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Sample records for hospital-based paediatric units

  1. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    PubMed

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  2. Midazolam for sedation in the paediatric intensive care unit.

    PubMed

    Rosen, D A; Rosen, K R

    1991-01-01

    This retrospective study examines data from 55 patients sedated in a paediatric intensive care unit (PICU) with midazolam. Midazolam sedation was initiated with a bolus of 0.25 mg.kg-1 followed by a continuous infusion of 0.4-4 micrograms.kg-1.min-1. Physiological and metabolic parameters, infusion rates, duration, and sedation scores were monitored. Midazolam infusions were effective in sedating all the children studied during all or part of their PICU admission. The median duration of sedation was 74 h with a range of 4 to 1272 h. Haemodynamics were unchanged. Of the patients 46% were effectively alimented by the enteral route, and enteral alimentation was successful in all patients in whom it was attempted. Unassisted ventilation occurred in 44% of the patients during infusion. Oxygen consumption was 28% lower than in the control. Disadvantages of midazolam infusion have included inability to sedate during extracorporeal membrane oxygenation and development of acute tolerance.

  3. The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

    PubMed

    Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang

    2011-01-01

    The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. PMID:21159414

  4. [The management of an adverse event in a paediatric unit].

    PubMed

    Cruz, Emmanuelle; Dubrulle, Aurélie

    2016-04-01

    Adverse events remain a major issue in care services. The mission of hospital authorities is to analyse them in order to put in place corrective and preventive measures. The objective is to prevent them reoccurring and to ensure the sustainable improvement of the quality and safety of care. This article presents an example in paediatrics with parenteral nutrition. PMID:27085928

  5. 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

  6. International Symposium on Ion Therapy: Planning the First Hospital-Based Heavy Ion Therapy Center in the United States

    PubMed Central

    Laine, Aaron; Pompos, Arnold; Story, Michael; Jiang, Steve; Timmerman, Robert; Choy, Hak

    2015-01-01

    Investigation into the use of heavy ions for therapeutic purposes was initially pioneered at Lawrence Berkeley National Laboratory in the 1970s [1, 2]. More recently, however, significant advances in determining the safety and efficacy of using heavy ions in the hospital setting have been reported in Japan and Germany [3, 4]. These promising results have helped to resurrect interest in the establishment of hospital-based heavy ion therapy in the United States. In line with these efforts, world experts in the field of heavy ion therapy were invited to attend the first annual International Symposium on Ion Therapy, which was held at the University of Texas Southwestern Medical Center, Dallas, Texas, from November 12 to 14, 2014. A brief overview of the results and discussions that took place during the symposium are presented in this article. PMID:27110586

  7. Attitudes to Education in a Paediatric Renal Unit.

    ERIC Educational Resources Information Center

    Cross, Janet

    1983-01-01

    The effects of renal failure on children are outlined and current research findings relevant to the physical and psychological effects of the handicap are summarized. Results from a survey of renal unit patients is noted to include that teachers in British renal units feel that many patients underachieve. (SW)

  8. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    PubMed

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia.

  9. Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

    PubMed Central

    ÓhAiseadha, Coilín; Mannix, Mai; Saunders, Jean; Philip, Roy K.

    2016-01-01

    Background: Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods: We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results: Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion: At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions

  10. Nutritional therapy in paediatric intensive care units: a consensus statement of the Section of Paediatric Anaesthesia and Intensive Therapy the Polish Society of Anaesthesiology and Intensive Therapy, Polish Society of Neonatology and Polish Society for.

    PubMed

    Bartkowska-Śniatkowska, Alicja; Zielińska, Marzena; Świder, Magdalena; Bittner, Grażyna; Sarnowska-Wroczyńska, Irena; Witulska, Katarzyna; Migdał, Marek; Piotrowski, Andrzej; Bober-Olesińska, Krystyna; Kęsiak, Marcin; Lauterbach, Ryszard; Gawecka, Agnieszka; Danko, Mikołaj; Popińska, Katarzyna; Romanowska, Hanna; Szlagatys-Sidorkiewicz, Agnieszka; Toporowska-Kowalska, Ewa; Żyła, Aleksandra; Książyk, Janusz

    2015-01-01

    Providing nutritional therapy via the gastrointestinal tract in patients in paediatric intensive care units (PICUs) is an effective method for delivering energy and other nutrients. In the event of contraindications to using this method, it is necessary to commence parenteral nutrition. In the present study, methods for nutritional treatments in critically ill children are presented, depending on the clinical situation.

  11. Epidemiology of pertussis-related paediatric intensive care unit (ICU) admissions in Australia, 1997–2013: an observational study

    PubMed Central

    Ware, Robert S; McEniery, Julie A; Coulthard, Mark G; Lambert, Stephen B

    2016-01-01

    Objective To review the epidemiology of pertussis-related intensive care unit (ICU) admissions across Australia, over a 17-year period. Design Retrospective descriptive study. Setting Australian ICUs contributing data to the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry. The number of contributing ICUs increased over the study period, from 8 specialist paediatric ICUs in 1997 to 8 specialist paediatric and 13 general ICUs in 2013. Participants All paediatric (<16 years) ICU admissions, coded as pertussis-related, between 1 January 1997 and 31 December 2013. Results A total of 373 pertussis-coded ICU admissions were identified in the ANZPIC Registry over the study period. Of these cases, 52.8% occurred during the 4 years of the recent Australian epidemic (2009–2012). ICU admissions were most likely to occur in infants aged younger than 6 weeks (41.8%, n=156) and aged 6 weeks to 4 months (42.9%, n=160). The median length of stay for pertussis-related ICU admissions was 3.6 days, with 77.5% of cases staying in ICU for <7 days. Approximately half of all admissions (54.8%) required some form of respiratory support, with 32.7% requiring invasive respiratory support. Over the study period, 23 deaths were recorded (6.2% of pertussis-related ICU admissions), of which 20 (87.0%) were infants <4 months old. Conclusions Pertussis-related ICU admissions occur primarily in infants too young to be fully protected from active immunisation. More needs to be done to protect these high-risk infants, such as maternal immunisation. PMID:27053270

  12. Epidemiology of Australian Influenza-Related Paediatric Intensive Care Unit Admissions, 1997-2013

    PubMed Central

    Kaczmarek, Marlena C.; Ware, Robert S.; Coulthard, Mark G.; McEniery, Julie; Lambert, Stephen B.

    2016-01-01

    Background Influenza virus predictably causes an annual epidemic resulting in a considerable burden of illness in Australia. Children are disproportionately affected and can experience severe illness and complications, which occasionally result in death. Methods We conducted a retrospective descriptive study using data collated in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry of influenza-related intensive care unit (ICU) admissions over a 17-year period (1997–2013, inclusive) in children <16 years old. National laboratory-confirmed influenza notifications were used for comparison. Results Between 1997 and 2013, a total of 704 influenza-related ICU admissions were recorded, at a rate of 6.2 per 1,000 all-cause ICU admissions. Age at admission ranged from 0 days and 15.9 years (median = 2.1 years), with 135 (19.2%) aged <6 months. Pneumonia/pneumonitis and bronchiolitis were the most common primary diagnoses among influenza-related admissions (21.9% and 13.6%, respectively). More than half of total cases (59.2%) were previously healthy (no co-morbidities recorded), and in the remainder, chronic lung disease (16.7%) and asthma (12.5%) were the most common co-morbidities recorded. Pathogen co-detection occurred in 24.7% of cases, most commonly with respiratory syncytial virus or a staphylococcal species. Median length of all ICU admissions was 3.2 days (range 2.0 hours– 107.4 days) and 361 (51.3%) admissions required invasive respiratory support for a median duration of 4.3 days (range 0.2 hours– 107.5 days). There were 27 deaths recorded, 14 (51.9%) in children without a recorded co-morbidity. Conclusion Influenza causes a substantial number of ICU admissions in Australian children each year with the majority occurring in previously healthy children. PMID:27023740

  13. Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards.

    PubMed

    Colman, Sarah; Stewart, Robert C; MacArthur, Christine; Kennedy, Neil; Tomenson, Barbara; Creed, Francis

    2015-10-01

    In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≥8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea.

  14. Social paediatrics

    PubMed Central

    Spencer, N.; Colomer, C.; Alperstein, G.; Bouvier, P.; Colomer, J.; Duperrex, O.; Gokcay, G.; Julien, G.; Kohler, L.; Lindstrom, B.; Macfarlane, A.; Mercer, R.; Panagiotopoulos, T.; Schulpen, T.; on, b

    2005-01-01

    Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective. PMID:15650140

  15. Retrospective Comparison of Two Years in a Paediatric Burns Unit, with and Without ActicoatTM as a Standard Dressing

    PubMed Central

    Strand, O.; San Miguel, L.; Rowan, S.; Sahlqvist, A.

    2010-01-01

    Summary The Karolinska Burn Unit in Stockholm, Sweden, carried out a retrospective case review in order to compare the cost of the current protocol of care - in place since mid-2002 - with a previous protocol in paediatric burn patients. The study compared the years 2004 and 2007 with the year 2001. 2004 was the first full year in which the unit staff used ActicoatTM (Smith & Nephew Wound Management, Hull, England), IntraSite GelTM (idem), and Allevyn AdhesiveTM (idem) in the treatment of paediatric burns patients. In 2001 the unit used MepitelTM (Molnlycke, Göteborg, Sweden) together with a saline solution and peroxide for cleansing. This study examined differences in both labour and material costs, measured from the hospital's perspective. Our results show that the main impact of the new protocol was on length of stay for hospitalized patients. In 2001 the mean in-patient stay was 12.5 days; in 2004 the mean stay was 5.6 days and, in 2007, 4.5 days (p < 0.001). It is hypothesized that the reason for this significant reduction in length of stay is that most of the patients treated with Acticoat were sent home earlier to be treated as outpatients because there was less need for sedation and/or analgesics, and because the risk of infection was perceived to be less. Pure hospitalization costs per in-patient were approximately Swedish kronor (kr) 67,725 in 2001 (1 kr = approx. € 0.1 or US$ 0.15) and kr 30,305 and kr 24,440 in 2004 and 2007, respectively. This represents a saving of 55% and 64% with respect to 2001 costs. PMID:21991222

  16. Ventilator-Associated Pneumonia: Incidence, Risk Factors and Outcome in Paediatric Intensive Care Units at Cairo University Hospital

    PubMed Central

    Galal, Yasmine S.; Ibrahiem, Sally K.

    2016-01-01

    Introduction Ventilator-Associated Pneumonia (VAP) is a major cause of hospital morbidity, mortality and increased health care costs. Although the epidemiology, pathogenesis and outcome of VAP are well described in adults; few data exist regarding VAP in paediatric patients, especially in developing countries. Aim To determine the incidence, risk factors and outcome of VAP in two Paediatric Intensive Care Units (PICUs) at Cairo University Hospital. Materials and Methods A total of 427 patients who received Mechanical Ventilation (MV) were included in this prospective study during the period from September 2014 till September 2015. Patients were observed daily till VAP occurrence, discharge from the unit or death, whichever came first. Demographic, clinical characteristics, laboratory results, radiographic and microbiological reports were recorded for all patients. Results Nearly 31% patients developed VAP among the entire cohort. The incidence density was 21.3 per 1000 ventilator days. The most frequently isolated organisms from VAP patients were Pseudomonas aeruginosa (47.7%), Acinetobacter (18.2%) and Methicillin-resistant Staphylococcus aureus (MRSA) (14.4%). VAP patients were significantly younger than non-VAP ones. The incidence of VAP in comatose patients and those with MOSF was significantly higher. Prior antibiotic use for > 48 h before MV, supine body positioning and reintubation were significantly associated with VAP. On multiple logistic regression analysis, MOSF; prior antibiotic use > 48h; reintubation; coma; and age remained independent predictors of VAP. Mortality rate among the VAP group was significantly higher compared to the non-VAP one (68.2% vs. 48.5%, p<0.001). Survival curve analysis showed a shorter median survival time in VAP patients. Conclusion Identification of risk factors and outcome of VAP in PICUs may help in reducing the incidence and improving patients’ outcomes. The incidence of VAP in this study was relatively high. The most

  17. The water supply system as a potential source of fungal infection in paediatric haematopoietic stem cell units

    PubMed Central

    2013-01-01

    Background We conducted a prospective study to investigate the presence of microfungal contamination in the water supply system of the Oncology Paediatric Institute, São Paulo – Brazil after the occurrence of one invasive Fusarium solani infection in a patient after Haematopoietic Stem Cell Transplantation (HSCT). During a twelve-month period, we investigated the water supply system of the HSCT unit by monitoring a total of fourteen different collection sites. Methods One litre of water was collected in each location, filtered through a 0.45 μm membrane and cultured on SDA to detect the presence of filamentous fungi. Physicochemical analyses of samples were performed to evaluate the temperature, turbidity, pH, and the concentration of free residual chlorine. Results Over the 12 months of the study, 164 samples were collected from the water supply system of the HSCT unit, and 139 of the samples tested positive for filamentous fungi (84.8%), generating a total of 2,362 colonies. Cladosporium spp., Penicillium spp., Purpureocillium spp. and Aspergillus spp. were ranked as the most commonly found genera of mould in the collected samples. Of note, Fusarium solani complex isolates were obtained from 14 out of the 106 samples that were collected from tap water (mean of 20 CFU/L). There was a positive correlation between the total number of fungal CFU obtained in all cultures and both water turbidity and temperature parameters. Our findings emphasise the need for the establishment of strict measures to limit the exposure of high-risk patients to waterborne fungal propagules. Conclusions We were able to isolate a wide variety of filamentous fungi from the water of the HSCT unit where several immunocompromised patients are assisted. PMID:23802862

  18. 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

  19. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    PubMed Central

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D.K.; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were 2,04,787 (US$ 3,413) and 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care. PMID:27377508

  20. The utility of procalcitonin in the prediction of serious bacterial infection in a tertiary paediatric intensive care unit.

    PubMed

    Sm, Matha; Sn, Rahiman; Bg, Gelbart; Td, Duke

    2016-09-01

    To determine utility of procalcitonin (PCT) for the prediction of bacterial infection in critically ill children, we analysed the relationship between serum PCT, cultures and other laboratory markers of bacterial sepsis or viral infection in a tertiary paediatric intensive care unit (PICU). The outcome measures were levels of PCT in proven bacteraemia, pneumonia and viral respiratory infection; and comparison of PCT to immature to total neutrophil ratio (ITR) in prediction of bacteraemia. In 420 children with suspected sepsis, 1,226 serum PCT levels were analysed. Children with bacteraemia had a higher median PCT (2.03 ng/ml, interquartile range [IQR] 0.67-42.4) than those who did not have bacteraemia (0.82 ng/ml, IQR 0.295-2.87) (P=0.033). PCT was a significant but only moderate predictor of bacteraemia (AUC 0.65). In 866 episodes of suspected sepsis where paired PCT and ITR were performed, the median ITR in children with bacteraemia was 0.19 ng/ml (IQR 0.04-0.35), and the median PCT was 6.5 ng/ml (IQR 0.71-61.8). PCT was a marginally better predictor of bacteraemia (AUC 0.69) than the ITR (AUC 0.66). In children with viral respiratory tract infection only, the median PCT was 1.26 ng/ml (0.35-5.5), and in those with likely bacterial pneumonia the median PCT was 0.80 ng/ml (IQR 0.28-1.70). In a heterogeneous population of children in a tertiary PICU, PCT measured at a single timepoint was a moderate predictor of proven bacteraemia. In our population PCT did not reliably identify localised bacterial infection or distinguish bacterial from viral respiratory infection. PMID:27608345

  1. [Treatment of the child and adolescent with type 1 diabetes: special paediatric diabetes units].

    PubMed

    Hermoso López, F; Barrio Castellanos, R; Garcia Cuartero, B; Gómez Gila, A; González Casado, I; Oyarzabal Irigoyen, M; Rica Etxebarria, I; Rodríguez-Rigual, M; Torres Lacruz, M

    2013-05-01

    Intensive treatment of type 1 diabetes mellitus (DM1) delays and slows down the progression of chronic diabetes complications (DCCT 1993). This type of treatment in children and adolescents with DM1 has a different complexity to other stages of life and therefore, needs specialized care units. Various documents and declarations of diabetic patient's rights are evaluated, and the need for an adequate health care is emphasized. In the last decade, several projects have been developed in Europe to create a benchmark treatment of pediatric diabetes, with the aim of establishing hospitals with highly qualified healthcare to control it. The Diabetes Working Group of the Spanish Society for Pediatric Endocrinology (SEEP) has prepared this document in order to obtain a national consensus for the care of children and adolescents with type 1 diabetes in specialist Pediatric Diabetes Units, and at the same time advise Health Care Administrators to establish a national healthcare network for children and adolescents with diabetes mellitus, and organize comprehensive pediatric diabetes care units in hospitals with a reference level in quality of care.

  2. 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

  3. [Current treatment strategies for paediatric burns].

    PubMed

    Küntscher, M V; Hartmann, B

    2006-06-01

    Paediatric burns occupy the third place in the severe accident statistics in Germany after traffic injuries and drowning. The paper reviews current treatment concepts of pre-hospital management, fluid resuscitation and surgical therapy in paediatric burned patients. Specific features in the approximation of the total body surface area burn and indications for transfer of paediatric burn victims to specialized units are discussed. The therapy of severe paediatric burns requires an interdisciplinary team consisting of especially skilled plastic or paediatric surgeons,anaesthetists, psychiatrists or psychologists, specifically trained nurses, physiotherapists and social workers. The rehabilitation process starts basically with admission to the burn unit. A tight cooperation between therapists and the relatives of the paediatric burn victim is needed for psychological recovery and reintegration into society.'The adaptation to the suffered trauma resulting in life-long disability and disfigurement is the main task of psychotherapy.

  4. Two years’ study of Tetanus cases in a Paediatric Intensive Care Unit

    PubMed Central

    Naseem, Faizia; Mahar, Imtiaz Ahmad; Arif, Fehmina

    2016-01-01

    Objective: To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit (PICU) of Civil Hospital Karachi (CHK). Methods: It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results. Results: During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases (13) belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG & OPV. None was appropriately vaccinated for age. There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs. Conclusion: Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus. PMID:27375706

  5. Experience of influenza A H1N1 in a paediatric emergency unit.

    PubMed

    Biçer, Suat; Ercan Sariçoban, Hülya; Özen, Ahmet Oğuzhan; Saf, Coşkun; Ergenekon Ulutaş, Pinar; Gürol, Yeşim; Yilmaz, Gülden; Vitrinel, Ayça; Özelgün, Berna

    2015-06-01

    This study was carried out to evaluate symptoms, clinical findings, treatment options and complications of H1N1 influenza infection in patients who applied to our emergency unit during the influenza season in 2009. The clinical and laboratory findings of children with influenza A (H1N1) during the influenza season in 2009 were evaluated retrospectively. Influenza A was diagnosed by polymerase chain reaction and/or rapid antigen test. Clinical and laboratory findings of the patients with H1N1 (group I) and without H1N1 (group II) were compared. Fever and myalgia were noted to be higher in group I (p <0.05). The mean body temperature in group I was 39.0?, which was statistically different from group II (p <0.001). Myalgia was observed only in group I (15.4%), but not in group II (p <0.05). There were three patients with diarrhoea, two of whom were in group I, and they had no significant respiratory symptoms. Lymphopenia was seen in 18 patients (81.8%) in group I and in four patients (23.5%) in group II (p <0.05). Oseltamivir treatment was applied to 28 patients, where 24 had severe symptoms, nine had comorbid factors and two did not have any of these. The fever was higher in group I and myalgia was present only in group I. In group I, the lymphocyte count was significantly lower than in group II. The fever was higher in patients of H1N1 (average of 39°C) and myalgia was present only in patients with H1N1. The lymphocyte count was significantly lower in patients with H1N1 than those without H1N1. While none of the patients required intensive care, three patients requiring hospitalization were discharged after referral and completion of their treatment.

  6. Glucose-6-phosphate dehydrogenase deficiency among children attending the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

    PubMed Central

    Isaac, IZ; Mainasara, AS; Erhabor, Osaro; Omojuyigbe, ST; Dallatu, MK; Bilbis, LS; Adias, TC

    2013-01-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital for pediatric-related care. The study included 118 children, made up of 77 (65.3%) males and 41 (34.7%) females aged ≤5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4%) were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%). Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01). The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2%) were moderately deficient, while five (29.4%) were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD deficiency in our environment, to allow for evidence-based management of these children and to ensure the avoidance of food, drugs, and infective agents that can potentially predispose these children to oxidative stress as well as diseases that deplete micronutrients that protect against oxidative stress. There is need to build capacity in our

  7. Pulmonary hypertension in the intensive care unit. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.

    PubMed

    Kaestner, Michael; Schranz, Dietmar; Warnecke, Gregor; Apitz, Christian; Hansmann, Georg; Miera, Oliver

    2016-05-01

    Acute pulmonary hypertension (PH) complicates the course of several cardiovascular, pulmonary and other systemic diseases in children. An acute rise of RV afterload, either as exacerbating chronic PH of different aetiologies (eg, idiopathic pulmonary arterial hypertension (PAH), chronic lung or congenital heart disease), or pulmonary hypertensive crisis after corrective surgery for congenital heart disease, may lead to severe circulatory compromise. Only few clinical studies provide evidence on how to best treat children with acute severe PH and decompensated RV function, that is, acute RV failure. The specific treatment in the intensive care unit should be based on the underlying pathophysiology and not only be focused on so-called 'specific' or 'tailored' drug therapy to lower RV afterload. In addition therapeutic efforts should aim to optimise RV preload, and to achieve adequate myocardial perfusion, and cardiac output. Early recognition of patients at high risk and timely initiation of appropriate therapeutic measures may prevent the development of severe cardiac dysfunction and low cardiac output. In patients not responding adequately to pharmacotherapy, (1) novel surgical and interventional techniques, temporary mechanical circulatory support with extracorporeal membrane oxygenation, (2) pumpless lung assist devices (3) and/or lung or heart-lung transplantation should be timely considered. The invasive therapeutic measures can be applied in a bridge-to-recovery or bridge-to-lung transplant strategy. This consensus statement focuses on the management of acute severe PH in the paediatric intensive care unit and provides an according treatment algorithm for clinical practice. PMID:27053699

  8. Pulmonary hypertension in the intensive care unit. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.

    PubMed

    Kaestner, Michael; Schranz, Dietmar; Warnecke, Gregor; Apitz, Christian; Hansmann, Georg; Miera, Oliver

    2016-05-01

    Acute pulmonary hypertension (PH) complicates the course of several cardiovascular, pulmonary and other systemic diseases in children. An acute rise of RV afterload, either as exacerbating chronic PH of different aetiologies (eg, idiopathic pulmonary arterial hypertension (PAH), chronic lung or congenital heart disease), or pulmonary hypertensive crisis after corrective surgery for congenital heart disease, may lead to severe circulatory compromise. Only few clinical studies provide evidence on how to best treat children with acute severe PH and decompensated RV function, that is, acute RV failure. The specific treatment in the intensive care unit should be based on the underlying pathophysiology and not only be focused on so-called 'specific' or 'tailored' drug therapy to lower RV afterload. In addition therapeutic efforts should aim to optimise RV preload, and to achieve adequate myocardial perfusion, and cardiac output. Early recognition of patients at high risk and timely initiation of appropriate therapeutic measures may prevent the development of severe cardiac dysfunction and low cardiac output. In patients not responding adequately to pharmacotherapy, (1) novel surgical and interventional techniques, temporary mechanical circulatory support with extracorporeal membrane oxygenation, (2) pumpless lung assist devices (3) and/or lung or heart-lung transplantation should be timely considered. The invasive therapeutic measures can be applied in a bridge-to-recovery or bridge-to-lung transplant strategy. This consensus statement focuses on the management of acute severe PH in the paediatric intensive care unit and provides an according treatment algorithm for clinical practice.

