE and HL7.

    PubMed

    Oštir, Majda; Purkart, Marinka; Stih, Anita; Prinčič, Biljana; Orel, Andrej

    2012-01-01

    The acuity of illness of sick children requiring care in hospital is increasing. There are many more children now with disabilities and complicated long term illnesses. Respiratory illness is the commonest cause of morbidity in young children. Nurses have a pivotal role in the anticipation of and/or early identification of the sick child with potential or actual respiratory failure through the assessment and measurement of the child's pattern of breathing, including rate, rhythm and effort. It should also be conducted and interpreted in association with other clinical assessments, for example cardiovascular. Record keeping is an essential part of nursing care because it details the patient journey through the healthcare process. Good quality record keeping can improve the quality of patient care and for this reason nurses must seek to ensure that their documentation practices meet high standards. Poor standards of documentation were a contributory factor in the failure to detect patients who were clinically deteriorating. In this article we searched for evidence whether electronic health records has positive impact on quality of nursing care and present our experiences with electronic nursing documentation in the field of respiratory assessment of the children and young people. PMID:22874358

  1. Recent advances in paediatric cardiac anaesthesia.

    PubMed

    Vakamudi, Mahesh; Ravulapalli, Harish; Karthikeyan, Ranjith

    2012-09-01

    Paediatric cardiac anaesthesia involves anaesthetizing very small children with complex congenital heart disease for major surgical procedures. The unique nature of this patient population requires considerable expertise and in-depth knowledge of the altered physiology. There have been several developments in the last decade in this subspecialty that has contributed to better care and improved outcome in this vulnerable group of patients. The purpose of this review is to present some of the recent advances in the anesthetic management of these children from preoperative evaluation to postoperative care. This article reviews the role of magnetic resonance imaging and contrast-enhanced magnetic resonance angiography in preoperative evaluation, the use of ultrasound to secure vascular access, the use of cuffed endotracheal tubes, the optimal haematocrit and the role of blood products, including the use of recombinant factor VIIa. It also deals with the advances in technology that have led to improved monitoring, the newer developments in cardiopulmonary bypass, the use of centrifugal pumps and extracorporeal membrane oxygenation and the role of DHCA. The role of new drugs, especially the α-2 agonists in paediatric cardiac anesthetic practice, fast tracking and effective postoperative pain management have also been reviewed. PMID:23293388

  2. A paediatric X-ray exposure chart

    PubMed Central

    Knight, Stephen P

    2014-01-01

    The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes. PMID:26229655

  3. A paediatric X-ray exposure chart

    SciTech Connect

    Knight, Stephen P

    2014-09-15

    The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.

  4. A paediatric X-ray exposure chart.

    PubMed

    Knight, Stephen P

    2014-09-01

    The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies - body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior-posterior (AP)/posterior-anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes. PMID:26229655

  5. Pediatric & Congenital Electrophysiology Society: building an international paediatric electrophysiology organisation.

    PubMed

    Cohen, Mitchell; Sanatani, Shubhayan; Stephenson, Elizabeth; Skinner, Jon; Drago, Fabrizio; Davis, Andrew; Janousek, Jan; Rosenthal, Eric; Collins, Kathryn K; Triedman, John

    2016-08-01

    The Pediatric and Congenital Electrophysiology Society (PACES) is a non-profit organisation comprised of individuals dedicated to improving the care of children and young adults with cardiac rhythm disturbances. Although PACES is a predominantly North American-centric organisation, international members have been a part of PACES for the last two decades. This year, PACES expanded its North American framework into a broadly expansive international role. On 12 May, 2015, paediatric electrophysiology leaders from within the United States of America and Canada met with over 30 international paediatric electrophysiologists from 17 countries and five continents discussing measures to (1) expand PACES' global vision, (2) address ongoing challenges such as limited resource allocation that may be present in developing countries, (3) expand PACES' governance to include international representation, (4) promote joint international sessions at future paediatric EP meetings, and (5) facilitate a global multi-centre research consortium. This meeting marked the inception of a formal international collaborative spirit in PACES. This editorial addresses some solutions to breakdown the continental silos paediatric electrophysiologists have practiced within; however, there remain ongoing limitations, and future discussions will be needed to continue to move the PACES global international vision forward. PMID:27075202

  6. Pediatric & Congenital Electrophysiology Society: building an international paediatric electrophysiology organisation.

    PubMed

    Cohen, Mitchell; Sanatani, Shubhayan; Stephenson, Elizabeth; Skinner, Jon; Drago, Fabrizio; Davis, Andrew; Janousek, Jan; Rosenthal, Eric; Collins, Kathryn K; Triedman, John

    2016-05-01

    The Pediatric and Congenital Electrophysiology Society (PACES) is a non-profit organisation comprised of individuals dedicated to improving the care of children and young adults with cardiac rhythm disturbances. Although PACES is a predominantly North American-centric organisation, international members have been a part of PACES for the last two decades. This year, PACES expanded its North American framework into a broadly expansive international role. On May 12, 2015, paediatric electrophysiology leaders from within the United States of America and Canada met with over 30 international paediatric electrophysiologists from 17 countries and five continents discussing measures to (1) expand PACES' global vision, (2) address ongoing challenges such as limited resource allocation that may be present in developing countries, (3) expand PACES' governance to include international representation, (4) promote joint international sessions at future paediatric EP meetings, and (5) facilitate a global multi-centre research consortium. This meeting marked the inception of a formal international collaborative spirit in PACES. This editorial addresses some solutions to breakdown the continental silos paediatric electrophysiologists have practiced within; however, there remain ongoing limitations, and future discussions will be needed to continue to move the PACES global international vision forward. PMID:27090729

  7. Usage of unpublished paediatric data.

    PubMed

    Saint-Raymond, Agnès; Pelle, Benjamin; Zaccaria, Cosimo; Sennwitz, Matthias; Branch, Sarah

    2016-01-01

    The European Paediatric Regulation (EC No 1901/2006) has three main objectives: increasing the number of appropriate medicines for children, increasing information on these medicines and stimulating high-quality ethical research with children. To contribute to the information, pharmaceutical companies were required under article 45 of the Regulation to submit existing paediatric studies to regulatory authorities for review and update of the product information. Nearly, 19 000 study reports have been identified for a thousand active substances. The data are being assessed by member states' competent authorities in collaboration with European Medicines Agency (EMA). After 7 years, 262 active substances have been assessed, all of the 62 centrally approved and nearly 200 nationally approved medicines. The review so far has led to 16 new paediatric indications, of importance in addressing previously unmet needs, in particular, in younger age groups. The information is being made publicly available in an EMA database accessible directly or through the public face of the European Clinical Trials Register. This will increase awareness of existing data that are useful to researchers and other healthcare professionals, and contribute to avoiding unnecessary duplication of paediatric trials. PMID:26543071

  8. Essentials of paediatric infection control

    PubMed Central

    Moore, Dorothy L

    2001-01-01

    Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and paediatric intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general paediatric wards, respiratory and gastrointestinal infections predominate, reflecting the occurrence in the community. The surveillance of nosocomial infections identifies priorities for infection control activities and permits evaluation of interventions. The prevention of transmission between patients and to personnel requires that certain measures be taken with all patients, and that additional precautions be taken with some infections, based on the route of transmission. The prevention of transmission from personnel involves ensuring that personnel are appropriately immunized and counselled about working with infections. The prevention of nosocomial infection also involves control of visitors, appropriate management of invasive procedures and devices, sterilization and disinfection of equipment, provision of a clean environment and adequate staffing. Severely immunocompromised children require extra protection, including ventilation systems that reduce the risk of exposure to filamentous fungi. Infection control in paediatrics is an evolving field that must adapt to changes in the paediatric patient population and in health care technology. PMID:20084127

  9. Impact of human resource management practices on nursing home performance.

    PubMed

    Rondeau, K V; Wagar, T H

    2001-08-01

    Management scholars and practitioners alike have become increasingly interested in learning more about the ability of certain 'progressive' or 'high-performance' human resource management (HRM) practices to enhance organizational effectiveness. There is growing evidence to suggest that the contribution of various HRM practices to impact firm performance may be synergistic in effect yet contingent on a number of contextual factors, including workplace climate. A contingency theory perspective suggests that in order to be effective, HMR policies and practices must be consistent with other aspects of the organization, including its environment. This paper reports on empirical findings from research that examines the relationship between HRM practices, workplace climate and perceptions of organizational performance, in a large sample of Canadian nursing homes. Data from 283 nursing homes were collected by means of a mail survey that included questions on HRM practices, programmes, and policies, on human resource aspects of workplace climate, as well as a variety of indicators that include employee, customer/resident and facility measures of organizational performance. Results derived from ordered probit analysis suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and which reported a workplace climate that strongly values employee participation, empowerment and accountability tended to be perceived to generally perform better on a number of valued organizational outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not only have implemented more of these HRM practices, but also to report having a workplace climate that reflects the seminal value that it places on its human resources. This finding is consistent with the conclusion that simply introducing HRM practices or programmes, in the absence of an appropriately supportive workplace climate, will be insufficient to attain

  10. Targeted detection of genetic alterations reveal the prognostic impact of H3K27M and MAPK pathway aberrations in paediatric thalamic glioma.

    PubMed

    Ryall, Scott; Krishnatry, Rahul; Arnoldo, Anthony; Buczkowicz, Pawel; Mistry, Matthew; Siddaway, Robert; Ling, Cino; Pajovic, Sanja; Yu, Man; Rubin, Joshua B; Hukin, Juliette; Steinbok, Paul; Bartels, Ute; Bouffet, Eric; Tabori, Uri; Hawkins, Cynthia

    2016-01-01

    Paediatric brain tumours arising in the thalamus present significant diagnostic and therapeutic challenges to physicians due to their sensitive midline location. As such, genetic analysis for biomarkers to aid in the diagnosis, prognosis and treatment of these tumours is needed. Here, we identified 64 thalamic gliomas with clinical follow-up and characterized targeted genomic alterations using newly optimized droplet digital and NanoString-based assays. The median age at diagnosis was 9.25 years (range, 0.63-17.55) and median survival was 6.43 (range, 0.01-27.63) years. Our cohort contained 42 and 22 tumours reviewed as low and high grade gliomas, respectively. Five (12 %) low grade and 11 (50 %) high grade gliomas were positive for the H3F3A/HIST1H3B K27M (H3K27M) mutation. Kaplan-Meier survival analysis revealed significantly worse overall survival for patients harbouring the H3K27M mutation versus H3F3A/HIST1H3B wild type (H3WT) samples (log-rank p < 0.0001) with a median survival of 1.02 vs. 9.12 years. Mitogen-activated protein kinase (MAPK) pathway activation via BRAF or FGFR1 hotspot mutations or fusion events were detected in 44 % of patients, and was associated with long-term survival in the absence of H3K27M (log-rank p < 0.0001). Multivariate analysis demonstrated H3K27M status and high grade histology to be the most significant independent predictors of poor overall survival with hazard ratios of 6.945 and 7.721 (p < 0.0001), respectively. In contrast, MAPK pathway activation is a predictor of favourable patient outcome, although not independent of other clinical factors. Importantly, we show that low grade malignancies may harbour H3K27M mutations and that these tumours show a dismal survival compared to low grade H3WT cases. Our data strongly supports the inclusion of targeted genetic testing in childhood thalamic tumours to most accurately stratify patients into appropriate risk groups. PMID:27577993

  11. Medical thermography (digital infrared thermal imaging - DITI) in paediatric forearm fractures - A pilot study.

    PubMed

    Ćurković, S; Antabak, A; Halužan, D; Luetić, T; Prlić, I; Šiško, J

    2015-11-01

    Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched. PMID:26603613

  12. Proceedings of the seventh Northern region paediatric colloquium.

    PubMed

    Barkla, Xanthe; Kaplan, Carole

    2014-01-01

    Ethical and legal dilemmas frequently arise in paediatric practice. Given the nature of the speciality, these issues are relevant to both the medical and legal professions. To this end, senior figures from the medical and legal professions in the Northern region have met on a regular basis in order to discuss anonymised case material. We report on the proceedings of the seventh such meeting. Six cases are described and key points arising from the subsequent discussion are presented. PMID:23864488

  13. Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology

    PubMed Central

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad

    2015-01-01

    Since the first report of use of endoscopy in children in the 1970s, there has seen an exponential growth in published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract. PMID:25789087

  14. Paediatric entrance doses from exposure index in computed radiography

    NASA Astrophysics Data System (ADS)

    Vano, E.; Martinez, D.; Fernandez, J. M.; Ordiales, J. M.; Prieto, C.; Floriano, A.; Ten, J. I.

    2008-06-01

    Over the last two years we have evaluated paediatric patient doses in projection radiography derived from exposure level (EL) in computed radiography (CR) in a large university hospital. Entrance surface air kerma (ESAK) for 3501 paediatric examinations was calculated from the EL, which is a dose index parameter related to the light emitted by the phosphor-stimulable plate, archived in the Digital Imaging and Communications in Medicine (DICOM) header of the images and automatically transferred to a database using custom-built dedicated software. Typical mean thicknesses for several age bands of paediatric patients was estimated to calculate ESAK from the EL values, using results of experimental measurements with phantoms for the typical x-ray beam qualities used in paediatric examinations. Mean/median ESAK values (in µGy) for the age bands of <1 year, 1-5 years, 6-10 years and 11-15 years have been obtained for chest without a bucky: 51/41, 57/34, 91/54 and 122/109; chest with a bucky (for only the last three age bands): 114/87, 129/105 and 219/170; abdomen: 119/91, 291/225, 756/600 and 1960/1508 and pelvis: 65/48, 455/314, 943/707 and 2261/1595. Sample sizes of clinical images used for the (indirect) measurements were 1724 for chest without a bucky, 799 for chest with a bucky, 337 for abdomen and 641 for pelvis. The methodology we describe could be applicable to other centres using CR as an imaging modality for paediatrics. Presently, this method is the only practical approach to automatically extract parameters contained in the DICOM header, for the calculation of patient dose values for the CR modality.

  15. Paediatric non-Hodgkin lymphoma in low and middle income countries.

    PubMed

    Gross, Thomas G; Biondi, Andrea

    2016-05-01

    Great advances have been made in the treatment of paediatric non-Hodgkin lymphoma (NHL). In high-income countries (HIC), cure rates now exceed 85%. However, in low- and middle-income countries (LMIC), cure rates remain less than 50%. It is estimated that over 90% of paediatric NHL worldwide occur in LMIC; therefore, even modest improvements in outcome would have significant impact in reducing the burden of paediatric NHL globally. This article will discuss some of the issues required to improve the outcome of paediatric NHL in LMIC using data presented at the Fifth International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma held in Varese, Italy, 2015 to illustrate these issues. Additionally, potential bi-directional benefits for patients in both LMIC and HIC from future collaborations will be discussed. PMID:27098084

  16. Evidence-based paediatric nursing: paediatric early warning systems.

    PubMed

    Gawronski, Orsola

    2016-05-01

    In hospital cardiac arrest are rare events in paediatrics. Most children receive appropriate care without experiencing undetected severe clinical deterioration during hospital admission. Outcomes of paediatric cardiac arrests are however generally poor, with high mortality rates and neurological damage at survival. A review of child mortality in the UK showed that a high proportion of unexpected deaths were preventable ( Pearsons 2008 ). Several studies of patient records of children who suffered cardiac arrests showed the presence of clear signs of clinical deterioration up to 24 hours before (Tume 2006). Appropriate recognition of clinical deterioration could have led to timely intervention to stabilise the patient. Missed deterioration may be due to lack of staff situational awareness, communication failure among professionals or between staff and families and other human factors ( Brady 2014 ). PMID:27214413

  17. A review of epidemiology of paediatric elbow injuries in sports.

    PubMed

    Magra, Merzesh; Caine, Dennis; Maffulli, Nicola

    2007-01-01

    The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many

  18. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

    PubMed

    Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. PMID:27118546

  19. The impact of the `Getting Practical: Improving Practical Work in Science' continuing professional development programme on teachers' ideas and practice in science practical work

    NASA Astrophysics Data System (ADS)

    Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael

    2014-09-01

    Background:Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The 'Getting Practical' CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of practical work through initiating changes in teachers' predominantly 'hands-on' approach to practical work to one which manifests a more equitable balance between 'hands-on' and 'minds-on'. Purpose:To evaluate the impact of the Getting Practical: Improving Practical Work in Science CPD programme on teachers' ideas and practice in science practical work in primary and secondary schools in England. Programme description:The CPD programme was designed to improve the effectiveness of science practical work in developing conceptual understanding in primary and secondary schools in England. Sample:Ten teachers of primary science and 20 secondary science teachers. Design and methods:The study employed a condensed fieldwork strategy with data collected using interviews, observational field notes and pre- and post-CPD training observations in practical lessons within 30 schools. Results:Whilst the CPD programme was effective in getting teachers to reflect on the ideas associated with the Getting Practical programme, it was much less effective in bringing about changes in actual teaching practice. Conclusion:The findings suggest that if change, rather than only an enhanced awareness of the issues, is to be brought about in established teaching <span class="hlt">practice</span> then there is a need for ongoing support over an extended period of time. Furthermore, the <span class="hlt">impact</span> of such CPD is more likely to be effective if it is undertaken by a senior member of a department or school with the full support of the SMT.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27420083','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27420083"><span id="translatedtitle">Inequality of <span class="hlt">Paediatric</span> Workforce Distribution in China.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Song, Peige; Ren, Zhenghong; Chang, Xinlei; Liu, Xuebei; An, Lin</p> <p>2016-01-01</p> <p>Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of <span class="hlt">paediatric</span> workforce distribution. This study aimed to analyse the inequality of the distributions of the <span class="hlt">paediatric</span> workforce (including paediatricians and <span class="hlt">paediatric</span> nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the <span class="hlt">paediatric</span> workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the <span class="hlt">paediatric</span> workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of <span class="hlt">paediatric</span> nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the <span class="hlt">paediatric</span> workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the <span class="hlt">paediatric</span> workforce in China for the first time, substantial inequality of <span class="hlt">paediatric</span> workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation. PMID:27420083</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_4");'>4</a></li> <li><a href="#" onclick='return showDiv("page_5");'>5</a></li> <li class="active"><span>6</span></li> <li><a href="#" onclick='return showDiv("page_7");'>7</a></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_6 --> <div id="page_7" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_5");'>5</a></li> <li><a href="#" onclick='return showDiv("page_6");'>6</a></li> <li class="active"><span>7</span></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="121"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4962244','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4962244"><span id="translatedtitle">Inequality of <span class="hlt">Paediatric</span> Workforce Distribution in China</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Song, Peige; Ren, Zhenghong; Chang, Xinlei; Liu, Xuebei; An, Lin</p> <p>2016-01-01</p> <p>Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of <span class="hlt">paediatric</span> workforce distribution. This study aimed to analyse the inequality of the distributions of the <span class="hlt">paediatric</span> workforce (including paediatricians and <span class="hlt">paediatric</span> nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the <span class="hlt">paediatric</span> workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the <span class="hlt">paediatric</span> workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of <span class="hlt">paediatric</span> nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the <span class="hlt">paediatric</span> workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the <span class="hlt">paediatric</span> workforce in China for the first time, substantial inequality of <span class="hlt">paediatric</span> workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation. PMID:27420083</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/17191101','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/17191101"><span id="translatedtitle">The <span class="hlt">impact</span> of PACS on radiologists' work <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fridell, Kent; Edgren, Lars; Lindsköld, Lars; Aspelin, Peter; Lundberg, Nina</p> <p>2007-12-01</p> <p>This paper identifies and analyzes how the implementation and use of picture archiving and communication system <span class="hlt">impacts</span> radiologists' work <span class="hlt">practice</span>. The study is longitudinal from 1999 to 2005 and have a qualitative perspective were data were collected by structured interviews in a total of 46. The interviews were transcribed, analyzed, and coded using grounded theory as an organizing principle. In radiologists' work <span class="hlt">practice</span>, three main categories were defined: professional role, diagnostic <span class="hlt">practice</span>, and technology in use. The changing trends within the professional role indicated that radiologists moved from a more individual professional expertise to become more of an actor in a network. The diagnostic <span class="hlt">practice</span> changed, as reading x-ray films was seen as an art form in 1999, requiring years of training. Once everyone could view digital images, including 3-dimensional technology, it was easier for other clinicians to see and interpret the images and the skills become accessible to everyone. The change in technology in use as a result of the shift to digital images led to an increased specialization of the radiologist. PMID:17191101</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3938221','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3938221"><span id="translatedtitle">Clostridium difficile in <span class="hlt">paediatric</span> populations</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Allen, Upton D</p> <p>2014-01-01</p> <p>An increase in Clostridium difficile infection incidence has been observed among hospitalized children in the United States. The present statement, targeted at clinicians caring for infants and children in community and institutional settings, summarizes the relevant information relating to the role of C difficile in childhood diarrhea and provides recommendations for diagnosis, prevention and treatment. Significant differences between adult and <span class="hlt">paediatric</span> risk factors and disease are discussed, along with emerging therapies. The relationship between age and disease severity in children with a newly emergent and more fluoroqinolone-resistant strain of C difficile (North American Pulse-field type-1 [NAP1]) remains unknown. The importance of antimicrobial stewardship as a preventive strategy is highlighted. This statement replaces a previous Canadian <span class="hlt">Paediatric</span> Society position statement on C difficile published in 2000. PMID:24627655</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/23758424','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/23758424"><span id="translatedtitle">Simulation in nursing <span class="hlt">practice</span>: the <span class="hlt">impact</span> on patient care.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Aebersold, Michelle; Tschannen, Dana</p> <p>2013-01-01</p> <p>Simulation has a well-known history in the military, nuclear power, and aviation. It is also a recommended teaching and learning strategy supported by several landmark studies. Although in the past 20 years simulation has become more integrated into the education of nurses and physicians, it has not been as well integrated into the development of skills for <span class="hlt">practicing</span> nurses. This article will provide an overview of simulation techniques and uses and review of selected simulation research. Despite recommendations for using simulation and growing integration of simulation into education, we still lack empirical evidence of its <span class="hlt">impact</span> on patient outcomes. Our discussion provides a review of the current uses of simulation in the nursing <span class="hlt">practice</span> environment with several exemplars and offers recommendations to develop a simulation program. PMID:23758424</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4237943','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4237943"><span id="translatedtitle">The influence of the European <span class="hlt">paediatric</span> regulation on marketing authorisation of orphan drugs for children</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2014-01-01</p> <p>Background Drug development for rare diseases is challenging, especially when these orphan drugs (OD) are intended for children. In 2007 the EU <span class="hlt">Paediatric</span> Drug Regulation was enacted to improve the development of high quality and ethically researched medicines for children through the establishment of <span class="hlt">Paediatric</span> Investigation Plans (PIPs). The effect of the EU <span class="hlt">Paediatric</span> Drug Regulation on the marketing authorisation (MA) of drugs for children with rare diseases was studied. Methods Data on all designated orphan drugs, their indication, MA, PIPs and indication group (adult or child) were obtained from the European Medicines Agency (EMA). The outcome and duration of the process from orphan drug designation (ODD) to MA, was compared, per indication, by age group. The effect of the <span class="hlt">Paediatric</span> Drug Regulation, implemented in 2007, on the application process was assessed with survival analysis. Results Eighty-one orphan drugs obtained MA since 2000 and half are authorised for (a subgroup of) children; another 34 are currently undergoing further investigations in children through agreed PIPs. The <span class="hlt">Paediatric</span> Drug Regulation did not significantly increase the number of ODDs with potential <span class="hlt">paediatric</span> indications (58% before vs 64% after 2007 of ODDs, p = 0.1) and did not lead to more MAs for ODs with <span class="hlt">paediatric</span> indications (60% vs 43%, p = 0.22). ODs authorised after 2007 had a longer time to MA than those authorised before 2007 (Hazard ratio (95% CI) 2.80 (1.84-4.28), p < 0.001); potential <span class="hlt">paediatric</span> use did not influence the time to MA (Hazard ratio (95% CI) 1.14 (0.77-1.70), p = 0.52). Conclusions The EU <span class="hlt">Paediatric</span> Drug Regulation had a minor <span class="hlt">impact</span> on development and availability of ODs for children, was associated with a longer time to MA, but ensured the further <span class="hlt">paediatric</span> development of drugs still off-label to children. The <span class="hlt">impact</span> of the <span class="hlt">Paediatric</span> Drug Regulation on research quantity and quality in children through PIPs is not yet clear. PMID</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/6161337','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/6161337"><span id="translatedtitle"><span class="hlt">Impact</span> of an education program on perinatal care <span class="hlt">practices</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Harlan, W R; Hess, G E; Borer, R C; Hiss, R G</p> <p>1980-12-01</p> <p>Education of health professionals has an important role in improving health care. A media-based, self-instructional, perinatal education program was developed and field tested in rural and urban regions of Michigan. Cognitive tests, chart audits, and consultation/referral times were used to measure the <span class="hlt">impact</span> on education and patient care. The program effectively increased knowledge and improved patient care <span class="hlt">practices</span> by physicians and nurses. This study presents evidence that a targeted educational program in a media-based format can significantly improve perinatal care. PMID:6161337</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/8461171','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/8461171"><span id="translatedtitle">Priorities and <span class="hlt">practice</span> in tropical <span class="hlt">paediatrics</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Biddulph, J</p> <p>1993-02-01</p> <p>More than 14 million children under 5 years of age die annually in the Third World, mainly due to diarrhoea, pneumonia, malaria and immunizable diseases. The problems of poverty, malnutrition, poor sanitation, illiteracy and high fertility that traditionally are associated with underdevelopment are now being compounded by social disruption due to rapid changes in lifestyle, new diseases such as AIDS and Third World debt. A vital part of the solution is provision of basic medical and education services to all, with emphasis on female literacy and improving the status of women. Key elements in providing basic medical services are delegation and empowerment. Doctors must delegate the delivery of essential child health services to appropriately trained and adequately supported auxiliaries. Parents, especially mothers, need to be empowered with the knowledge and resources to recognize and manage, or assist in the management of, their children's health problems. PMID:8461171</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/15051247','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/15051247"><span id="translatedtitle">Life cycle assessment part 2: current <span class="hlt">impact</span> assessment <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pennington, D W; Potting, J; Finnveden, G; Lindeijer, E; Jolliet, O; Rydberg, T; Rebitzer, G</p> <p>2004-07-01</p> <p>Providing our society with goods and services contributes to a wide range of environmental <span class="hlt">impacts</span>. Waste generation, emissions and the consumption of resources occur at many stages in a product's life cycle-from raw material extraction, energy acquisition, production and manufacturing, use, reuse, recycling, through to ultimate disposal. These all contribute to <span class="hlt">impacts</span> such as climate change, stratospheric ozone depletion, photooxidant formation (smog), eutrophication, acidification, toxicological stress on human health and ecosystems, the depletion of resources and noise-among others. The need exists to address these product-related contributions more holistically and in an integrated manner, providing complimentary insights to those of regulatory/process-oriented methodologies. A previous article (Part 1, Rebitzer et al., 2004) outlined how to define and model a product's life cycle in current <span class="hlt">practice</span>, as well as the methods and tools that are available for compiling the associated waste, emissions and resource consumption data into a life cycle inventory. This article highlights how practitioners and researchers from many domains have come together to provide indicators for the different <span class="hlt">impacts</span> attributable to products in the life cycle <span class="hlt">impact</span> assessment (LCIA) phase of life cycle assessment (LCA). PMID:15051247</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/cgi-bin/nph-data_query?bibcode=2014PMB....59.1165X&link_type=ABSTRACT','NASAADS'); return false;" href="http://adsabs.harvard.edu/cgi-bin/nph-data_query?bibcode=2014PMB....59.1165X&link_type=ABSTRACT"><span id="translatedtitle">Evaluation of radiation dose to anthropomorphic <span class="hlt">paediatric</span> models from positron-emitting labelled tracers</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Xie, Tianwu; Zaidi, Habib</p> <p>2014-03-01</p> <p>PET uses specific molecules labelled with positron-emitting radionuclides to provide valuable biochemical and physiological information. However, the administration of radiotracers to patients exposes them to low-dose ionizing radiation, which is a concern in the <span class="hlt">paediatric</span> population since children are at a higher cancer risk from radiation exposure than adults. Therefore, radiation dosimety calculations for commonly used positron-emitting radiotracers in the <span class="hlt">paediatric</span> population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic <span class="hlt">paediatric</span> models including the newborn, 1-, 5-, 10- and 15-year-old male and female. This is achieved using pre-calculated S-values of positron-emitting radionuclides of UF-NCI <span class="hlt">paediatric</span> phantoms and published biokinetic data for various radiotracers. The influence of the type of anthropomorphic model, tissue weight factors and direct human- versus mouse-derived biokinetic data on the effective dose for <span class="hlt">paediatric</span> phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference <span class="hlt">paediatric</span> patients from various dose regimens were also calculated. Among the considered radiotracers, 18F-FBPA and 15O-water resulted in the highest and lowest effective dose in the <span class="hlt">paediatric</span> phantoms, respectively. The ICRP 103 updated tissue-weighting factors decrease the effective dose in most cases. Substantial differences of radiation dose were observed between direct human- versus mouse-derived biokinetic data. Moreover, the effect of using voxel- versus MIRD-type models on the calculation of the effective dose was also studied. The generated database of absorbed organ dose and effective dose for various positron-emitting labelled radiotracers using new generation computational models and the new ICRP tissue-weighting factors can be used for the assessment of radiation risks to <span class="hlt">paediatric</span> patients in clinical <span class="hlt">practice</span>. This work also contributes</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/2703266','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/2703266"><span id="translatedtitle">Forty years of research--its <span class="hlt">impact</span> on dental <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mandel, I D</p> <p>1989-03-01</p> <p>With the multiple use of fluorides the philosophical basis of dental <span class="hlt">practice</span> shifted from the restoration of the dentition to the prevention of the initiation of dental disease. In the United States, the profound <span class="hlt">impact</span> on caries in children, with 50 per cent of the 5-17 year olds caries-free, has changed the relative distribution of the various dental services and the pattern of dental care. The child orientation has been superceded by greater attention to the restorative and other needs of the middle-aged and geriatric population. The research-generated insights into the role of plaque in the periodontal diseases and the wide-scale efforts to improve oral hygiene via plaque control have resulted in a marked reduction in gingivitis and manageable levels of periodontis in the employed population below the age of 65. More advanced disease can be treated more effectively because of new diagnostic procedures and new technologies as well as the use of anti-bacterial and anti-inflammatory agents. Major research advances in oral biology, oral medicine and oral diagnosis have extended both the depth and breadth of preventive dental <span class="hlt">practice</span>. The scope of preventive dentistry now goes well beyond caries and periodontal disease to include: (1) injury, oro-facial defects, malocclusion and temporomandibular joint dysfunction; (2) oral mucosal lesions; (3) systemic diseases with oral manifestations and (4) hazards associated with dental <span class="hlt">practice</span>. Dentistry is now being practised with an ordered set of priorities. PMID:2703266</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/22935113','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/22935113"><span id="translatedtitle">Incorporating educative environments into the holistic care of <span class="hlt">paediatric</span> patients.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wilks, Susan E; Green, Julie B; Zazryn, Tsharni R</p> <p>2012-08-01</p> <p>Hospital settings can, and should, create educative spaces and learning opportunities as part of their holistic care for young patients. The purpose of this paper is to examine the evidence for creating high quality, child-centred learning environments within <span class="hlt">paediatric</span> settings. We explore the <span class="hlt">impact</span> of physical spaces on learning; the literature on developmental stages of learning for children and young people as it relates to learning environments; and the literature on learning in out-of-school settings, particularly as this applies to children who are separated from their daily communities. As all <span class="hlt">paediatric</span> settings can create opportunities for the ongoing educational development of their patients, this paper presents a way forward for this approach to holistic care. PMID:22935113</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3500799','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3500799"><span id="translatedtitle">Sedation/anaesthesia in <span class="hlt">paediatric</span> radiology</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Arlachov, Y; Ganatra, R H</p> <p>2012-01-01</p> <p>Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in <span class="hlt">practice</span> and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, <span class="hlt">paediatric</span> radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological <span class="hlt">practice</span> is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and <span class="hlt">practice</span> safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment. PMID:22898157</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27214414','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27214414"><span id="translatedtitle">Design of <span class="hlt">paediatric</span> hospitals.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lambert, Veronica</p> <p>2016-05-01</p> <p>The <span class="hlt">impact</span> of healthcare environments on children and young people's (CYP) health and psychosocial wellbeing has attracted much attention in recent years. This sits within the realm of the political drive for enhanced awareness of the need to take account of the rights and voice of the child. Perhaps as a direct result of the United Nations Convention on the Rights of the Child, and recognition from evidence in adult population studies of the <span class="hlt">impact</span> of healthcare environments on psychosocial healing, contemporary times have witnessed a discernible movement towards enhancing quality care by promoting child and adolescent-friendly hospital environments. The Council of Europe guidelines on child-friendly health care moved to place the rights and needs of children at the heart of health care. The Council acknowledges that the delivery of child-oriented services, which includes the notion of family-centred care, should be delivered in child and family friendly environments. However, knowledge about what constitutes a child-friendly healthcare environment from CYP's perspective is often lacking with hospital architectural blueprints predominantly designed around adult proxy-reported assumptions about the needs and desires of children. PMID:27214414</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26946709','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26946709"><span id="translatedtitle">[News in <span class="hlt">paediatrics</span>].