  9. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study

    PubMed Central

    Gibson, Philippa S.; Lang, Sarah; Gilbert, Marianne; Kamat, Deepa; Bansal, Sanjay; Ford-Adams, Martha E.; Desai, Ashish P.; Dhawan, Anil; Fitzpatrick, Emer; Moore, J. Bernadette; Hart, Kathryn H.

    2015-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management. PMID:26703719

  10. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study.

    PubMed

    Gibson, Philippa S; Lang, Sarah; Gilbert, Marianne; Kamat, Deepa; Bansal, Sanjay; Ford-Adams, Martha E; Desai, Ashish P; Dhawan, Anil; Fitzpatrick, Emer; Moore, J Bernadette; Hart, Kathryn H

    2015-12-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management. PMID:26703719

  11. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study.

    PubMed

    Gibson, Philippa S; Lang, Sarah; Gilbert, Marianne; Kamat, Deepa; Bansal, Sanjay; Ford-Adams, Martha E; Desai, Ashish P; Dhawan, Anil; Fitzpatrick, Emer; Moore, J Bernadette; Hart, Kathryn H

    2015-11-26

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management.

  12. 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.

  13. Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit.

    PubMed

    Brierley, Joe; Highe, Lorraine; Hines, Sarah; Dixon, Garth

    2012-02-01

    Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health Saving Lives initiatives. We describe the institution of a purpose-designed bundle of care in a tertiary paediatric ICU based on the available literature as part of our hospital's transformation project into reducing health-care-associated infection. A nurse-led VAP surveillance programme is in place, and we used this to compare VAP incidence before and after commencing a series of care measures aimed at reducing VAP as part of an overall drive for patient safety. The diagnostic criteria, surveillance methods and rates of VAP (5.6 per 1,000 ventilator days) have been previously reported. Nurse educators were added to the original core group, as a key feature is buy in from nursing staff. All nursing staff had multiple training opportunities, and VAP project education became a routine part of staff induction. The major features of the bundle of care were (1) elevation of bed to maximum (target, 45°; however, no beds currently permit this so achieved 20-30°), (2) mouth care using chlorhexidine or tooth brushing, (3) clean suctioning practice, (4) all patients not on full feeds commenced on ranitidine and (5) 4-hourly documentation. Compliance with these aspects was monitored. After the institution of the bundle, no paediatric case of VAP was recorded over a 12-month period, according to a priori definitions. One adult patient had a confirmed VAP over the same time interval. A paediatric VAP bundle was associated with reduced VAP on a UK PICU.

  14. Estimation of risks associated with paediatric cochlear implantation.

    PubMed

    Johnston, J Cyne; Smith, Andrée Durieux; Fitzpatrick, Elizabeth; O'Connor, Annette; Angus, Douglas; Benzies, Karen; Schramm, David

    2010-09-01

    The objectives of this study were to estimate the rates of complications associated with paediatric cochlear implantation use: a) at one Canadian cochlear implant (CI) centre, and b) in the published literature. It comprised a retrospective hospital-based chart review and a concurrent review of complications in the published literature. There were 224 children who had undergone surgery from 1994 to June 2007. Results indicate that the rates of complications at the local Canadian paediatric CI centre are not significantly different from the literature rates for all examined complication types. This hospital-based retrospective chart review and review of the literature provide readers with an estimation of the risks to aid in evidence-based decision-making surrounding paediatric cochlear implantation.

  15. How creation of a parent satisfaction questionnaire improved multidisciplinary service delivery in a paediatric day surgery unit.

    PubMed

    Bradley, Alison

    2013-01-01

    Auditing patient satisfaction has become a keystone of quality patient centred healthcare. A plethora of patient satisfaction studies exist but only a few studies have been evaluated for their validity, reliability, specificity or psychometric properties. And the majority focus on adult health care. However, if validated tools are not utilised, then inaccurate results could stymie service improvement. The level of satisfaction with the paediatric day surgery service at Tayside Children's Hospital was unknown. Our objective was to measure parent satisfaction with the paediatric day surgery by creating a parent satisfaction questionnaire which has undergone satisfactory testing for validity, reliability, specificity and psychometric properties. A Likert-style questionnaire was constructed through literature review and focus group meetings with professionals, parents and patient groups to establish content validity. Statements worded in positive phrasing were re-worded in negative phrasing to ensure intra-rater reliability. A pilot study was conducted and responses analysed for construct validity and inter-rater agreement. Internal reliability was established using Chronbach's alpha analysis, which produced scores for each part of the questionnaire between 0.7 and 0.9. Overall parent satisfaction was high. 95.48% either strongly agreed or agreed with positively worded statements regarding pre-operative clinic service. In particular 100% satisfaction was reported with the pre-operative phone call which only 70% of participants received. 96.60% strongly agreed or agreed with positive statements regarding service provided on the ward and 87.50% strongly agreed or agreed with positive statements regarding the discharge process. 5% specifically requested improved information giving. In conclusion the parent satisfaction questionnaire was found to have proven validity, reliability, specificity and psychometric properties. Overall parent satisfaction was found to be high

  16. Is regional paediatric surveillance useful? Experience in Wales

    PubMed Central

    Sibert, J; Morgan, R; O'Connell, H; Lynn, R; Guildea, Z; Palmer, S; group, t. W.

    2001-01-01

    The Welsh Paediatric Surveillance Unit was established in 1994 to monitor the incidence and prevalence of a number of uncommon disorders of childhood in Wales. Its work complements that of the British Paediatric Surveillance Unit. Information from consultant paediatricians is obtained by means of a monthly card return system; return rate is over 90%.

 PMID:11369563

  17. Palliative care needs of HIV exposed and infected children admitted to the inpatient paediatric unit in Uganda

    PubMed Central

    Nakawesi, Jane; Kasirye, Ivy; Kavuma, David; Muziru, Benjamin; Businge, Alice; Naluwooza, Jackie; Kabunga, Grace; Karamagi, Yvonne; Akankwasa, Edith; Odiit, Mary; Mukasa, Barbara

    2014-01-01

    Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-limiting conditions and also for their families. It is a response to the suffering and unique needs of such children. Globally there is limited documented data available on the palliative care needs of children with HIV. A retrospective review of data of all the HIV exposed and positive children who were admitted to the ward from January to December 2012 was done to document their palliative care needs. A total of 243 children were admitted to the ward during the stated period. Of these, 139 (57.2%) were female and 104 (42.8%) were male. Among them 131 (54%) were aged five years and below whereas 112 (46%) were above five years. Some of the identified palliative care needs documented included physical needs: pneumonia 46 (19%), severe acute malnutrition 38 (16%), mild and moderate acute malnutrition 23 (9.6%), and respiratory tract infections 22 (9.3%). Social needs: poor social support 21 (41%), financial instability 16 (31%), and child neglect 4 (8%). Psychological needs: antiretroviral treatment (ART) counselling 127 (36%), HIV counselling and testing for the child and family 63 (18%), adherence support 53 (15%), and others 11 (3%). Spiritual needs: discontinuing ART because of belief in spiritual healing 18 (81%), loss of hope because of severe ill health 1 (5%), and others 3 (14%). These results emphasise the need for palliative care in children with HIV even in the era of ART. The needs identified are in keeping with studies done elsewhere and are similar to the palliative care needs of children with other life-limiting illnesses such as cancer. Conclusion HIV positive and exposed children plus their families have vast palliative care needs and a holistic approach is the key in their management. PMID:25624870

  18. 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

  19. Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a paediatric surgical unit associated with tap-water contamination.

    PubMed

    Ferroni, A; Nguyen, L; Pron, B; Quesne, G; Brusset, M C; Berche, P

    1998-08-01

    An outbreak of 14 cases of urinary tract infections by Pseudomonas aeruginosa, including six symptomatic infections, occurred from September to November 1994 in a paediatric surgical unit. During the outbreak, urine samples from patients and multiple samples from the environment of patients were tested for the presence of P. aeruginosa. Bacterial isolates were studied by pulsed-field gel electrophoresis. Genotypic analysis showed that most of the isolates from children were different. Multiple P. aeruginosa isolates were also found in the tap water, as the only putative source of contamination. Two of these isolates were identified in two infected patients, indicating possible direct contamination of patients via tap water and this was related to the distal colonization of faucets. Bacteria were eradicated from tap water by replacement of taps. The cluster of cases of P. aeruginosa urinary infection was, therefore, related to multiple contaminations through tap water. These results illustrate an unexpected risk of nosocomial infection and emphasizes the importance of checking tap water to prevent bacterial contamination through handwashing in contaminated water. PMID:9749401

  20. Information structure and organisation in change of shift reports: An observational study of nursing hand-offs in a Paediatric Intensive Care Unit.

    PubMed

    Foster-Hunt, Tara; Parush, Avi; Ellis, Jacqueline; Thomas, Margot; Rashotte, Judy

    2015-06-01

    Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition.

  1. Pilot feasibility study of an emergency paediatric kit for intra-rectal quinine administration used by the personnel of community-based health care units in Senegal

    PubMed Central

    Ndiaye, Jean Louis A; Tine, Roger C; Faye, Babacar; Dieye, El Hadj Lamine; Diack, Pape Amadou; Lameyre, Valérie; Gaye, Oumar; Sow, Husseyn Dembel

    2007-01-01

    Background Quinine injection is the reference treatment for malaria when oral administration is impossible. Quinine can also be administered by the intra-rectal route and, over the last ten years, a series of studies have been conducted in children to determine the ideal dose and dilution in the African situation. The aim of the present study was to evaluate the feasibility and usefulness of a kit for an immediate administration of quinine alkaloids (Quinimax®) by community health workers, prior to transfer of the child to a more sophisticated health care establishment. Methods A prospective, open, descriptive community intervention study conducted in northern Senegal at six village Health Units in children fewer than ten years of age with non-per-os malaria. Controls were given the routine care prior to transfer to a Health Center, and cases were in addition administered Quinimax® (20 mg/ml) via the intra-rectal route before transfer. Patients were followed through complete cure and parasitological tests were carried out on Days 0, 3 and 7. Results 134 patients (79 cases/55 controls) were recruited between November 2003 and May 2004 or October and November 2004. The two groups were comparable at inclusion. In the case group, oral drugs could be administered after a mean of 16.8 hours versus 33.6 hours in the control group. Time-to cure was shorter in cases than in controls. Complete parasite clearance was obtained in all patients by Day 7. The kit was well accepted by all concerned and more than 80% of community health workers judged the kit easy to use. Conclusion The emergency paediatric kit is a useful tool in the management of malaria in children who cannot be treated orally. It is feasible and easy to use for health workers in community-based Health Units where, according to the WHO, nearly 80% of malarial morbidity and mortality occurs. PMID:18005442

  2. Paediatrics in Barcelona.

    PubMed

    Midulla, Fabio; Lombardi, Enrico; Rottier, Bart; Lindblad, Anders; Grigg, Jonathan; Bohlin, Kajsa; Rusconi, Franca; Pohunek, Petr; Eber, Ernst

    2014-08-01

    This update will describe the paediatric highlights from the 2013 European Respiratory Society (ERS) annual congress in Barcelona, Spain. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) have been chosen by group officers and are presented in the context of current literature.

  3. Paediatrics: messages from Munich

    PubMed Central

    Midulla, Fabio; Lombardi, Enrico; Pijnenburg, Marielle; Balfour-Lynn, Ian M.; Grigg, Jonathan; Bohlin, Kajsa; Rusconi, Franca; Pohunek, Petr

    2015-01-01

    The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS) International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) are presented in the context of the current literature. PMID:27730136

  4. 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.

  5. Clostridium difficile in paediatric populations

    PubMed Central

    Allen, Upton D

    2014-01-01

    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 paediatric 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 Paediatric Society position statement on C difficile published in 2000. PMID:24627655

  6. 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

  7. Paediatrics in Vienna.

    PubMed

    Midulla, Fabio; Lombardi, Enrico; Lødrup Carlsen, Karin C; Regamey, Nicolas; Grigg, Jonathan; Ross Russell, Robert I; Turner, Steve W; Priftis, Kostas; Eber, Ernst

    2013-10-01

    The aim of this update is to describe, in the context of the current literature, major papers from the seven groups of the Paediatric Assembly (Respiratory Physiology; Asthma and Allergy; Cystic Fibrosis; Respiratory Infection and Immunology; Neonatology and Paediatric Intensive Care; Respiratory Epidemiology; and Bronchology) presented during the annual European Respiratory Society congress held in 2012 in Vienna, Austria.

  8. Oesophageal inflammatory paediatric chylothorax

    PubMed Central

    Aherne, Thomas; Cullen, Paul; Mortell, Alan; McGuinness, Jonathan

    2014-01-01

    Paediatric chylothoraces are rare, particularly outside the operative setting. Cases of spontaneous chylothorax are often demanding diagnostically and frequently associated with patient morbidity. We present a challenging case of paediatric chylothorax associated with inflammatory oesophageal perforation likely related to foreign body ingestion. PMID:24920516

  9. Influenza and respiratory syncytial virus in infants and children: relationship with attendance at a paediatric emergency unit and characteristics of the circulating strains.

    PubMed

    Gasparini, R; Durando, P; Ansaldi, F; Sticchi, L; Banfi, F; Amicizia, D; Panatto, D; Esposito, S; Principi, N; Icardi, G; Crovari, P

    2007-09-01

    A study was carried out on 2,696 Italian children, aged 0-14 years. The goals were: (1) to define the age-related impact of acute respiratory infections (ARI), measured as the risk of attendance at the Paediatric Emergency Room, (2) to better define the importance and proportion of influenza and respiratory syncytial virus (RSV) infections and (3) to acquire deeper knowledge of the influenza strains circulating in infants and children. A standardised emergency unit attendance risk (EUAR) was calculated, by age group for ARI. Specific EUARs were also calculated for the two pathogens. Pharyngeal swabs were tested by polymerase chain reaction (PCR) for influenza and RSVs. Isolation in Madine-Darby canine kidney cells (MDCK) and Hep cells, haemagglutination inhibition (HI) testing and HA1 gene sequence analysis were performed for influenza viruses. Most of the patients enrolled were aged 0-5 years, 1,139 (84.6%) and 1,061 (78.5%) in the two seasons, respectively. The most represented age class was that of 1 year olds (331 cases in 2001-2002 and 301 in 2002-2003). The highest EUAR for ARI was in patients aged 0-3 years (16.8 and 12.9 during the two seasons). The same was observed on calculating this risk by specific pathogens: 17.4 and 5.5 for influenza and 13.0 and 12.7 for RSV. Virological analysis was performed on 2,696 samples, 595 of which proved positive (22%). The highest number of isolates (326) came from patients aged 1-3 years. RSVs were more often identified than influenza viruses in infants aged up to 1 year (32 vs. 20 isolates). Of 265 strains isolated in 2001-2002, 103 were RSVs (87 type A, 16 B) and 162 were influenza (90 type A, 72 B). HI showed that influenza B viruses were related to two lineages, B/Victoria/2/87 (32%) and B/Yamagata/16/88 (68%). Of 330 strains isolated in 2002-2003, 102 were RSVs (91 type A, 11 B) and 228 were influenza viruses (220 type A, 8 B). A/H3N2 strains belonged to two clusters, A/Panama/2007/99-like and A/Fujian/411/02-like

  10. Advanced practice in emergency care: the paediatric flow nurse.

    PubMed

    Gray, Constance; Hutch, Michelle; Christensen, Martin

    2016-05-01

    Children admitted to emergency departments (EDs) in Australia are often placed in an environment better suited to the treatment of adult patients. This can lead to problems because ED staff are unfamiliar with specialist paediatric care and children often find adult EDs frightening. The development of the paediatric flow nurse (PFN) role at Caboolture Hospital has meant children are treated and supported by a trained paediatric nurse and triaged and treated quickly and effectively. The PFN team collaborates with ED nursing and medical staff to start treating patients and to help move children from the ED to the paediatric emergency short stay unit or inpatient paediatric beds. Each week, the PFN team sees about 30-50 children, many of whom are cared for and discharged directly from the ED.

  11. [Treating pain in paediatric intensive care].

    PubMed

    Abderrahamn, Nadia; Beck, Nathalie; Fazilleau, Laura; Langlois, Claudette

    2014-01-01

    Pain is extremely present in paediatric intensive care units. It is caused both by the care procedures and by the pathology itself. Its assessment is essential and is based on scales adapted to the child.Treatment methods, pharmacological or not, depend on the type of pain and its intensity.

  12. [What's new in paediatric dermatology?].

    PubMed

    Plantin, P

    2014-12-01

    Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014. PMID:25539754

  13. Paediatric musculoskeletal interventional radiology.

    PubMed

    Natali, Gian L; Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo

    2016-01-01

    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.

  14. 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

  15. Migrant-friendly hospitals: a paediatric perspective - improving hospital care for migrant children

    PubMed Central

    2013-01-01

    Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care

  16. Key paediatric messages from Amsterdam

    PubMed Central

    Barben, Jürg; Bohlin, Kajsa; Everard, Mark L.; Hall, Graham; Pijnenburg, Mariëlle; Priftis, Kostas N.; Rusconi, Franca; Midulla, Fabio

    2016-01-01

    The Paediatric Assembly of the European Respiratory Society (ERS) maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly's Groups highlight the key messages from the abstracts presented at the Congress. PMID:27730186

  17. Epidemiology of paediatric injury.

    PubMed Central

    Mazurek, A J

    1994-01-01

    Thousands of young lives are lost every year as a result of accidents, and trauma remains the number one cause of paediatric death. There is a pattern and regularity to children's injury: boys are more often victims than the girls, most injuries occur during the summer months, the pedestrian child has usually been the victim of a road traffic accident (RTA) and, in 75% of these cases, has suffered head injury. The research into paediatric trauma is still very young. For instance, socio-economic and ethnic factors play a significant role in the statistics of accidental death. In order to take effective preventative measures more factors must be determined. PMID:7921561

  18. Canadian Paediatric Surveillance Program: Two years of a system for investigating unusual paediatric disorders.

    PubMed

    Sockett, P

    1998-07-01

    The Canadian Paediatric Surveillance Program (CPSP) is an active surveillance program for rare and unusual paediatric conditions of public health importance in Canada. The program was initiated in 1996 as a joint venture of the Canadian Paediatric Society (CPS) and the Laboratory Centre for Disease Control (LCDC), and is currently overseen by a steering committee representing the fields of paediatrics, epidemiology, genetics and public health. In the first two years of activity seven conditions were reported to the program via a monthly report card mailed to all clinically active paediatricians in Canada. Respondents were asked to indicate on the card the number of new cases seen for each condition and to ensure that all nil reports were also returned. Case reports were followed up with detailed report forms requesting case specific information which, when returned to the CPS, were forwarded to the principal investigator for assessment and analysis. Studies are for a minimum of one year, and new conditions may be included in the program following review by the steering committee and confirmation of ethical approval. Future development of the program includes linkage with a growing international network of paediatric surveillance units and the potential for collaboration in international studies of conditions of common interest.

  19. Paediatric pituitary adenomas: a decade of change.

    PubMed

    Guaraldi, Federica; Storr, Helen L; Ghizzoni, Lucia; Ghigo, Ezio; Savage, Martin O

    2014-01-01

    Pituitary adenomas, although rare in the paediatric 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 paediatric pituitary adenomas occur very infrequently within the paediatric age range, paediatric 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

  20. The training paths and practice patterns of Canadian paediatric residency graduates, 2004–2010

    PubMed Central

    Hameed, Tahir; Lawrence, Sarah

    2016-01-01

    BACKGROUND: The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres. OBJECTIVE: To describe the training paths and the practice patterns of Canadian paediatric residency graduates. METHODS: A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation. RESULTS: Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas. CONCLUSIONS: Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada. PMID:27398047

  1. Paediatric pharmacokinetics: key considerations

    PubMed Central

    Batchelor, Hannah Katharine; Marriott, John Francis

    2015-01-01

    A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug. Differences in physiology in paediatric populations compared with adults can influence the concentration of drug within the plasma or tissue. Healthcare professionals need to be aware of anatomical and physiological changes that affect pharmacokinetic profiles of drugs to understand consequences of dose adjustments in infants and children. Pharmacokinetic clinical trials in children are complicated owing to the limitations on blood sample volumes and perception of pain in children resulting from blood sampling. There are alternative sampling techniques that can minimize the invasive nature of such trials. Population based models can also limit the sampling required from each individual by increasing the overall sample size to generate robust pharmacokinetic data. This review details key considerations in the design and development of paediatric pharmacokinetic clinical trials. PMID:25855821

  2. [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.

  3. Robotics in paediatric urology.

    PubMed

    Olsen, Lars Henning

    2006-02-01

    After the emergence of robotically assisted systems in laparoscopic surgery more than 15 years ago, several systems have been on the market. At the time being only one system, the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA), has survived in clinical use with an increasing spread particularly among adult urologists used primarily for radical prostatectomies. However, the reconstructive nature of paediatric urology makes the system interesting for the paediatric urologists, since its strength is laparoscopic suturing and difficult dissection. So far only few reports have been published about its clinical use in paediatric urology. The main advantages are the 3D magnified view, the wrist-like movements of the instruments, and the scaling and precision of instrument movements. The system has been used for upper tract reconstruction like pyeloplasties and heminephrectomies, both for the transperitoneal and, more technical challenging, the retroperitoneal approach. In the pelvic region, anti-reflux surgery (both extra- and intravesically) and surgery for malformations of the internal genitalia like utriculus cysts and gonadal streaks are feasible. More simple procedures like nephrectomies and the management of the intra-abdominal testis are not justified due to the high costs. In addition, no advantage for the patients related to standard laparoscopic procedures has been proofed yet. For the surgeon the minimally challenging invasive procedures become feasible with certainly improved ergonomics. The use of the system is much easier than standard laparoscopic surgery and its widespread will give more patients to access minimal invasive surgery. PMID:18947593

  4. Robotics in paediatric urology.

    PubMed

    Olsen, Lars Henning

    2006-02-01

    After the emergence of robotically assisted systems in laparoscopic surgery more than 15 years ago, several systems have been on the market. At the time being only one system, the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA), has survived in clinical use with an increasing spread particularly among adult urologists used primarily for radical prostatectomies. However, the reconstructive nature of paediatric urology makes the system interesting for the paediatric urologists, since its strength is laparoscopic suturing and difficult dissection. So far only few reports have been published about its clinical use in paediatric urology. The main advantages are the 3D magnified view, the wrist-like movements of the instruments, and the scaling and precision of instrument movements. The system has been used for upper tract reconstruction like pyeloplasties and heminephrectomies, both for the transperitoneal and, more technical challenging, the retroperitoneal approach. In the pelvic region, anti-reflux surgery (both extra- and intravesically) and surgery for malformations of the internal genitalia like utriculus cysts and gonadal streaks are feasible. More simple procedures like nephrectomies and the management of the intra-abdominal testis are not justified due to the high costs. In addition, no advantage for the patients related to standard laparoscopic procedures has been proofed yet. For the surgeon the minimally challenging invasive procedures become feasible with certainly improved ergonomics. The use of the system is much easier than standard laparoscopic surgery and its widespread will give more patients to access minimal invasive surgery.

  5. The EU paediatric regulation: effects on paediatric psychopharmacology in Europe.

    PubMed

    Stoyanova-Beninska, Violeta V; Wohlfarth, Tamar; Isaac, Maria; Kalverdijk, Luuk J; van den Berg, Henk; Gispen-de Wied, Christine

    2011-08-01

    Child and adolescent psychiatry is a relatively young field and the recognition, classification, and treatment of disorders in children and adolescents lag behind those in adults. In recent years there is an increasing awareness of the differences between children and adults in psychopathology and pharmacology. Related to this new paediatric regulations have been introduced. This article reviews the regulatory and legislative measures that were adopted in the EU in 2007 and the subsequent impact of these measures on the field of paediatric psychopharmacology. The consequences of the paediatric regulation in the EU are reflected in several domains: regulatory, research aimed at drug development and clinical practices. In the regulatory domain, the consequences include: new paediatric indications, inclusion of special (class) warnings, specification of dose regimens, and information on safety specific to children and adolescents, and development of new medicinal formulations. The paediatric regulation leads to timely development of paediatric friendly formulations and better quality of the clinical evidence. In clinical practices, an increased awareness of the uniqueness of paediatric pharmacology is emerging among medical professionals, and subsequent improvement of medical care (i.e. correct doses, appropriate formulation, monitoring for expected adverse events). In addition, clinical guidelines will have to be revised more frequently in order to integrate the recently acquired knowledge. The new regulations stimulate transparency and discussions between academia, pharmaceutical industry, and regulators. The purpose is to optimize clinical research and obtain evidence for paediatric psychopharmacology, thereby providing adequate support for treatment.

  6. Treatment of paediatric burns with a nanocrystalline silver dressing compared with standard wound care in a burns unit: a cost analysis.

    PubMed

    Cox, S G; Cullingworth, L; Rode, H

    2011-10-01

    Burns are a leading cause of non-natural death in South African infants and children. Conventional care of partial-thickness burns often requires painful, time consuming and costly twice-daily dressing changes to clean the wound and apply antimicrobial topical agents. A new topical nanocrystalline silver-coated NS dressing (Acticoat; Smith & Nephew) has been developed and is the first-line treatment of choice in many burn centres. However, because of its cost the Department of Health has been reluctant to introduce it as a standard of care. We retrospectively studied 4 randomly selected paediatric burn patients, calculating the cost associated with the use of NS dressings and comparing this with the projected costs of three previously standard burn wound treatment regimens. NS dressings were changed every 3 days based on their sustained and slow release of silver ions over 72 hours. Using NS clearly saved costs compared with the three other regimens. The demonstrated cost savings resulted primarily from the decreased number of dressings, and the presumed shorter hospital stay. PMID:22272852

  7. 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

  8. Effects and repercussions of local/hospital-based health technology assessment (HTA): a systematic review

    PubMed Central

    2014-01-01

    Background Health technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed. Although local/hospital-based HTA has been implemented for more than two decades in some jurisdictions, little is known about its effects and impact on hospital budget, clinical practices, and patient outcomes. We conducted a mixed-methods systematic review that aimed to synthesize current evidence regarding the effects and impact of local/hospital-based HTA. Methods We identified articles through PubMed and Embase and by citation tracking of included studies. We selected qualitative, quantitative, or mixed-methods studies with empirical data about the effects or impact of local/hospital-based HTA on decision-making, budget, or perceptions of stakeholders. We extracted the following information from included studies: country, methodological approach, and use of conceptual framework; local/hospital HTA approach and activities described; reported effects and impacts of local/hospital-based HTA; factors facilitating/hampering the use of hospital-based HTA recommendations; and perceptions of stakeholders concerning local/hospital HTA. Due to the great heterogeneity among studies, we conducted a narrative synthesis of their results. Results A total of 18 studies met the inclusion criteria. We reported the results according to the four approaches for performing HTA proposed by the Hospital Based HTA Interest Sub-Group: ambassador model, mini-HTA, internal committee, and HTA unit. Results showed that each of these approaches for performing HTA corresponds to specific needs and structures and has its strengths and limitations. Overall, studies showed positive impacts related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians. Conclusions Local/hospital-based HTA could influence decision-making on several aspects

  9. Paediatric cardiovascular clinical trials: an analysis of ClinicalTrials.gov and the Food and Drug Administration Pediatric Drug Labeling Database.

    PubMed

    Hill, Kevin D; Henderson, Heather T; Hornik, Christoph P; Li, Jennifer S

    2015-08-01

    Recent regulatory initiatives in the United States of America and Europe have transformed the paediatric clinical trials landscape by significantly increasing capital investment and paediatric trial volume. The purpose of this manuscript was to review the impact of these initiatives on the paediatric cardiovascular trials landscape when compared with other paediatric sub-specialties. We also evaluate factors that may have contributed to the success or failure of recent major paediatric cardiovascular trials so as to inform the optimal design and conduct of future trials in the field.

  10. [Assessing and making safe the medicine use pathway in paediatrics].

    PubMed

    Didelot, Nicolas; Guerrier, Catherine; Didelot, Anne; Fritsch, Sandrine; Pelte, Jean-Pierre; Socha, Marie; Javelot, Hervé

    2016-01-01

    Based on an assessment of adverse events in a follow-up care and rehabilitation unit in paediatrics, audits were carried out of the medicine use pathway. The evaluation grid taken from this study today serves as a basis for the audits carried out on the medicine use pathway on a national level.

  11. The ethics of paediatric research.

    PubMed

    Spriggs, Merle; Caldwell, Patrina H Y

    2011-09-01

    Paediatric research is essential for improving health outcomes of children. Waiting for adult studies before conducting paediatric studies will prolong the denial of effective treatment for children. If we rely on information from adult studies rather than conducting studies with children, we risk causing harm to children. In this paper, we identify and examine ethical issues unique to conducting research with children. These include the function and the value of a child's assent and the criteria that should guide a proxy in making decisions about a child's involvement in research, offering payment to children for research participation and acceptable levels of risk for paediatric research. Justice demands that children not be denied the benefits of research, and it is the role of the paediatric medical community to advocate not only for more research for children but also to ensure that the research conducted is of the highest quality. PMID:21951455

  12. [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

  13. Management of paediatric asthma

    PubMed Central

    Grigg, J

    2004-01-01

    Paediatric asthma best practice not only includes prescribing the correct therapeutic mix based on consensus guidelines, but also reducing therapy once control has been achieved. Clinicians should also be aware that asthma in young children is a heterogeneous entity, and a beneficial response to bronchodilators and/or inhaled steroids is not inevitable. In general, preschool children and infants should not be prescribed inhaled corticosteroids above 200 µg beclometasone dipropionate equivalent twice a day, or regular oral steroids, or long acting ß2-adrenoceptor agonists. New therapies such as anti-IgE antibodies are on the horizon, but these are unlikely to replace the established drug combinations. More likely is that the delivery of established drugs will become more convenient (for example, once a day inhaled corticosteroids, or season dependent prophylactic therapy). PMID:15356355

  14. [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.

  15. Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team.

    PubMed Central

    Britto, J.; Nadel, S.; Maconochie, I.; Levin, M.; Habibi, P.

    1995-01-01

    OBJECTIVE--To evaluate the morbidity and severity of illness during interhospital transfer of critically ill children by a specialised paediatric retrieval team. DESIGN--Prospective, descriptive study. SETTING--Hospitals without paediatric intensive care facilities in and around the London area, and a paediatric intensive care unit at a tertiary centre. SUBJECTS--51 critically ill children transferred to the paediatric intensive care unit. MAIN OUTCOME MEASURES--Adverse events related to equipment and physiological deterioration during transfer. Paediatric risk of mortality score before and after retrieval. Therapeutic intervention score before and after arrival of retrieval team. RESULTS--Two (4%) patients had preventable physiological deterioration during transport. There were no adverse events related to equipment. Severity of illness decreased during stabilisation and transport by the retrieval team, suggested by the difference between risk of mortality scores before and after retrieval (P < 0.001). The median (range) difference between the two scores was 3.0 (-6 to 17). Interventions during stabilisation by the retrieval team increased, demonstrated by the difference between intervention scores before and after retrieval, median (range) difference between the two scores being 6 (-8 to 38) (P < 0.001). CONCLUSIONS--Our study indicates that a specialised paediatric retrieval team can rapidly deliver intensive care to critically ill children awaiting transfer. Such children can be transferred to a paediatric intensive care unit with minimal morbidity and mortality related to transport. There was no deterioration in the clinical condition of most patients during transfer. PMID:7580489

  16. 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

  17. Rationale for hospital-based rehabilitation in obesity with comorbidities.

    PubMed

    Capodaglio, P; Lafortuna, C; Petroni, M L; Salvadori, A; Gondoni, L; Castelnuovo, G; Brunani, A

    2013-06-01

    Severely obese patients affected by two or more chronic conditions which could mutually influence their outcome and disability can be defined as "complex" patients. The presence of multiple comorbidities often represents an obstacle for being admitted to clinical settings for the treatment of metabolic diseases. On the other hand, clinical Units with optimal standards for the treatment of pathological conditions in normal-weight patients are often structurally and technologically inadequate for the care of patients with extreme obesity. The aims of this review paper were to review the intrinsic (anthropometrics, body composition) and extrinsic (comorbidities) determinants of disability in obese patients and to provide an up-to-date definition of hospital-based multidisciplinary rehabilitation programs for severely obese patients with comorbidities. Rehabilitation of such patients require a here-and-now multidimensional, comprehensive approach, where the intensity of rehabilitative treatments depends on the disability level and severity of comorbidities and consists of the simultaneous provision of physiotherapy, diet and nutritional support, psychological counselling, adapted physical activity, specific nursing in hospitals with appropriate organizational and structural competences.

  18. [Consensus document by the Spanish Society of Paediatric Infectious Diseases and the advisory committee on vaccines of the Spanish Paediatrics Association on vaccination in immunocompromised children].

    PubMed

    Mellado Peña, M J; Moreno-Pérez, D; Ruíz Contreras, J; Hernández-Sampelayo Matos, T; Navarro Gómez, M L

    2011-12-01

    Vaccination in immunocompromised infants, children and adolescents is a major aspect in the follow-up of this complex pathology in specific Paediatric Units. Vaccination is also an important prevention tool, as this can, to a certain extent, determine the morbidity and mortality in these patients. This consensus document was jointly prepared by Working Groups of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Paediatric Association, who are usually involved in updating the management of vaccinations in immunocompromised children, and reflects their opinions. The consensus specifically summarises indications for vaccination in the following special paediatric populations: Solid organ and haematopoietic transplant-recipients; primary immunodeficiency; asplenic children; non-previously transplanted immunocompromised patients; chronically ill patients; HIV-infected children and also the vaccines recommended for immunodeficient children who travel.

  19. Aspects of tropical paediatrics.

    PubMed

    Hendrickse, R G

    1976-01-01

    Malnutrition interacting with infectious and parasitic diseases are the main causes of the appalling mortality in childhood in the tropics. The most important single safeguard against these in infancy is breast feeding and the trend now evident to abandon this is a disaster which demands urgent attention. Reasons for this trend are discussed. Efforts to control infectious diseases, other than smallpox, have had little success and the emergence and spread of dengue haemorrhagic fever in S.E. Asia have added new dimensions to the problem. Malaria is still widely prevalent in the tropics and falciparum malaria, holoendemic in much of Africa, remains a major cause of death with its most serious impact on pregnant women and children. The emergence and spread of drug resistant strains of this parasite in parts of the world is a cause for serious concern. Quartan malaria is also an insidious corruptor of health in childhood and commonly causes the nephrotic syndrome. Neonatal jaundice, often associated with G6PD deficiency, is increasing in frequency in urban areas of Africa and now constitutes a significant hazard to the newborn and requires urgent investigation. These problems in tropical paediatrics indicate the need for urgent reappraisal of our role as a profession in the affairs of the tropical developing world.

  20. Critical factors for successful hospital-based case management.

    PubMed

    Williams, F G; Warrick, L H; Christianson, J B; Netting, F E

    1993-01-01

    Six hospitals were funded to develop programs for long-term case management. Factors that should be considered when developing hospital-based case management are discussed within three areas: organizational placement, program management, and financial viability.

  1. Revenue risk and price transparency in hospital-based laboratories.

    PubMed

    Myers, Jeffrey H

    2015-11-01

    Two developments with important revenue implications for hospital laboratories demand the attention of hospital finance leaders: > Significant differences in pricing between higher-priced hospital-based laboratory services and lower-priced services delivered by commercial laboratories give patients a disincentive to use the hospital-based services. > Hospital operating revenue will be substantially affected beginning in 2017 by deep, statutory cuts in payment for the highest-volume tests on the Part B Clinical Laboratory Fee Schedule. PMID:26685443

  2. Implementing computer information systems for hospital-based case management.

    PubMed

    Williams, F G; Netting, F E; Engstrom, K M

    1991-01-01

    Like all health care services, case management is a process that relies on information. Based on the experiences in implementing computer information systems in six hospital-based case management programs, several financial, technical, and management issues are reviewed. These issues, which are also relevant for other specialized hospital-based programs, include information priorities, user acceptance, quantifying data, data entry methods, data security, and systems integration. The lessons learned regarding these issues are discussed, and categories of software alternatives are presented.

  3. 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.

  4. 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.

  5. 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

  6. The perioperative care of the paediatric neurosurgical patient.

    PubMed

    Wheatley, R

    1994-07-01

    The Queen's Medical Centre, University of Nottingham, is one of the largest neuro-science centres in Britain and serves a population of five million people. Its catchment area covers the counties of Nottinghamshire, Leicestershire, Derbyshire and Lincolnshire though patients are often referred from other parts of Britain and from abroad. The total number of neuro-paediatric beds is 20 plus access to 12 beds in the paediatric intensive care unit and 18 beds of the neonatal unit. In the year 1992 the total number of operations was 300, a number which increased by 25% the following year and included such operations as craniostenosis, craniotomies, spinal surgery, repair of meningocele, shunts, implanting and endoscopic and stereotactic procedures. PMID:7633065

  7. Paediatric surgery--a general hospital experience.

    PubMed

    Fahy, E; Ahmed, K; Lowery, A J; Khan, W; Waldron, R; Barry, K

    2012-01-01

    Plans to centralise paediatric surgery in Ireland have potentially significant implications for service provision and surgical training. study assesses the workload of paediatric surgery in a district hospital over a five-year period. Paediatric surgical admissions and procedures at Mayo General Hospital from January 2006 - December 2010 were reviewed. Data was obtained from the Hospital inpatient enquiry (HIPE) systems and theatre logbooks. 4,255 surgical procedures were performed in 3981 paediatric patients, accounting for 7.4% of the total surgical workload. 2,578 (65%) of cases were elective and 1403 (35%) of paediatric surgery was performed in the emergency setting; paediatric appendicectomy was the most commonly performed procedure (n = 554) with a complication rate of 2.5%. There were no paediatric surgery related mortalities. Paediatric surgery represents a significant part of the surgical workload. There is a continued need for general paediatric surgical provision in this regional setting, supported by access to specialist centres for complicated paediatric surgery. PMID:23495544

  8. Paediatric intensive care in Kuala Lumpur, Malaysia: a developing subspecialty.

    PubMed

    Goh, A Y; Lum, L C; Chan, P W

    1999-12-01

    Paediatric intensive care in Malaysia is a developing subspecialty with an increasing number of specialists with a paediatric background being involved in the care of critically ill children. A part prospective and part retrospective review of 118 consecutive non-neonatal ventilated patients in University Hospital, Kuala Lumpur was carried out from 1 June 1995 to 31 December 1996 to study the clinical epidemiology and outcome in our paediatric intensive case unit (PICU). The mean age of the patients was 33.9 +/- 6.0 months (median 16 months). The main mode of admission was emergency (96.6 per cent) with an overall mortality rate of 42 per cent (50/118). The mean paediatric risk of mortality (PRISM) score was 20 +/- 0.98 SEM, with 53 per cent of patients having a score of over 30 per cent. Multiorgan dysfunction (MODS) was identified in 71 per cent of patients. Admission efficiency (mortality risk > 1 per cent) was 97 per cent. Standardized mortality rate using PRISM was an acceptable 1.06. The main diagnostic categories were respiratory (32 per cent), neurology (22 per cent), haematology-oncology (18 per cent); the aetiology of dysfunction was mainly infective. Non-survivors were older (29.5 vs. 13.8 months, p < 0.0001), had more severe illness (mean PRISM score 30 vs. 14, p < 0.0001), were more likely to develop MODS (96 vs. 53 per cent, p < 0.0001) and required more intervention and monitoring. Paediatric intensive care in Malaysia differs widely from that in developed countries in patient characteristics, severity of illness, and care modalities provided.

  9. The burden of paediatric intensive care: a South American perspective.

    PubMed

    Piva, Jefferson Pedro; Schnitzler, Eduardo; Garcia, Pedro Celiny; Branco, Ricardo Garcia

    2005-09-01

    Paediatric intensive care is a relatively new medical specialty that has shown a marked growing up around the world over the last three decades. The limits and the development of this new specialty are not uniform from country to country. Original articles relating to paediatric intensive care and some South American data bases of health care were evaluated and relevant results were selected. Using these data, we describe the main characteristics of paediatric intensive care in South America and discuss some associated factors (e.g. economic aspects, health systems, ethical aspects) that could interfere with the quality and extent of care. A strong relationship between the financial stability of each region and the complexity and quality of paediatric intensive care was seen. A better coverage and more sophisticated paediatric intensive care units (PICUs) are concentrated in the more developed countries (Brazil, Chile and Argentina). Compared to the northern hemisphere, children admitted to the South American PICUs have higher mortality and higher rates of intervention (mechanical ventilation and indwelling catheters). Medical paternalism has a strong influence in the decision-making process offered to terminally ill patients. This phenomenon increases the length of stay, reduces the number of available beds and increases costs. In conclusion, during the last 20 years PICUs have developed and increased their coverage in South America. However, the most sophisticated and well equipped PICUs are preferentially located in the more developed areas whereas those areas with higher infant mortality rates have few PICU beds. Improvements in the economical stability, regional health organisation as well as the rationale for PICU localisation are some of the important goals to be reached in the near future.

  10. 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

  11. 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

  12. Volunteers in hospital-based case management programs.

    PubMed

    Netting, F E; Williams, F G; Jones-McClintic, S; Warrick, L

    1989-01-01

    This article examines the use of volunteers within hospital-based long-term care case management programs. As hospitals diversify into long-term care, the roles played by volunteers are also diversifying. A brief description of the involvement of volunteers with the frail elderly is followed by a comparison of the roles and relationships of volunteers within existing hospital auxiliaries and long-term care case management programs. Three models for structuring hospital-based volunteer programs that address the needs of the frail elderly within diverse communities are presented. Implications surrounding the involvement of volunteers beyond hospital walls are discussed.

  13. Hospital-based case management: results from a demonstration.

    PubMed

    Warrick, L H; Netting, F E; Christianson, J B; Williams, F G

    1992-12-01

    The Flinn Foundation Hospital-based Coordinated Care case management demonstration was designed to help patients discharged from six participating hospitals be linked to community services by a case manager. One unexpected result was that about half of the clients served were referred from the community, not from the hospital. We examine the characteristics of hospital-based case management clients, the predictors of their continuation in case management, and their health status over 1 year, focusing on the differences between hospital- and community-referred clients.

  14. 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

  15. Factors Related to Healthy Diet and Physical Activity in Hospital-Based Clinical Nurses.

    PubMed

    Albert, Nancy M; Butler, Robert; Sorrell, Jeanne

    2014-09-30

    Hospitals often promote healthy lifestyles, but little is known about nurses' actual diet and physical activity. Greater understanding about these lifestyle choices for clinical nurses may improve existing hospital-based programs and/or create desirable services. This article discusses a study that considered diet and physical activity of clinical nurses, using elements of Pender's self-care theory as a conceptual framework. Study methods included a cross-sectional, correlational design and a convenience sample of 278 nurses who worked on units with 24 hours/day and seven days-per-week responsibilities. Participants completed diet and exercise questionnaires about perceptions of attitudes and opinions, barriers, diet benefits/exercise motivators, self-efficacy, and locus of control, and personal and work characteristics. Diet and activity categories were created. Study results demonstrated that over 50% of nurses had moderately healthy diets but were insufficiently active. Healthy diet and physical activity levels were associated with higher self-efficacy, more diet benefits and physical activity motivators, fewer perceived barriers, and confidence in body image. The article discussion and conclusion sections note areas for future research and suggest that focused interventions that address benefits, motivators, and self-efficacy may increase participation in hospital-based programs and enhance healthy lifestyle for hospital-based clinical nurses.

  16. Inequality of Paediatric Workforce Distribution in China

    PubMed Central

    Song, Peige; Ren, Zhenghong; Chang, Xinlei; Liu, Xuebei; An, Lin

    2016-01-01

    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 paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric 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 paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric 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 paediatric 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 paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric 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

  17. [Current aspects of paediatric cholesteatomas].

    PubMed

    Thomas, J P; Volkenstein, S; Minovi, A; Dazert, S

    2013-05-01

    Cholesteatomas can be subclassified into genuine and acquired forms. Whilst epidermoid formations are the generally accepted cause of genuine cholesteatomas, metaplasia, immigration, proliferation and retraction pocket theories have all been proposed to explain the development of acquired cholesteatomas. Clinically, paediatric cholesteatomas exhibit more extensive and aggressive growth than those arising in adulthood. Molecular biological differences in terms of angiogenesis, cytokine expression and particularly the more marked inflammatory responses of the perimatrix could potentially explain these clinical differences. The surgical therapy of paediatric cholesteatomas should be adapted to the individual pathological findings, although where possible a canal wall up procedure is preferred during initial surgery. The "inside-out" mastoidectomy tracking-technique combines the benefits of a good surgical overview with those of a physiological postoperative auditory canal.

  18. Hypnosis in paediatric respiratory medicine.

    PubMed

    McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D

    2014-03-01

    Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.

  19. 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.

  20. Hospital-based, acute care following ambulatory surgery center discharge

    PubMed Central

    Fox, Justin P.; Vashi, Anita A.; Ross, Joseph S.; Gross, Cary P.

    2014-01-01

    Background As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. However, this may underestimate patient’s acute care needs after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Methods Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or surgical procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. Results We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1/1,000 discharges (95% CI, 1.1–1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8/1,000 discharges (95% CI, 31.6–32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median=1.0/1,000 discharges [25th–75th percentile=1.0–2.0]), while substantial variation existed in adjusted hospital-based, acute care rates (28.0/1,000 [21.0–39.0]). Conclusions Among adult patients undergoing ambulatory surgery center care, hospital transfer at discharge is a rare event. In contrast, the hospital-based, acute care rate is nearly 30-fold higher, varies across centers, and may be a more meaningful measure for discriminating quality. PMID:24787100

  1. [Naples: the historic capital of Italian paediatrics].

    PubMed

    Farnetani, I; Farnetani, F

    2008-06-01

    No other Italian city has contributed to the birth and development of paediatrics more than Naples. This is why it can be considered the historic capital of Italian paediatrics. Here are the main reasons: Luigi Somma was the first professor of Italian paediatrics whereas Francesco Fede was the first president of the Italian Paediatrics Association. Neapolitan paediatricians have been the most numerous amongst the founder members. The first three Italian journals of paediatrics were founded in Naples as well as the journal ''La Pediatria'' which was the most distributed and long-lasting journal in this field. Moreover, Neapolitans have been the most numerous presidents of the Italian Paediatrics Association, while Rocco Jemma was the one who remained the longest in charge. ''Rocco Jemma's school'' taught not only to most professors in paediatrics who afterwards taught in most Italian universities, but also four out of five paediatricians who took charge of the position as president. The first regional department of the Italian Paediatrics Association was founded in Naples as well as the Association of Nipiology.