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Depallens, Sarah; Lutz, Nicolas; Carlomagno, Raffaella; Meyrat, Blaise; Barazzoni, Mirjam Schuler; Tchameni, Yves Yamgoue; Pascual, Andres; Scerba, François; Superti-Furga, Andrea</p> <p>2016-01-13</p> <p>Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A <span class="hlt">practical</span> algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings. PMID:26946709</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.osti.gov/scitech/servlets/purl/1166033','SCIGOV-STC'); return false;" href="http://www.osti.gov/scitech/servlets/purl/1166033"><span id="translatedtitle">Resilient Control Systems <span class="hlt">Practical</span> Metrics Basis for Defining Mission <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p>Craig G. Rieger</p> <p>2014-08-01</p> <p>"Resilience” describes how systems operate at an acceptable level of normalcy despite disturbances or threats. In this paper we first consider the cognitive, cyber-physical interdependencies inherent in critical infrastructure systems and how resilience differs from reliability to mitigate these risks. Terminology and metrics basis are provided to integrate the cognitive, cyber-physical aspects that should be considered when defining solutions for resilience. A <span class="hlt">practical</span> approach is taken to roll this metrics basis up to system integrity and business case metrics that establish “proper operation” and “<span class="hlt">impact</span>.” A notional chemical processing plant is the use case for demonstrating how the system integrity metrics can be applied to establish performance, and</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/16443953','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/16443953"><span id="translatedtitle">The <span class="hlt">impact</span> of genetic information on policy and clinical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Abel, Elizabeth; Horner, Sharon D; Tyler, Diane; Innerarity, Sheryl A</p> <p>2005-02-01</p> <p>This article discusses genetics-related policy issues that have an <span class="hlt">impact</span> on health care systems, health care providers, and their patients: privacy, mass screening, family screening, and knowledge dissemination. Access, cost, and ethical implications are important discussant points for each of these genetic-related policy issues. Embedded in the issue of privacy are concerns of insurability, confidentiality, and discrimination. The public health policy implications related to mass screening programs include efficacy of the screening tests, availability of primary and secondary interventions, access, costs, and program evaluation. Policy issues for family screening are similar to mass screening, with added concerns about privacy and availability of adequate resources, including health care providers and counselors trained in genetics. Knowledge dissemination is critical to maintaining currency of clinical information and applications of genetic technologies and treatments. As genetic information expands, the need for knowledge dissemination will increase. The importance of advanced <span class="hlt">practice</span> nurses' involvement in these policy issues is discussed. PMID:16443953</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2008AIPC.1064...46S','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2008AIPC.1064...46S"><span id="translatedtitle"><span class="hlt">Impact</span> of Chemistry Teachers' Knowledge and <span class="hlt">Practices</span> on Student Achievement</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Scantlebury, Kathryn</p> <p>2008-10-01</p> <p>Professional development programs promoting inquiry-based teaching are challenged with providing teachers content knowledge and using pedagogical approaches that model standards based instruction. Inquiry <span class="hlt">practices</span> are also important for undergraduate students. This paper focuses on the evaluation of an extensive professional development program for chemistry teachers that included chemistry content tests for students and the teachers and the <span class="hlt">impact</span> of undergraduate research experiences on college students' attitudes towards chemistry. Baseline results for the students showed that there were no gender differences on the achievement test but white students scored significantly higher than non-white students. However, parent/adult involvement with chemistry homework and projects, was a significant negative predictor of 11th grade students' test chemistry achievement score. This paper will focus on students' achievement and attitude results for teachers who are mid-way through the program providing evidence that on-going, sustained professional development in content and pedagogy is critical for improving students' science achievement.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4518764','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4518764"><span id="translatedtitle">Conflict escalation in <span class="hlt">paediatric</span> services: findings from a qualitative study</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Forbat, Liz; Teuten, Bea; Barclay, Sarah</p> <p>2015-01-01</p> <p>Objective To explore clinician and family experiences of conflict in <span class="hlt">paediatric</span> services, in order to map the trajectory of conflict escalation. Design Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict. Participants Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assault and court proceedings, at the interface of acute and palliative care. Setting Two teaching hospitals, one district general hospital and two <span class="hlt">paediatric</span> hospices in England, in 2011. Results Conflicts escalate in a predictable manner. Clearly identifiable behaviours by both clinicians and parents are defined as mild, moderate and severe. Mild describes features like the insensitive use of language and a history of unresolved conflict. Moderate involves a deterioration of trust, and a breakdown of communication and relationships. Severe marks disintegration of working relationships, characterised by behavioural changes including aggression, and a shift in focus from the child's best interests to the conflict itself. Though conflicts may remain at one level, those which escalated tended to move sequentially from one level to the next. Conclusions Understanding how conflicts escalate provides clinicians with a <span class="hlt">practical</span>, evidence-based framework to identify the warning signs of conflict in <span class="hlt">paediatrics</span>. PMID:25940425</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4717424','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4717424"><span id="translatedtitle">Varicella <span class="hlt">paediatric</span> hospitalisations in Belgium: a 1-year national survey</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Blumental, Sophie; Sabbe, Martine; Lepage, Philippe</p> <p>2016-01-01</p> <p>Background Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results Participation of 101 hospitals was obtained, covering 97.7% of the total <span class="hlt">paediatric</span> beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of <span class="hlt">paediatric</span> varicella hospitalisations reached 29.5/105 person-years, with the highest <span class="hlt">impact</span> among those 0–4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. <span class="hlt">Paediatric</span> intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian <span class="hlt">paediatric</span> population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium. PMID:26130380</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/16854558','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/16854558"><span id="translatedtitle">Recent pharmacological advances in <span class="hlt">paediatric</span> analgesics.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Anderson, B J; Palmer, G M</p> <p>2006-08-01</p> <p>Growth and development are two linked processes that distinguish children from adults. The use of size as the primary covariate during pharmacokinetic (PK) analyses allows exploration of the effects of age. Allometric scaling models have assisted understanding of the developmental clearance changes in common analgesic drugs such as paracetamol, morphine, tramadol and local anaesthetics agents. Single nucleotide polymorphisms (pharmacogenomics [PG]) and their <span class="hlt">impact</span> on hepatic drug metabolism for opioids, tramadol, non-steroidal anti-inflammatory drugs (NSAIDs) and drug receptor responses are increasingly reported. Altered chemical structure or formulations of common analgesics alter pharmacodynamic (PD) effects enhancing safety and efficacy for NSAIDs by stereoselectivity and the addition of nitric oxide, for intravenous paracetamol by formulation and structural difference from propacetamol and for local anaesthetics through stereoselectivity. This article focuses upon recent data for analgesics used in <span class="hlt">paediatric</span> pain management including paracetamol, NSAIDs, morphine, tramadol, amide local anaesthetics and ketamine. It centres on PK and clinical studies in neonates, infants and children. PG studies are acknowledged as potentially allowing individual drug therapy tailoring through a decrease in between-patient population variability, although the <span class="hlt">impact</span> of PG in the very young is less certain. There are few data describing age-related PD changes in children despite recognition that the number, affinity and type of receptors or the availability of natural ligands changes with age. PMID:16854558</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_5");'>5</a></li> <li><a href="#" onclick='return showDiv("page_6");'>6</a></li> <li class="active"><span>7</span></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_7 --> <div id="page_8" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_6");'>6</a></li> <li><a href="#" onclick='return showDiv("page_7");'>7</a></li> <li class="active"><span>8</span></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="141"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/24907888','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/24907888"><span id="translatedtitle">[The electrocardiogram in the <span class="hlt">paediatric</span> age group].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sanches, M; Coelho, A; Oliveira, E; Lopes, A</p> <p>2014-09-01</p> <p>A properly interpreted electrocardiogram (ECG) provides important information and is an inexpensive and easy test to perform. It continues to be the method of choice for the diagnosis of arrhythmias. Although the principles of cardiac electrophysiology are the same, there are anatomical and physiological age-dependent changes which produce specific alterations in the <span class="hlt">paediatric</span> ECG, and which may be misinterpreted as pathological. The intention of this article is to address in a systematic way the most relevant aspects of the <span class="hlt">paediatric</span> ECG, to propose a possible reading scheme of the ECG and to review the electrocardiograph tracings most frequently found in the <span class="hlt">paediatric</span> age group. PMID:24907888</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/24351606','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/24351606"><span id="translatedtitle"><span class="hlt">Paediatric</span> exercise training in prevention and treatment.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pieles, Guido E; Horn, Richard; Williams, Craig A; Stuart, A Graham</p> <p>2014-04-01</p> <p>Exercise training is an underused intervention in <span class="hlt">paediatric</span> healthcare. This is surprising, since initial evidence demonstrates its effectiveness and safety; furthermore it confers socioeconomic benefits for healthcare systems. Pilot studies have assessed and confirmed the feasibility of exercise training in many <span class="hlt">paediatric</span> disease settings. However, more research is needed to understand the pathophysiology, quantify treatment effects and monitor outcomes. A concerted effort from researchers, health professionals and police makers will be necessary to make exercise training an evidence-based and cost-effective intervention in <span class="hlt">paediatric</span> care. PMID:24351606</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=211787','TEKTRAN'); return false;" href="http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=211787"><span id="translatedtitle">Designing <span class="hlt">impact</span> assessments for evaluating ecological effects of agricultural conservation <span class="hlt">practices</span> on streams</span></a></p> <p><a target="_blank" href="http://www.ars.usda.gov/services/TekTran.htm">Technology Transfer Automated Retrieval System (TEKTRAN)</a></p> <p></p> <p></p> <p>Conservation <span class="hlt">practices</span> are regularly implemented within agricultural watersheds throughout the United States without evaluating their ecological <span class="hlt">impacts</span>. Scientific evaluations documenting how habitat and aquatic biota within streams respond to these <span class="hlt">practices</span> are needed for evaluating the effects o...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2011epsc.conf.1775H','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2011epsc.conf.1775H"><span id="translatedtitle">Teacher Workshops in the US: Goals, Best <span class="hlt">Practices</span> and <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Hörst, S. M.</p> <p>2011-10-01</p> <p>The goal of the workshop is to educate the teachers on a few focused topics so that they can transfer the knowledge they gain to their students. We will recruit scientists who are attending the meeting to participate in the workshops and will also pair the teachers with scientists in the field who can serve as a resource for the teacher and their class throughout the school year. The scientists can answer questions the teachers may have, be available to do video lectures or interactive question and answer sessions over skype, and work with the teachers to develop hands-on classroom activities. We will partner closely with EPO professionals in NASA's Science Mission Directorate to ensure that best <span class="hlt">practices</span> for the workshops are employed, including ensuring that the workshop and workshop materials are designed within the framework of the state standards, surveying participating teachers before the workshops about their needs and goals, assessing the participants pre-workshop knowledge, and engaging participants as learners during the workshop [1]. The <span class="hlt">impact</span> of the workshop will be increased by providing the teachers and students with a scientist who will serve as a long-term resource. We will maintain contact with the teachers after the workshop to ensure that the scientists are still actively engaged in their classroom and to collect feedback. References [1] Shupla C, et al. (2011) Lessons Learned: Best <span class="hlt">Practices</span> in Educator Workshops. 42nd Lunar and Planetary Science Conference, no. 2828. EPSC Abstracts Vol. 6, EPSC-DPS2011-1775, 2011 EPSC-DPS Joint Meeting 2011 c Author(s) 2011</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/22776610','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/22776610"><span id="translatedtitle">Popliteal vasculature injuries in <span class="hlt">paediatric</span> trauma patients.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Jones, S A; Roberts, D C; Clarke, N M P</p> <p>2012-10-01</p> <p>Popliteal-artery injuries in the <span class="hlt">paediatric</span>-trauma patient are uncommon, difficult to diagnose and with prolonged ischaemia lead to substantial complications. We report three cases of popliteal-vasculature injury in <span class="hlt">paediatric</span>-trauma patients with diverse mechanisms of injury: blunt trauma, penetrating injury and a Salter-Harris I fracture. We present a range of the significant sequelae that can result from <span class="hlt">paediatric</span> popliteal-artery injury, both physically and psychologically. It is imperative that clinicians have a high index of suspicion when confronted with <span class="hlt">paediatric</span> patients with trauma around the knee and that popliteal-vasculature injuries are diagnosed early. If insufficiencies are detected, further imaging should be considered, but surgical exploration should not be delayed in the presence of ischaemia. PMID:22776610</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25836694','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25836694"><span id="translatedtitle">Establishment of diagnostic reference levels in computed tomography for <span class="hlt">paediatric</span> patients in Sudan: a pilot study.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sulieman, A</p> <p>2015-07-01</p> <p><span class="hlt">Paediatric</span> patients are recognised to be at higher risk of developing radiation-induced cancer than adults. The purpose of this pilot study was to evaluate the radiation doses to <span class="hlt">paediatric</span> patients during computed tomography (CT) procedures in order to propose local diagnostic reference levels (DRLs). A total of 296 patients (aged 6-10 y) were investigated in 8 hospitals equipped with 64-, 16- and dual-slice CT machines. The mean dose length product values were 772, 446 and 178 mGy cm for head, abdomen and chest, respectively. Imaging protocols were not adapted to the patient's weight in certain CT machines. The results confirmed that <span class="hlt">paediatric</span> patients are exposed to an unnecessary radiation dose. The established DRLs were higher than those available in other countries. This study showed the need for harmonisation of the <span class="hlt">practice</span> in CT departments and radiation dose optimisation. PMID:25836694</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3005666','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3005666"><span id="translatedtitle">Steroid Assays in <span class="hlt">Paediatric</span> Endocrinology</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2010-01-01</p> <p>Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in <span class="hlt">paediatric</span> endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation. Conflict of interest:None declared. PMID:21274330</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/21646328','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/21646328"><span id="translatedtitle"><span class="hlt">Paediatrics</span>: the etymology of a name.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pearn, John</p> <p>2011-08-01</p> <p>Within the history of <span class="hlt">paediatrics</span> is the history of the name used to describe it. The etymology of the word '<span class="hlt">paediatrics</span>' dates from its first written use, recorded as 'pädiatrik' in the German literature and as '<span class="hlt">paediatric</span>', later 'pediatric' in the USA, both first in 1850. Professor Robley Dunglison (1788-1869), the British and American medical lexicographer, first defined 'paediatria' as 'the treatment of the diseases of children' in 1855. 'Pediatric medicine' was promoted as a specialty in the USA in 1880. The oldest monumental inscription defining the specialty of '<span class="hlt">paediatrics</span>' in the UK is to be found on a plaque added (in 1950) to the memorial to Dr George Armstrong (1719-1789), a founder of the specialty of <span class="hlt">paediatrics</span>, in Castleton Cemetery, Scottish Borders, Roxburghshire. '<span class="hlt">Paediatrics</span>' and 'child health', with subtle semantic distinctions, had become well established in the English-speaking world by the middle of the 20th century. This paper presents an interpretative chronology of the etymology of the descriptors of the specialty that enjoins all who care for children. PMID:21646328</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4349440','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4349440"><span id="translatedtitle"><span class="hlt">Paediatrics</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Shumer, Daniel E.</p> <p>2015-01-01</p> <p>Medical intervention for transgender adolescents is a controversial issue but a recently published article describing long-term psychological outcomes using ‘the Dutch model’ of care should help to silence critics and reassure the growing number of clinicians treating this patient population. PMID:25403246</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/10168441','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/10168441"><span id="translatedtitle"><span class="hlt">Impact</span> of tax sanctions on physician <span class="hlt">practice</span> acquisitions and employment.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hardy, C T; Lyden, S M; Kasmarcak, S J</p> <p>1997-07-01</p> <p>The intermediate tax sanctions create significant concerns for tax-exempt healthcare organizations that seek to integrate <span class="hlt">practicing</span> physicians through <span class="hlt">practice</span> acquisition or employment. The sanctions will force not-for-profit healthcare organizations to examine both the strategic and business implications of the dollars they have committed to <span class="hlt">practice</span> acquisition and physician employment. The sanctions also should motivate organizations to reexamine their existing physician compensation arrangements, which may be creating negative incentives for <span class="hlt">practice</span> productivity. PMID:10168441</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25458138','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25458138"><span id="translatedtitle"><span class="hlt">Impact</span> of evidence and health policy on nursing <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Geurden, Bart; Adriaenssens, Jef; Franck, Erik</p> <p>2014-12-01</p> <p>The story of evidence-based <span class="hlt">practice</span> in nursing is long, with many successes, contributors, leaders, scientists, and enthusiasts. Nurse educators have great advantages offered from a wide variety of educational resources for evidence-based <span class="hlt">practice</span>. These resources offer students the opportunity to connect their emerging competencies with clinical needs for best <span class="hlt">practices</span> in clinical and microsystem changes. PMID:25458138</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3178788','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3178788"><span id="translatedtitle">Parental involvement in <span class="hlt">paediatric</span> cancer treatment decisions</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>McKenna, K; Collier, J; Hewitt, M; Blake, H</p> <p>2010-01-01</p> <p>This study investigated parents' information needs and involvement in decision-making processes affecting the care of children diagnosed with cancer. Interviews and questionnaires were used to assess parental satisfaction in 50 mothers and 16 fathers responsible for 58 children in an English <span class="hlt">Paediatric</span> Oncology Unit. Parents reported that doctors contributed almost twice as much to the decision-making process as they did, but parental satisfaction was positively correlated with the amount of information provided when giving informed consent. Satisfaction about their involvement in this process relied heavily upon the level of support received from others. Parents consenting to their child's involvement in non-randomised trials perceived themselves to be under greater pressure from others during the decision-making process while those whose children were further along the treatment trajectory were more uncertain about decisions previously made. Findings indicate that the accessibility, support, information and degree of control afforded to parents by healthcare professionals <span class="hlt">impacts</span> upon their satisfaction with both the decision-making process and their confidence in the decisions thus made. Information and support tailored to parents' specific needs may therefore enhance satisfaction with clinical decision making and reassure parents about decisions made in the long-term interest of their child's health. PMID:19807776</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=stroke&id=EJ1032116','ERIC'); return false;" href="http://eric.ed.gov/?q=stroke&id=EJ1032116"><span id="translatedtitle">The Self-Directed Learning Experience of Mothers Whose Child Has Had a <span class="hlt">Paediatric</span> Stroke</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Grover, Kenda S.</p> <p>2014-01-01</p> <p>This study employed qualitative research methodology to explore the experiences of mothers who self-directed their learning following their child's stroke diagnosis. <span class="hlt">Paediatric</span> stroke, although rare, is among the top 10 causes of death in children in the USA, but information about the cause, treatment and long-term <span class="hlt">impact</span> are difficult to…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=evaluation+AND+institutional&pg=4&id=EJ1033982','ERIC'); return false;" href="http://eric.ed.gov/?q=evaluation+AND+institutional&pg=4&id=EJ1033982"><span id="translatedtitle">The Conditional Nature of High <span class="hlt">Impact</span>/Good <span class="hlt">Practices</span> on Student Learning Outcomes</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Seifert, Tricia A.; Gillig, Benjamin; Hanson, Jana M.; Pascarella, Ernest T.; Blaich, Charles F.</p> <p>2014-01-01</p> <p>Using a multi-institutional sample of undergraduate students, this study found that the relationships between engaging in high <span class="hlt">impact</span>/good <span class="hlt">practices</span> and liberal arts outcomes differ based on students' precollege and background characteristics. Findings suggest that high <span class="hlt">impact</span>/good <span class="hlt">practices</span> are not a panacea and require a greater degree of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25579287','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25579287"><span id="translatedtitle"><span class="hlt">Impact</span> of conversion from an open ward design <span class="hlt">paediatric</span> intensive care unit environment to all isolated rooms environment on incidence of bloodstream infections and antibiotic resistance in Southern Israel (2000 to 2008).