  2. Hospital-Based Physicians: Current Issues and Descriptive Evidence

    PubMed Central

    Steinwald, Bruce

    1980-01-01

    Hospital-based physicians (HBPs) have been the recipients of considerable attention in health policy debates in recent years. This paper discusses issues and trends concerning HBPs and presents evidence on practice characteristics, compensation methods, and incomes of anesthesiologists, pathologists, and radiologists. Some comparisons with office-based MDs are included. The primary data source is composed of physician surveys sponsored by the Health Care Financing Administration and conducted by the National Opinion Research Center in 1977 and 1978. Findings generated from these surveys support past research showing that radiology is the most lucrative HBP specialty, followed by pathology and anesthesiology; hospital-based practice tends to be considerably more lucrative than office-based practice, taken as a whole. Survey findings are discussed in light of current policy developments in the health services sector. PMID:10309258

  3. Target marketing for the hospital-based wellness center.

    PubMed

    Cangelosi, J D

    1997-01-01

    The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market. PMID:10163917

  4. In the beginning, there was general paediatrics ….

    PubMed

    Gunasekera, Hasantha; Kilham, Henry

    2015-01-01

    In this article, we address how general paediatrics has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general paediatrics with that of general adult medicine. We argue that general paediatrics must continue to have a strong role both in paediatric teaching hospitals and the community.

  5. Adverse Drug Reactions Causing Admission to a Paediatric Hospital

    PubMed Central

    Gallagher, Ruairi M.; Mason, Jennifer R.; Bird, Kim A.; Kirkham, Jamie J.; Peak, Matthew; Williamson, Paula R.; Nunn, Anthony J.; Turner, Mark A.; Pirmohamed, Munir; Smyth, Rosalind L.

    2012-01-01

    Objective(s) To obtain reliable information about the incidence of adverse drug reactions, and identify potential areas where intervention may reduce the burden of ill-health. Design Prospective observational study. Setting A large tertiary children’s hospital providing general and specialty care in the UK. Participants All acute paediatric admissions over a one year period. Main Exposure Any medication taken in the two weeks prior to admission. Outcome Measures Occurrence of adverse drug reaction. Results 240/8345 admissions in 178/6821 patients admitted acutely to a paediatric hospital were thought to be related to an adverse drug reaction, giving an estimated incidence of 2.9% (95% CI 2.5, 3.3), with the reaction directly causing, or contributing to the cause, of admission in 97.1% of cases. No deaths were attributable to an adverse drug reaction. 22.1% (95% CI 17%, 28%) of the reactions were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44/249 (17.7%) of adverse drug reactions, the remainder originating from hospital. 120/249 (48.2%) reactions resulted from treatment for malignancies. The drugs most commonly implicated in causing admissions were cytotoxic agents, corticosteroids, non-steroidal anti-inflammatory drugs, vaccines and immunosuppressants. The most common reactions were neutropenia, immunosuppression and thrombocytopenia. Conclusions Adverse drug reactions in children are an important public health problem. Most of those serious enough to require hospital admission are due to hospital-based prescribing, of which just over a fifth may be avoidable. Strategies to reduce the burden of ill-health from adverse drug reactions causing admission are needed. PMID:23226510

  6. Paediatric nephrology on the threshold of European integration.

    PubMed

    Chantler, C

    1991-07-01

    The European Society for Paediatric Nephrology (ESPN) was founded 25 years ago. The progress of paediatric nephrology in Europe since then has been considerable, but we now face a number of problems. The care of the child with kidney disease is often expensive and more needs to be done to examine the cost effectiveness of the management of the child with kidney disease. International co-operation can also foster clinical research to determine the effectiveness of treatment through the institution of controlled trials and outcome studies. Particular problems are posed by the need to integrate the countries of Eastern Europe that have changed from command to market economies over the last year. In many instances there is no shortage of doctors, nurses and hospital beds but there is a need to change administrative and academic structures and to introduce appropriate technology. It is suggested that this may be assisted by twinning units. The integration of Europe requires that the role of the paediatric nephrologist in different countries needs to be examined, and appropriate training to fulfil these responsibilities needs to be agreed. Different countries obviously have different ways of organising and providing services for children with kidney disease. Kidney failure is rare in childhood and there are economic and academic advantages from close collaboration, both with adult nephrology services and with other paediatric specialities. Where it is intended to integrate children's hospitals into large multidisciplinary university hospitals for economic reasons, it is nonetheless necessary to make sure that the requirements of children are properly recognised and the requirements of the European Charter for children in hospital are met.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Varicella paediatric hospitalisations in Belgium: a 1-year national survey

    PubMed Central

    Blumental, Sophie; Sabbe, Martine; Lepage, Philippe

    2016-01-01

    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 paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact 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. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric 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

  8. Design of paediatric hospitals.

    PubMed

    Lambert, Veronica

    2016-05-01

    The impact 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 impact 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.

  9. Are paediatric burns more common in asylum seekers? An analysis of paediatric burn admissions.

    PubMed

    Dempsey, M P; Orr, D J A

    2006-03-01

    The number of asylum seekers in Ireland has increased dramatically over the last 10 years. Based on our impression that the number of children admitted to our burn unit was disproportionately represented by children of asylum seekers we performed an audit to establish (1) what proportion of admissions are from this subgroup and (2) the characteristics of their burns. All paediatric burn admissions from May 2003 to April 2004 were reviewed. Data collected from a retrospective chart review included patient demographics and details of the burn injuries. The National Census of 2002 and the Office of the Refugee Applications Commissioner were consulted for population statistics. Total burn admissions for the period were 126: Irish nationals (n=107), non-national residents (n=2), asylum seekers (n=14) and patients of unknown asylum status (n=3, excluded from study). In the asylum seeker group, the median age was 18.6 months (range 10 months-5.3 years) with the majority less than 2 years (n=11). All burns occurred in the domestic setting. Scalds accounted for 13 cases, one contact burn occurred from a hot grill. The median total body surface area burned was 5.7% (range 1.5-26%). The National Census of 2002 recorded a population of 3,917,203. With less than 12,000 asylum seekers in the country, they comprise only approximately 0.3% of the population yet they account for 11.4% of the burn patients admitted to our unit, p<0.0001. Children of asylum seekers are over-represented in our series of paediatric admissions for burns and are more likely than Irish children to sustain a burn at a younger age and in the domestic setting. This may indicate an increased risk of injury and warrants further investigation. PMID:16448770

  10. Full breastfeeding and paediatric cancer

    PubMed Central

    Ortega-García, Juan A.; Ferrís-Tortajada, Josep; Torres-Cantero, Alberto M.; Soldin, Offie P.; Torres, Encarna Pastor; Fuster-Soler, Jose L.; Lopez-Ibor, Blanca; Madero-López, Luis

    2013-01-01

    Aim It has been suggested that there is an inverse association between breastfeeding and the risk of childhood cancer. We investigated the association between full breastfeeding and paediatric cancer (PC) in a case control study in Spain. Methods Maternal reports of full breastfeeding, collected through personal interviews using the Paediatric Environmental History, were compared among 187 children 6 months of age or older who had PC and 187 age-matched control siblings. Results The mean duration of full breastfeeding for cases were 8.43 and 11.25 weeks for controls. Cases had been significantly more often bottle-fed than controls (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1–2.8). Cases were significantly less breastfed for at least 2 months (OR 0.5; 95% CI 0.3–0.8), for at least 4 months (OR 0.5; 95% CI 0.3–0.8), and for 24 weeks or more (OR 0.5; 95% CI 0.2–0.9). Conclusions Breastfeeding was inversely associated with PC, the protection increasing with the duration of full breastfeeding. Additional research on possible mechanisms of this association may be warranted. Meanwhile, breastfeeding should be encouraged among mothers. PMID:17999666

  11. 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

  12. Paediatric clinical pharmacology in the UK

    PubMed Central

    Choonara, Imti; Sammons, Helen

    2014-01-01

    Paediatric clinical pharmacology is the scientific study of medicines in children and is a relatively new subspecialty in paediatrics in the UK. Training encompasses both the study of the effectiveness of drugs in children (clinical trials) and aspects of drug toxicity (pharmacovigilance). Ethical issues in relation to clinical trials and also studies of the pharmacokinetics and drug metabolism in children are crucial. Paediatric patients require formulations that young children in particular are able to take. The scientific evidence generated from clinical trials, pharmacokinetic studies and studies of drug toxicity all need to be applied in order to ensure that medicines are used rationally in children. PMID:25202131

  13. [The electrocardiogram in the paediatric age group].

    PubMed

    Sanches, M; Coelho, A; Oliveira, E; Lopes, A

    2014-09-01

    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 paediatric 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 paediatric ECG, to propose a possible reading scheme of the ECG and to review the electrocardiograph tracings most frequently found in the paediatric age group.

  14. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  15. [Hospital-based health technology assessment in France: how to proceed to evaluate innovative medical devices?].

    PubMed

    Martelli, N; van den Brink, H; Denies, F; Dervaux, B; Germe, A F; Prognon, P; Pineau, J

    2014-01-01

    Innovative medical devices offer solutions to medical problems and greatly improve patients' outcomes. Like National Health Technology Assessment (HTA) agencies, hospitals face numerous requests for innovative and costly medical devices. To help local decision-makers, different approaches of hospital-based HTA (HB-HTA) have been adopted worldwide. The objective of the present paper is to explore HB-HTA models for adopting innovative medical devices in France and elsewhere. Four different models have been conceptualized: "ambassador" model, "mini-HTA" model, "HTA unit" model and "internal committee". Apparently, "HTA unit" and "internal committee" (or a mixture of both models) are the prevailing HB-HTA models in France. Nevertheless, some weaknesses of these models have been pointed out in previous works. Only few examples involving hospital pharmacists have been found abroad, except in France and in Italy. Finally, the harmonization of the assessment of innovative medical devices in France needs a better understanding of HB-HTA practices.

  16. Hospital Based Customization of a Medical Information System

    PubMed Central

    Rath, Marilyn A.; Ferguson, Julie C.

    1983-01-01

    A Medical Information System must be current if it is to be a viable adjunct to patient care within a hospital setting. Hospital-based customization provides a means of achieving this timeliness with maximum user satisfaction. It, however, requires a major commitment in personnel time as well as additional software and training expenses. The enhanced control of system modifications and overall flexibility in planning the change process result in enthusiastic support of this approach by many hospitals. The key factors for success include careful selection of local personnel with adequate vendor support, extensive QA control, thorough auditing/validation and direct user involvement.

  17. United States laws under review.

    PubMed

    Leahey, M

    2007-01-01

    As well as reauthorisation of the Medical Device User Fee and Modernization Act, others isues are under consideration by the United States Congress. These include the introduction of incentives for the development of medical devices for paediatric care.

  18. Case report: paediatric intramuscular haemangiomata--don't overlook the phlebolith!

    PubMed

    Morris, S J; Adams, H

    1995-02-01

    Three children presented with soft tissue masses which were clinically suspected to be soft tissue sarcomas. The identification of phleboliths on initial radiological studies should have suggested the correct diagnosis of benign intramuscular haemangiomata. Subsequent referral to a paediatric oncological unit, and the unnecessary parental anxiety so generated, could have been avoided. PMID:7735755

  19. 42 CFR 413.174 - Prospective rates for hospital-based and independent ESRD facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Prospective rates for hospital-based and....174 Prospective rates for hospital-based and independent ESRD facilities. Link to an amendment... January 1, 2009, the methodology differentiates between hospital-based and independent ESRD facilities;...

  20. 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

  1. Paediatric biobanks: what makes them so unique?

    PubMed

    Samuël, Julie; Knoppers, Bartha M; Avard, Denise

    2012-02-01

    Paediatric biobanks store and organise the biological material of children. They are an invaluable resource for the study of the development, health and behaviour of children. International norms for the management of adult biobanks exist, but paediatric biobanks require distinct policies to account for the needs of children, their general incapacity, and their intellectual development throughout the life of the biobank. Because of their particular nature we revisit the issues of consent, the return of research results, and privacy, and discuss how each could be modulated in the paediatric context. We recognize that such modifications entail further financial and logistical complications but maintain that it is essential that paediatric biobanks consider these issues and adapt their biobanks management policies accordingly, rather than extrapolate the current adult-based norms and jeopardise the rights of child participants.

  2. Popliteal vasculature injuries in paediatric trauma patients.

    PubMed

    Jones, S A; Roberts, D C; Clarke, N M P

    2012-10-01

    Popliteal-artery injuries in the paediatric-trauma patient are uncommon, difficult to diagnose and with prolonged ischaemia lead to substantial complications. We report three cases of popliteal-vasculature injury in paediatric-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 paediatric popliteal-artery injury, both physically and psychologically. It is imperative that clinicians have a high index of suspicion when confronted with paediatric 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.

  3. Paediatric Palliative Care: Theory to Practice

    PubMed Central

    Muckaden, Maryann; Dighe, Manjiri; Balaji, PD; Dhiliwal, Sunil; Tilve, Prajakta; Jadhav, Sunita; Goswami, Savita

    2011-01-01

    Paediatric palliative care is a holistic approach aimed at addressing the complex issues related to the care of children and families facing chronic life limiting illnesses. The needs of children are unique and often quite different from those of adults receiving palliative care. This review article outlines some of the salient features of paediatric palliative care which are relevant to all professionals caring for children with life limiting illnesses in their practice. PMID:21811373

  4. Therapeutic clowning in paediatric practice.

    PubMed

    Finlay, Fiona; Baverstock, Anna; Lenton, Simon

    2014-10-01

    Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through 'doses of fun' to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams.

  5. Therapeutic clowning in paediatric practice.

    PubMed

    Finlay, Fiona; Baverstock, Anna; Lenton, Simon

    2014-10-01

    Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through 'doses of fun' to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams. PMID:23855014

  6. Developing and understanding a hospital-based proton facility: bringing physics into medicine.

    PubMed

    Slater, James M

    2007-08-01

    From October 18 to 20, 2006, a symposium, Developing and Understanding a Hospital-based Proton Facility: Bringing Physics Into Medicine, was held at the Renaissance Esmeralda Resort and Spa, Indian Wells, California. The event was offered by the Department of Radiation Medicine at Loma Linda University (LLU), supported by the Telemedicine and Advanced Technology Research Center (TATRC) and the United States Army Medical Research and Materiel Command (USAMRMC). The meeting was intended to discuss factors involved in planning, developing, and operating a hospital-based proton treatment center. It brought together some of the most distinguished physicists, radiation biologists, and radiation oncologists in the world, and more than 100 individuals participated in the three-day educational offering. This overview reports on the event and introduces several papers written by many of the speakers from their presentations, for publication in this issue of Technology in Cancer Research and Treatment. Both the symposium and the papers are appropriate for this journal: exploitation of technology was one of the underlying themes of the symposium.

  7. Parental knowledge of paediatric vaccination

    PubMed Central

    Borràs, Eva; Domínguez, Àngela; Fuentes, Miriam; Batalla, Joan; Cardeñosa, Neus; Plasencia, Antoni

    2009-01-01

    Background Although routine vaccination is a major tool in the primary prevention of some infectious diseases, there is some reluctance in a proportion of the population. Negative parental perceptions of vaccination are an important barrier to paediatric vaccination. The aim of this study was to investigate parental knowledge of paediatric vaccines and vaccination in Catalonia. Methods A retrospective, cross-sectional study was carried out in children aged < 3 years recruited by random sampling from municipal districts of all health regions of Catalonia. The total sample was 630 children. Parents completed a standard questionnaire for each child, which included vaccination coverage and knowledge about vaccination. The level of knowledge of vaccination was scored according to parental answers. Results An association was observed between greater vaccination coverage of the 4:4:4:3:1 schedule (defined as: 4 DTPa/w doses, 4 Hib doses, 4 OPV doses, 3 MenC doses and 1 MMR dose) and maternal age >30 years (OR: 2.30; 95% CI: 1.20–4.43) and with a knowledge of vaccination score greater than the mean (OR: 0.45; 95% CI: 0.28–0.72). The score increased with maternal educational level and in parents of vaccinated children. A total of 20.47% of parents stated that vaccines could have undesirable consequences for their children. Of these, 23.26% had no specific information and 17.83% stated that vaccines can cause adverse reactions and the same percentage stated that vaccines cause allergies and asthma. Conclusion Higher vaccination coverage is associated with older maternal age and greater knowledge of vaccination. Vaccination coverage could be raised by improving information on vaccines and vaccination. PMID:19473498

  8. Paediatrics: the etymology of a name.

    PubMed

    Pearn, John

    2011-08-01

    Within the history of paediatrics is the history of the name used to describe it. The etymology of the word 'paediatrics' dates from its first written use, recorded as 'pädiatrik' in the German literature and as 'paediatric', 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 'paediatrics' 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 paediatrics, in Castleton Cemetery, Scottish Borders, Roxburghshire. 'Paediatrics' 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.

  9. Paediatrics

    PubMed Central

    Shumer, Daniel E.

    2015-01-01

    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

  10. The incidence, spectrum and outcome of paediatric trauma managed by the Pietermaritzburg Metropolitan Trauma Service

    PubMed Central

    Manchev, V; Bruce, JL; Oosthuizen, GV; Laing, GL

    2015-01-01

    Introduction The Pietermaritzburg Metropolitan Trauma Service (PMTS) has run a systematic quality improvement programme since 2006. A key component included the development and implementation of an effective surveillance system in the form of an electronic surgical registry (ESR). This study used data from the ESR to review the incidence, spectrum and outcome of paediatric trauma in Pietermaritzburg, South Africa. Methods The ESR was reviewed, and all cases of paediatric trauma managed between 1 January 2012 and 30 July 2014 were retrieved for analysis. Results During the study period, 1,041 paediatric trauma patients (724 male, 69.5%) were managed by the PMTS, averaging a monthly admission of 36. The mean age was 10.9 years (standard deviation: 5.4 years). The mechanism of injury (MOI) was blunt trauma in 753 patients (72.3%) and penetrating trauma in 170 (16.3%). Pedestrian vehicle collisions accounted for 21% of cases and motor vehicle collisions for a further 11%. Intentional trauma accounted for 282 patients (27.1%) and self-inflicted trauma for 14 cases (1.3%). Ninety patients admitted to the intensive care unit and fifty-one required high dependency unit admission. There were 17 deaths, equating to an in-hospital mortality rate of 1.7%. A total of 172 children died on the scene of an incident. There were 35 road traffic related deaths, 26 suicides by hanging, 27 deaths from blunt assault and 23 deaths from penetrating assault. The overall mortality rate for paediatric trauma was 18.2%. Conclusions The ESR has proved to be an effective surveillance system and has enabled the accurate quantification of the burden of paediatric trauma in Pietermaritzburg. This has improved our understanding of the mechanisms and patterns of injury, and has identified a high incidence of intentional and penetrating trauma as well as road traffic collisions. These data can be used to guide strategies to reduce the burden of paediatric trauma in our environment. PMID:26263934

  11. The World Congress of Paediatric Cardiology and Cardiac Surgery: "The Olympics of our profession".

    PubMed

    Hugo-Hamman, Christopher; Jacobs, Jeffery Phillip

    2012-12-01

    The first World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr. Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children should really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses, and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada (2001, organised by Bill Williams and Lee Benson), Buenos Aires, Argentina (2005, organised by Horatio Capelli and Guillermo Kreutzer), and most recently Cairns, Australia (2009, organised by Jim Wilkinson). Having visited Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), and Australia (2009), and reflecting the "African Renaissance", the

  12. Aetiologies of Central Nervous System Infection in Viet Nam: A Prospective Provincial Hospital-Based Descriptive Surveillance Study

    PubMed Central

    Ho Dang Trung, Nghia; Le Thi Phuong, Tu; Wolbers, Marcel; Nguyen Van Minh, Hoang; Nguyen Thanh, Vinh; Van, Minh Pham; Thieu, Nga Tran Vu; Le Van, Tan; Song, Diep To; Le Thi, Phuong; Thi Phuong, Thao Nguyen; Van, Cong Bui; Tang, Vu; Ngoc Anh, Tuan Hoang; Nguyen, Dong; Trung, Tien Phan; Thi Nam, Lien Nguyen; Kiem, Hao Tran; Thi Thanh, Tam Nguyen; Campbell, James; Caws, Maxine; Day, Jeremy; de Jong, Menno D.; Van Vinh, Chau Nguyen; Van Doorn, H. Rogier; Tinh, Hien Tran; Farrar, Jeremy; Schultsz, Constance

    2012-01-01

    Background Infectious diseases of the central nervous system (CNS) remain common and life-threatening, especially in developing countries. Knowledge of the aetiological agents responsible for these infections is essential to guide empiric therapy and develop a rational public health policy. To date most data has come from patients admitted to tertiary referral hospitals in Asia and there is limited aetiological data at the provincial hospital level where most patients are seen. Methods We conducted a prospective Provincial Hospital-based descriptive surveillance study in adults and children at thirteen hospitals in central and southern Viet Nam between August 2007– April 2010. The pathogens of CNS infection were confirmed in CSF and blood samples by using classical microbiology, molecular diagnostics and serology. Results We recruited 1241 patients with clinically suspected infection of the CNS. An aetiological agent was identified in 640/1241 (52%) of the patients. The most common pathogens were Streptococcus suis serotype 2 in patients older than 14 years of age (147/617, 24%) and Japanese encephalitis virus in patients less than 14 years old (142/624, 23%). Mycobacterium tuberculosis was confirmed in 34/617 (6%) adult patients and 11/624 (2%) paediatric patients. The acute case fatality rate (CFR) during hospital admission was 73/617 (12%) in adults and to 42/624 (7%) in children. Conclusions Zoonotic bacterial and viral pathogens are the most common causes of CNS infection in adults and children in Viet Nam. PMID:22662232

  13. A new tool for the paediatric HIV research: general data from the Cohort of the Spanish Paediatric HIV Network (CoRISpe)

    PubMed Central

    2013-01-01

    There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children. PMID:23282073

  14. Transcending Competency Testing in Hospital-Based Simulation.

    PubMed

    Lassche, Madeline; Wilson, Barbara

    2016-02-01

    Simulation is a frequently used method for training students in health care professions and has recently gained acceptance in acute care hospital settings for use in educational programs and competency testing. Although hospital-based simulation is currently limited primarily to use in skills acquisition, expansion of the use of simulation via a modified Quality Health Outcomes Model to address systems factors such as the physical environment and human factors such as fatigue, reliance on memory, and reliance on vigilance could drive system-wide changes. Simulation is an expensive resource and should not be limited to use for education and competency testing. Well-developed, peer-reviewed simulations can be used for environmental factors, human factors, and interprofessional education to improve patients' outcomes and drive system-wide change for quality improvement initiatives. PMID:26909459

  15. Exploring the phenomenon of spiritual care between hospital chaplains and hospital based healthcare providers.

    PubMed

    Taylor, Janie J; Hodgson, Jennifer L; Kolobova, Irina; Lamson, Angela L; Sira, Natalia; Musick, David

    2015-01-01

    Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.

  16. Exploring the phenomenon of spiritual care between hospital chaplains and hospital based healthcare providers.

    PubMed

    Taylor, Janie J; Hodgson, Jennifer L; Kolobova, Irina; Lamson, Angela L; Sira, Natalia; Musick, David

    2015-01-01

    Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities. PMID:26207904

  17. Phase Synchronization in Electroencephalographic Recordings Prognosticates Outcome in Paediatric Coma

    PubMed Central

    Nenadovic, Vera; Perez Velazquez, Jose Luis; Hutchison, James Saunders

    2014-01-01

    Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG) phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000–2010) analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8) admitted to the paediatric critical care unit (PCCU) following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC) based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index), a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome. PMID:24752289

  18. Recommendations from the Association for European Paediatric Cardiology for training in paediatric cardiac intensive care.

    PubMed

    da Cruz, Eduardo; Lechner, Evelyn; Stiller, Brigitte; Munoz, Ricardo; Beghetti, Maurice; Fakler, Ulrich; Haas, Nikolaus

    2011-08-01

    The following document provides a summary of the guidelines and recommendations for paediatric cardiac intensive care training as a requirement for recognition as a European paediatric cardiologist. It is therefore primarily targeting paediatric cardiology trainees in Europe, including those doctors who might wish to become experts in cardiac intensive care. These recommendations represent a frame for consistency, will evolve, and may be adapted to specific institutional requirements. They will be complemented by a learning module to be provided by our Association in the near future.

  19. Disease Activity Measures in Paediatric Rheumatic Diseases

    PubMed Central

    Luca, Nadia J.; Feldman, Brian M.

    2013-01-01

    Disease activity refers to potentially reversible aspects of a disease. Measurement of disease activity in paediatric 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 paediatric 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 paediatric rheumatology. PMID:24089617

  20. Providing paediatric palliative care: collaboration in practice.

    PubMed

    Farrell, M; Sutherland, P

    One of the main aims of palliative care is to enable clients to receive and access services in a way that maximizes their choice in relation to where, when and how they receive care. To achieve this end, it is essential that statutory and voluntary care agencies collaborate to provide an effective range of services. This article offers for consideration the experience of a children's hospice service and a paediatric oncology outreach service who collaborated to provide a service for children requiring paediatric and terminal care. It identifies a number of elements which are important for positive and effective collaboration.

  1. Global health: A lasting partnership in paediatric surgery

    PubMed Central

    Lakhoo, Kokila; Msuya, David

    2015-01-01

    Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment. PMID:26168748

  2. The Extent of Consumer Product Involvement in Paediatric Injuries

    PubMed Central

    Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

    2016-01-01

    A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases. PMID:27399744

  3. The Extent of Consumer Product Involvement in Paediatric Injuries.

    PubMed

    Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

    2016-07-07

    A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

  4. Non-operative advances: what has happened in the last 50 years in paediatric surgery?

    PubMed

    Holland, Andrew J A; McBride, Craig A

    2015-01-01

    Paediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long-term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non-operative management of solid organ injury following blunt abdominal trauma. Nano-crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case-only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure. PMID:25588791

  5. [The medicine use pathway in paediatrics].

    PubMed

    Didelot, Nicolas

    2016-01-01

    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 paediatrics must tolerate no error and must be able to detect all warning signs, however minor, in order to optimise this approach.

  6. 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

  7. Recent advances in paediatric respiratory medicine.

    PubMed

    Turnbull, Andrew; Balfour-Lynn, Ian M

    2016-02-01

    This review highlights important advances in paediatric 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

  8. [Czech paediatric cardiac surgery - history and presence].

    PubMed

    Hučín, Bohumil

    2012-01-01

    The beginnings of the Paediatric Cardiac Surgery in the Czech Republic date back to the period immediately after the end of World War II. Its protagonists were Prof. Emerich Polák from the Surgical Clinic in Prague, Vinohrady, Prof. Jan Bedrna from Surgical Clinic in Hradec Kralove, Prof. Vladislav Rapant from Surgical Clinic in Olomouc and Prof. Václav Kafka from the Second Surgical Clinic in Prague. They started with operations of the patent ductus arteriosus, the Blalock-Taussig shunt in cyanotic heart defects and resection of coarctation of the aorta. Operations of congenital heart defects, on the open heart were elaborated namely by cardiosurgeons in Brno, under the leadership of Professor Jan Navrátil. On the extension of those methods participated Professor Jaroslav Procházka in Hradec Kralove and Prof. Václav Kafka at the newly opened department of Paediatric surgery in Prague. In the next period, attention of paediatric cardiac surgery was directed at operations of critical congenital heart defects in the smallest children. Palliative operations of the critical heart defects in newborns and infants were first introduced at the clinic of paediatric surgery of the Paediatric University Hospital in Prague. Radical operations of infants and newborns with extra-corporal circulation were elaborated in the Children's heart centre in Prague, Motol. Initiative in the further development of paediatric cardiac surgery was taken over by the Children's heart centre in Prague since its founding in 1977. There was concentrated all medical care of children born with a congenital heart defect in the Czech Republic. This concentration of specialized care at one institution allowed to accumulate extremely large experience with the diagnostics and surgical treatment of congenital heart defects in all age groups with the decrease of patients mortality after operations to 1% even for the smallest children and enabled continuously monitor the quality of life of patients

  9. Quality and clinical supply considerations of Paediatric Investigation Plans for IV preparations-A case study with the FP7 CloSed project.

    PubMed

    Hanning, Sara M; Orlu Gul, Mine; Winslade, Jackie; Baarslag, Manuel A; Neubert, Antje; Tuleu, Catherine

    2016-09-25

    A Paediatric Investigation Plan (PIP) is a development plan that aims to ensure that sufficient data are obtained through studies in paediatrics to support the generation of marketing authorisation of medicines for children. This paper highlights some practical considerations and challenges with respect to PIP submissions and paediatric clinical trials during the pharmaceutical development phase, using the FP7-funded Clonidine for Sedation of Paediatric Patients in the Intensive Care Unit (CloSed) project as a case study. Examples discussed include challenges and considerations regarding formulation development, blinding and randomisation, product labelling and shipment and clinical trial requirements versus requirements for marketing authorisation. A significant quantity of information is required for PIP submissions and it is hoped that future applicants may benefit from an insight into some critical considerations and challenges faced in the CloSed project. PMID:27113865

  10. Quality and clinical supply considerations of Paediatric Investigation Plans for IV preparations-A case study with the FP7 CloSed project.

    PubMed

    Hanning, Sara M; Orlu Gul, Mine; Winslade, Jackie; Baarslag, Manuel A; Neubert, Antje; Tuleu, Catherine

    2016-09-25

    A Paediatric Investigation Plan (PIP) is a development plan that aims to ensure that sufficient data are obtained through studies in paediatrics to support the generation of marketing authorisation of medicines for children. This paper highlights some practical considerations and challenges with respect to PIP submissions and paediatric clinical trials during the pharmaceutical development phase, using the FP7-funded Clonidine for Sedation of Paediatric Patients in the Intensive Care Unit (CloSed) project as a case study. Examples discussed include challenges and considerations regarding formulation development, blinding and randomisation, product labelling and shipment and clinical trial requirements versus requirements for marketing authorisation. A significant quantity of information is required for PIP submissions and it is hoped that future applicants may benefit from an insight into some critical considerations and challenges faced in the CloSed project.

  11. Meteorological factors and El Nino Southern Oscillation are associated with paediatric varicella infections in Hong Kong, 2004-2010.

    PubMed

    Chan, J Y C; Lin, H L; Tian, L W

    2014-07-01

    Varicella accounts for substantial morbidities and remains a public health issue worldwide, especially in children. Little is known about the effect of meteorological variables on varicella infection risk for children. This study described the epidemiology of paediatric varicella notifications in Hong Kong from 2004 to 2010, and explored the association between paediatric varicella notifications in children aged <18 years and various meteorological factors using a time-stratified case-crossover model, with adjustment of potential confounding factors. The analysis found that daily mean temperature, atmospheric pressure and Southern Oscillation Index (SOI) were positively associated with paediatric varicella notifications. We found that an interquartile range (IQR) increase in temperature (8·38°C) at lag 1 day, a 9·50 hPa increase in atmospheric pressure for the current day, and a 21·91 unit increase in SOI for the current day may lead to an increase in daily cases of 5·19% [95% confidence interval (CI) 1·90-8·58], 5·77% (95% CI 3·01-8·61), and 4·32% (95% CI 2·98-5·68), respectively. An IQR increase in daily relative humidity (by 11·96%) was associated with a decrease in daily paediatric varicella (-2·79%, 95% CI -3·84 to -1·73). These findings suggest that meteorological factors might be important predictors of paediatric varicella infection in Hong Kong.

  12. Retinal Detachment in Southwest Ethiopia: A Hospital Based Prospective Study

    PubMed Central

    Asaminew, Tsedeke; Gelaw, Yeshigeta; Bekele, Sisay; Solomon, Berhan

    2013-01-01

    Purpose The incidence of retinal detachment in Blacks is generally considered to be low though there are few supporting studies in Africa. This study, thus, aimed at describing the clinical profile of patients with retinal detachment in Southwest Ethiopia. Methods A hospital-based study was done on all consecutive retinal detachment patients who presented to Jimma University Hospital over six months period. A semi-structured questionnaire was used to collect patients’ sociodemographic characteristics and clinical history. Comprehensive anterior and posterior segment eye examinations were done and risk factors were sought for. Statistical tests were considered significant if P < 0.05. Results A total of 94 eyes of 80 patients (1.5%) had retinal detachment (RD) and about 69% of patients were symptomatic for over a month before presentation. The mean age was 41.4 years (SD ±16.5). Fourteen patients (17.5%) had bilateral RD. At presentation, 61 eyes (64.9%) were blind from RD and 11 (13.8%) patients were bilaterally blind from RD. Rhegmatogenous RD was seen in 55 eyes (58.5%) and tractional RD in 22 eyes (23.4%). The most common risk factors were ocular trauma (32 eyes, 34.0%), myopia (23 eyes, 24.5%), posterior uveitis (13 eyes, 13.8%) and diabetic retinopathy (9 eyes, 9.6%). Most retinal breaks (25 eyes, 43.1%) were superotemporal and horse-shoe tear was the most common (19 eyes, 20.2%). Macula was off in 77 eyes (81.9%) and 38 eyes (69.1% of RRD eyes) had grade C proliferative vitreoretinopathy (PVR). Macular status was significantly associated with PVR (P=0.011), and duration of symptoms (RR=1.25, 95%CI: 1.059-1.475, P=0.040). Conclusions A significant numbers of patients with ocular problem had retinal detachment, and nearly two third of the patients presented late. Trauma and myopia were the most important risk factors. People should be educated to improve their health seeking behavior and use eye safety precautions to prevent ocular trauma. PMID:24086614

  13. Current views and advances on Paediatric Virology: An update for paediatric trainees

    PubMed Central

    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.

    2016-01-01

    Paediatric Virology is a bold new scientific field, which combines Paediatrics with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on Paediatric 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 paediatric 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 Paediatric 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

  14. Creating and being created: the changing panorama of paediatric rehabilitation.

    PubMed

    Helders, Paul J M; Engelbert, Raoul H H; Custers, Jan W H; Gorter, Jan Willem; Takken, Tim; van der Net, Janjaap

    2003-01-01

    Paediatric rehabilitation as a discipline is rapidly changing, especially during the last decades. In the past, paediatric rehabilitation was characterized by merely adult intervention strategies in a miniaturized form, delivered by a merely adult patients-oriented profession. Theories on childhood development, however, changed, as did the focus of interventions: from impairments to function, from the child itself to family, community and peers. The call for outcome-oriented and evidence-based medicine lastly, changed paediatric rehabilitation into a mature paediatric profession with it's own scientific framework. This is reflected among other things in the increasing number of paediatric measures and instruments specifically geared to the paediatric rehabilitation profession, for example the Gross Motor Function Measure, Paediatric Evaluation of Disability Inventory and Movement ABC. More recently, paediatric exercise physiologists are pointing to the benefits of an active lifestyle and training for patients with chronic diseases and disabilities. Several studies have evaluated the effects of such training programmes and came up with positive results. It shows that paediatric rehabilitation continues to develop as a dynamic profession, having growth, childhood development and childhood activities as it's core business.

  15. 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

  16. Paediatric intrasubstance posterior cruciate ligament rupture.

    PubMed

    Scott, Chloe E H; Murray, Alastair W

    2011-01-01

    The authors present the case of a 4-year-old boy who sustained an intrasubstance posterior cruciate ligament (PCL) tear whist trampolining. He was managed non-operatively with return to full function by 8 months. A high index of suspicion is required when assessing paediatric hyperflexion/extension injuries at the knee as ligamentous injury may occur without osteochondral fracture and may be missed on routine radiographs. Early MRI can identify such injuries in addition to osteochondral avulsions which are often amenable to acute internal fixation. In the case of paediatric intrasubstance PCL tears, it appears that non-operative management yields a good functional outcome in the short term in the skeletally immature.

  17. Alternative diagnoses at paediatric appendicitis MRI.

    PubMed

    Moore, M M; Kulaylat, A N; Brian, J M; Khaku, A; Hulse, M A; Engbrecht, B W; Methratta, S T; Boal, D K B

    2015-08-01

    As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis-colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed. PMID:26072983

  18. Perioperative neonatal and paediatric blood transfusion

    PubMed Central

    Bharadwaj, Avnish; Khandelwal, Mamta; Bhargava, Suresh Kumar

    2014-01-01

    Paediatric patients undergoing surgical procedures commonly require some volume of blood or blood component replacement in the perioperative period. Paediatric patients undergoing major surgery associated with substantial blood loss should be evaluated pre-operatively. Pre-operative correction of anaemia may be done considering the age, plasma volume status, clinical status and comorbidities. Maximum allowable blood loss (MABL) for surgery must be calculated, and appropriate quantity of blood and blood components should be arranged. Intraoperative monitoring of blood loss should be done, and volume of transfusion should be calculated in a protocol based manner considering the volemia and the trigger threshold for transfusion for the patient and the MABL. Early haemostasis should be achieved by judicious administration of red blood cells, blood components and pharmacological agents. PMID:25535431

  19. Dose reduction in paediatric MDCT: general principles.

    PubMed

    Paterson, A; Frush, D P

    2007-06-01

    The number of multi-detector array computed tomography (MDCT) examinations performed per annum continues to increase in both the adult and paediatric populations. Estimates from 2003 suggested that CT contributed 17% of a radiology department's workload, yet was responsible for up to 75% of the collective population dose from medical radiation. The effective doses for some CT examinations today overlap with those argued to have an increased risk of cancer. This is especially pertinent for paediatric CT, as children are more radiosensitive than adults (and girls more radiosensitive than boys). In addition, children have a longer life ahead of them, in which radiation induced cancers may become manifest. Radiologists must be aware of these facts and practise the ALARA (as low as is reasonably achievable) principle, when it comes to deciding CT protocols and parameters. PMID:17467387

  20. Improving quality in paediatric respiratory disease management.

    PubMed

    Harrop, Michele; Amegavie, Laweh

    2003-11-01

    Throughout the development, implementation and dissemination of the Paediatric Respiratory Newsletter, effective channels of communication between healthcare professionals have been established, highlighting the importance of collaboration. Promoting education, training, audit and research, the newsletter has nurtured both professional and practice development. The work begun during this project, and the outcomes it has achieved, have been developed into an ethos that recognises effective clinical practice and organisational development as central to the delivery of a quality service. This work informs and is informed by strategic developments, in particular, research and development, clinical audit, quality, practice development and clinical risk, all of which are observed to be the key elements of clinical governance. On a personal level, the project has provided me with an opportunity to consolidate information, forge links with the multidisciplinary team and establish a framework for the development of paediatric respiratory services. We hope it will continue to respond to, and be influenced by, changing health and social care demands.

  1. Alternative diagnoses at paediatric appendicitis MRI.

    PubMed

    Moore, M M; Kulaylat, A N; Brian, J M; Khaku, A; Hulse, M A; Engbrecht, B W; Methratta, S T; Boal, D K B

    2015-08-01

    As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis-colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed.

  2. Regrets Associated with Providing Healthcare: Qualitative Study of Experiences of Hospital-Based Physicians and Nurses

    PubMed Central

    Courvoisier, Delphine S.; Agoritsas, Thomas; Perneger, Thomas V.; Schmidt, Ralph E.; Cullati, Stéphane

    2011-01-01

    Background Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. Objective To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. Method Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis Results All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. Conclusions Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover. PMID:21829706

  3. Sleep · 8: Paediatric obstructive sleep apnoea

    PubMed Central

    Nixon, G; Brouillette, R

    2005-01-01

    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 paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research. PMID:15923253

  4. Hospital-Based Acute Care Use in Survivors of Septic Shock

    PubMed Central

    Ortego, Alexandra; Gaieski, David F.; Fuchs, Barry D.; Jones, Tiffanie; Halpern, Scott D.; Small, Dylan S.; Sante, S. Cham; Drumheller, Byron; Christie, Jason D.; Mikkelsen, Mark E.

    2014-01-01

    Objective Septic shock is associated with increased long-term morbidity and mortality. However, little is known about the use of hospital-based acute care in survivors after hospital discharge. The objectives of the study were to examine the frequency, timing, causes, and risk factors associated with Emergency Department (ED) visits and hospital readmissions within 30 days of discharge. Design Retrospective cohort study. Setting Tertiary, academic hospital in the United States. Patients Patients admitted with septic shock (serum lactate ≥ 4 mmol/L or refractory hypotension) and discharged alive to a non-hospice setting between 2007 and 2010. Interventions None. Measurements and Main Results The co-primary outcomes were all-cause hospital readmission and ED visits (treat-and-release encounters) within 30 days to any of the three health system hospitals. Of 269 at-risk survivors, 63 (23.4%, 95% confidence interval (CI): 18.2, 28.5) were readmitted within 30 days of discharge and another 12 (4.5%, 95% CI: 2.3, 7.7) returned to the ED for a treat-and-release visit. Readmissions occurred within 15 days of discharge in 75% of cases and were more likely in oncology patients (p=0.001) and patients with a longer hospital length of stay (p=0.04). Readmissions were frequently due to another life-threatening condition and resulted in death or discharge to hospice in 16% of cases. The reasons for readmission were deemed potentially related to the index septic shock hospitalization in 78% (49/63) of cases. The most common cause was infection-related, accounting for 46% of all 30-day readmissions, followed by cardiovascular or thromboembolic events (18%). Conclusions The use of hospital-based acute care appeared to be common in septic shock survivors. Encounters often led to readmission within 15 days of discharge, were frequently due to another acute condition, and appeared to result in substantial morbidity and mortality. Given the potential public health implications of

  5. Paediatric extracranial germ-cell tumours.

    PubMed

    Shaikh, Furqan; Murray, Matthew J; Amatruda, James F; Coleman, Nicholas; Nicholson, James C; Hale, Juliet P; Pashankar, Farzana; Stoneham, Sara J; Poynter, Jenny N; Olson, Thomas A; Billmire, Deborah F; Stark, Daniel; Rodriguez-Galindo, Carlos; Frazier, A Lindsay

    2016-04-01

    Management of paediatric extracranial germ-cell tumours carries a unique set of challenges. Germ-cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ-cell tumours are managed by a diverse array of specialists. Thus, staging, risk stratification, and treatment approaches for germ-cell tumours have evolved disparately along several trajectories. Paediatric germ-cell tumours differ from the adolescent and adult disease in many ways, leading to complexities in applying age-appropriate, evidence-based care. Suboptimal outcomes remain for several groups of patients, including adolescents, and patients with extragonadal tumours, high tumour markers at diagnosis, or platinum-resistant disease. Survivors have significant long-term toxicities. The challenge moving forward will be to translate new insights from molecular studies and collaborative clinical data into improved patient outcomes. Future trials will be characterised by improved risk-stratification systems, biomarkers for response and toxic effects, rational reduction of therapy for low-risk patients and novel approaches for poor-risk patients, and improved international collaboration across paediatric and adult cooperative research groups. PMID:27300675

  6. Paediatric Virology in the Hippocratic Corpus

    PubMed Central

    Mammas, Ioannis N.; Spandidos, Demetrios A.

    2016-01-01

    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 Paediatric 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 paediatric trainees and future Paediatric Virology subspecialists. PMID:27446241

  7. Genomic landscape of paediatric adrenocortical tumours.

    PubMed

    Pinto, Emilia M; Chen, Xiang; Easton, John; Finkelstein, David; Liu, Zhifa; Pounds, Stanley; Rodriguez-Galindo, Carlos; Lund, Troy C; Mardis, Elaine R; Wilson, Richard K; Boggs, Kristy; Yergeau, Donald; Cheng, Jinjun; Mulder, Heather L; Manne, Jayanthi; Jenkins, Jesse; Mastellaro, Maria J; Figueiredo, Bonald C; Dyer, Michael A; Pappo, Alberto; Zhang, Jinghui; Downing, James R; Ribeiro, Raul C; Zambetti, Gerard P

    2015-01-01

    Paediatric adrenocortical carcinoma is a rare malignancy with poor prognosis. Here we analyse 37 adrenocortical tumours (ACTs) by whole-genome, whole-exome and/or transcriptome sequencing. Most cases (91%) show loss of heterozygosity (LOH) of chromosome 11p, with uniform selection against the maternal chromosome. IGF2 on chromosome 11p is overexpressed in 100% of the tumours. TP53 mutations and chromosome 17 LOH with selection against wild-type TP53 are observed in 28 ACTs (76%). Chromosomes 11p and 17 undergo copy-neutral LOH early during tumorigenesis, suggesting tumour-driver events. Additional genetic alterations include recurrent somatic mutations in ATRX and CTNNB1 and integration of human herpesvirus-6 in chromosome 11p. A dismal outcome is predicted by concomitant TP53 and ATRX mutations and associated genomic abnormalities, including massive structural variations and frequent background mutations. Collectively, these findings demonstrate the nature, timing and potential prognostic significance of key genetic alterations in paediatric ACT and outline a hypothetical model of paediatric adrenocortical tumorigenesis. PMID:25743702

  8. Paediatric radiology seen from Africa. Part I: providing diagnostic imaging to a young population.

    PubMed

    Andronikou, Savvas; McHugh, Kieran; Abdurahman, Nuraan; Khoury, Bryan; Mngomezulu, Victor; Brant, William E; Cowan, Ian; McCulloch, Mignon; Ford, Nathan

    2011-07-01

    Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children.

  9. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    PubMed

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  10. An inexpensive, interdisciplinary, methodology to conduct an impact study of homeless persons on hospital based services.

    PubMed

    Parker, R David; Regier, Michael; Brown, Zachary; Davis, Stephen

    2015-02-01

    Homelessness is a primary concern for community health. Scientific literature on homelessness is wide ranging and diverse. One opportunity to add to existing literature is the development and testing of affordable, easily implemented methods for measuring the impact of homeless on the healthcare system. Such methodological approaches rely on the strengths in a multidisciplinary approach, including providers, both healthcare and homeless services and applied clinical researchers. This paper is a proof of concept for a methodology which is easily adaptable nationwide, given the mandated implementation of homeless management information systems in the United States and other countries; medical billing systems by hospitals; and research methods of researchers. Adaptation is independent of geographic region, budget restraints, specific agency skill sets, and many other factors that impact the application of a consistent methodological science based approach to assess and address homelessness. We conducted a secondary data analysis merging data from homeless utilization and hospital case based data. These data detailed care utilization among homeless persons in a small, Appalachian city in the United States. In our sample of 269 persons who received at least one hospital based service and one homeless service between July 1, 2012 and June 30, 2013, the total billed costs were $5,979,463 with 10 people costing more than one-third ($1,957,469) of the total. Those persons were primarily men, living in an emergency shelter, with pre-existing disabling conditions. We theorize that targeted services, including Housing First, would be an effective intervention. This is proposed in a future study.

  11. Medical students' views on selecting paediatrics as a career choice.

    PubMed

    Bindal, Taruna; Wall, David; Goodyear, Helen M

    2011-09-01

    Despite increasing numbers of UK medical students, the number of trainees selecting paediatrics as their specialty choice has decreased. Previous studies show that most students will choose their ultimate career during undergraduate training. We therefore explored the views of students in the final year at Birmingham University about a career in paediatrics. Students completed a 27-item questionnaire during the penultimate week of their paediatric clerkship (PC) and 97% responded (127/131). Prior to the PC, 29% (37/127) of students had considered a career in paediatrics, rising to 50% (63/127) after the PC (p < 0.001). Students felt that paediatricians were enthusiastic and keen on teaching, and the ward working atmosphere was good. However, students perceived paediatrics as a difficult specialty with high competition for training posts. Students felt their paediatric experience was too limited and advice was needed on paediatric careers early in undergraduate training. This study confirmed that focusing on improving the PC is not sufficient if we are to inspire medical students to consider a career in paediatrics. Exposure to the specialty is needed from year 1 of undergraduate training along with career advice to dispel current myths about specialty training. Students would then be able to make more informed career decisions.