</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lazar, I; Abukaf, H; Sofer, S; Peled, N; Leibovitz, E</p> <p>2015-01-01</p> <p>We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary <span class="hlt">paediatric</span> intensive care unit. All BSI episodes were prospectively identified and analysed. The <span class="hlt">paediatric</span> intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. Three hundred and fifty-three BSI episodes occurred in 299 of 4162 patients. Overall, BSI incidence was 85 per 1000 hospitalised children. Fewer BSI episodes occurred during the last two years of the study (2007 to 2008), compared with 2000 to 2006 (70 of 1061 admissions, 6.5% versus 283 of 3101 admissions, 9.1%, respectively, P=0.01). There were 127 of 340 (37.4%) community-acquired and 213 of 340 (62.6%) nosocomial BSI episodes (31 of 1000 and 51 of 1000, respectively). Nosocomial BSI episodes decreased during 2007 to 2008 versus 2000 to 2006 (37.7% versus 55.8%, P=0.03). In 448 instances, pathogens were isolated, 231 (52%) Gram-positive and 188 (42%) Gram-negative. Coagulase-negative Staphylococci, S. pneumoniae and S. aureus (41.1%, 19.9% and 11.7%, respectively) were the most common Gram-positive and Enterobacteriaceae spp. the most frequent Gram-negative organisms (45.2%, of them Klebsiella spp. and E. coli 40% and 29.4%, respectively). A significant decrease was recorded during 2007 to 2008 in Enterobacteriaceae resistance to piperacillin, gentamicin and ciprofloxacin. Thirty of 299 (10%, 9 with S. pneumoniae-BSI) patients died. A significant decrease in BSI and nosocomial incidence and Enterobacteriaceae spp. antibiotic resistance was recorded following the conversion of the <span class="hlt">paediatric</span> intensive care unit from an open ward to an all isolated rooms environment. PMID:25579287</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25486164','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25486164"><span id="translatedtitle">Community psychology <span class="hlt">practice</span>: expanding the <span class="hlt">impact</span> of psychology's work.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wolff, Tom</p> <p>2014-11-01</p> <p>This article introduces the reader to community psychology <span class="hlt">practice</span> by defining the field and its key principles and then illustrating through brief case stories what community psychology <span class="hlt">practice</span> looks like in various employment settings. An exploration of the development of the field includes a review of the competencies of community psychology <span class="hlt">practice</span>. Finally, the emerging opportunities for community psychology <span class="hlt">practice</span> for psychologists are outlined. Well-publicized issues such as health disparities give psychologists an opportunity to bring social problems such as racism, sexism, homophobia, and income inequality to the forefront and to create community-wide efforts to improve the ways in which people live. Community psychology <span class="hlt">practice</span> offers psychologists a format and a set of competencies for moving forward on this work by focusing on approaches that are ecological, community centered, population based, preventive, focused on systems change and empowerment, and multidisciplinary and that bring those most affected by the issues to the heart of the decision making. PMID:25486164</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26377723','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26377723"><span id="translatedtitle">Can linking databases answer questions about <span class="hlt">paediatric</span> heart failure?</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pasquali, Sara K; Schumacher, Kurt R; Davies, Ryan R</p> <p>2015-08-01</p> <p>Numerous data sets collect information on patients with <span class="hlt">paediatric</span> cardiovascular disease, including <span class="hlt">paediatric</span> heart failure and transplant patients. This review discusses methodologies available for linking and integrating information across data sets, which may help facilitate answering important questions in the field of <span class="hlt">paediatric</span> heart failure and transplant that cannot be answered with individual data sets or single-centre data alone. PMID:26377723</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/19614789','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/19614789"><span id="translatedtitle">V.A.C. Therapy in the management of <span class="hlt">paediatric</span> wounds: clinical review and experience.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Baharestani, Mona; Amjad, Ibrahim; Bookout, Kim; Fleck, Tatjana; Gabriel, Allen; Kaufman, David; McCord, Shannon Stone; Moores, Donald C; Olutoye, Oluyinka O; Salazar, Jorge D; Song, David H; Teich, Steven; Gupta, Subhas</p> <p>2009-08-01</p> <p>Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat <span class="hlt">paediatric</span> wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure (V.A.C. Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of <span class="hlt">paediatric</span> wounds. The primary objectives of the expert advisory panel were to exchange state-of-<span class="hlt">practice</span> information on <span class="hlt">paediatric</span> wound care, review the published data regarding the use of NPWT/ROCF in <span class="hlt">paediatric</span> wounds, evaluate the strength of the existing data and establish guidelines on best <span class="hlt">practices</span> with NPWT/ROCF for the <span class="hlt">paediatric</span> population. The proposed <span class="hlt">paediatrics</span>-specific clinical <span class="hlt">practice</span> guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating <span class="hlt">paediatric</span> wounds. Best <span class="hlt">practices</span> are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351256','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351256"><span id="translatedtitle">Estimation of head <span class="hlt">impact</span> exposure in high school football: Implications for regulating contact <span class="hlt">practices</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Broglio, Steven P.; Martini, Douglas; Kasper, Luke; Eckner, James T.; Kutcher, Jeffrey S.</p> <p>2015-01-01</p> <p>Background Increased attention is being placed on the role of subconcussive <span class="hlt">impacts</span> to the head during football participation and long-term cognitive health. Some have suggested that mitigating <span class="hlt">impacts</span> to the head can be achieved by reducing or eliminating contact football <span class="hlt">practices</span>. The effect that this might have on the number and magnitude of <span class="hlt">impacts</span> is unknown. Purpose To estimate the effect of limiting contact <span class="hlt">practices</span> on the frequency and magnitude of head <span class="hlt">impacts</span> through the retrospective assessment of in vivo head <span class="hlt">impact</span> data. Study Design Cross-sectional study; Level of evidence, 3. Methods Data on <span class="hlt">impact</span> magnitude and frequency were collected with the Head <span class="hlt">Impact</span> Telemetry System during the 2009 football season among 42 varsity high school football athletes (mean age, 16.2 ± 0.6 years; mean height, 180.9 ± 7.2 cm; mean weight, 89.8 ± 20.1 kg). Head <span class="hlt">impacts</span> were compared between player positions and session types (noncontact <span class="hlt">practice</span>, contact <span class="hlt">practice</span>, and game). These results were used to estimate the frequency and magnitude of head <span class="hlt">impacts</span> when contact sessions were restricted. Results The participants collectively sustained 32,510 <span class="hlt">impacts</span> over the 15-week season. The typical athlete sustained a mean of 774 ± 502 <span class="hlt">impacts</span> during the season with linemen (center, guard, and offensive or defensive tackle positions) sustaining the highest number of <span class="hlt">impacts</span> per athlete (1076 ± 541), followed by the tight ends, running backs, and linebackers (779 ± 286);wide receivers, cornerbacks, and safeties (417 ± 266); and quarterbacks (356 ± 433). When viewed by session type, noncontact <span class="hlt">practices</span> (n = 21) accounted for 1998 total <span class="hlt">impacts</span> (2.4 ± 1.4 per athlete per session), contact <span class="hlt">practices</span> (n = 36) accounted for 16,346 <span class="hlt">impacts</span> (10.5 ± 7.7 per athlete per session), and games (n = 14) accounted for 14,166 <span class="hlt">impacts</span> (24.1 ± 19.1 per athlete per session). Significantly more <span class="hlt">impacts</span> occurred during games when compared with contact (P = .02) and noncontact <span class="hlt">practices</span></p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3555046','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3555046"><span id="translatedtitle"><span class="hlt">Paediatric</span> use of mycophenolate mofetil</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Downing, Heather J; Pirmohamed, Munir; Beresford, Michael W; Smyth, Rosalind L</p> <p>2013-01-01</p> <p>A number of medications do not have a licence, or label, for use in the <span class="hlt">paediatric</span> age group nor for the specific indication for which they are being used in children. Over recent years, mycophenolate mofetil has increasingly been used off-label (i.e. off-licence) in adults for a number of indications, including autoimmune conditions; progressively, this wider use has been extended to children. This review summarizes current use of mycophenolate mofetil (MMF) in children, looking at how MMF works, the pharmacokinetics, the clinical conditions for which it is used, the advantages it has when compared with other immunosuppressants and the unresolved issues remaining with use in children. The review aims to focus on off-label use in children so as to identify areas that require further research and investigation. The overall commercial value of MMF is limited because it has now come off patent in adults. Given the increasing knowledge of the pharmacodynamics, pharmacokinetics and pharmacogenomics demonstrating the clinical benefits of MMF, new, formal, investigator-led studies, including trials focusing on the use of MMF in children, would be of immense value. PMID:22519685</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_6");'>6</a></li> <li><a href="#" onclick='return showDiv("page_7");'>7</a></li> <li class="active"><span>8</span></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_8 --> <div id="page_9" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_7");'>7</a></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li class="active"><span>9</span></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="161"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/19436534','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/19436534"><span id="translatedtitle">Social <span class="hlt">paediatrics</span> and early child development: Part 1.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ford-Jones, Elizabeth Lee; Williams, Robin; Bertrand, Jane</p> <p>2008-11-01</p> <p>Diseases of modernism, rather than infectious diseases and chronic medical conditions, increasingly cause childhood morbidity and mortality. Thus, the goal of enhancing life outcomes for all children has become imperative. Paediatricans may begin with a renewed interest in social <span class="hlt">paediatrics</span> - the care of the disadvantaged child in Canada, requiring a focus on all the complex factors that <span class="hlt">impact</span> families and the community. New paediatricians need the tools to <span class="hlt">impact</span> both social determinants of health and political policies to support health for all. Such interest is as old as the field of <span class="hlt">paediatrics</span> (social medicine began with the great pathologist, Virchow, in the 1800s). The new neuroscience of experience-based brain and biological development has caught up with the social epidemiology literature. It is now known from both domains that a child's poor developmental and health outcomes are a product of early and ongoing socioeconomic and psychological experiences. In the era of epigenetics, it is now understood that both nature and nurture control the genome. Future paediatricians need to understand the science of experience-based brain development, and the interventions demonstrated to improve life trajectories. A challenge is to connect the traditional population health approach with traditional primary care responsibilities. New and enhanced collaborative interdisciplinary networks with, for example, public health, primary care, community resources, education and justice systems are required. PMID:19436534</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4451793','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4451793"><span id="translatedtitle">Bounded rationality alters the dynamics of <span class="hlt">paediatric</span> immunization acceptance</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Oraby, Tamer; Bauch, Chris T.</p> <p>2015-01-01</p> <p>Interactions between disease dynamics and vaccinating behavior have been explored in many coupled behavior-disease models. Cognitive effects such as risk perception, framing, and subjective probabilities of adverse events can be important determinants of the vaccinating behaviour, and represent departures from the pure “rational” decision model that are often described as “bounded rationality”. However, the <span class="hlt">impact</span> of such cognitive effects in the context of <span class="hlt">paediatric</span> infectious disease vaccines has received relatively little attention. Here, we develop a disease-behavior model that accounts for bounded rationality through prospect theory. We analyze the model and compare its predictions to a reduced model that lacks bounded rationality. We find that, in general, introducing bounded rationality increases the dynamical richness of the model and makes it harder to eliminate a <span class="hlt">paediatric</span> infectious disease. In contrast, in other cases, a low cost, highly efficacious vaccine can be refused, even when the rational decision model predicts acceptance. Injunctive social norms can prevent vaccine refusal, if vaccine acceptance is sufficiently high in the beginning of the vaccination campaign. Cognitive processes can have major <span class="hlt">impacts</span> on the predictions of behaviour-disease models, and further study of such processes in the context of vaccination is thus warranted. PMID:26035413</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ1083261.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ1083261.pdf"><span id="translatedtitle">The <span class="hlt">Impact</span> of OER on Teaching and Learning <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Weller, Martin; de los Arcos, Bea; Farrow, Rob; Pitt, Beck; McAndrew, Patrick</p> <p>2015-01-01</p> <p>The OER Research Hub has been investigating the <span class="hlt">impact</span> of OER, using eleven hypotheses, and a mixed methods approach to establish an evidence base. This paper explores the findings relating to teaching and learning. The findings reveal a set of direct <span class="hlt">impacts</span>, including an increase in factors relating to student performance, increased reflection…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED372106.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED372106.pdf"><span id="translatedtitle">Evaluation for Training <span class="hlt">Impact</span>: Insights from Advanced <span class="hlt">Practices</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Voerman, Irene; And Others</p> <p></p> <p>A literature review examined major trends in organizations and training and the ways in which evaluation may help drive training <span class="hlt">impact</span>. In addition, 3 case studies and 18 interviews were conducted in the United States to study evaluation methods. Recommendations about the use of evaluation for training <span class="hlt">impact</span> were then formulated, and four Dutch…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26036205','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26036205"><span id="translatedtitle">Evaluating an outreach service for <span class="hlt">paediatric</span> burns follow up.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q</p> <p>2015-09-01</p> <p>Complications following <span class="hlt">paediatric</span> burns are well documented and care needs to be taken to ensure the appropriate follow up of these patients. Historically this has meant follow up into adulthood however this is often not necessary. The centralisation of burns services in the UK means that patients and their parents may have to travel significant distances to receive this follow up care. To optimise our burns service we have introduced a burns outreach service to enable the patients to be treated closer to home. The aim of this study is to investigate the <span class="hlt">impact</span> of the introduction of the burns outreach service and within this environment define the optimum length of time needed to follow up these patients. A retrospective analysis was carried out of 100 consecutive <span class="hlt">paediatric</span> burns patients who underwent surgical management of their burn. During the follow up period there were 43 complications in 32 patients (32%). These included adverse scarring (either hypertrophic or keloid), delayed healing (taking >1 month to heal) and contractures (utilising either splinting or surgical correction). Fifty-nine percent of these complications occurred within 6 months of injury and all occurred within 18 months. Size of burn was directly correlated to the risk of developing a complication. The outreach service reduced the distance the patient needs to travel for follow up by more than 50%. There was also a significant financial benefit for the service as the follow up clinics were on average 50% cheaper with burns outreach than burns physician. Burns outreach is a feasible service that not only benefits the patients but also is cheaper for the burns service. The optimum length of follow up for <span class="hlt">paediatric</span> burns in 18 months, after which if there have not been any complications they can be discharged. PMID:26036205</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2540224','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2540224"><span id="translatedtitle">Guidelines for <span class="hlt">paediatric</span> life support. <span class="hlt">Paediatric</span> Life Support Working Party of the European Resuscitation Council.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>1994-01-01</p> <p>The <span class="hlt">paediatric</span> life support working party of the European Resuscitation Council was set up in 1992 with the aim of producing guidelines for basic and advanced <span class="hlt">paediatric</span> resuscitation that would be acceptable throughout Europe. The commonest cause of cardiac arrest in children is problems with the airway. The resulting difficulties in breathing and the associated hypoxia rapidly cause a severe bradycardia or asystole. In contrast, adults have primary cardiac events resulting in ventricular fibrillation. This important difference in the pathogenesis of <span class="hlt">paediatric</span> and adult cardiac arrest is reflected in these European Resuscitation Council guidelines, which complement those already published for adults. PMID:8019227</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=review&pg=2&id=EJ1098870','ERIC'); return false;" href="http://eric.ed.gov/?q=review&pg=2&id=EJ1098870"><span id="translatedtitle">Beyond Synthesis: Augmenting Systematic Review Procedures with <span class="hlt">Practical</span> Principles to Optimise <span class="hlt">Impact</span> and Uptake in Educational Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Green, Chris; Taylor, Celia; Buckley, Sharon; Hean, Sarah</p> <p>2016-01-01</p> <p>Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited <span class="hlt">impact</span> on educational policy and <span class="hlt">practice</span> has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4081767','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4081767"><span id="translatedtitle">The HOPE (Helping to Outline <span class="hlt">Paediatric</span> Eating Disorders) Project: development and debut of a <span class="hlt">paediatric</span> clinical eating disorder registry</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2013-01-01</p> <p>Background The HOPE (Helping to Outline <span class="hlt">Paediatric</span> Eating Disorders) Project is an ongoing registry study made up of a sequential cross-sectional sample prospectively recruited over 17 years, and is designed to answer empirical questions about <span class="hlt">paediatric</span> eating disorders. This paper introduces the HOPE Project, describes the registry sample to-date, and discusses future directions and challenges and accomplishments. The project and clinical service were established in a tertiary academic hospital in Western Australia in 1996 with a service development grant. Research processes were inbuilt into the initial protocols and data collection was maintained in the following years. Recognisable progress with the research agenda accelerated only when dedicated research resources were obtained. The registry sample consists of consecutive children and adolescents assessed at the eating disorder program from 1996 onward. Standardised multidisciplinary data collected from family intake interview, parent and child clinical interviews, medical review, parent, child and teacher psychometric assessments, and inpatient admission records populate the HOPE Project database. Results The registry database to-date contains 941 assessments, of whom 685 met DSM-IV diagnostic criteria for an eating disorder at admission. The majority of the sample were females (91%) from metropolitan Perth (83%). The cases with eating disorders consist of eating disorders not otherwise specified (68%), anorexia nervosa (25%) and bulimia nervosa (7%). Among those with eating disorders, a history of weight loss since illness onset was almost universal (96%) with fear of weight gain (71%) common, and the median duration of illness was 8 months. Conclusions Over the next five years and more, we expect that the HOPE Project will make a strong scientific contribution to <span class="hlt">paediatric</span> eating disorders research and will have important real-world applications to clinical <span class="hlt">practice</span> and policy as the research unfolds</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4054483','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4054483"><span id="translatedtitle">Hot tonsillectomy for <span class="hlt">paediatric</span> obstructive sleep apnoea</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Coyle, Paula; Marzouk, Sherief Deya; Gerolympou, Margarita; Marais, Joe</p> <p>2014-01-01</p> <p>Obstructive sleep apnoea is a common presentation in <span class="hlt">paediatric</span> ear, nose and tongue (ENT) outpatients. The use of sleep studies is controversial however once a diagnosis has been made, frequently treatment is surgery. Should these patients be operated on as urgent cases? A 5-year-old boy was admitted under the <span class="hlt">paediatric</span> team with difficultly breathing and desaturations to 77%. The patient had previously been seen by ENT as an outpatient with an 8-month history of obstructive sleep apnoea and was listed for an adenotonsillectomy with the standard waiting time. During this admission he had an emergency adenotonsillectomy. The patient improved immediately with no large desaturations in recovery and normal observations throughout his stay. It is never ideal to do a <span class="hlt">paediatric</span> emergency operation and we have reviewed the evidence base to answer the question: Should these patients be treated urgently when seen in outpatients? PMID:24907212</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3781994','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3781994"><span id="translatedtitle">Disease Activity Measures in <span class="hlt">Paediatric</span> Rheumatic Diseases</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Luca, Nadia J.; Feldman, Brian M.</p> <p>2013-01-01</p> <p>Disease activity refers to potentially reversible aspects of a disease. Measurement of disease activity in <span class="hlt">paediatric</span> rheumatic diseases is a critical component of patient care and clinical research. Disease activity measures are developed systematically, often involving consensus methods. To be useful, a disease activity measure must be feasible, valid, and interpretable. There are several challenges in quantifying disease activity in <span class="hlt">paediatric</span> rheumatology; namely, the conditions are multidimensional, the level of activity must be valuated in the context of treatment being received, there is no gold standard for disease activity, and it is often difficult to incorporate the patient's perspective of their disease activity. To date, core sets of response variables are defined for juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis, as well as definitions for improvement in response to therapy. Several specific absolute disease activity measures also exist for each condition. Further work is required to determine the optimal disease activity measures in <span class="hlt">paediatric</span> rheumatology. PMID:24089617</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/24567497','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/24567497"><span id="translatedtitle"><span class="hlt">Paediatric</span> CT optimisation utilising Catphan® 600 and age-specific anthropomorphic phantoms.