  12. Use of Zoledronic Acid in Paediatric Craniofacial Fibrous Dysplasia

    PubMed Central

    Rossin, Sara; Divisic, Antuan; De Gregorio, Alesandra; Agosto, Caterina; Catalano, Igor; Mazza, Alessandro; Sartori, Leonardo; Benini, Franca

    2016-01-01

    We describe a case of a paediatric patient affected by mandibular fibrous dysplasia (FD) with severe and chronic pain who was successfully treated with zoledronic acid (ZOL): a third-generation bisphosphonate. Further research is needed to assess its safety and efficacy as a treatment option for FD in the paediatric population. PMID:27747122

  13. Paediatric anaesthesia in Afghanistan: a review of the current experience.

    PubMed

    Nordmann, G R

    2010-12-01

    This paper describes the author's experience of the paediatric patient load on the U.K. medical services in Afghanistan. Over a 3 month period there was a mean of 2.9 paediatric trauma admissions per week, mean age was 6.8 years with gunshot wound or explosive injury being the mechanisms of injury in 77% of the trauma admissions. Overall these children represented 10.8% of the surgical workload. Some of the issues of paediatric anaesthesia in this environment are discussed including paediatric equipment, resuscitation for paediatric massive haemorrhage and regional anaesthesia. The need to formally recognise the problem in training and equipping deployed medical personnel to deal with this challenge is examined.

  14. Cerebral blood flow imaging in paediatrics: a review.

    PubMed

    Gordon, I

    1996-12-01

    The ability to study regional cerebral blood flow (rCBF) is available in many institutions, especially with the spread of multi-headed gamma cameras. The use of this technique in paediatrics requires special attention to detail in the manner of data acquisition and handling the child. The interpretation of the rCBF study in a child requires knowledge of normal brain maturation. The major clinical use in paediatrics is epilepsy because of the advances in surgery and the frequency of complex partial seizures. Other indications in paediatric neurology include brain death, acute neurological loss including stroke, language disorders, cerebral palsy, hypertension due to renovascular disease, traumatic brain injury and migraine. There are paediatric psychological conditions in which rCBF assessment has been undertaken, including anorexia nervosa, autism, Gilles de la Tourette Syndrome (GTS) and attention deficit disorder-hyperactivity (ADHD). This article attempts to review all aspects of rCBF studies in paediatrics. PMID:9004297

  15. War zone paediatrics in Rwanda.

    PubMed

    Pearn, J

    1996-08-01

    Children are particularly vulnerable to injury and death in two types of 20th century conflicts; terrorist attack and civil war. This account describes some first-hand experiences of the aftermath of the Rwandan Civil War of 1994. Events leading to the conflict are described, eye witness accounts of child trauma during the war are recorded and the medical problems (currently ongoing) affecting children are described. Over a period of 3 months from April to June 1994, between half and one million Rwandese, a significant proportion of them women and children, were murdered in brutal hand-to-hand killing, dying from close-quarter gunshot and machete slaughter. Nearly half of the population became refugees in neighbouring countries or displaced persons in their own land. UNAMIR II, the United Nations Emergency Humanitarian Response, grew to some 7000 persons by May 1995. Medical aid was provided by emergency medical contingents from the United Kingdom, Canada and Australia, the latter through its Australian Medical Support Force, providing the definitive emergency medical infrastructure from August 1994. In the consequent post-war civil and social disruption, children suffered from burns, cholera and from motor vehicle trauma. Ongoing landmine blasts continue to affect children and adolescents especially. A new International humanitarian code to build a time-expiry device into landmines and other similar ordinance is urgently required as the post-conflict ongoing disasters in Rwanda, Afghanistan and Cambodia illustrate. Current problems affecting children include an increasing risk of HIV infection, trauma and the special humanitarian needs of thousands of orphans.

  16. War zone paediatrics in Rwanda.

    PubMed

    Pearn, J

    1996-08-01

    Children are particularly vulnerable to injury and death in two types of 20th century conflicts; terrorist attack and civil war. This account describes some first-hand experiences of the aftermath of the Rwandan Civil War of 1994. Events leading to the conflict are described, eye witness accounts of child trauma during the war are recorded and the medical problems (currently ongoing) affecting children are described. Over a period of 3 months from April to June 1994, between half and one million Rwandese, a significant proportion of them women and children, were murdered in brutal hand-to-hand killing, dying from close-quarter gunshot and machete slaughter. Nearly half of the population became refugees in neighbouring countries or displaced persons in their own land. UNAMIR II, the United Nations Emergency Humanitarian Response, grew to some 7000 persons by May 1995. Medical aid was provided by emergency medical contingents from the United Kingdom, Canada and Australia, the latter through its Australian Medical Support Force, providing the definitive emergency medical infrastructure from August 1994. In the consequent post-war civil and social disruption, children suffered from burns, cholera and from motor vehicle trauma. Ongoing landmine blasts continue to affect children and adolescents especially. A new International humanitarian code to build a time-expiry device into landmines and other similar ordinance is urgently required as the post-conflict ongoing disasters in Rwanda, Afghanistan and Cambodia illustrate. Current problems affecting children include an increasing risk of HIV infection, trauma and the special humanitarian needs of thousands of orphans. PMID:8844531

  17. Summary of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute.

    PubMed

    Jacobs, Jeffrey P; Quintessenza, James A; Karl, Tom R; Asante-Korang, Alfred; Everett, Allen D; Collins, Susan B; Ramirez-Correa, Genaro A; Burns, Kristin M; Cohen, Mitchell; Colan, Steven D; Costello, John M; Daly, Kevin P; Franklin, Rodney C G; Fraser, Charles D; Hill, Kevin D; Huhta, James C; Kaushal, Sunjay; Law, Yuk M; Lipshultz, Steven E; Murphy, Anne M; Pasquali, Sara K; Payne, Mark R; Rossano, Joseph; Shirali, Girish; Ware, Stephanie M; Xu, Mingguo; Jacobs, Marshall L

    2015-08-01

    In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute, to describe the "state of the art" of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.

  18. Tinea capitis outbreak among paediatric refugee population, an evolving healthcare challenge.

    PubMed

    Mashiah, Jacob; Kutz, Ana; Ben Ami, Ronen; Savion, Mihal; Goldberg, Ilan; Gan Or, Tamar; Zidan, Omri; Sprecher, Eli; Harel, Avikam

    2016-09-01

    Outbreaks of tinea capitis (TC) represent a major medical and economic burden. Population migrations have become a phenomenon of increasing relevance for medical conditions management. Given the recent massive arrival of immigrants, we sought to determine epidemiologic trends for TC among paediatric populations at the Tel Aviv Medical Center. We conducted a retrospective study of all TC cases diagnosed between 2010 and 2014 in a paediatric dermatology unit of a tertiary medical centre, serving as a referral centre for the paediatric refugee population from the great Tel Aviv area. Epidemiologic, clinical and treatment data including effectiveness and safety were reviewed. In all, 145 children met the inclusion criteria. Trend analyses showed increases in TC rates over the study period. Incidence rates were higher in boys than in girls. Children of African origin had the highest TC incidence rates as compared with other ethnic groups. Trichophyton violaceum and Microsporum audouinii were the predominant causative organisms. Treatment with griseofulvin was satisfactory in all cases. There was a significant increase in TC incidence rates in the Tel Aviv area over the study period. TV and MA were the predominant organisms. These trends may be a result of poor living conditions and crowded school premises. PMID:27061446

  19. Tinea capitis outbreak among paediatric refugee population, an evolving healthcare challenge.

    PubMed

    Mashiah, Jacob; Kutz, Ana; Ben Ami, Ronen; Savion, Mihal; Goldberg, Ilan; Gan Or, Tamar; Zidan, Omri; Sprecher, Eli; Harel, Avikam

    2016-09-01

    Outbreaks of tinea capitis (TC) represent a major medical and economic burden. Population migrations have become a phenomenon of increasing relevance for medical conditions management. Given the recent massive arrival of immigrants, we sought to determine epidemiologic trends for TC among paediatric populations at the Tel Aviv Medical Center. We conducted a retrospective study of all TC cases diagnosed between 2010 and 2014 in a paediatric dermatology unit of a tertiary medical centre, serving as a referral centre for the paediatric refugee population from the great Tel Aviv area. Epidemiologic, clinical and treatment data including effectiveness and safety were reviewed. In all, 145 children met the inclusion criteria. Trend analyses showed increases in TC rates over the study period. Incidence rates were higher in boys than in girls. Children of African origin had the highest TC incidence rates as compared with other ethnic groups. Trichophyton violaceum and Microsporum audouinii were the predominant causative organisms. Treatment with griseofulvin was satisfactory in all cases. There was a significant increase in TC incidence rates in the Tel Aviv area over the study period. TV and MA were the predominant organisms. These trends may be a result of poor living conditions and crowded school premises.

  20. NSAIDs in paediatrics: caution with varicella!

    PubMed

    Durand, L; Sachs, P; Lemaitre, C; Lorrot, M; Bassehila, J; Bourdon, O; Prot-Labarthe, S

    2015-12-01

    Anti-inflammatory drugs have been suspected on several occasions to have promoted development of bacterial infection among varicella patients. Some countries have not implemented childhood varicella vaccination. Three cases in our hospital suggested the predisposing role of NSAIDs in varicella patient deterioration. Open access to these drugs widely increases their use and patient information should be continually provided in the medical offices and at dispensing pharmacy counters. Taking account of the benefit/risk balance and applying the simple precautionary principle, it would be appropriate to be cautious about the use of NSAIDs in the paediatric population.

  1. 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

  2. Predictors of Mortality in Paediatric Myocarditis

    PubMed Central

    Ansari, Mohammed Junaid; Mittal, Mahima; Kushwaha, K.P.

    2016-01-01

    Introduction Paediatric myocarditis can present as mild flu like symptoms to fulminent form. Early identification of the severity of illness and prioritization of intensive care is helpful especially in developing countries with limited resources. Aim To know the factors at admission that can predict mortality in paediatric myocarditis. Materials and Methods This was an observational study which enrolled children who presented with fever of acute onset (less than 15 days in duration), and were diagnosed as suspected myocarditis on the basis of clinical features, Troponin I and echocardiography, according to Expanded criteria for myocarditis in Paediatric ward at our institute over a period from August 2014 to December 2015. Their clinical features, cardiac biomarkers and echocardiography findings were compared between survivors and non-survivors. Statistical Analysis All statistical analysis was done using graphpad Prism 5 and SPSS statistical software. A Fisher exact p-value <0.05 was regarded as significant. Multivariate Logistic Regression was carried out to quantify the relationship between cardiac death and other predictor variables. The logistic coefficients for the predictor variables and their exponents, that is, log odds were calculated. Statistical significance of these predictor variables was interpreted by p-values. Results A 17.7% (n=11/62) patients of paediatric myocarditis died in this study. New York Heart Association (NYHA) class IV dyspnea (p=0.0115) and hypotension (p=0.0174) were more in patients who did not survive. The mean value of Troponin I was more in the non-survivor group (0.958 ± 1.13ng/ml); (p=0.0074). More number of patients who died had Brain Natriuretic Peptide (BNP) levels increased in their plasma (p=0.0087) with higher mean value (p=0.0175). LV ejection fraction was decreased markedly in non survivor group with mean value of 37±8.09 % as compared to survivor group with mean value of 46.6±10.5%, (p=0.0115). On multivariate

  3. 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

  4. MIH: epidemiologic clinic study in paediatric patient

    PubMed Central

    CONDÒ, R.; PERUGIA, C.; MATURO, P.; DOCIMO, R.

    2012-01-01

    SUMMARY The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. Aim. Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. Results and discussion. From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. Conclusions. MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and

  5. Thyroid dysfunction in major psychiatric disorders in a hospital based sample

    PubMed Central

    Radhakrishnan, Rajiv; Calvin, Sam; Singh, Jyotin Kshitiz; Thomas, Binston; Srinivasan, Krishnamachari

    2013-01-01

    Background & objectives: Abnormalities in thyroid hormonal status is common in major psychiatric disorders. Although the relevance of thyroid dysfunction to bipolar disorder is well-recognized, yet the association between thyroid dysfunction and schizophrenia-spectrum disorders is under-emphasized. The aim of this study was to examine and compare the rates of abnormal thyroid hormonal status in patients with schizophrenia-spectrum disorders and mood disorders in an inpatient tertiary care general hospital psychiatry unit. Methods: This was a retrospective hospital-based study on 468 inpatient samples. Data on serum thyroid stimulating hormone (TSH), T3 (triiodothyroxine), T4 (L-thyroxine), free unbound fractions of T3 and T4 (FT3 and FT4) were obtained from records of 343 patients, 18 patients were anti-TPO (anti thyroid peroxidase antibody) positive. The rates of abnormal thyroid hormonal status were compared using the chi square test. Results: Abnormal thyroid hormonal status in general, and presence of hypothyroidism and hyperthyroidism, in particular were seen in 29.3, 25.17 and 4.08 per cent patients with schizophrenia spectrum disorders, respectively. These were comparable to the rates in patients with mood disorders (23.24, 21.62 and 1.62%, respectively). Eleven of the 18 patients with antiTPO positivity had a schizophrenia-spectrum disorder. There were no gender differences. Interpretation & conclusions: Thyroid dysfunction was present in patients with schizophrenia-spectrum disorder as well as mood disorders. Autoimmune thyroid disease was more commonly seen in patients with schizophrenia-spectrum disorders compared to mood disorders. The findings reiterate the relevance of screening patients with schizophrenia-spectrum disorders for abnormal thyroid hormonal status. PMID:24521631

  6. A national, cross-sectional survey of children's hospital-based safety resource centres

    PubMed Central

    Kendi, Sadiqa; Zonfrillo, Mark R; Seaver Hill, Karen; Arbogast, Kristy B; Gittelman, Michael A

    2014-01-01

    Objective To describe the location, staffing, clientele, safety product disbursement patterns, education provided and sustainability of safety resource centres (SRCs) in US children's hospitals. Methods A cross-sectional survey was distributed to children's hospital-based SRC directors. Survey categories included: funding sources, customer base, items sold, items given free of charge, education provided and directors’ needs. Results 32/38 (84.2%) SRC sites (affiliated with 30 hospitals) completed the survey. SRCs were in many hospital locations including lobby (28.1%), family resource centres (12.5%), gift shop/retail space (18.8%), mobile units (18.8%) and patient clinics (12.5%). 19% of respondents reported that their SRC was financially self-sustainable. Sales to patients predominated (mean of 44%); however, hospital employees made up a mean of 20% (range 0–60%) of sales. 78.1% of SRCs had products for children with special healthcare needs. Documentation kept at SRC sites included items purchased (96.9%), items given free of charge (65.6%) and customer demographics (50%). 56.3% of SRCs provided formal injury prevention education classes. The SRCs’ directors’ most important needs were finances (46.9%), staffing (50%) and space (46.9%). All of the directors were ‘somewhat interested’ or ‘very interested’ in each of the following: creation of a common SRC listserv, national SRC data bank and multisite SRC research platform. Conclusions SRCs are located in many US children's hospitals, and can be characterised as heterogeneous in location, products sold, data kept and ability to be financially sustained. Further research is needed to determine best practices for SRCs to maximise their impact on injury prevention. PMID:24667383

  7. Accounting for care: Healthcare Resource Groups for paediatric critical care.

    PubMed

    Murphy, Janet; Morris, Kevin

    2008-02-01

    Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.

  8. Hospital based superconducting cyclotron for neutron therapy: Medical physics perspective

    NASA Astrophysics Data System (ADS)

    Yudelev, M.; Burmeister, J.; Blosser, E.; Maughan, R. L.; Kota, C.

    2001-12-01

    The neutron therapy facility at the Gershenson Radiation Oncology Center, Harper University Hospital in Detroit has been operational since September 1991. The d(48.5)+Be beam is produced in a gantry mounted superconducting cyclotron designed and built at the National Superconducting Cyclotron Laboratory (NSCL). Measurements were performed in order to obtain the physical characteristics of the neutron beam and to collect the data necessary for treatment planning. This included profiles of the dose distribution in a water phantom, relative output factors and the design of various beam modifiers, i.e., wedges and tissue compensators. The beam was calibrated in accordance with international protocol for fast neutron dosimetry. Dosimetry and radiobiology intercomparions with three neutron therapy facilities were performed prior to clinical use. The radiation safety program was established in order to monitor and reduce the exposure levels of the personnel. The activation products were identified and the exposure in the treatment room was mapped. A comprehensive quality assurance (QA) program was developed to sustain safe and reliable operation of the unit at treatment standards comparable to those for conventional photon radiation. The program can be divided into three major parts: maintenance of the cyclotron and related hardware; QA of the neutron beam dosimetry and treatment delivery; safety and radiation protection. In addition the neutron beam is used in various non-clinical applications. Among these are the microdosimetric characterization of the beam, the effects of tissue heterogeneity on dose distribution, the development of boron neutron capture enhanced fast neutron therapy and variety of radiobiology experiments.

  9. Proposed educational objectives for hospital-based dentists during catastrophic events and disaster response.

    PubMed

    Psoter, Walter J; Herman, Neal G; More, Frederick G; Park, Patricia; Robbins, Miriam; Rekow, E Dianne; Ryan, James M; Triola, Marc M; Glotzer, David

    2006-08-01

    The purpose of this project was to define education and training requirements for hospital-based dentists to efficiently and meaningfully participate in a hospital disaster response. Eight dental faculty with hospital-based training and/or military command and CBRNE (chemical, biological, radiological, nuclear, and explosive) expertise were recruited as an expert panel. A consensus set of recommended educational objectives for hospital-based dentists was established using the following process: 1) identify assumptions supported by all expert panelists, 2) determine current advanced dental educational training requirements, and 3) conduct additional training and literature review by various panelists and discussions with other content and systems experts. Using this three-step process, educational objectives that the development group believed necessary for hospital-based dentists to be effective in treatment or management roles in times of a catastrophic event were established. These educational objectives are categorized into five thematic areas: 1) disaster systems, 2) triage/medical assessment, 3) blast and burn injuries, 4) chemical agents, and 5) biological agents. Creation of training programs to help dentists acquire these educational objectives would benefit hospital-based dental training programs and strengthen hospital surge manpower needs. The proposed educational objectives are designed to stimulate discussion and debate among dental, medical, and public health professionals about the roles of dentists in meeting hospital surge manpower needs.

  10. Standard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration in paediatric critical care.

    PubMed

    O'Leary, Jessica; Nash, Robyn; Lewis, Peter

    2016-01-01

    Identifying and stabilising deterioration in a child with significant clinical compromise is both a challenging and necessary role of the paediatric critical care nurse. Within adult critical care research, high fidelity patient simulation (HFPS) has been shown to positively impact learner outcomes regarding identification and management of a deteriorating patient; however, there is a paucity of evidence examining the use of HFPS in paediatric nursing education. The aim of this study was to investigate the effect of HFPS on nurses' self-efficacy and knowledge for recognising and managing paediatric deterioration. Further, participants' perceptions of the learning experiences specific to the identification and management of a deteriorating child were also explored. Registered nurses working in a tertiary-referral paediatric critical care unit were recruited for this quasi-experimental study. Using a pre-test/post-test control-group design, participants were assigned to one of two learning experiences: HFPS or standard instruction. Following the learning experience, nurses were also invited to participate in semi-structured interviews. 30 nurses participated in the study (control n=15, experiment n=15). Participants in the HFPS intervention were most likely to demonstrate an increase in both perceived self-efficacy (p=<0.01) and knowledge (p=<0.01). No statistically significant change was observed in control group scores. The mean difference in self-efficacy gain score between the two groups was 5.67 score units higher for the experiment group compared to the control. HFPS also yielded higher follow-up knowledge scores (p=0.01) compared to standard instruction. Ten nurses participated in semi-structured interviews. Thematic analysis of the interview data identified four themes: self-awareness, hands-on learning, teamwork, and maximising learning. The results of this study suggest that HFPS can positively influence nurses' self-efficacy and knowledge test scores

  11. A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations

    PubMed Central

    McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M; Marete, Irene; Vreeman, Rachel Christine

    2016-01-01

    Introduction HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. Methods We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Results and discussion Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Conclusions Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity. PMID:27717409

  12. 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

  13. Osteoporosis in paediatric patients with spina bifida

    PubMed Central

    Marreiros, Humberto Filipe; Loff, Clara; Calado, Eulalia

    2012-01-01

    The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Methods Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB. PMID:22330186

  14. Systems for Paediatric Sepsis: A Global Survey

    PubMed Central

    Kang, KT; Chandler, HK; Espinosa, V; Kissoon, N

    2014-01-01

    ABSTRACT Objectives: To evaluate the resources available for early diagnosis and treatment of paediatric sepsis at hospitals in developing and developed countries. Methods: This was a voluntary online survey involving 101 hospitals from 41 countries solicited through the World Federation of Pediatric Intensive and Critical Care Societies contact list and website. The survey was designed to assess the spectrum of sepsis epidemiology, patterns of applied therapies, availability of resources and barriers to optimal sepsis treatment. Results: Ninety per cent of respondents represented a tertiary or general hospital with paediatric intensive care facilities, including 63% from developed countries. Adequate triage services were absent in more than 20% of centres. Insufficiently trained personnel and lack of a sepsis protocol was reported in 40% of all sites. While there were specific guidelines for sepsis management in 78% of centres (n = 100), protocols for assessing sepsis patients were not applied in nearly 70% of centres. Lack of parental recognition of sepsis and failure of referring centres to diagnose sepsis were identified as major barriers by more than 50% of respondents. Conclusions: Even among centres with no significant resource constraints and advanced medical systems, significant deficits in sepsis care exist. Early recognition and management remains a key issue and may be addressed through improved triage, augmented support for referring centres and public awareness. Focussed research is necessary at the institutional level to identify and address specific barriers. PMID:25867557

  15. 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

  16. 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.

  17. 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.

  18. Selective lung intubation during paediatric thoracic surgeries.

    PubMed

    Mixa, V; Nedomova, B; Rygl, M

    2016-01-01

    Selective lung intubation is a necessary prerequisite for the completion of most interventions comprising thoracotomy and thoracoscopy. In paediatric care, our site uses Univent tubes for children up to the age of three years and double-lumen tubes (DLT) for children from 6-8 years of age. In younger children, we usually use regular endotracheal intubation, with the lung being held in the hemithorax position being operated on using a surgical retractor. The article presents the analysis of 860 thoracic surgeries, of which 491 comprised selective intubation (Univent 57 cases, DLT 434 cases). The use of the aforementioned devices is connected with certain complications. Univent tube can be connected with intraoperative dislocation of the obturating balloon (29.8%) and balloon perforation (5.2%). DLT insertion may be connected with failure of tube fitting. In 84 cases we had to repeat DLT insertion (20.6%). In 8 cases we were not able to insert DLT at all (1.8%). Standard use of selective intubation methods in paediatric patients from two years of age improved the conditions for surgical interventions (Tab. 2, Fig. 2, Ref. 19). PMID:27546541

  19. Assessment of paediatric pain: a critical review.

    PubMed

    Manocha, Sachin; Taneja, Navneet

    2016-06-01

    Pain is a complex experience, and its quantification involves many aspects including physiological, behavioural, and psychological factors. References related to the topic were selected and analysed, along with a PubMed search of the recent and earlier reports. Assessment of pain in infants and children has always been a dilemma for the clinicians. Unlike in adults, it is difficult to assess and effectively treat pain in paediatric age groups, and it often remains untreated or undertreated. Misperceptions are attributed not only to the difficulties in isolating the specific signs of pain but also in recognising and inferring the meaning of the cues available in the complex of individual differences in the reaction pattern of children to pain. In children, several parameters such as age, cognitive level, type of pain, etc. are required to be considered for the selection of appropriate pain assessment tools. Although considerable progress has been made, there is a critical need for a more accurate measurement tool for both research and clinical purposes. This review has critically analysed the various techniques available to assess pain in children with emphasis on current research and present-day status of paediatric pain assessment.