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Santos, Joana; Batista, Maria do Carmo; Foley, Shane; Paulo, Graciano; McEntee, Mark F; Rainford, Louise</p> <p>2014-12-01</p> <p>The purpose of the study is to perform phantom-based optimisation of <span class="hlt">paediatric</span> computed tomography (CT) protocols and quantify the <span class="hlt">impact</span> upon radiation dose and image noise levels. The study involved three Portuguese <span class="hlt">paediatric</span> centres. Currently employed scanning protocols for head and chest examinations and combinations of exposure parameters were applied to a Catphan(®)600 phantom to review the CT dose <span class="hlt">impact</span>. Contrast-noise ratio (CNR) was quantified using Radia Diagnostic(®) tool. Imaging parameters, returning similar CNRs (<1) and dose savings were applied to three <span class="hlt">paediatric</span> anthropomorphic phantoms. OsiriX software based on standard deviation pixel values facilitated image noise analysis. Currently employed protocols and age categorisation varied between centres. Manipulation of exposure parameters facilitated mean dose reductions of 33 and 28 % for <span class="hlt">paediatric</span> head and chest CT examinations, respectively. The majority of the optimised CT examinations resulted in image noise similar to currently employed protocols. Dose reductions of up to 33 % were achieved with image quality maintained. PMID:24567497</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/23263630','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/23263630"><span id="translatedtitle">Promoting <span class="hlt">practice</span> in public health academia: assessing <span class="hlt">impact</span> on student education.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Beck, Angela J; Sarigiannis, Amy N; Thomas, Dana; Montgomery, JoLynn P; Boulton, Matthew L</p> <p>2013-01-01</p> <p>This article reviews the activities of an office of public health <span class="hlt">practice</span> in a school of public health (SPH) and assesses their <span class="hlt">impact</span> on master's of public health student training and education. The University of Michigan SPH established a <span class="hlt">Practice</span> Office in 2005 to develop programs in community-based public health, workforce development, student training, and <span class="hlt">practice</span>-based research. Student training objectives included increasing <span class="hlt">practice</span> activity offerings and participation rates, ensuring participant satisfaction with activities, and raising the number of students seeking public health <span class="hlt">practice</span> employment. According to student survey results from the 2007-2008 and 2008-2009 academic years, the <span class="hlt">Practice</span> Office achieved mixed success in meeting objectives. Approximately 50% of students participated in at least 1 activity, nearly 50% of students reported that the activities <span class="hlt">impacted</span> their decision to pursue a <span class="hlt">practice</span> career, and approximately 75% of students reported moderate to extensive public health <span class="hlt">practice</span> experience on graduation, compared with 30% at the beginning of their degree program, although this change was not significantly different for those who had participated in <span class="hlt">Practice</span> Office activities. Initiation of a systematic process to evaluate the <span class="hlt">impact</span> of <span class="hlt">practice</span>-based activities early in program development is recommended for all <span class="hlt">Practice</span> Offices. PMID:23263630</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/8466242','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/8466242"><span id="translatedtitle">Evaluation and audit in a <span class="hlt">paediatric</span> disability service.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cass, H D; Kugler, B T</p> <p>1993-03-01</p> <p>Parental and professional responses to questionnaires evaluating a <span class="hlt">paediatric</span> disability service are reported and the viability of auditing structural, process, and outcome aspects of clinical <span class="hlt">practice</span> are discussed. Expectations of waiting time to first appointment (met for only 52% of consumers) illustrate structural issues. Process issues are reflected in consumer reactions to outreach work (for example, 94% of parents and 84% of professionals found this supportive). Outcome measures such as consumer satisfaction with the service (76% of consumers reported being 'very satisfied' and 20% 'fairly satisfied') suggest that service aims are being met. Good concurrence of service aims with consumer needs is indicated by parental reasons for referral (for example, 75% for diagnostic help, 73% for a better understanding of the disorder, 88% for <span class="hlt">practical</span> help), referrers' reasons (for example, 55% for a second diagnostic opinion, 45% due to lack of local expertise), and reports from most other professionals involved with the case that a similar service was not provided locally. PMID:8466242</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/17119078','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/17119078"><span id="translatedtitle">Resuscitation of general <span class="hlt">paediatrics</span> in the UK.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wacogne, I; Scott-Jupp, R; Chambers, T</p> <p>2006-12-01</p> <p>"The report of my death was an exaggeration", said Mark Twain. For a dying specialty, general <span class="hlt">paediatrics</span> has certainly been looking very healthy recently. It is timely to examine why our specialty was thought to be at such risk, and to explore why, although in many cases shocked and confused, it is well on the way to recovery. This article explores what is needed to keep it healthy to ensure that the general paediatrician is at the centre of the delivery of <span class="hlt">paediatrics</span> in the UK. PMID:17119078</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27117211','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27117211"><span id="translatedtitle">[<span class="hlt">Impact</span> of digital technology on clinical <span class="hlt">practices</span>: perspectives from surgery].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Zhang, Y; Liu, X J</p> <p>2016-04-01</p> <p>Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical <span class="hlt">practices</span>. Being integrated into clinical <span class="hlt">practice</span>, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical <span class="hlt">practices</span>. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes. PMID:27117211</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25439093','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25439093"><span id="translatedtitle"><span class="hlt">Practical</span> management of cumulative anthropogenic <span class="hlt">impacts</span> with working marine examples.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wright, Andrew J; Kyhn, Line A</p> <p>2015-04-01</p> <p>Human pressure on the environment is expanding and intensifying, especially in coastal and offshore areas. Major contributors to this are the current push for offshore renewable energy sources, which are thought of as environmentally friendly sources of power, as well as the continued demand for petroleum. Human disturbances, including the noise almost ubiquitously associated with human activity, are likely to increase the incidence, magnitude, and duration of adverse effects on marine life, including stress responses. Stress responses have the potential to induce fitness consequences for individuals, which add to more obvious directed takes (e.g., hunting or fishing) to increase the overall population-level <span class="hlt">impact</span>. To meet the requirements of marine spatial planning and ecosystem-based management, many efforts are ongoing to quantify the cumulative <span class="hlt">impacts</span> of all human actions on marine species or populations. Meanwhile, regulators face the challenge of managing these accumulating and interacting <span class="hlt">impacts</span> with limited scientific guidance. We believe there is scientific support for capping the level of <span class="hlt">impact</span> for (at a minimum) populations in decline or with unknown statuses. This cap on <span class="hlt">impact</span> can be facilitated through implementation of regular application cycles for project authorization or improved programmatic and aggregated <span class="hlt">impact</span> assessments that simultaneously consider multiple projects. Cross-company collaborations and a better incorporation of uncertainty into decision making could also help limit, if not reduce, cumulative <span class="hlt">impacts</span> of multiple human activities. These simple management steps may also form the basis of a rudimentary form of marine spatial planning and could be used in support of future ecosystem-based management efforts. PMID:25439093</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/12373007','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/12373007"><span id="translatedtitle">Growth in <span class="hlt">paediatric</span> Crohn's disease.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cezard, J P; Touati, G; Alberti, C; Hugot, J P; Brinon, C; Czernichow, P</p> <p>2002-01-01</p> <p>Growth failure (GF) is one of the major complications affecting children with inflammatory bowel disease. The faltering is temporary in 40-50% of cases and prolonged in 10-20% in Crohn's disease (CD). Such failure is rare in children with ulcerative colitis (5%). This complication is often associated with retarded bone development and delayed onset of sexual maturation. The delayed linear growth has a variety of causes including insufficient intake due to anorexia and the inflammatory process with increased energy and protein expenditure. Other factors are increased intestinal loss, secondary hypopituitarism and treatment with steroids. Therapeutic strategies of CD in children have changed this last decade by introducing new therapeutic agents such as topic steroids, immunosuppressors, anti-TNF (antibody and notably in children enteral nutrition which has shown its efficacy in inducing remissions of active CD, restoring nutritional status and stimulation of linear growth. The results of a recent prospective multicentric study over 2 years in 82 CD show that severe GF (-2 SD) is initially present in 15% (n = 12), among them 11 remain < -2SD after 2 years of follow-up. Six patients who were on the normal range initially increased their GF during the follow-up (< -2SD) (total 21% < -2SD (n = 17) at 2 years). At inclusion in this group there was no difference in growth velocity, used of steroids, enteral nutrition or severity of CD as compared to the group with no GF. It suggests that new treatment strategy should be developed in the future for this specific complication of <span class="hlt">paediatric</span> CD. PMID:12373007</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=irrigation&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=68566309&CFTOKEN=44092942','EPA-EIMS'); return false;" href="http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=irrigation&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=68566309&CFTOKEN=44092942"><span id="translatedtitle">Novel Use of Time Domain Reflectometry in Infiltration-based Low <span class="hlt">Impact</span> Development <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://oaspub.epa.gov/eims/query.page">EPA Science Inventory</a></p> <p></p> <p></p> <p>Low <span class="hlt">impact</span> development (LID) <span class="hlt">practices</span> are structures that intercept stormwater runoff and infiltrate it through a range of media types, including aggregate, rain garden media, and underlying soils. Hydrologic performance is typically evaluated by comparing inlet and underdrain o...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/15279861','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/15279861"><span id="translatedtitle"><span class="hlt">Paediatric</span> nurses' attitudes to massage and aromatherapy massage.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hunt, V; Randle, J; Freshwater, D</p> <p>2004-08-01</p> <p>Complementary therapies have continued to increase in popularity in healthcare and it is widely accepted that they can be incorporated into the nursing role. However, this acceptance does not necessarily mean that the introduction of therapies into the nursing arena has been without confusion and without professional and legal implications. Consequently, this small-scale, qualitative study aimed to explore the perceptions and lived experiences of <span class="hlt">paediatric</span> nurses of two therapies, namely massage and aromatherapy massage. There is a dearth of literature exploring nurses' perceptions to the incorporation of these therapies, especially in the arena of <span class="hlt">paediatric</span> nursing where massage and aromatherapy massage are common <span class="hlt">practice</span>. Semi-structured interviews were undertaken with qualified nurses and revealed the themes of 'benefit', 'family centred care', 'nursing care' and 'being held back'. It was found that at some stage during their professional career each nurse had performed massage and/or aromatherapy massage. All nurses were able to recall certain benefits of the therapies for the children that they had observed and many discussed the importance of involving the family as a way of including them in to the care of their child. However, for the nurses in this study, it was evident that the incorporation of complementary therapies into the nursing role was determined by the context in which they practised. Due to the dominance of the medical model, nurses faced pressures and conflicts in the realities of their nursing work, which meant they were often unable to carry out these therapies. PMID:15279861</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=heart+AND+failure&pg=3&id=EJ926393','ERIC'); return false;" href="http://eric.ed.gov/?q=heart+AND+failure&pg=3&id=EJ926393"><span id="translatedtitle">Evidence and <span class="hlt">Impact</span>: How Scholarship Can Improve Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Lingenfelter, Paul E.</p> <p>2011-01-01</p> <p>Researchers, policy makers, and practitioners share a sincere interest in improving the human condition. Academics may be tempted to fault irrationality, ideology, or ignorance for the failure of research to inform policy and <span class="hlt">practice</span> more powerfully, but policy makers and practitioners want academics to tell them "what works" in order to find a…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_7");'>7</a></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li class="active"><span>9</span></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_9 --> <div id="page_10" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li class="active"><span>10</span></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="181"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://pubs.er.usgs.gov/publication/70157273','USGSPUBS'); return false;" href="http://pubs.er.usgs.gov/publication/70157273"><span id="translatedtitle"><span class="hlt">Impact</span> of fishing and stocking <span class="hlt">practices</span> on Coregonid diversity</span></a></p> <p><a target="_blank" href="http://pubs.er.usgs.gov/pubs/index.jsp?view=adv">USGS Publications Warehouse</a></p> <p>Anneville, Orlane; Lasne, Emilien; Guillard, Jean; Eckmann, Reiner; Stockwell, Jason D.; Gillet, Christian; Yule, Daniel</p> <p>2015-01-01</p> <p>Fish species diversity can be lost through interacting stressors including habitat loss, stocking and overfishing. Although a multitude of stressors have played a role in the global decline of coregonid (Coregonus spp.) diversity, a number of contemporary studies have identified habitat loss stemming from eutrophication as the primary cause. Unfortunately, reconstructing the role of fishing and stocking <span class="hlt">practices</span> can be difficult, because these records are incomplete or appear only in hard-to-access historic grey literature. Based on an illustrative set of historic and contemporary studies, we describe how fisheries management <span class="hlt">practices</span> may have contributed to coregonid diversity loss in European and North American lakes. We provide case studies examining how fishing and stocking may reduce coregonid diversity through demographic decline and introgressive hybridization. In some lakes, fisheries management <span class="hlt">practices</span> may have led to a loss of coregonid diversity well before issues with habitat degradation manifested. Our review suggests that fish conservation policies could beneficially consider the relative importance of all stressors, including management <span class="hlt">practices</span>, as potential drivers of diversity loss.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/23513431','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/23513431"><span id="translatedtitle"><span class="hlt">Impact</span> of unit <span class="hlt">practice</span> councils on culture and outcomes.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wessel, Susan</p> <p>2012-01-01</p> <p>This article describes positive outcomes in culture, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, employee engagement, and clinical quality as a result of using shared governance, specifically unit <span class="hlt">practice</span> councils (UPC) or staff councils, to implement Relationship-Based Care (RBC). PMID:23513431</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Workflow+AND+Design&pg=7&id=ED255988','ERIC'); return false;" href="http://eric.ed.gov/?q=Workflow+AND+Design&pg=7&id=ED255988"><span id="translatedtitle">Research <span class="hlt">Impact</span> on Educational Policy and <span class="hlt">Practice</span> in the USA.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Mitchell, Douglas E.</p> <p></p> <p>This chapter examines, from four perspectives, the ways in which educational research, development, and evaluation activities in the United States are organized, controlled, and supported, and considers whether research can be properly used to shape educational policy and <span class="hlt">practice</span>. First, the size and historical development of the research and…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=information+AND+confidence&pg=7&id=EJ1021207','ERIC'); return false;" href="http://eric.ed.gov/?q=information+AND+confidence&pg=7&id=EJ1021207"><span id="translatedtitle">Considering the <span class="hlt">Impact</span> of Preservice Teacher Beliefs on Future <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Thomas, Cathy Newman</p> <p>2014-01-01</p> <p>Preservice teacher beliefs merit additional attention from special education teacher-educators. Given current policy and reforms aimed at improving outcomes for students with disabilities and increasing the adoption of evidence-based <span class="hlt">practices</span>, teacher-educators should recognize the barrier that preservice teacher beliefs can pose and consider…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=277969','TEKTRAN'); return false;" href="http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=277969"><span id="translatedtitle">Nutritional <span class="hlt">practices</span> to reduce environmental <span class="hlt">impact</span> of grazing beef cattle.</span></a></p> <p><a target="_blank" href="http://www.ars.usda.gov/services/TekTran.htm">Technology Transfer Automated Retrieval System (TEKTRAN)</a></p> <p></p> <p></p> <p>The effects of beef cattle operations on water quality, climate change, wildlife, and the general environment is a growing concern. With increased concern about the environment, many "common" <span class="hlt">practices</span> might need to be revised in order to balance production efficiency and income with real and percei...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/18799306','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/18799306"><span id="translatedtitle">Global child health priorities: what role for <span class="hlt">paediatric</span> oncologists?</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kellie, Stewart J; Howard, Scott C</p> <p>2008-11-01</p> <p>Despite increasing globalisation, international mobility and economic interdependence, 9.7 million children aged less than 5 years in low income countries will die this year, almost all from preventable or treatable diseases. Diarrhoea, pneumonia and malaria account for 5 million of these deaths each year, compared to about 150,000 deaths from childhood cancer in low- and middle-income countries. In high-income countries, 80% of the 50,000 children diagnosed with cancer each year survive, yet cancer remains the leading disease-related cause of childhood death. In low- and middle-income countries, where 80% of children live, the 200,000 children diagnosed with cancer each year have limited access to curative treatment, and only about 25% survive. Some might argue that death from <span class="hlt">paediatric</span> cancer in poor countries is insignificant compared to death from other causes, and that scarce health resources may be better used in other areas of public health. Is there a role for the treatment of children with cancer in these regions? Do international partnerships or 'twinning' programmes enhance local health care or detract from other public health priorities? What is ethical and what is possible? This review examines the health challenges faced by infants and children in low-income countries, and assesses the role and <span class="hlt">impact</span> of international <span class="hlt">paediatric</span> oncology collaboration to improve childhood cancer care worldwide. PMID:18799306</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=ERI&pg=2&id=ED508108','ERIC'); return false;" href="http://eric.ed.gov/?q=ERI&pg=2&id=ED508108"><span id="translatedtitle">Capturing Research <span class="hlt">Impacts</span>: A Review of International <span class="hlt">Practice</span>. Documented Briefing</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Grant, Jonathan; Brutscher, Philipp-Bastian; Kirk, Susan Ella; Butler, Linda; Wooding, Steven</p> <p>2010-01-01</p> <p>In February 2009, the Higher Education Funding Council for England (HEFCE) commissioned RAND Europe to review approaches to evaluating the <span class="hlt">impact</span> of research as part of their wider work programme to develop new arrangements for the assessment and funding of research--referred to as the Research Excellence Framework (REF). The objectives were 1) to…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=scientific+AND+revolution&pg=6&id=EJ214976','ERIC'); return false;" href="http://eric.ed.gov/?q=scientific+AND+revolution&pg=6&id=EJ214976"><span id="translatedtitle">The <span class="hlt">Impact</span> of Paradigm-Based Research on Classroom <span class="hlt">Practice</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Peterson, Rita W.</p> <p>1979-01-01</p> <p>The first part of the paper describes the nature of scientific revolutions and how paradigms of scientists drive these revolutions. Against their background, the second part describes studies of the <span class="hlt">impact</span> of paradigm-based research on the classroom. The third part speculates on the likelihood of a science teaching revolution. (Author/RE)</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=safety&pg=5&id=EJ950091','ERIC'); return false;" href="http://eric.ed.gov/?q=safety&pg=5&id=EJ950091"><span id="translatedtitle">Safety Education <span class="hlt">Impact</span> and Good <span class="hlt">Practice</span>: A Review</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Mulvaney, Caroline A.; Watson, Michael C.; Errington, Gail</p> <p>2012-01-01</p> <p>Purpose: The aim of this literature review was to examine recent evidence of the <span class="hlt">impact</span> of safety education for children and young people on unintentional injury rates and to update an earlier review. Evidence was sought that linked safety education for children and young people in schools, centres and other settings with changes in knowledge,…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=instructional+AND+practices+AND+student+AND+achievement+AND+science&pg=6&id=EJ1034755','ERIC'); return false;" href="http://eric.ed.gov/?q=instructional+AND+practices+AND+student+AND+achievement+AND+science&pg=6&id=EJ1034755"><span id="translatedtitle">Modeling Instruction: The <span class="hlt">Impact</span> of Professional Development on Instructional <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Barlow, Angela T.; Frick, Tasha M.; Barker, Heather L.; Phelps, Amy J.</p> <p>2014-01-01</p> <p>Modeling Instruction holds the potential for transforming science instruction and improving student achievement. Key to the success of Modeling Instruction, however, is the fidelity of implementation of its curriculum. This qualitative study examined the <span class="hlt">impact</span> of Modeling Instruction professional development on participating teachers'…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED472070.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED472070.pdf"><span id="translatedtitle">Form or Flesh: Social Factors That <span class="hlt">Impact</span> Women's <span class="hlt">Practice</span> of Breast Self-Examination.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>London, Patricia A.