  20. Using vision to become viable: how rural hospital-based home health can thrive.

    PubMed

    2010-02-01

    It's been the trend for some years that, with their own particular set of challenges and constraints, hospital-based home health agencies have struggled to maintain profitability and efficiency in their operations. That can especially be true for hospital-based agencies operating in more rural areas, even as such agencies have been shown to play an important--or even critical--role in ensuring individuals in the communities they serve have access to needed treatment and health care services. Two executives who've successfully led a rural hospital-based agency discuss how to engage employees, referral sources, and communities and instill the right core philosophy to help your business succeed and grow. PMID:20391656

  1. [Meningococcal disease admissions in a paediatric intensive care unit].

    PubMed

    Mação, Patrícia; Januário, Gustavo; Ferreira, Sofia; Dias, Andrea; Dionísio, Teresa; Pinto, Carla; Carvalho, Leonor

    2014-01-01

    Introdução: A infecção meningocócica tem uma elevada mortalidade e morbilidade em crianças. O tratamento agressivo do choque, a referenciação precoce, o transporte secundário especializado e a vacinação são factores com impacto potencial na redução da mortalidade. Foram objectivos caracterizar as crianças com doença invasiva meningocócica admitidas em cuidados intensivos, avaliar parâmetros de gravidade e mortalidade. Material e Métodos: Estudo observacional, cujo método de colheita de dados foi retrospectivo. Foram constituídos dois períodos, de seis anos cada, de acordo com o ano de admissão (A: 2000-2005 e B: 2006-2011) e nestes compararam-se índices de gravidade, disfunção orgânica e mortalidade. Resultados: Foram admitidas 70 crianças com doença invasiva meningocócica. Quando comparadas com as outras causas verificouse uma redução nas admissões por doença invasiva meningocócica (período A: 3,4%; período B: 1,5%; p = 0,001). A ocorrência de meningite foi de 41% no período A e de 29% no período B (p = 0,461). Tiveram púrpura rapidamente progressiva 78% no período A e 50% no período B (p = 0,0032). As crianças do período A tiveram disfunção multi-órgão (80%), coagulação intravascular disseminada (76%) e coma (22%) mais frequentemente que as crianças do período B (29%, 29%, 0%; p < 0,05). A mortalidade foi 26% no período A e 0% no período B (p = 0,006) e a mortalidade estandardizada pelo PRISM foi 1,3 e 0 no período A e B respectivamente. Discussão: A redução do número de admissões por doença menigocócica invasiva pode ser explicada pela introdução da vacina anti-meningocócica C em 2006. Pensa-se que a redução da mortalidade observada, possa ser atribuível à melhoria da estabilização inicial e ao transporte secundário. Conclusão: Nos últimos anos houve uma redução significativa no número de admissões e na mortalidade por doença invasiva meningocócica.

  2. The design and implementation of hospital-based coordinated care programs.

    PubMed

    Warrick, L H; Christianson, J B; Williams, F G; Netting, F E

    1990-01-01

    This article contains the initial findings of an ongoing evaluation of a hospital-based coordinated care demonstration. The goal of the demonstration is to investigate the appropriateness and feasibility of providing hospital-based case management services for extended periods to elderly individuals living in the community. The rationale for the demonstration is reviewed, and the structure of each participating hospital's coordinated care program is described. Data are presented on the characteristics of clients served by the programs during the first six months of the demonstration. The factors that influenced implementation and early operations of these programs are analyzed, and their implications for hospital managers are discussed.

  3. Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

    PubMed

    Maan, Zeshaan N; Frew, Quentin; Din, Asmat H; Unluer, Zeynep; Smailes, Sarah; Philp, Bruce; El-Muttardi, Naguib; Dziewulski, Peter

    2014-12-01

    Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.

  4. [Development of a specialised paediatric palliative home care service].

    PubMed

    Kuhlen, M; Balzer, S; Richter, U; Fritsche-Kansy, M; Friedland, C; Borkhardt, A; Janssen, G

    2009-01-01

    In Germany annually 1,500-3,000 children die from life-limiting diseases. Symptoms and course of disease differ considerably depending on the character of the underlying disease. Due to the desire of the children and their families to spend the end of life at home a paediatric palliative home care service was founded at the university children's hospital of Duesseldorf. In the last 20 years a specialised paediatric palliative team evolved from an unstructured voluntary activity. Prospective aims are an area-wide professional supply of all paediatric palliative patients and the improvement of the cooperation with the resident paediatrician and paediatric palliative nursing services. Furthermore the establishment of networks as well as a proper communication among the professionals is inalienable.

  5. A 3D digital medical photography system in paediatric medicine.

    PubMed

    Williams, Susanne K; Ellis, Lloyd A; Williams, Gigi

    2008-01-01

    In 2004, traditional clinical photography services at the Educational Resource Centre were extended using new technology. This paper describes the establishment of a 3D digital imaging system in a paediatric setting at the Royal Children's Hospital, Melbourne.

  6. Facial dysmorphology in the neglected paediatric head and neck burn.

    PubMed

    Katsaros, J; David, D J; Griffin, P A; Moore, M H

    1990-03-01

    The morphological distortion of the facial skeleton induced by untreated paediatric burns of the head and neck reinforces the theories of craniofacial growth and the modern principles of acute burn management and post-burn facial reconstruction.

  7. Microbial diversity on intravascular catheters from paediatric patients.

    PubMed

    Zhang, L; Marsh, N; Long, D; Wei, M; Morrison, M; Rickard, C M

    2015-12-01

    Microorganisms play important roles in intravascular catheter (IVC)-related infections, which are the most serious complications in children with IVCs, leading to increased hospitalisation, intensive care admissions, extensive antibiotic treatment and mortality. A greater understanding of bacterial communities is needed in order to improve the management of infections. We describe here the systematic culture-independent evaluation of IVC bacteriology in IVC biofilms. Twenty-four IVC samples (six peripherally inserted central catheters, eight central venous catheters and ten arterial catheters) were collected from 24 paediatric patients aged 0 to 14 years old. Barcoded amplicon libraries produced from genes coding 16S rRNA and roll-plate culture methods were used to determine the microbial composition of these samples. From a total of 1,043,406 high-quality sequence reads, eight microbial phyla and 136 diverse microbial genera were detected, separated into 12,224 operational taxonomic units (OTUs). Three phyla (Actinobacteria, Firmicutes and Proteobacteria) predominate the microorganism on the IVC surfaces, with Firmicutes representing nearly half of the OTUs found. Among the Firmicutes, Staphylococcus (15.0% of 16S rRNA reads), Streptococcus (9.6%) and Bacillus (6.1%) were the most common. Community composition did not appear to be affected by patients' age, gender, antibiotic treatment or IVC type. Differences in IVC microbiota were more likely associated with events arising from catheter dwell time, rather than the type of IVC used. PMID:26515578

  8. Characteristics of Hospital-Based Munchausen Syndrome by Proxy in Japan

    ERIC Educational Resources Information Center

    Fujiwara, Takeo; Okuyama, Makiko; Kasahara, Mari; Nakamura, Ayako

    2008-01-01

    Objective: This article explores characteristics of Munchausen Syndrome by Proxy (MSBP) in Japan, a country which provides an egalitarian, low cost, and easy-access health care system. Methods: We sent a questionnaire survey to 11 leading doctors in the child abuse field in Japan, each located in different hospital-based sites. Child abuse doctors…

  9. Caring for Young Adolescent Sexual Abuse Victims in a Hospital-Based Children's Advocacy Center

    ERIC Educational Resources Information Center

    Edinburgh, Laurel; Saewyc, Elizabeth; Levitt, Carolyn

    2008-01-01

    Objectives: This study compared health care assessments, referrals, treatment, and outcomes for young adolescent sexual assault/sexual abuse victims seen at a hospital-based Child Advocacy Center (CAC), to that provided to similar victims evaluated by other community providers. A second purpose was to document how common DNA evidence is found…

  10. 42 CFR 413.174 - Prospective rates for hospital-based and independent ESRD facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... independent ESRD facilities. 413.174 Section 413.174 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs § 413.174 Prospective rates for hospital-based and independent ESRD facilities. (a) Establishment of...

  11. 42 CFR 413.174 - Prospective rates for hospital-based and independent ESRD facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... independent ESRD facilities. 413.174 Section 413.174 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs § 413.174 Prospective rates for hospital-based and independent ESRD facilities. Link to an...

  12. 42 CFR 413.174 - Prospective rates for hospital-based and independent ESRD facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... independent ESRD facilities. 413.174 Section 413.174 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs § 413.174 Prospective rates for hospital-based and independent ESRD facilities. (a) Establishment of...

  13. DriveWise: An Interdisciplinary Hospital-Based Driving Assessment Program

    ERIC Educational Resources Information Center

    O'Connor, Margaret G.; Kapust, Lissa R.; Hollis, Ann M.

    2008-01-01

    Health care professionals working with the elderly have opportunities through research and clinical practice to shape public policy affecting the older driver. This article describes DriveWise, an interdisciplinary hospital-based driving assessment program developed in response to clinical concerns about the driving safety of individuals with…

  14. Developmental paediatrics in primary care: what should we teach?

    PubMed Central

    Baird, G; Hall, D M

    1985-01-01

    There is little agreement about what constitutes good developmental paediatric practice at the level of primary care. Many of the available screening tests are intrinsically unsatisfactory or badly performed, but screening is only a small part of developmental paediatrics. Every primary care doctor should be familiar with the scientific basis of the subject even if a decision is made not to embark on a formal screening programme. PMID:2412629

  15. 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

  16. Aspects of deceased organ donation in paediatrics.

    PubMed

    Brierley, J; Hasan, A

    2012-01-01

    Organ transplantation offers children in acute or chronic severe organ failure similar opportunities to adults. However, while the number who might benefit is relatively low, significantly fewer cadaveric donors exist for any given child compared with an adult. Incompatible organ size and relatively low donation rates mean that despite living parental donation and innovations to reduce donated organ size, children die before organs become available. The severity of the UK situation is compounded by restrictions on paediatric living donation, uncertainties over the application of brain death criteria, and ethical concerns about the use of donation after circulatory death. The UK Department of Health's Organ Donation Task Force suggested the means by which the adult donor pool might be increased, recommending that outstanding ethical and legal issues be resolved, but made no specific recommendations about children. PMID:22194438

  17. Informed consent & ethical issues in paediatric psychopharmacology.

    PubMed

    Malhotra, Savita; Subodh, B N

    2009-01-01

    Issues relating to informed consent and ethics in paediatric psychopharmacology limit research in this population. Children vary in their levels of cognitive development, and presence of psychiatric disorder may further impair their ability to give informed consent. In decisional impairment subjects, various methods used for consent are assent/dissent; inclusion of advance directives; and/or alternative decision-makers. India is emerging as a new market for clinical trials in recent years. Moreover, in India the sociocultural realities are different from those in the western countries making it necessary for professionals to be cautious in conducting drug trials. In this review, issues regarding informed consent in children and adolescent with psychiatric diagnosis are discussed for information, discussion and debate by professionals, parents, society and legal experts to create awareness and to facilitate development of guidelines that are appropriate and applicable to the Indian system.

  18. Practical aspects of advanced paediatric cardiopulmonary resuscitation.

    PubMed

    Tibballs, J

    1988-08-01

    Successful cardiopulmonary resuscitation in the paediatric age group necessitates the acquisition of technical skills for rapid tracheal intubation, external cardiac compression and access to the circulation. Skills and equipment must be adapted to each age group. For optimal mechanical ventilation and the avoidance of complications, correct selection of endotracheal tube diameter and length is necessary. New techniques in resuscitation incorporate an understanding of the mechanism of blood flow during cardiac compression, the use of the intratracheal route for drug administration, and a revision of the use of catecholamines, sodium bicarbonate and calcium solutions in the treatment of asystole-bradycardia, electromechanical dissociation, ventricular fibrillation and tachycardia. Early intubation, adequate ventilation with oxygen, well performed external cardiac compression, prompt defibrillation and administration of adrenaline remain the cornerstones of advanced cardiopulmonary resuscitation. PMID:3064747

  19. Delivery devices for the administration of paediatric formulations: overview of current practice, challenges and recent developments.

    PubMed

    Walsh, Jennifer; Bickmann, Deborah; Breitkreutz, Joerg; Chariot-Goulet, Maryvonne

    2011-08-30

    The European Paediatric Formulation Initiative (EuPFI), a group consisting of paediatric formulation experts from industry, academia and clinical pharmacy was founded with the aim of raising awareness of paediatric formulation issues. It is imperative that paediatric medicines can be administered accurately to ensure the correct dose is provided and that the administration device is easy to use and acceptable from the patient's and carer's perspectives. This reflection paper provides an overview of currently available paediatric administration devices and highlights some of the challenges associated with, recommendations and recent developments in delivery devices for the oral, inhaled, parenteral, nasal and ocular administration of paediatric formulations, on behalf of the EuPFI.

  20. Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

    PubMed

    Klingberg, Gunilla; Andersson-Wenckert, Ingrid; Grindefjord, Margaret; Lundin, Sven-Ake; Ridell, Karin; Tsilingaridis, Georgios; Ullbro, Christer

    2010-09-01

    International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

  1. Case definitions for paediatric AIDS: the Zambian experience.

    PubMed

    Chintu, C; Malek, A; Nyumbu, M; Luo, C; Masona, J; DuPont, H L; Zumla, A

    1993-01-01

    For the purpose of surveillance of the acquired immunodeficiency syndrome (AIDS) in developing countries, the World Health Organization (WHO) has recommended criteria for the clinical case definition of AIDS in adults and children. In a preliminary examination of children in Zambia a number of patients with obvious AIDS did not fit the published WHO case definition for paediatric AIDS. Based on this the Zambia National AIDS Surveillance Committee designed local criteria for the clinical case definition of paediatric AIDS. We compared the Zambian criteria with the WHO criteria for the diagnosis of paediatric AIDS by studying 134 consecutively admitted children to one of the paediatric wards at the University Teaching Hospital in Lusaka. Twenty-nine of the patients were HIV-1 seropositive and 105 were HIV-1 seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23, and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results give the Zambian criteria for the diagnosis of AIDS a sensitivity of 79.3%, a specificity of 91.4% and a positive predictive value of 86.8% compared to a sensitivity of 69%, specificity of 64% and a positive predictive value of 38% for the WHO criteria. The current WHO criteria are inadequate for the diagnosis of paediatric AIDS. The need to refine the WHO criteria for the diagnosis of paediatric AIDS is discussed.

  2. Development of a Comprehensive Hospital-Based Elder Abuse Intervention: An Initial Systematic Scoping Review

    PubMed Central

    Du Mont, Janice; Macdonald, Sheila; Kosa, Daisy; Elliot, Shannon; Spencer, Charmaine; Yaffe, Mark

    2015-01-01

    Introduction Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review. Objectives Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation. Methods The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1) addressed a response (e.g., an intervention) to elder abuse, 2) contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3) were available in English. Analysis The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics. Results 649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser; Assessment: physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of

  3. 77 FR 9665 - Submission for OMB Emergency Review; Comment Request: A Multi-Center International Hospital-Based...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-17

    ... Multi- Center International Hospital-Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI... currently valid OMB control number. Proposed Collection: Title: A Multi-Center International Hospital- Based... viral infections, ultraviolet radiation exposure, medical conditions, and other lifestyle factors...

  4. Caring for severely ill cancer patients. A comparison of working conditions in hospital-based home care and in hospital.

    PubMed

    Beck-Friis, B; Strang, P; Sjödén, P O

    1993-05-01

    The goal of the study was to compare working conditions in a hospital with the conditions in a specialized hospital-based home care (HBHC) unit, which aims to replace hospital care for patients in need of institutional car. Staff (doctors included) in a HBHC unit (n = 35) and on three hospital wards (n = 113) participated in the study. All staff members worked regularly with severely ill cancer patients. Question about stress, job satisfaction and working conditions were asked in a self-administered questionnaire. Both groups showed a limited degree of continuous stress and a high degree of job satisfaction. Thus, the overall perception was than the working conditions were good. When significant differences were found, the responses of the HBHC staff were more positive. This included items such as more freedom to make their own decisions (P < 0.001), better co-operation between day and night shifts (P < 0.001), a more reasonable work load (P = 0.0001), fewer problems in communication with patients (P < 0.001), and fewer problems with tension (P < 0.05) and with sleeping (P < 0.05). The findings may be due to several factors: the HBHC staff were older, more often married, had more children, had worked longer in health care and were thus more experienced. Complementary explanations may be continuous education within the HBHC and an organization stimulating the staff's own initiative, but also capable of supporting when necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Relationships of hospital-based emergency department culture to work satisfaction and intent to leave of emergency physicians and nurses.

    PubMed

    Lin, Blossom Yen-Ju; Wan, Thomas T H; Hsu, Chung-Ping Cliff; Hung, Feng-Ru; Juan, Chi-Wen; Lin, Cheng-Chieh

    2012-05-01

    Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses. PMID:22673696

  6. Assessing the burden of paediatric influenza in Europe: the European Paediatric Influenza Analysis (EPIA) project

    PubMed Central

    Paget, W. John; Casas, Inmaculada; Donker, Gé; Edelman, Laurel; Fleming, Douglas; Larrauri, Amparo; Meijer, Adam; Puzelli, Simona; Rizzo, Caterina; Simonsen, Lone

    2010-01-01

    The European Paediatric Influenza Analysis (EPIA) project is a multi-country project that was created to collect, analyse and present data regarding the paediatric influenza burden in European countries, with the purpose of providing the necessary information to make evidence-based decisions regarding influenza immunisation recommendations for children. The initial approach taken is based on existing weekly virological and age-specific influenza-like illness (ILI) data from surveillance networks across Europe. We use a multiple regression model guided by longitudinal weekly patterns of influenza virus to attribute the weekly ILI consultation incidence pattern to each influenza (sub)type, while controlling for the effect of respiratory syncytial virus (RSV) epidemics. Modelling the ILI consultation incidence during 2002/2003–2008 revealed that influenza infections that presented for medical attention as ILI affected between 0.3% and 9.8% of children aged 0–4 and 5–14 years in England, Italy, The Netherlands and Spain in an average season. With the exception of Spain, these rates were always higher in children aged 0–4 years. Across the six seasons analysed (five seasons were analysed from the Italian data), the model attributed 47–83% of the ILI burden in primary care to influenza virus infection in the various countries, with the A(H3N2) virus playing the most important role, followed by influenza viruses B and A(H1N1). National season averages from the four countries studied indicated that between 0.4% and 18% of children consulted a physician for ILI, with the percentage depending on the country and health care system. Influenza virus infections explained the majority of paediatric ILI consultations in all countries. The next step will be to apply the EPIA modelling approach to severe outcomes indicators (i.e. hospitalisations and mortality data) to generate a complete range of mild and severe influenza burden estimates needed for decision making

  7. A review of paediatric telehealth for pre- and post-operative surgical patients.

    PubMed

    Smith, Anthony C; Garner, Lisa; Caffery, Liam J; McBride, Craig A

    2014-10-01

    The Queensland Telepaediatric Service (QTS) was established in the year 2000 to deliver a broad range of paediatric specialist health services from the Royal Children's Hospital (RCH) in Brisbane, mainly via videoconference. During a 13-year study period, the QTS facilitated 18,949 video consultations, comprising Mental Health (42%), Medicine (30%), Surgery (21%) and Other (8%). We reviewed the surgical services provided through the QTS. There were 3880 video consultations with a paediatric surgeon. Most of these (91%) used fixed videoconferencing units, 8% were delivered via mobile units (robots) and 1% were delivered using Skype. Surgical consultations were provided by telehealth to 106 sites: 89% in Queensland and the rest to other states. The main surgical specialties were burns (50%), ear, nose and throat (19%), general surgery (21%), orthopaedics (9%) and vascular anomalies (2%). During a 12-month audit period, there were 224 teleconsultations in general surgery; the most common reason for referral was for undescended testes (17%). During the study period there was a significant growth in all surgical telehealth activity: linear regression showed an annual increase of 17 cases per year (P < 0.02). In the last four years of the study, there was a substantial growth in the general surgical component, although there was also a reduction in the burns component. Telehealth has potential for other specialist consultations which require periodic assessment and review. PMID:25400001

  8. Organizational issues in the implementation of a hospital-based syringe exchange program.

    PubMed

    Masson, Carmen L; Sorensen, James L; Grossman, Nina; Sporer, Karl A; Des Jarlais, Don C; Perlman, David C

    2010-05-01

    Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution.

  9. Organizational Issues in the Implementation of a Hospital-Based Syringe Exchange Program

    PubMed Central

    Masson, Carmen L.; Sorensen, James L.; Grossman, Nina; Sporer, Karl A.; Des Jarlais, Don C.; Perlman, David C.

    2012-01-01

    Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution. PMID:20397875

  10. Determinants of client termination in hospital-based case management programs.

    PubMed

    Netting, F E; Warrick, L H; Christianson, J B; Williams, F G

    1994-01-01

    Increasing attention is being focused on hospital-based programs that address the needs of the frail elderly. This article reports results from a demonstration of hospital-based case management (HBCC). Baseline, 3-, 6-, and 12-month assessment data are analyzed to determine why clients terminated from HBCC programs. Subsamples of community- and hospital-originated clients are examined to determine what factors predict case management termination. About half of both hospital- and community-originated clients left case management within 12 months because of death, nursing home placement, referral to another case management agency, relocation out of the service area, or discharge as self-sufficient. Hospital-originated clients were more likely to die within the first 6 months after entering case management than were community-originated clients. Cognitive and functional abilities were important predictors of termination status.

  11. Ethnic diversity outpatient clinic in paediatrics

    PubMed Central

    2012-01-01

    Background The health status of chronic sick ethnic minority children in the Netherlands is unequal compared with indigenous Dutch children. In order to optimize the health care for these children a specific patient-oriented clinic in ethnic-cultural diversity: the Mosaic Outpatient Clinic (MOC) was integrated in the general Paediatric Outpatient Departments (POPD) of three hospitals in Amsterdam. Methods Feasibility of the MOC, factors influencing the health care process and encountered bottlenecks in health care were studied in ethnic minority children with asthma, diabetes type 1 or metabolic disease originating from Morocco, Turkey and Surinam. Feasibility was determined by the number of patients attended, support from the paediatric medical staff and willingness of the patients to participate. Influences on the health care process comprised parents' level of knowledge of disease, sense of disease severity, level of effort, linguistic skills, health literacy, adherence to treatment and encountered bottlenecks in the health care process. Moreover, the number of admissions and visits to the POPD in the years before, during and after the MOC were analysed. Results In 2006 a total of 189 ethnic minority children were seen. Integration of the MOC within the general POPD of the hospital is feasible. The ability of the parents to speak and understand Dutch was found to be 58%, functional health literacy was 88%; sufficient knowledge of disease and sense of disease severity were 59% and 67%, respectively. The main bottlenecks in the healthcare process: poor knowledge of disease, limited sense of disease severity and low health literacy in the parents proved to be the best predictors for decreased adherence. After attending the MOC there was a decrease in the number of admissions and visits to the POPD for asthma while the number of visits increased in patients with diabetes and the amount of no-shows decreased in patients with a metabolic disease. Conclusion

  12. Hospital based ethics, current situation in France: between "Espaces" and committees.

    PubMed

    Guerrier, M

    2006-09-01

    Unlike research ethics committees, which were created in 1988, the number of functioning hospital based ethical organisations in France, such as clinical ethics committees, is unknown. The objectives of such structures are diverse. A recent law created regional ethical forums, the objectives of which are education, debate, and research in relation to healthcare ethics. This paper discusses the current situation in France and the possible evolution and conflicts induced by this law. The creation of official healthcare ethics structures raises several issues.