</p> <p></p> <p>The social factors that <span class="hlt">impact</span> Caucasian middle-class women's <span class="hlt">practice</span> of breast self-examination (BSE) were examined through in-depth interviews with 15 women who were selected to represent a mix of women who <span class="hlt">practiced</span> BSE monthly, occasionally, or never. The meaning of BSE was analyzed in relation to body image and the social definition of being…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3627201','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3627201"><span id="translatedtitle">National Board Certification and Developmentally Appropriate <span class="hlt">Practices</span>: Perceptions of <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>McKenzie, Ellen Nancy</p> <p>2013-01-01</p> <p>The study investigated a relationship between National Board certification and perceived use of developmentally appropriate <span class="hlt">practices</span> (DAP). A self-developed survey, the Early-childhood Teacher Inventory of <span class="hlt">Practices</span>, was e-mailed to participants. Participants included 246 non-National Board-certified (non-NBCT) and 135 National Board-certified (NBCT) early childhood teachers. Descriptives were reported for age, years of teaching experience, grade level currently teaching, ethnicity, degree type, certification type, and degree level. Inferential statistics were used to understand the differences between perceived use of DAP. NBCTs scored significantly higher than non-NBCTs in three of the four target areas and on the total of the scale. Pearson product-moment corelations were used to determine a relationship between years of experience or level of education and NBCTs’ perceived use of DAP. Years of experience were significantly related, but level of education was not. The findings indicate that NBCT teachers perceive they incorporate more developmentally appropriate <span class="hlt">practices</span> into their teaching than do non-NBCT teachers. PMID:23626399</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26289061','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26289061"><span id="translatedtitle">Recent advances in <span class="hlt">paediatric</span> respiratory medicine.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Turnbull, Andrew; Balfour-Lynn, Ian M</p> <p>2016-02-01</p> <p>This review highlights important advances in <span class="hlt">paediatric</span> respiratory medicine since 2014, excluding cystic fibrosis. It focuses mainly on the more common conditions, bronchopulmonary dysplasia, bronchiolitis and preschool wheezing, asthma, pneumonia and sleep, and highlights some of the rarer conditions such as primary ciliary dyskinesia and interstitial lung disease (ILD). PMID:26289061</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27177481','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27177481"><span id="translatedtitle">[The medicine use pathway in <span class="hlt">paediatrics</span>].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Didelot, Nicolas</p> <p>2016-01-01</p> <p>The medicine use pathway is a process which is constantly evolving in order to comply with intangible rules. As in other therapeutic fields, the drug regimen in <span class="hlt">paediatrics</span> must tolerate no error and must be able to detect all warning signs, however minor, in order to optimise this approach. PMID:27177481</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/24525527','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/24525527"><span id="translatedtitle"><span class="hlt">Paediatric</span> pituitary adenomas: a decade of change.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Guaraldi, Federica; Storr, Helen L; Ghizzoni, Lucia; Ghigo, Ezio; Savage, Martin O</p> <p>2014-01-01</p> <p>Pituitary adenomas, although rare in the <span class="hlt">paediatric</span> age range and mostly benign, represent very challenging disorders for diagnosis and management. The recent identification of genetic alterations in young individuals with pituitary adenomas has broadened the scope of molecular investigations and contributed to the understanding of mechanisms of tumorigenesis. Recent identification of causative mutations of genes such as GNAS, PRKAR1A, MEN1 and AIP has introduced the concept of molecular screening of young apparently healthy family members. Population-based studies have reported a significantly higher number of affected subjects and genetic variations than expected. Radiological techniques have advanced, yet many microadenomas remain undetectable on scanning. However, experience with transsphenoidal and endoscopic pituitary surgery has led to higher rates of cure. Prolactinomas, corticotroph and somatotroph adenomas remain the most prevalent, with each diagnosis presenting its own challenges. As <span class="hlt">paediatric</span> pituitary adenomas occur very infrequently within the <span class="hlt">paediatric</span> age range, <span class="hlt">paediatric</span> endocrine units cannot provide expert management in isolation. Consequently, close co-operation with adult endocrinology colleagues with experience of pituitary disease is strongly recommended. PMID:24525527</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3531002','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3531002"><span id="translatedtitle">Recent developments in <span class="hlt">paediatric</span> neuraxial blocks</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ponde, Vrushali Chandrashekhar</p> <p>2012-01-01</p> <p><span class="hlt">Paediatric</span> anaesthesia and <span class="hlt">paediatric</span> regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulation in the pursuit of safety and an objective end point. This review also takes account of the traditional technique and understand the benefits as well the risk of each as compared with the recent technique. The recent trends in choosing the most appropriate peripheral block for a given surgery thereby sparing the central neuroaxis is considered. A penile block for circumcision or a sciatic block for unilateral foot surgery, rather than caudal epidural would have a better risk benefit equation. Readers will find a special mention on the recent thoughts on continuous epidural analgesia in <span class="hlt">paediatrics</span>, especially its rise and fall, yet its unique importance. Lastly, the issue of block placements under sedation or general anaesthesia with its implication in this special population is dealt with. We conducted searches in MEDLINE (PubMed) and assessed the relevance of the abstracts of citations identified from literature searches. The search was carried out in English, for last 10 years, with the following key words: Recent advances in <span class="hlt">paediatric</span> regional anaesthesia; ultrasound guidance for central neuraxial blocks in children; role of electrical stimulation in neuraxial blocks in children; complications in neuraxial block. Full-text articles of potentially relevant abstracts were retrieved for further review. PMID:23293386</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=EFFICIENT+AND+ICT&pg=3&id=EJ731454','ERIC'); return false;" href="http://eric.ed.gov/?q=EFFICIENT+AND+ICT&pg=3&id=EJ731454"><span id="translatedtitle">The <span class="hlt">Impact</span> of Information and Communication Technology (ICT) on the Management <span class="hlt">Practices</span> of Malaysian Smart Schools</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Zain, Muhammad Z. M.; Atan, Hanafi; Idrus, Rozhan M.</p> <p>2004-01-01</p> <p>The <span class="hlt">impact</span> of Information and Communication Technology (ICT) on the management <span class="hlt">practices</span> in the Malaysian Smart Schools was investigated. The analysis revealed that the <span class="hlt">impact</span> has resulted in changes that include the enrichment of the ICT culture among students and teachers, more efficient student and teacher administration, better accessibility…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=pharmaceutical+AND+industry&pg=3&id=EJ941445','ERIC'); return false;" href="http://eric.ed.gov/?q=pharmaceutical+AND+industry&pg=3&id=EJ941445"><span id="translatedtitle"><span class="hlt">Impact</span> of Knowledge Management on Learning Organization <span class="hlt">Practices</span> in India: An Exploratory Analysis</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Chawla, Deepak; Joshi, Himanshu</p> <p>2011-01-01</p> <p>Purpose: This paper aims to report the preliminary findings of the difference in learning organization (LO) <span class="hlt">practices</span> across industries. It also reports the <span class="hlt">impact</span> of knowledge management (KM) dimensions on LO and whether this <span class="hlt">impact</span> is different across manufacturing, IT and IT-enabled services (ITES) and power generation and distribution in…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=instructional+AND+practices+AND+student+AND+achievement+AND+science&pg=3&id=EJ975185','ERIC'); return false;" href="http://eric.ed.gov/?q=instructional+AND+practices+AND+student+AND+achievement+AND+science&pg=3&id=EJ975185"><span id="translatedtitle">Faculty Development Programs: Assessing the <span class="hlt">Impact</span> on Instructional <span class="hlt">Practices</span>, and Student Learning and Motivation</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Ambrosino, Roberta; Peel, Jennifer</p> <p>2011-01-01</p> <p>Demonstrating the <span class="hlt">impact</span> of faculty development activities is difficult and infrequently attempted beyond assessing participant satisfaction. This study examines how faculty development activities affect instructional <span class="hlt">practices</span> and the <span class="hlt">impact</span> on student learning and motivation in accordance with Kirkpatrick's levels of evaluation. Ten instructors…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27298135','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27298135"><span id="translatedtitle">Translating Knowledge Into <span class="hlt">Practice</span> Through an Academic-<span class="hlt">Practice</span> Partnership for Exploring Barriers That <span class="hlt">Impact</span> Management of Homebound Patients With Heart Failure.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Echevarria, Mercedes</p> <p>2016-01-01</p> <p>A knowledge translation project involving an academic-<span class="hlt">practice</span> partnership and guided by action-oriented research was used for exploring barriers that <span class="hlt">impact</span> management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (<span class="hlt">practice</span>) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current <span class="hlt">practice</span> against evidence-based <span class="hlt">practice</span> recommendations, introduce strategies to "close the gap" between actual <span class="hlt">practice</span> and the desired <span class="hlt">practice</span>, develop audit criteria, and reevaluate the <span class="hlt">impact</span>. PMID:27298135</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_8");'>8</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li class="active"><span>10</span></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_10 --> <div id="page_11" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li class="active"><span>11</span></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="201"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2975087','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2975087"><span id="translatedtitle"><span class="hlt">Paediatric</span> and adult colonic manometry: A tool to help unravel the pathophysiology of constipation</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Dinning, Philip G; Benninga, Marc A; Southwell, Bridget R; Scott, S Mark</p> <p>2010-01-01</p> <p>Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Colonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipation, a heterogeneous condition which is extremely prevalent in the general population, and has huge socioeconomic <span class="hlt">impact</span> and individual suffering. Physiological testing plays a crucial role in patient management, as it is now accepted that symptom-based assessment, although important, is unsatisfactory as the sole means of directing therapy. Colonic manometry provides a direct method for studying motor activities of the large bowel, and this review provides a contemporary understanding of how this technique has enhanced our knowledge of normal colonic motor physiology, as well as helping to elucidate pathophysiological mechanisms underlying constipation. Methodological approaches, including available catheter types, placement technique and recording protocols, are covered, along with a detailed description of recorded colonic motor activities. This review also critically examines the role of colonic manometry in current clinical <span class="hlt">practice</span>, and how manometric assessment may aid diagnosis, classification and guide therapeutic intervention in the constipated individual. Most importantly, this review considers both adult and <span class="hlt">paediatric</span> patients. Limitations of the procedure and a look to the future are also addressed. PMID:21049550</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25993151','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25993151"><span id="translatedtitle">The <span class="hlt">impact</span> of industry on oncology research and <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Moy, Beverly; Jagsi, Reshma; Gaynor, Richard B; Ratain, Mark J</p> <p>2015-01-01</p> <p>Public scrutiny has increased over potential conflicts of interest among oncology researchers and providers. Given the increased prevalence and complexity of industry relationships, oncologists are increasingly faced with ethical challenges when navigating their financial relationships with industry. Oncologists are continually dealing with changing conflict of interest policies within academic centers and professional societies. With the recent passage of The Sunshine Act, oncologists are beginning to understand the repercussions of this new law. The consequences of the increasing use of direct-to-consumer advertising on patients with cancer are also unclear. Finally, industry's perspective on the evolution of these relationships is not clearly understood. This manuscript discusses issues related to industry's influence on oncology <span class="hlt">practice</span> and research. PMID:25993151</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3954187','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3954187"><span id="translatedtitle"><span class="hlt">Paediatric</span> admissions to the British military hospital at Camp Bastion, Afghanistan</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Arul, GS; Reynolds, J; DiRusso, S; Scott, A; Bree, S; Templeton, P; Midwinter, MJ</p> <p>2012-01-01</p> <p>INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of <span class="hlt">paediatric</span> admissions with the pattern of injury and the resources they consume. METHODS All <span class="hlt">paediatric</span> admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths. CONCLUSIONS <span class="hlt">Paediatric</span> admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK <span class="hlt">paediatric</span> emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK <span class="hlt">paediatric</span> <span class="hlt">practice</span>. PMID:22524930</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4958657','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4958657"><span id="translatedtitle">Beyond the guidelines of <span class="hlt">paediatric</span> septic shock: A focused review</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Temsah, Mohamad-Hani</p> <p>2015-01-01</p> <p>Severe sepsis and septic shock continue to cause major morbidity and mortality among children, especially in the resource-limited areas. Guidelines that focus on these entities, such as “Surviving Sepsis” and “<span class="hlt">Paediatric</span> Advanced Life Support” guidelines, are revised and updated on regular basis to incorporate new evidence based medicine. There is ongoing need to review these updated guidelines, and address potentially best available solutions for adapting them into suitable <span class="hlt">practical</span> steps for paediatricians worldwide, especially those working in resource-limited areas. The available recommendations may help to improve sepsis management in middle- and low-income countries; however, guidelines must be wisely implemented according to the available resources, with follow up auditing to ensure appropriate implementation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4955460','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4955460"><span id="translatedtitle">Endoscopic removal of <span class="hlt">impacted</span> oesophageal foreign body: A case report and a review of literature</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Obateru, Olusegun A.; Durowaye, Matthew O.; Olokoba, Abdulfatai B.; Olaniyi, Olufemi K.</p> <p>2016-01-01</p> <p>Foreign body (FB) <span class="hlt">impaction</span> in the oesophagus is fairly common in <span class="hlt">paediatric</span> Gastroenterology <span class="hlt">practice</span>. This study aims to describe a case of an unusually <span class="hlt">impacted</span> button lithium battery, in the mid-oesophagus of a 7-year-old child that was confirmed, and removed during oesophagogastroduodenoscopy. A 7-year-old male child, presented at the Emergency <span class="hlt">Paediatric</span> Unit of our hospital with a history of ingestion of a button-like metallic object. A plain soft tissue X-ray of the neck and chest, however, revealed a dense round object located at the sternal angle of Louis. The object was dislodged and identified as a flat lithium battery after an oesophagogastroduodenoscopy, carried out under general anaesthesia using a flexible forward-viewing video gastroscope. The button battery was subsequently passed in faeces. Endoscopic removal of <span class="hlt">impacted</span> oesophageal FBs under general anaesthesia is an effective and safe procedure in children in experienced hands. PMID:27251523</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27251523','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27251523"><span id="translatedtitle">Endoscopic removal of <span class="hlt">impacted</span> oesophageal foreign body: A case report and a review of literature.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Obateru, Olusegun A; Durowaye, Matthew O; Olokoba, Abdulfatai B; Olaniyi, Olufemi K</p> <p>2016-01-01</p> <p>Foreign body (FB) <span class="hlt">impaction</span> in the oesophagus is fairly common in <span class="hlt">paediatric</span> Gastroenterology <span class="hlt">practice</span>. This study aims to describe a case of an unusually <span class="hlt">impacted</span> button lithium battery, in the mid-oesophagus of a 7-year-old child that was confirmed, and removed during oesophagogastroduodenoscopy. A 7-year-old male child, presented at the Emergency <span class="hlt">Paediatric</span> Unit of our hospital with a history of ingestion of a button-like metallic object. A plain soft tissue X-ray of the neck and chest, however, revealed a dense round object located at the sternal angle of Louis. The object was dislodged and identified as a flat lithium battery after an oesophagogastroduodenoscopy, carried out under general anaesthesia using a flexible forward-viewing video gastroscope. The button battery was subsequently passed in faeces. Endoscopic removal of <span class="hlt">impacted</span> oesophageal FBs under general anaesthesia is an effective and safe procedure in children in experienced hands. PMID:27251523</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/18051997','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/18051997"><span id="translatedtitle">[Consensus on <span class="hlt">paediatric</span> parenteral nutrition: a document approved by SENPE/SEGHNP/SEFH].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Muñoz, P Gomis; López, L Gómez; Costa, C Martínez; Villares, J M Moreno; Giner, C Pedrón; Maristany, C Pérez-Portabella; del Río, M T Pozas</p> <p>2007-01-01</p> <p>In current medical <span class="hlt">practice</span>, standardization of procedures has become a desirable objective. The Spanish Society of Parenteral and Enteral Nutrition (SENPE) has undertaken a considerable effort to create clinical <span class="hlt">practice</span> guidelines or documents of consensus and quality gold standards in artificial nutrition. As a result the SENPE group of standardization has put together a document called "Consensus of <span class="hlt">Paediatric</span> Parenteral Nutrition" supported by the Spanish Society of Gastroenterology, Hepatology and Nutrition (SEGHNP) and by the Spanish Society of Hospital Pharmacies (SEFH). This is a reduced version of our work. The complete version is available at www.nutricionhospitalaria.com and www.senpe.com. This document covers many aspects such as <span class="hlt">paediatric</span> patient indications, vascular access, macro and micro nutrients needs; also preparation in special situations, components, forms of prescription, possibilities for standardization of the elaboration and prescription, elaboration, administration, monitoring, complications and side effects. Much research has been done, incorporating current publications, books and clinical <span class="hlt">practice</span> guidelines such as those published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and by the European Society of <span class="hlt">Paediatric</span> Gastroenterology, Hepatology and Nutrition (ESPGHAN) in collaboration with the European Society for Clinical Nutrition and Metabolism (ESPEN). PMID:18051997</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2010EGUGA..1214168G','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2010EGUGA..1214168G"><span id="translatedtitle">Serbian Torrent Flood Defense <span class="hlt">Practice</span> - Modeling, observation, forecasting and <span class="hlt">impact</span></span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Gavrilovic, Zoran; Stefnovic, Milutin</p> <p>2010-05-01</p> <p>Many areas in Europe have been affected by an increasing number of severe flood events in the past few years. Because of these floods numerous measures to improve the organization of disaster management have been taken. This includes the preparation of specific alarm plans for flood disaster events. Serbian Torrent Flood Defense methodology, combines observation by radar meteorology, torrential hydrology and new GIS techniques to enable quick determination and assessment of the detected situation in order to provide a sufficient time for the flood defense system to be put in operation. Alarm plans can be seen as one corner stone of disaster management but their <span class="hlt">practical</span> use can still be optimized. For this end aims to support the risk analysis and risk communication process by improving the availability, reliability and communicability of hazard maps and alarm plans. The main focus will be on levels of population protection and critical infrastructure protection in respect to natural hazards. Paper presents Obtained results in the field of torrent defense in Serbia. Key words: Hydrology, Torrent Flood Analysis, Meteorology, Flood Defense</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/27062615','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/27062615"><span id="translatedtitle">Quality in <span class="hlt">paediatric</span> emergency medicine: Measurement and reporting.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Borland, Meredith L; Shepherd, Mike</p> <p>2016-02-01</p> <p>There is a clear demand for quality in the delivery of health care around the world; <span class="hlt">paediatric</span> emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. Within the <span class="hlt">paediatric</span> emergency department (ED), there is a lack of research into <span class="hlt">paediatric</span> specific indicators. The existing literature regarding <span class="hlt">paediatric</span> acute care quality measures has been recently summarised, and expert consensus has now been reported. It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the <span class="hlt">paediatric</span> acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their <span class="hlt">paediatric</span> patients. PMID:27062615</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3163536','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3163536"><span id="translatedtitle"><span class="hlt">Paediatric</span> UK demyelinating disease longitudinal study (PUDDLS)</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2011-01-01</p> <p>Background There is evidence that at least 5% of Multiple sclerosis (MS) cases manifest in childhood. Children with MS present with a demyelinating episode involving single or multiple symptoms prior to developing a second event (usually within two years) to then meet criteria for diagnosis. There is evidence from adult cohorts that the incidence and sex ratios of MS are changing and that children of immigrants have a higher risk for developing MS. A <span class="hlt">paediatric</span> population should reflect the vanguard of such changes and may reflect trends yet to be observed in adult cohorts. Studying a <span class="hlt">paediatric</span> population from the first demyelinating event will allow us to test these hypotheses, and may offer further valuable insights into the genetic and environmental interactions in the pathogenesis of MS. Methods/Design The <span class="hlt">Paediatric</span> UK Demyelinating Disease Longitudinal Study (PUDDLS) is a prospective longitudinal observational study which aims to determine the natural history, predictors and outcomes of childhood CNS inflammatory demyelinating diseases. PUDDLS will involve centres in the UK, and will establish a cohort of children affected with a first CNS inflammatory demyelinating event for long-term follow up by recruiting for approximately 5 years. PUDDLS will also establish a biological sample archive (CSF, serum, and DNA), allowing future hypothesis driven research. For example, the future discovery of a biomarker will allow validation within this dataset for the evaluation of novel biomarkers. Patients will also be requested to consent to be contacted in the future. A secondary aim is to collaborate internationally with the International <span class="hlt">Paediatric</span> Multiple Sclerosis Study Group when future collaborative studies are proposed, whilst sharing a minimal anonymised dataset. PUDDLS is the second of two jointly funded studies. The first (UCID-SS) is an epidemiological surveillance study that already received ethical approvals, and started on the 1st September 2009. There is</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.osti.gov/scitech/biblio/22479770','SCIGOV-STC'); return false;" href="http://www.osti.gov/scitech/biblio/22479770"><span id="translatedtitle">Putting social <span class="hlt">impact</span> assessment to the test as a method for implementing responsible tourism <span class="hlt">practice</span></span></a></p> <p><a target="_blank" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p>McCombes, Lucy; Vanclay, Frank; Evers, Yvette</p> <p>2015-11-15</p> <p>The discourse on the social <span class="hlt">impacts</span> of tourism needs to shift from the current descriptive critique of tourism to considering what can be done in actual <span class="hlt">practice</span> to embed the management of tourism's social <span class="hlt">impacts</span> into the existing planning, product development and operational processes of tourism businesses. A pragmatic approach for designing research methodologies, social management systems and initial actions, which is shaped by the real world operational constraints and existing systems used in the tourism industry, is needed. Our pilot study with a small Bulgarian travel company put social <span class="hlt">impact</span> assessment (SIA) to the test to see if it could provide this desired approach and assist in implementing responsible tourism development <span class="hlt">practice</span>, especially in small tourism businesses. Our findings showed that our adapted SIA method has value as a <span class="hlt">practical</span> method for embedding a responsible tourism approach. While there were some challenges, SIA proved to be effective in assisting the staff of our test case tourism business to better understand their social <span class="hlt">impacts</span> on their local communities and to identify actions to take. - Highlights: • Pragmatic approach is needed for the responsible management of social <span class="hlt">impacts</span> of tourism. • Our adapted Social <span class="hlt">impact</span> Assessment (SIA) method has value as a <span class="hlt">practical</span> method. • SIA can be embedded into tourism businesses existing ‘ways of doing things’. • We identified challenges and ways to improve our method to better suit small tourism business context.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3425877','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3425877"><span id="translatedtitle"><span class="hlt">Impact</span> of spinal cord injury on sexuality: Broad-based clinical <span class="hlt">practice</span> intervention and <span class="hlt">practical</span> application</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Hess, Marika J.; Hough, Sigmund</p> <p>2012-01-01</p> <p>This study focuses on the <span class="hlt">impact</span> a spinal cord injury may have on achieving physical and emotional intimacy, and potential to maximize sexual ability and quality of life. Spinal cord injury is a traumatic, life-altering event that is usually associated with loss of motor and sensory function, as well as sexual impairment. At the time of injury, the individual is faced with devastating loss and an abundance of new information in a setting of extreme stress and challenge. In the acute rehabilitation setting, there is often a considerable void in providing education and resources regarding sexual concerns and needs. There is a positive relationship between sexual education and sexual activity. The <span class="hlt">impact</span> of inadequate sexual counseling and education as a part of rehabilitation can be deleterious. PMID:22925747</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/cgi-bin/nph-data_query?bibcode=1996SPIE.2711..168D&link_type=ABSTRACT','NASAADS'); return false;" href="http://adsabs.harvard.edu/cgi-bin/nph-data_query?bibcode=1996SPIE.2711..168D&link_type=ABSTRACT"><span id="translatedtitle"><span class="hlt">Impact</span> of ultrasound video transfer on the <span class="hlt">practice</span> of ultrasound</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Duerinckx, Andre J.; Hayrapetian, Alek S.; Grant, Edward G.; Valentino, Daniel J.; Rahbar, Darius; Kiszonas, Mike; Franco, Ricky; Melany, Michelle; Narin, Sherelle L.; Ragavendra, Nagesh</p> <p>1996-05-01</p> <p>Sonography can be highly dependent on real-time imaging and as such is highly physician intensive. Such situations arise mostly during complicated ultrasound radiology studies or echocardiology examinations. Under those circumstances it would be of benefit to transmit real-time images beyond the immediate area of the ultrasound laboratory when a physician is not on location. We undertook this study to determine if both static and dynamic image transfer to remote locations might be accomplished using an ultrafast ATM network and PACS. Image management of the local image files was performed by a commercial PACS from AGFA corporation. The local network was Ethernet based, and the global network was based on Asynchronous Transfer Mode (ATM, rates up to 100 Mbits/sec). Real-time image transfer involved two teaching hospitals, one of which had 2 separate ultrasound facilities. Radiologists consulted with technologists via telephone while the examinations were being performed. The applications of ATM network providing real time video for ultrasound imaging in a clinical environment and its potential <span class="hlt">impact</span> on health delivery and clinical teaching. This technology increased technologist and physician productivity due to the elimination of commute time for physicians and waiting time for technologists and patients. Physician confidence in diagnosis increased compared to reviewing static images alone. This system provided instant access for radiologists to real-time scans from remote sites. Image quality and frame rate were equivalent to the original. The system increased productivity by allowing physicians to monitor studies at multiple sites simultaneously.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4726865','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4726865"><span id="translatedtitle">Current views and advances on <span class="hlt">Paediatric</span> Virology: An update for <span class="hlt">paediatric</span> trainees</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>MAMMAS, IOANNIS N.; GREENOUGH, ANNE; THEODORIDOU, MARIA; KRAMVIS, ANNA; CHRISTAKI, ILIANA; KOUTSAFTIKI, CHRYSSIE; KOUTSAKI, MARIA; PORTALIOU, DIMITRA M.; KOSTAGIANNI, GEORGIA; PANAGOPOULOU, PARASKEVI; SOURVINOS, GEORGE; SPANDIDOS, DEMETRIOS A.</p> <p>2016-01-01</p> <p><span class="hlt">Paediatric</span> Virology is a bold new scientific field, which combines <span class="hlt">Paediatrics</span> with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on <span class="hlt">Paediatric</span> Virology, which took place on Saturday October 10, 2015 in Athens, Greece, provided an overview of recent views and advances on viral infections occurring in neonates and children. It was included in the official programme of the 20th World Congress on Advances in Oncology and the 18th International Symposium on Molecular Medicine, which attracted over 500 delegates from the five continents. During the Workshop, the topics covered included the challenges of vaccine implementation against human papillomaviruses in countries under financial crisis, strategies for eradicating poliomyelitis and its 60th vaccine anniversary, as well as the debate on the association between autism and vaccination against measles, mumps and rubella. Among the non-vaccine related topics, emphasis was given to viral infections in prematurely born infants and their long-term outcomes, new <span class="hlt">paediatric</span> intensive care management options for bronchiolitis related to respiratory syncytial virus, the clinical implications of hepatitis B virus and cytomegalovirus genotyping, the Ebola virus threat and preparedness in <span class="hlt">Paediatric</span> Emergency Departments, oral, oropharynx, laryngeal, nasal and ocular viral infections and Merkel cell polyomavirus as a novel emerging virus of infancy and childhood. In this review, we provide selected presentations and reports discussed at the Workshop. PMID:26889211</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25529375','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25529375"><span id="translatedtitle">[Child health and international cooperation: A <span class="hlt">paediatric</span> approach].</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sobrino Toro, M; Riaño Galan, I; Bassat, Q; Perez-Lescure Picarzo, J; de Aranzabal Agudo, M; Krauel Vidal, X; Rivera Cuello, M</p> <p>2015-05-01</p> <p>The international development cooperation in child health arouses special interest in <span class="hlt">paediatric</span> settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with <span class="hlt">impact</span>, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters. PMID:25529375</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/8721907','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/8721907"><span id="translatedtitle">Advances in computer technology: <span class="hlt">impact</span> on the <span class="hlt">practice</span> of medicine.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Groth-Vasselli, B; Singh, K; Farnsworth, P N</p> <p>1995-01-01</p> <p>Advances in computer technology provide a wide range of applications which are revolutionizing the <span class="hlt">practice</span> of medicine. The development of new software for the office creates a web of communication among physicians, staff members, health care facilities and associated agencies. This provides the physician with the prospect of a paperless office. At the other end of the spectrum, the development of 3D work stations and software based on computational chemistry permits visualization of protein molecules involved in disease. Computer assisted molecular modeling has been used to construct working 3D models of lens alpha-crystallin. The 3D structure of alpha-crystallin is basic to our understanding of the molecular mechanisms involved in lens fiber cell maturation, stabilization of the inner nuclear region, the maintenance of lens transparency and cataractogenesis. The major component of the high molecular weight aggregates that occur during cataractogenesis is alpha-crystallin subunits. Subunits of alpha-crystallin occur in other tissues of the body. In the central nervous system accumulation of these subunits in the form of dense inclusion bodies occurs in pathological conditions such as Alzheimer's disease, Huntington's disease, multiple sclerosis and toxoplasmosis (Iwaki, Wisniewski et al., 1992), as well as neoplasms of astrocyte origin (Iwaki, Iwaki, et al., 1991). Also cardiac ischemia is associated with an increased alpha B synthesis (Chiesi, Longoni et al., 1990). On a more global level, the molecular structure of alpha-crystallin may provide information pertaining to the function of small heat shock proteins, hsp, in maintaining cell stability under the stress of disease. PMID:8721907</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4664207','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4664207"><span id="translatedtitle"><span class="hlt">Impact</span> of Advertising on Tampon Wear-time <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Woeller, Kara E.; Miller, Kenneth W.; Robertson-Smith, Amy L.; Bohman, Lisa C.</p> <p>2015-01-01</p> <p>OBJECTIVES (1) To determine whether advertising nighttime tampon use for up to eight hours was understood to be consistent with label recommendations and (2) to determine whether television and print advertising with this message affected tampon wear times in adults and teens. METHODS (1) A comprehension study (online advertising and follow-up questionnaire) among women aged 14–49 years (300 per group) who viewed either the test or a control advertising message; (2) Diary-based surveys of tampon wear times performed prior to (n = 292 adults, 18–49 years, 74 teens, 12–17 years) and after (n = 287 adults, 104 teens) the launch of national advertising. RESULTS Significantly more test message viewers than controls stated tampons should be worn less than or equal to eight hours (93.6% vs. 88.6%, respectively, P = 0.049). A directionally higher percentage of test message viewers said they would use a pad if sleeping longer than eight hours (52% vs. 42% of controls). Among the women who used tampons longer than eight hours when sleeping, 52% reported they would wake up and change compared with 45% of controls. No significant difference between baseline and follow-up diary surveys was found among teens or adults in various measures of tampon wear time (mean wear times; usage intervals from less than two hours to more than 10 hours; percentage of tampons used for more than or equal to eight hours; frequency of wearing at least one tampon more than eight hours). CONCLUSIONS Advertising nighttime tampon wear for up to eight hours effectively communicated label recommendations but did not alter tampon wear times. The informational intervention had limited <span class="hlt">impact</span> on established habits. PMID:26688668</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26152791','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26152791"><span id="translatedtitle">Economic <span class="hlt">impact</span> of homeopathic <span class="hlt">practice</span> in general medicine in France.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Colas, Aurélie; Danno, Karine; Tabar, Cynthia; Ehreth, Jenifer; Duru, Gérard</p> <p>2015-12-01</p> <p>Health authorities are constantly searching for new ways to stabilise health expenditures. To explore this issue, we compared the costs generated by different types of medical <span class="hlt">practice</span> in French general medicine: i.e. conventional (CM-GP), homeopathic (Ho-GP), or mixed (Mx-GP).Data from a previous cross-sectional study, EPI3 La-Ser, were used. Three types of cost were analysed: (i) consultation cost (ii) prescription cost and (iii) total cost (consultation + prescription). Each was evaluated as: (i) the cost to Social Security (ii) the remaining cost (to the patient and/or supplementary health insurance); and (iii) health expenditure (combination of the two costs).With regard to Social Security, treatment by Ho-GPs was less costly (42.00 <euro> vs 65.25 <euro> for CM-GPs, 35 % less). Medical prescriptions were two-times more expensive for CM-GPs patients (48.68 <euro> vs 25.62 <euro>). For the supplementary health insurance and/or patient out-of-pocket costs, treatment by CM-GPs was less expensive due to the lower consultation costs (6.19 <euro> vs 11.20 <euro> for Ho-GPs) whereas the prescription cost was comparable between the Ho-GPs and the CM-GPs patients (15.87 <euro> vs 15.24 <euro> respectively) . The health expenditure cost was 20 % less for patients consulting Ho-GPs compared to CM-GPs (68.93 <euro> vs 86.63 <euro>, respectively). The lower cost of medical prescriptions for Ho-GPs patients compared to CM-GPs patients (41.67 <euro> vs 63.72 <euro>) was offset by the higher consultation costs (27.08 <euro> vs 22.68 <euro> respectively). Ho-GPs prescribed fewer psychotropic drugs, antibiotics and non-steroidal anti-inflammatory drugs.In conclusions management of patients by homeopathic GPs may be less expensive from a global perspective and may represent an important interest to public health. PMID:26152791</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26856027','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26856027"><span id="translatedtitle">Focus On <span class="hlt">Impact</span> for a Profit-Driven Medical <span class="hlt">Practice</span>. Part II: Six Processes You Can Use to Maximize and Capitalize on the Uniqueness of Your <span class="hlt">Practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lipton-Dibner, Wendy</p> <p>2015-01-01</p> <p>This article presents the second part of the proven Focus on <span class="hlt">Impact</span> strategic model for <span class="hlt">practice</span> growth. It spotlights six specific processes you can use to maximize and capitalize on the uniqueness of your <span class="hlt">practice</span> to increase revenues, enhance patient care and service, improve executive team alignment and intra- and interdepartmental teamwork, and dramatically reduce conflict and stress among <span class="hlt">practice</span> personnel. PMID:26856027</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26165241','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26165241"><span id="translatedtitle">The use of nalbuphine in <span class="hlt">paediatric</span> anaesthesia.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kubica-Cielińska, Anna; Zielińska, Marzena</p> <p>2015-01-01</p> <p>Nalbuphine is an agonist-antagonist opioid. It causes analgesic and sedative effect and because of ceiling effect it does not cause a respiratory depression. In a perioperative therapy of <span class="hlt">paediatric</span> patients it may be used for premedication, sedation during diagnostic procedures as well as for postoperative pain treatment. It reverses adverse reactions of other opioids such as itch or urinary retention, not significantly influencing its analgetic properties. After sevoflurane anaesthesia of small children, it reduces the incidences of emergence agitation. Nalbuphine is considered a safe drug, which causes nausea and vomiting less frequently than other opioids. Analgesic effect, the ability to provide moderate sedation and a large margin of safety make that analgesic often used for <span class="hlt">paediatric</span> patients. PMID:26165241</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li class="active"><span>11</span></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_11 --> <div id="page_12" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li class="active"><span>12</span></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="221"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25557805','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25557805"><span id="translatedtitle"><span class="hlt">Paediatric</span> infectious diseases: the last 50 years.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Starr, Mike</p> <p>2015-01-01</p> <p>Many advances and challenges have occurred in the field of <span class="hlt">paediatric</span> infectious diseases during the past 50 years. It is impossible to cover all of these in a short review, but a few highlights and lowlights will be covered. These include virtual disappearance of some infectious diseases, emergence of new ones, infections in the immunocompromised, antimicrobial resistance, development of new and improved antimicrobials, improved diagnostic tests and the Human Microbiome Project. PMID:25557805</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1747440','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1747440"><span id="translatedtitle">Sleep · 8: <span class="hlt">Paediatric</span> obstructive sleep apnoea</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Nixon, G; Brouillette, R</p> <p>2005-01-01</p> <p>In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of <span class="hlt">paediatric</span> OSA, highlighting differences from adult OSA, and suggest future directions for research. PMID:15923253</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3155117','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3155117"><span id="translatedtitle">Ciprofloxacin safety in <span class="hlt">paediatrics</span>: a systematic review</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Adefurin, Abiodun; Sammons, Helen; Jacqz-Aigrain, Evelyne; Choonara, Imti</p> <p>2011-01-01</p> <p>Objective To determine the safety of ciprofloxacin in <span class="hlt">paediatric</span> patients in relation to arthropathy, any other adverse events (AEs) and drug interactions. Methods A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL and bibliographies of relevant articles was carried out for all published articles, regardless of design, that involved the use of ciprofloxacin in any <span class="hlt">paediatric</span> age group ≤17 years. Only articles that reported on safety were included. Results 105 articles met the inclusion criteria and involved 16 184 <span class="hlt">paediatric</span> patients. There were 1065 reported AEs (risk 7%, 95% CI 3.2% to 14.0%). The most frequent AEs were musculoskeletal AEs, abnormal liver function tests, nausea, changes in white blood cell counts and vomiting. There were six drug interactions (with aminophylline (4) and methotrexate (2)). The only drug related death occurred in a neonate who had an anaphylactic reaction. 258 musculoskeletal events occurred in 232 <span class="hlt">paediatric</span> patients (risk 1.6%, 95% CI 0.9% to 2.6%). Arthralgia accounted for 50% of these. The age of occurrence of arthropathy ranged from 7 months to 17 years (median 10 years). All cases of arthropathy resolved or improved with management. One prospective controlled study estimated the risk of arthropathy as 9.3 (OR 95% CI 1.2 to 195). Pooled safety data of controlled trials in this review estimated the risk of arthropathy as 1.57 (OR 95% CI 1.26 to 1.97). Conclusion Musculoskeletal AEs occur due to ciprofloxacin use. However, these musculoskeletal events are reversible with management. It is recommended that further prospective controlled studies should be carried out to evaluate the safety of ciprofloxacin, with particular focus on the risk of arthropathy. PMID:21785119</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26686529','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26686529"><span id="translatedtitle">Voluntary Informed Consent in <span class="hlt">Paediatric</span> Oncology Research.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Dekking, Sara A S; Van Der Graaf, Rieke; Van Delden, Johannes J M</p> <p>2016-07-01</p> <p>In <span class="hlt">paediatric</span> oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for <span class="hlt">paediatric</span> oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating <span class="hlt">paediatric</span> oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised in these two scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. PMID:26686529</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/26803366','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/26803366"><span id="translatedtitle"><span class="hlt">Paediatric</span> suicidal burns: A growing concern.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Segu, Smitha; Tataria, Rachana</p> <p>2016-06-01</p> <p>An alarming rise in rates of <span class="hlt">paediatric</span> population committing self-immolation acts is a growing social and medical problem. In recent times there seems to be a rising concern in <span class="hlt">paediatric</span> population. A study was conducted at a government tertiary care burn centre over 5 years in <span class="hlt">paediatric</span> age group of <18 years who had committed self-immolation. Demographic data, aetiology, burn severity, associated illnesses, treatment and outcomes of the patients were collected with preventive strategies. Of total 89 patients, 12 patients were below 12 years (children) and 77 between 12-18 years (adolescent) with female preponderance. Majority belonged to lower middle and upper lower class families. Most had deep partial thickness burns. Psychiatric and personality disorder were found in 24.03% and 31.46% patients respectively. Kerosene was the main agent chosen to inflict injury. The average length of hospital stay was 19.8 days. The crude mortality rate observed was 38.2%. With cultural and socio-economic changes children and adolescents are exposed to increased levels of stress and peer pressure leaving them vulnerable. A multidisciplinary care involving medical, psychological and social support is required. Identifying children at risk and proper counselling and support can form an important strategy at prevention rather than cure. PMID:26803366</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3530999','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3530999"><span id="translatedtitle"><span class="hlt">Paediatric</span> airway management: What is new?</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ramesh, S; Jayanthi, R; Archana, SR</p> <p>2012-01-01</p> <p>Airway management plays a pivotal role in <span class="hlt">Paediatric</span> Anaesthesia. Over the last two decades many improvements in this area have helped us to overcome this final frontier. From an era where intubation with a conventional laryngoscope or blind nasal intubation was the only tool for airway management, we have come a long way. Today supraglottic airway devices have pride of place in the Operating Room and are becoming important airway devices used in routine procedures. Direct and indirect fibreoptic laryngoscopes and transtracheal devices help us overcome difficult and previously impossible airway situations. These developments mean that we need to update our knowledge on these devices. Also much of our basic understanding of the physiology and anatomy of the <span class="hlt">paediatric</span> airway has changed. This article attempts to shed light on some of the most important advances/opinions in <span class="hlt">paediatric</span> airway management like, cuffed endotracheal tubes, supraglottic airway devices, video laryngoscopes, rapid sequence intubation, the newly proposed algorithm for difficult airway management and the role of Ex Utero Intrapartum Treatment (EXIT) procedure in the management of the neonatal airway. PMID:23293383</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4950906','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4950906"><span id="translatedtitle"><span class="hlt">Paediatric</span> Virology in the Hippocratic Corpus</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Mammas, Ioannis N.; Spandidos, Demetrios A.</p> <p>2016-01-01</p> <p>Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of <span class="hlt">Paediatric</span> Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire <span class="hlt">paediatric</span> trainees and future <span class="hlt">Paediatric</span> Virology subspecialists. PMID:27446241</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2015PhDT........11Y','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2015PhDT........11Y"><span id="translatedtitle">The <span class="hlt">impact</span> of a professional development program on teachers' <span class="hlt">practice</span> and how context variables influenced such <span class="hlt">practice</span>: a case study</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Yarema, Sandra Lynn</p> <p></p> <p>This case study investigated how context variables influenced the <span class="hlt">impact</span> of a state-funded longitudinal professional development (PD) program on the participant teachers' <span class="hlt">practice</span>. Data was collected to compare differences in Science Content Knowledge, Science Pedagogical Content Knowledge, and the teachers' <span class="hlt">practice</span> over the course of the PD program. Contextual variables related to district restructuring and school implementation of district policy evidence a direct effect on time spent on science instruction, specific instructional strategies used, and on the development of a professional community among the participants. This case study substantiates the implication that districts and school policies must provide adequate support for teachers to implement what is learned in professional development to enact any effective science education reform at the elementary school level.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/12035326','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/12035326"><span id="translatedtitle">The establishment of a nurse consultant role in <span class="hlt">paediatric</span> intensive care: a reflective analysis.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Haines, Caroline</p> <p>2002-01-01</p> <p>Through a review of literature and research, together with reflection on clinical <span class="hlt">practice</span>, this article reflectively analyses and evaluates the concept of the establishment and development of a nurse consultant post in <span class="hlt">paediatric</span> intensive care. Manley's (1997) conceptual framework is used as a structure for the reflection, which has enabled a detailed and logical approach and allowed both reflection and analysis of the role in relation to the speciality. It is evident that nurse consultant posts have been developed in a variety of clinical specialities and are providing a real opportunity to improve patient care, progress nursing as a profession and provide a clinical career framework for nurses. The concept of the nurse consultant in <span class="hlt">paediatric</span> intensive care is both innovative and strategic: Manley has identified many sub-roles, skills and processes necessary to influence and develop the role. The elements of 'transformational leadership', 'change agent' and 'collaborator' identified by Manley appear to hold the key to the ability to influence and develop <span class="hlt">paediatric</span> intensive care nursing from a <span class="hlt">practice</span> perspective. PMID:12035326</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=231482&keyword=delivery+AND+service&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=68603602&CFTOKEN=74704475','EPA-EIMS'); return false;" href="http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=231482&keyword=delivery+AND+service&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=68603602&CFTOKEN=74704475"><span id="translatedtitle">Of birds, carbon and water: integrating multiple ecosystem service <span class="hlt">impacts</span> to identify locations for agricultural conservation <span class="hlt">practice</span> adoption</span></a></p> <p><a target="_blank" href="http://oaspub.epa.gov/eims/query.page">EPA Science Inventory</a></p> <p></p> <p></p> <p>Human use of the landscape for crop production can degrade ecosystem services. A number of agricultural conservation <span class="hlt">practices</span> are touted as mitigating these <span class="hlt">impacts</span>. Many of these <span class="hlt">practices</span> are encouraged by incentive programs such as the Conservation Reserve Program administere...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=post+AND+notes&pg=5&id=EJ1041694','ERIC'); return false;" href="http://eric.ed.gov/?q=post+AND+notes&pg=5&id=EJ1041694"><span id="translatedtitle">The <span class="hlt">Impact</span> of the "Getting <span class="hlt">Practical</span>: Improving <span class="hlt">Practical</span> Work in Science" Continuing Professional Development Programme on Teachers' Ideas and <span class="hlt">Practice</span> in Science <span class="hlt">Practical</span> Work</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael</p> <p>2014-01-01</p> <p>Background: Despite the widespread use of <span class="hlt">practical</span> work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The "Getting <span class="hlt">Practical</span>" CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/23650541','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/23650541"><span id="translatedtitle">Potential of best <span class="hlt">practice</span> to reduce <span class="hlt">impacts</span> from oil and gas projects in the Amazon.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Finer, Matt; Jenkins, Clinton N; Powers, Bill</p> <p>2013-01-01</p> <p>The western Amazon continues to be an active and controversial zone of hydrocarbon exploration and production. We argue for the urgent need to implement best <span class="hlt">practices</span> to reduce the negative environmental and social <span class="hlt">impacts</span> associated with the sector. Here, we present a three-part study aimed at resolving the major obstacles impeding the advancement of best <span class="hlt">practice</span> in the region. Our focus is on Loreto, Peru, one of the largest and most dynamic hydrocarbon zones in the Amazon. First, we develop a set of specific best <span class="hlt">practice</span> guidelines to address the lack of clarity surrounding the issue. These guidelines incorporate both engineering-based criteria and key ecological and social factors. Second, we provide a detailed analysis of existing and planned hydrocarbon activities and infrastructure, overcoming the lack of information that typically hampers large-scale <span class="hlt">impact</span> analysis. Third, we evaluate the planned activities and infrastructure with respect to the best <span class="hlt">practice</span> guidelines. We show that Loreto is an extremely active hydrocarbon front, highlighted by a number of recent oil and gas discoveries and a sustained government push for increased exploration. Our analyses reveal that the use of technical best <span class="hlt">practice</span> could minimize future <span class="hlt">impacts</span> by greatly reducing the amount of required infrastructure such as drilling platforms and access roads. We also document a critical need to consider more fully the ecological and social factors, as the vast majority of planned infrastructure overlaps sensitive areas such as protected areas, indigenous territories, and key ecosystems and watersheds. Lastly, our cost analysis indicates that following best <span class="hlt">practice</span> does not impose substantially greater costs than conventional <span class="hlt">practice</span>, and may in fact reduce overall costs. Barriers to the widespread implementation of best <span class="hlt">practice</span> in the Amazon clearly exist, but our findings show that there can be great benefits to its implementation. PMID:23650541</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3641117','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3641117"><span id="translatedtitle">Potential of Best <span class="hlt">Practice</span> to Reduce <span class="hlt">Impacts</span> from Oil and Gas Projects in the Amazon</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Finer, Matt; Jenkins, Clinton N.; Powers, Bill</p> <p>2013-01-01</p> <p>The western Amazon continues to be an active and controversial zone of hydrocarbon exploration and production. We argue for the urgent need to implement best <span class="hlt">practices</span> to reduce the negative environmental and social <span class="hlt">impacts</span> associated with the sector. Here, we present a three-part study aimed at resolving the major obstacles impeding the advancement of best <span class="hlt">practice</span> in the region. Our focus is on Loreto, Peru, one of the largest and most dynamic hydrocarbon zones in the Amazon. First, we develop a set of specific best <span class="hlt">practice</span> guidelines to address the lack of clarity surrounding the issue. These guidelines incorporate both engineering-based criteria and key ecological and social factors. Second, we provide a detailed analysis of existing and planned hydrocarbon activities and infrastructure, overcoming the lack of information that typically hampers large-scale <span class="hlt">impact</span> analysis. Third, we evaluate the planned activities and infrastructure with respect to the best <span class="hlt">practice</span> guidelines. We show that Loreto is an extremely active hydrocarbon front, highlighted by a number of recent oil and gas discoveries and a sustained government push for increased exploration. Our analyses reveal that the use of technical best <span class="hlt">practice</span> could minimize future <span class="hlt">impacts</span> by greatly reducing the amount of required infrastructure such as drilling platforms and access roads. We also document a critical need to consider more fully the ecological and social factors, as the vast majority of planned infrastructure overlaps sensitive areas such as protected areas, indigenous territories, and key ecosystems and watersheds. Lastly, our cost analysis indicates that following best <span class="hlt">practice</span> does not impose substantially greater costs than conventional <span class="hlt">practice</span>, and may in fact reduce overall costs. Barriers to the widespread implementation of best <span class="hlt">practice</span> in the Amazon clearly exist, but our findings show that there can be great benefits to its implementation. PMID:23650541</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=high+AND+impact+AND+test&pg=6&id=EJ726953','ERIC'); return false;" href="http://eric.ed.gov/?q=high+AND+impact+AND+test&pg=6&id=EJ726953"><span id="translatedtitle"><span class="hlt">Impact</span> of a High School Graduation Examination on Social Studies Teachers' Instructional <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Vogler, Kenneth E.</p> <p>2005-01-01</p> <p>The purpose of this study was to explore the <span class="hlt">impact</span> of high-stakes tests on teachers' instructional <span class="hlt">practices</span>. Data were obtained from a survey instrument given to a stratified random sample of Mississippi social studies teachers who teach the same content that is tested on their state's high school graduation examination. An analysis found…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ1058165.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ1058165.pdf"><span id="translatedtitle">Creating a Model for High <span class="hlt">Impact</span> <span class="hlt">Practices</span> at a Large, Regional, Comprehensive University: A Case Study</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>McMahan, Shari</p> <p>2008-01-01</p> <p>Student engagement in High <span class="hlt">Impact</span> <span class="hlt">Practices</span> (HIPs) has been gaining the attention of higher education leaders and researchers. When students are actively engaged in the learning process they report greater gains in learning and personal development. Students involved in HIPs show better retention, higher GPA and succeed in graduating college in a…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4177634','PMC'); return false;" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4177634"><span id="translatedtitle">“Budget <span class="hlt">Impact</span> Analyses”: A <span class="hlt">Practical</span> Policy Making Tool for Drug Reimbursement Decisions</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Jamshidi, Hamid Reza; Foroutan, Naghmeh; Salamzadeh, Jamshid</p> <p>2014-01-01</p> <p>In the present article, Budget <span class="hlt">Impact</span> Analysis as an effective, <span class="hlt">practical</span> financial tool has been introduced to the policy makers for improving drug formulary and reimbursement decision making. In Iran, Ministry of Health (MOH), health insurance organizations, and health care providers such as hospitals could take the most advantage of the BIAs reports. PMID:25276214</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ncbi.nlm.nih.gov/pubmed/25276214','PUBMED'); return false;" href="http://www.ncbi.nlm.nih.gov/pubmed/25276214"><span id="translatedtitle">"Budget <span class="hlt">impact</span> analyses": a <span class="hlt">practical</span> policy making tool for drug reimbursement decisions.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Jamshidi, Hamid Reza; Foroutan, Naghmeh; Salamzadeh, Jamshid</p> <p>2014-01-01</p> <p>In the present article, Budget <span class="hlt">Impact</span> Analysis as an effective, <span class="hlt">practical</span> financial tool has been introduced to the policy makers for improving drug formulary and reimbursement decision making. In Iran, Ministry of Health (MOH), health insurance organizations, and health care providers such as hospitals could take the most advantage of the BIAs reports. PMID:25276214</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ1053724.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ1053724.pdf"><span id="translatedtitle">Accounting Practitioners Reflect on Faculty <span class="hlt">Impact</span>: Bridging the Gap between Theory and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Johnson, Ryan</p> <p>2014-01-01</p> <p>A gap exists between the perception of accounting education in the classroom and accounting as it is <span class="hlt">practiced</span>. This study explores qualitatively the perceptions and experiences of mid-career accounting professionals with respect to the <span class="hlt">impact</span> of academic faculty on their careers in accounting. The study identifies a perception gap in the…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Michael+AND+Brown&pg=3&id=EJ695646','ERIC'); return false;" href="http://eric.ed.gov/?q=Michael+AND+Brown&pg=3&id=EJ695646"><span id="translatedtitle">Examining the Legacy of "Brown": The <span class="hlt">Impact</span> on Special Education and Teacher <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Shealey, Monikawilliams; Lue, Marthascott; Brooks, Michael; McCray, Erica</p> <p>2005-01-01</p> <p>The "Brown v. Board of Education" (1954) case has left a lasting <span class="hlt">impact</span> on the way children are educated in this country. Much has been written about the legacy of "Brown" as it relates to current desegregation <span class="hlt">practices</span>, academic achievement for students of color, and school reform. This paper will examine the implications of the "Brown" decision…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=surveys+AND+applied+AND+mathematics&pg=6&id=ED549895','ERIC'); return false;" href="http://eric.ed.gov/?q=surveys+AND+applied+AND+mathematics&pg=6&id=ED549895"><span id="translatedtitle"><span class="hlt">Impact</span> of a Professional Learning Community on Teacher Collaboration, Teaching <span class="hlt">Practice</span>, and Student Achievement</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Morris, Iris J.</p> <p>2011-01-01</p> <p>Best instructional <span class="hlt">practice</span> occurs when teachers work collaboratively. Many teachers in the target elementary school appeared to work in isolation, struggling to respond to the needs of low-performing students without the benefit of collaboration with colleagues. The purpose of this applied dissertation was to investigate the <span class="hlt">impact</span> of a…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li class="active"><span>12</span></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_12 --> <div id="page_13" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li class="active"><span>13</span></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="241"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ939937.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ939937.pdf"><span id="translatedtitle">The <span class="hlt">Impact</span> of <span class="hlt">Practicing</span> Autonomy on the Writing Proficiency of Iranian Intermediate EFL Learners</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Bagheri, Mohammad Sadegh; Aeen, Laleh</p> <p>2011-01-01</p> <p>The present study examined the <span class="hlt">impact</span> of <span class="hlt">practicing</span> autonomy on the writing proficiency of Iranian intermediate EFL learners. To this end, Preliminary English Test (PET) by Thomas and Sharon (2006) was administered to 92 intermediate language learners as a pre-test. Accordingly, 60 homogeneous learners comprised the research sample. The…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Ma&pg=2&id=EJ932627','ERIC'); return false;" href="http://eric.ed.gov/?q=Ma&pg=2&id=EJ932627"><span id="translatedtitle">Emerging: The <span class="hlt">Impact</span> of the Artist Teacher Scheme MA on Students' Pedagogical and Artistic <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Page, Tara; Adams, Jeff; Hyde, Wendy</p> <p>2011-01-01</p> <p>The United Kingdom Artist Teacher Scheme (ATS) commissioned a study of the artistic and pedagogical <span class="hlt">practices</span> of students on a recently established Artist Teacher Scheme MA (ATS MA). The aims of this study were to: investigate the motives and objectives teachers/educators have for undertaking this ATS MA programme, the <span class="hlt">impact</span> the programme had on…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED545597.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED545597.pdf"><span id="translatedtitle"><span class="hlt">Impact</span> of Professional Learning Community <span class="hlt">Practices</span> on Morale of Urban High School Teachers</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Almanzar, Angel</p> <p>2014-01-01</p> <p>This applied dissertation was designed to determine the <span class="hlt">impact</span> a planned intervention, or participants' engagement in lesson study <span class="hlt">practices</span>, had on teacher morale and professional learning communities within a public high school located in the Southeastern part of the United States. A review of a yearly teacher survey conducted by the…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ars.usda.gov/research/publications/publication/?seqNo115=315219','TEKTRAN'); return false;" href="http://www.ars.usda.gov/research/publications/publication/?seqNo115=315219"><span id="translatedtitle">Kitchen <span class="hlt">practices</span> <span class="hlt">impact</span> on volatile flavors in ripe tomatoes: effects of refrigeration and blanching</span></a></p> <p><a target="_blank" href="http://www.ars.usda.gov/services/TekTran.htm">Technology Transfer Automated Retrieval System (TEKTRAN)</a></p> <p></p> <p></p> <p>Both blanching and refrigeration of ripe tomatoes are common <span class="hlt">practices</span> in kitchen and food service prior to being sliced. However, little is reported on the <span class="hlt">impact</span> of such treatments on volatile profiles in tomato fruit. In this study, ‘FL 47’ tomatoes at full red stage were dipped in 52 °C hot wate...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED431041.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED431041.pdf"><span id="translatedtitle">The <span class="hlt">Impact</span> of Mandated Statewide Testing on Teachers' Classroom Assessment and Instructional <span class="hlt">Practices</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>McMillan, James H.; Myran, Steve; Workman, Daryl</p> <p></p> <p>The <span class="hlt">impact</span> of the new Virginia statewide Standards of Learning (SOL) testing program on classroom instructional and assessment <span class="hlt">practices</span> was studied through surveys before and after implementation of the testing program. The sample represented responses from 570 secondary school teachers (of mathematics, social studies, English, and science) and…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=discourse+AND+manipulation&pg=3&id=EJ938484','ERIC'); return false;" href="http://eric.ed.gov/?q=discourse+AND+manipulation&pg=3&id=EJ938484"><span id="translatedtitle"><span class="hlt">Impact</span> of Curriculum Reform: Evidence of Change in Classroom <span class="hlt">Practice</span> in Mainland China</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Li, Qiong; Ni, Yujing</p> <p>2011-01-01</p> <p>The study examined the <span class="hlt">impact</span> of curriculum reform on teaching <span class="hlt">practice</span> in primary mathematics in mainland China. The participants included 58 fifth grade mathematics teachers from 20 schools. Thirty-two of the classrooms had utilized a reform curriculum for 5 years prior to conducting the study, and the remaining 26 had been using the…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Dentistry&pg=2&id=EJ879861','ERIC'); return false;" href="http://eric.ed.gov/?q=Dentistry&pg=2&id=EJ879861"><span id="translatedtitle">Using Dentistry as a Case Study to Examine Continuing Education and Its <span class="hlt">Impact</span> on <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Bullock, Alison; Firmstone, Vickie; Frame, John; Thomas, Hywel</p> <p>2010-01-01</p> <p>Continuing education is a defining characteristic of work in the professions. Yet the approach various professional groups take to continuing professional development (CPD) differs widely in terms of regulatory frameworks and requirements, modes of delivery and funding. Importantly, little is understood about how CPD <span class="hlt">impacts</span> on <span class="hlt">practice</span>. This…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=liberal+AND+conservative&pg=3&id=EJ943856','ERIC'); return false;" href="http://eric.ed.gov/?q=liberal+AND+conservative&pg=3&id=EJ943856"><span id="translatedtitle"><span class="hlt">Impact</span> of Occupational Socialization on the Perspectives and <span class="hlt">Practices</span> of Sport Pedagogy Doctoral Students</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Lee, Hong-Min; Curtner-Smith, Matthew D.</p> <p>2011-01-01</p> <p>The purpose of this study was to examine the <span class="hlt">impact</span> of occupational socialization on the perspectives and <span class="hlt">practices</span> of sport pedagogy doctoral students in terms of physical education (PE) teaching and physical education teacher education (PETE). Participants were 12 students. Data were collected through formal and informal interviews,…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=211408','TEKTRAN'); return false;" href="http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=211408"><span id="translatedtitle">Modeling Biochemical <span class="hlt">Impacts</span> of Alternative Management <span class="hlt">Practices</span> for a Row-Crop Field in Iowa</span></a></p> <p><a target="_blank" href="http://www.ars.usda.gov/services/TekTran.htm">Technology Transfer Automated Retrieval System (TEKTRAN)</a></p> <p></p> <p></p> <p>The management of contemporary agriculture is rapidly shifting from single-goal to multi-goal strategies. The bottleneck of implementing the strategies is the capacity of predicting the simultaneous <span class="hlt">impacts</span> of change in management <span class="hlt">practices</span> on agricultural production, soil, and water resources and e...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=cameroon&pg=6&id=EJ638416','ERIC'); return false;" href="http://eric.ed.gov/?q=cameroon&pg=6&id=EJ638416"><span id="translatedtitle">The <span class="hlt">Impact</span> of a Community Mobilization Project on Health-Related Knowledge and <span class="hlt">Practices</span> in Cameroon.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Babalola, Stella; Sakolsky, Natasha; Vondrasek, Claudia; Mounlom, Damaris; Brown, Jane; Tchupo, Jean-Paul</p> <p>2001-01-01</p> <p>Evaluated the <span class="hlt">impact</span> of a reproductive health community mobilization initiative in Cameroon. Baseline and followup survey data indicated that at a rural site, the intervention positively influenced family planning knowledge and <span class="hlt">practices</span>, HIV/AIDS and sexually transmitted disease knowledge and attitudes, and use of health services. At an urban…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_9");'>9</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li class="active"><span>13</span></li> <li><a href="#" onclick='return showDiv("page_13");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_13 --> <center> <div class="footer-extlink text-muted"><small>Some links on this page may take you to non-federal websites. 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