  13. Starting a hospital-based home health agency: Part II--Key success factors.

    PubMed

    Montgomery, P

    1993-09-01

    In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.

  14. Hospital-based Surveillance of Rotavirus Diarrhea among Under- five Children in Chandigarh.

    PubMed

    Gupta, Madhu; Singh, M P; Guglani, Vishal; Mahajan, K S; Pandit, S

    2016-07-01

    In a prospective hospital-based surveillance of 958 under five children admitted with acute gastroenteritis in Chandigarh (May 2011 to July 2012), 239 stool samples were collected. Rotavirus antigen was detected in 18.8% of samples by reverse transcriptase polymerase chain reaction. Genotypes G1P[8] (53.3%), G12P[6] (15.6%) were prevalent, and G3 not detected. PMID:27508548

  15. Policies to enhance coordination in hospital-based case management programs.

    PubMed

    Netting, F E; Williams, F G; Jones-McClintic, S; Warrick, L

    1990-02-01

    Social work practitioners in health and social services are expected to develop and implement programs and client care plans that require cooperation and coordination with numerous other individuals and programs. Such cooperation and coordination often are accomplished through informal networking. As programs develop, these relationships may be formalized in written policy agreements. In this article, the authors examine four policies designed to improve cooperation and coordination at different levels in hospital-based case management systems. Implications for social work practice are discussed.

  16. Students’ perceptions of the instructional quality of district hospital-based training

    PubMed Central

    Memon, Shehla Jabbar; Louw, Jakobus Murray; Hugo, Jannie; Rauf, Waqar-un Nisa; Sandars, John Edward

    2016-01-01

    Background An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria. Aim To measure the students’ perceptions of the instructional quality of district hospital-based training. Setting Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces. Methods A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results. Results The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year. Conclusion Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement. PMID:27543282

  17. Understanding the responsibilities and obligations of the modern paediatric surgeon.

    PubMed

    Beasley, Spencer W

    2015-02-01

    The modern paediatric surgeon needs to be competent in multiple domains that extend well beyond their clinical and technical expertise. This article, based on the Journal of Pediatric Surgery Lecture at the BAPS Congress (2014), explores some of these less well understood responsibilities and obligations, including professionalism, leadership, effective clinical teaching, and research. The consequence of falling short in these areas includes risks to our profession as a whole as well as compromising our ability to provide our patients with the best clinical care. Paediatric surgeons have a responsibility to influence the configuration of services to improve the quality of care and equity of access to specialist services for all children in their region. Evidence presented shows how a well-organised and funded regional paediatric surgical service allows children to receive quality treatment closer to home and is reflected in better clinical outcomes, less unnecessary surgery, and fewer complications. A paradigm for support to emerging countries as they increase the capacity and infrastructure of their paediatric surgical services is proposed. The way we judge ourselves and others should relate to our performance across the full scope of roles that a responsible and committed paediatric surgeon is expected to display.

  18. A simple, economical, and effective portable paediatric mock circulatory system.

    PubMed

    Vandenberghe, S; Shu, F; Arnold, D K; Antaki, J F

    2011-07-01

    Ventricular assist devices (VADs) and total artificial hearts have been in development for the last 50 years. Since their inception, simulators of the circulation with different degrees of complexity have been produced to test these devices in vitro. Currently, a new path has been taken with the extensive efforts to develop paediatric VADs, which require totally different design constraints. This paper presents the manufacturing details of an economical simulator of the systemic paediatric circulation. This simulator allows the insertion of a paediatric VAD, includes a pumping ventricle, and is adjustable within the paediatric range. Rather than focusing on complexity and physiological simulation, this simulator is designed to be simple and practical for rapid device testing. The simulator was instrumented with medical sensors and data were acquired under different conditions with and without the new PediaFlowTM paediatric VAD. The VAD was run at different impeller speeds while simulator settings such as vascular resistance and stroke volume were varied. The hydraulic performance of the VAD under pulsatile conditions could be characterized and the magnetic suspension could be tested via manipulations such as cannula clamping. This compact mock loop has proven to be valuable throughout the PediaFlow development process and has the advantage that it is uncomplicated and can be manufactured cheaply. It can be produced by several research groups and the results of different VADs can then be compared easily.

  19. An urban survey of paediatric environmental health concerns: Perceptions of parents, guardians and health care professionals

    PubMed Central

    Buka, Irena; Rogers, W Todd; Osornio-Vargas, Alvaro R; Hoffman, Harold; Pearce, Marni; Li, Yuen Yee

    2006-01-01

    OBJECTIVES To conduct a survey in Edmonton, Alberta, to gather information regarding concerns about the influence of environmental factors on children’s health and to use the information to set an agenda for the resources of the Paediatric Environmental Health Specialty Unit at Misericordia Hospital (Edmonton, Alberta). METHODS Two questionnaires with 28 closed-ended questions were developed to examine parents’, guardians’ and health care professionals’ concerns. They comprised items about six environmental factors (air, water and food quality; household supplies; radiation; and waste disposal). Health care professionals were also asked four questions about their knowledge of and their needs in Paediatric Environmental Health. Parents and guardians attending the public health centres and nurses working therein received questionnaires. Physicians were surveyed by e-mail. RESULTS After verification, the questionnaire data from 400 parents or guardians and 152 health care professionals were used for analyses. Results from contingency table, Hotelling’s T2 and effect size analyses revealed similarities in the levels of concern in both groups, and the results were combined. The greatest concern of both groups was with environmental tobacco smoke, followed by pesticides in water. Concerns about six additional environmental elements were also expressed. The health care professionals showed a high level of concern about the need for resources, specific training and public education regarding paediatric environmental health. CONCLUSION A significant level of concern was consistently found between the two groups studied, regardless of professional training. The highest level of concern was with a well-documented topic (ie, environmental tobacco smoke). Less concern associated with decreased documentation calls for increasing the knowledge of society, including health care professionals, to address the adverse effects of environmental factors on children. PMID

  20. Down syndrome and postoperative complications after paediatric cardiac surgery: a propensity-matched analysis

    PubMed Central

    Tóth, Roland; Szántó, Péter; Prodán, Zsolt; Lex, Daniel J; Sápi, Erzsébet; Szatmári, András; Gál, János; Szántó, Tamás; Székely, Andrea

    2013-01-01

    OBJECTIVES The incidence of congenital heart disease is ∼50%, mostly related to endocardial cushion defects. The aim of our study was to investigate the postoperative complications that occur after paediatric cardiac surgery. METHODS Our perioperative data were analysed in paediatric patients with Down syndrome undergoing cardiac surgery. We retrospectively analysed the data from 2063 consecutive paediatric patients between January 2003 and December 2008. After excluding the patients who died or had missing data, the analysed database (before propensity matching) contained 129 Down patients and 1667 non-Down patients. After propensity matching, the study population comprised 222 patients and 111 patients had Down syndrome. RESULTS Before propensity matching, the occurrences of low output syndrome (21.2 vs 32.6%, P = 0.003), pulmonary complication (14 vs 28.7%, P < 0.001) and severe infection (11.9 vs 22.5%, P = 0.001) were higher in the Down group. Down patients were more likely to have prolonged mechanical ventilation [median (interquartile range) 22 (9–72) h vs 49 (24–117) h, P = 0.007]. The total intensive care unit length of stay [6.9 (4.2–12.4) days vs 8.3 (5.3–13.2) days, P = 0.04] and the total hospital length of stay [17.3 (13.3–23.2) days vs 18.3 (15.1–23.6) days, P = 0.05] of the Down patients were also longer. Mortality was similar in the two groups before (3.58 vs 3.88%, P = 0.86) and after (5.4 vs 4.5%, P = 1.00) propensity matching. After propensity matching, there was no difference in the occurrence of adverse events. CONCLUSIONS After propensity matching Down syndrome was not associated with increased mortality or complication rate following congenital cardiac surgery. PMID:23832837

  1. Paediatrics and the doctor-soldier.

    PubMed

    Pearn, John H

    2012-08-01

    Sick and injured children, like combatants wounded by shot and shell in war, are disproportionately represented in the tallies of both man-made and national disasters. Paediatricians have a particularly proud heritage of military service, a nexus dating in Australia from the early 19th century. This paper traces this link between service to children in peacetime and the care of servicemen, women and children in times of war and disaster. The extraordinary record of Australian 'paediatric' doctors who also served in the Gallipoli Campaign (1915) is documented as an illustration of this duality. Paediatricians who serve in the Defence Reserves and in civilian non-government organisations which respond to disasters and civil wars have special credentials in their advocacy for the protection of children enmeshed in conflict or disaster. Such applies particularly to the banning of the recruitment and use of child soldiers; support for children caught up in refugee and illegal immigrant confrontations; and continued advocacy for greater international compliance with the Ottawa Convention to ban the use of anti-personnel landmines. Volunteering for such service must occur in cold 'down time', ensuring that paediatricians are trained in disaster and conflict response, when such challenges inevitably confront the paediatricians of the future. PMID:22471873

  2. Hand decontamination practices in paediatric wards.

    PubMed

    Jelly, S; Tjale, A

    2003-12-01

    The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixty-six health professionals was obtained through convenience sampling. Results indicated that significantly fewer health professionals did not decontaminate their hands on entering the ward (16.6%), prior to making patient contact (34.8%) and prior to donning gloves (9.1%). Significantly more health professionals did decontaminate their hands following contact with the patient (63.6%) and following removal of gloves (77.8%). More health professional did not wash their hands after leaving the ward (51.5%). More than half (57.6%) of the health professionals who decontaminate their hands used the correct hand washing technique. Compliance with standard hand decontamination practices of health professionals was found to be poor with only 83.4% of health professionals decontaminating their hands at the start of work.

  3. Rectal examination in paediatric trauma care.

    PubMed

    Winnett, M

    1999-01-01

    When providing trauma care, there is a danger that staff might forget what a frightening and confusing experience it can be for the patient, particularly if that patient is a child. As part of an academic exercise in reflection, I recently examined a critical incident involving the trauma care of a 9-year-old boy. In Accident and Emergency (A&E) the doctor inappropriately performed a rectal examination, which I witnessed in horror. The doctor failed to consider the effect of his actions on the child, the legal necessity for consent and the importance of a full explanation. Deeply disturbed by this incident and determined to avoid any repetition, I set out to find documented evidence to support my assertion that no child should be subjected to such intimate examinations, unless absolutely unavoidable. It is hoped that discussion of this incident will serve to raise the awareness of A&E staff working throughout the country with regard to paediatric rectal examination, as has been the case in my own workplace.

  4. Secondary surgery in paediatric facial paralysis reanimation.

    PubMed

    Terzis, Julia K; Olivares, Fatima S

    2010-11-01

    Ninety-two children, the entire series of paediatric facial reanimation by a single surgeon over thirty years, are presented. The objective is to analyse the incidence and value of secondary revisions for functional and aesthetic refinements following the two main stages of reanimation. The reconstructive strategy varied according to the denervation time, the aetiology, and whether the paralysis was uni- or bilateral, complete or partial. Irrespective of these variables, 89% of the patients required secondary surgery. Post-operative videos were available in seventy-two cases. Four independent observers graded patients' videos using a scale from poor to excellent. The effect of diverse secondary procedures was measured computing a mean-percent-gain score. Statistical differences between treatment groups means were tested by the t-test and one-way ANOVA. Two-thirds of the corrective and ancillary techniques utilized granted significantly higher mean-scores post-secondary surgery. A comparison of pre- and post-operative data found valuable improvements in all three facial zones after secondary surgery. In conclusion, inherent to dynamic procedures is the need for secondary revisions. Secondary surgery builds in the potential of reanimation surgery, effectively augmenting functional faculties and aesthesis.

  5. Whole-body MRI in paediatric oncology.

    PubMed

    Nievelstein, Rutger A J; Littooij, Annemieke S

    2016-05-01

    Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron emission tomography and single-photon emission tomography. These later techniques are often combined with CT allowing for simultaneous acquisition of image data on the biological behaviour of tumour, as well as the anatomical localisation and extent of tumour spread. Because of the small but not negligible risk of radiation induced secondary cancers and the significantly improved overall survival rates of children with cancer, there is an increasing interest in the use of alternative imaging techniques that do not use ionising radiation. Magnetic resonance imaging (MRI) is a radiation-free imaging tool that allows for acquiring images with a high spatial resolution and excellent soft tissue contrast throughout the body. Moreover, recent technological advances have resulted in fast diagnostic sequences for whole-body MR imaging (WB-MRI), including functional techniques such as diffusion weighted imaging. In this review, the current status of the technique and major clinical applications of WB-MRI in children with cancer will be discussed.

  6. Recurrent respiratory tract infections in paediatric patients.

    PubMed

    Bellanti, J A

    1997-01-01

    Paediatric respiratory tract infections are one of the most common reasons for physician visits and hospitalisation, and are associated with significant morbidity and mortality. The role of physicians and other healthcare professionals has expanded from merely treating disease to implementing measures aimed at health maintenance and disease prevention. Therefore, children with recurrent respiratory tract infections represent a great challenge for the paediatrician, from both therapeutic and preventive standpoints. The paediatrician must first determine whether these recurrent infections are because of host-derived factors or are the result of increased environmental exposure. Host-derived factors may be nonimmunological or related to host immunodeficiency. The leading cause of recurrent respiratory tract infections throughout the world is increased environmental exposure in children attending nursery school or daycare centres. Acute otitis media in children is of particular concern because of its high incidence, frequent recurrence, and serious long term sequelae, e.g. hearing loss. The socioeconomic impact of these recurrent infections is staggering, and there remains much scope for devising methods for their treatment and prevention. Recent approaches have included the encouragement of breastfeeding, the use of intravenous immunoglobulin and respiratory syncytical virus immune globulin, as well as methods of stimulating immunity, such as ribosomal immunotherapy. PMID:9378072

  7. Ethical issues in paediatric nontherapeutic pain research.

    PubMed

    Kankkunen, Päivi; Vehviläinen-Julkunen, Katri; Pietilä, Anna-Maija

    2002-01-01

    The purpose of this article is to describe the main ethical issues in paediatric nontherapeutic qualitative pain research. It is based on an analysis of the research literature related to ethical issues in research and on experiences from a family interview study focusing on pain assessment and management in children aged 1-6 years. In addition, different views concerning obtaining informed consent from children, as published in the research literature, are compared. Ethical challenges occur during all stages of qualitative research. The risks of emotional distress and possible benefits of the results must be assessed prior to conducting a study. However, risks and harm are difficult to avoid in a study in which the research area, pain, raises emotional distress in both parents and children. The children's assent and parental permission are both required. It is essential to obtain informed consent from all family members when family research is conducted. Participants' privacy and confidentiality should be protected during data collection, analysis and publication. Protecting children from harm may be impossible during pain research in which they are required to recall a painful postoperative period. However, after data collection they can be assisted to focus on pleasant activities, for example, by engaging in playful activities with them. Finally, the role of the nurse and the researcher should be carefully assessed, especially in qualitative research, in order to be able to analyse the data and report the findings in an unbiased manner.

  8. Recent pharmacological advances in paediatric analgesics.

    PubMed

    Anderson, B J; Palmer, G M

    2006-08-01

    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 impact 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 paediatric 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 impact 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

  9. Clinical applications of creatine supplementation on paediatrics.

    PubMed

    Evangeliou, Athanasios; Vasilaki, Konstantina; Karagianni, Paraskevi; Nikolaidis, Nikolaos

    2009-11-01

    Creatine plays a central role in energy metabolism and is synthesized in the liver, kidney and pancreas. In healthy patients, it is transported via the blood stream to the muscles, heart and brain with high and fluctuating energy demands by the molecule creatine transporter. Creatine, although naturally synthesized in the human body, can be ingested in the form of supplements and is commonly used by athletes. The purpose of this review was to assess the clinical applications of creatine supplementation on paediatrics. Creatine metabolism disorders have so far been described at the level of two synthetic steps, guanidinoacetate N-methyltransferase (GAMT) and arginine: glycine amidinotransferase (AGAT), and at the level of the creatine transporter 1(CrT1). GAMT and AGAT deficiency respond positively to substitutive treatment with creatine monohydrate whereas in CrT1 defect, it is not able to replenish creatine in the brain with oral creatine supplementation. There are also data concerning the short and long-term therapeutic benefit of creatine supplementation in children and adults with gyrate atrophy (a result of the inborn error of metabolism with ornithine delta- aminotransferase activity), muscular dystrophy (facioscapulohumeral dystrophy, Becker dystrophy, Duchenne dystrophy and sarcoglycan deficient limb girdle muscular dystrophy), McArdle's disease, Huntington's disease and mitochondria-related diseases. Hypoxia and energy related brain pathologies (brain trauma, cerebral ischemia, prematurity) might benefit from Cr supplementation. This review covers also the basics of creatine metabolism and proposed mechanisms of action. PMID:19751179

  10. Demographic Characteristics of Paediatric Pelvic Fractures: 10-Years’ Experience of Single Paediatric Orthopaedics Clinic

    PubMed Central

    Turgut, Ali; Kalenderer, Onder; Gunaydin, Burak; Korkmaz, Mehmet; Ilyas, Gokhan; Ipci, Fikri Burak

    2015-01-01

    Objective: To evaluate the demographic characteristics of paediatric pelvic fractures. Materials and Methods: Retrospective analysis of 26 patients who were hospitalized with the diagnosis of paediatric pelvic fracture between 2000 and 2010 was performed. Age, gender, hospitalization time, mechanism of injury, fracture type, associated injuries, haemoglobin level drop in the first 24 hours, management and blood transfusion requirement, injuries time (month) information were gathered from hospital records. Results: There were 16 male and 10 female patients. Average age was 10.5 (2–16). Average hospitalization time was 3.5 days (1–17). Average haemoglobin level drop in the first 24 hours was 1.51 (0.3–3.6) gr/dL. Mechanisms of the injuries were as following; 14 patients were struck by a car, 10 patients fell from height and 2 patients involved in a vehicle traffic accident. According to the classification of Torode and Zeig; there was 1 type 2, 22 type 3 and 3 type 4 injuries. Injuries’ occurrence season were; 12 in spring, 7 in summer and 7 in autumn. All of the patients had been managed conservatively. Conclusion: These injuries are rarely seen in children. Their management can be mostly conservative and even with a simple and stable pelvic injury marked bleeding can occur. PMID:26180498

  11. Paediatric dilated cardiomyopathy: clinical profile and outcome. The experience of a tertiary centre for paediatric cardiology.

    PubMed

    Miranda, Joana O; Costa, Liane; Rodrigues, Esmeralda; Teles, Elisa L; Baptista, Maria J; Areias, José C

    2015-02-01

    Dilated cardiomyopathy is the most common form of cardiomyopathy in the paediatric population and an important cause of heart transplantation in children. The clinical profile and course of dilated cardiomyopathy in children have been poorly characterised. A retrospective review of 61 patients (37 female; 24 male) diagnosed with dilated cardiomyopathy from January, 2005 to June, 2012 at a single institution was performed. The median age at diagnosis was 15 months. Heart failure was present in 83.6% of patients and 44.3% required intensive care. The most prevalent causes were idiopathic (47.5%), viral myocarditis (18.0%) and inherited metabolic diseases (11.5%). In viral myocarditis, Parvovirus B19 was the most common identified agent, in concurrence with the increasing incidence documented recently. Inherited metabolic diseases were responsible for 11.5% of dilated cardiomyopathy cases compared with the 4-6% described in the literature, which reinforces the importance of considering this aetiology in differential diagnosis of paediatric dilated cardiomyopathy. The overall mortality rate was 16.1% and five patients underwent heart transplantation. In our series, age at diagnosis and aetiology were the most important prognosis factors. We report no mortality in the five patients who underwent heart transplantation, after 2 years of follow-up.

  12. 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

  13. Pulmonary functional magnetic resonance imaging for paediatric lung disease.

    PubMed

    Kirby, Miranda; Coxson, Harvey O; Parraga, Grace

    2013-09-01

    A better understanding of the anatomic structure and physiological function of the lung is fundamental to understanding the pathogenesis of pulmonary disease and how to design and deliver better treatments and measure response to intervention. Magnetic resonance imaging (MRI) with the hyperpolarised noble gases helium-3 ((3)He) and xenon-129 ((129)Xe) provides both structural and functional pulmonary measurements, and because it does not require the use of x-rays or other ionising radiation, offers the potential for intensive serial and longitudinal studies in paediatric patients. These facts are particularly important in the evaluation of chronic lung diseases such as asthma and cystic fibrosis- both of which can be considered paediatric respiratory diseases with unmet therapy needs. This review discusses MRI-based imaging methods with a focus on hyperpolarised gas MRI. We also discuss the strengths and limitations as well as the future work required for clinical translation towards paediatric respiratory disease. PMID:23522599

  14. Prevalence and outcome of severe malnutrition in children less than five-year-old in Omdurman Paediatric Hospital, Sudan.

    PubMed

    Kanan, Shaza O H; Swar, Mohammed Osman

    2016-01-01

    This is a retrospective observational hospital-based study aimed to determine the prevalence and outcome of severe acute malnutrition in children less than five years admitted to Omdurman Paediatric Hospital during the period January 2014 to December 2014. Data was collected from patient's hospital records during the study period. Ethical approval and permission to access patients' record were obtained. A total of 593 children with severe malnutrition were identified; 305 of cases were male (51.4%) with a male: female ratio of 1:0.9. The mean age these children was 22.3 months. Children 36-59 months were least affected. 35.4% were classified as low socioeconomic class, 22.9% classified as an average class and there were no sufficient data to classify the remaining. The overall prevalence of severe malnutrition was 6.5%, and the general mortality rate was 2.4% while mortality rate among children with severe malnutrition was 9.3%. Among the 593 admitted children with malnutrition, 407 (68.6%) had marasmus, 141 (23.8%) had kwashiorkor and 45 (7.6%) had marasmic-kwashiorkor. The highest prevalence and mortality rate occurred in September. The most common clinical presentations were gastroenteritis, malaria, urinary tract infections, giardiasis, tuberculosis and AIDS. Only 10.8% of the admitted children were exclusively breast fed for the first three months. 33% were fully vaccinated. Overall 75.7% improved and discharged, 15% discharged against medical advice and 9.3% died. We concluded that prevalence and mortality among children with acute severe malnutrition at Omdurman paediatrics hospital were high, and the current management strategies require review to identify the causes. We recommended adopting policies to manage malnutrition in the community and hospitals. PMID:27651550

  15. Prevalence and outcome of severe malnutrition in children less than five-year-old in Omdurman Paediatric Hospital, Sudan

    PubMed Central

    Swar, Mohammed Osman

    2016-01-01

    This is a retrospective observational hospital-based study aimed to determine the prevalence and outcome of severe acute malnutrition in children less than five years admitted to Omdurman Paediatric Hospital during the period January 2014 to December 2014. Data was collected from patient’s hospital records during the study period. Ethical approval and permission to access patients’ record were obtained. A total of 593 children with severe malnutrition were identified; 305 of cases were male (51.4%) with a male: female ratio of 1:0.9. The mean age these children was 22.3 months. Children 36–59 months were least affected. 35.4% were classified as low socioeconomic class, 22.9% classified as an average class and there were no sufficient data to classify the remaining. The overall prevalence of severe malnutrition was 6.5%, and the general mortality rate was 2.4% while mortality rate among children with severe malnutrition was 9.3%. Among the 593 admitted children with malnutrition, 407 (68.6%) had marasmus, 141 (23.8%) had kwashiorkor and 45 (7.6%) had marasmic-kwashiorkor. The highest prevalence and mortality rate occurred in September. The most common clinical presentations were gastroenteritis, malaria, urinary tract infections, giardiasis, tuberculosis and AIDS. Only 10.8% of the admitted children were exclusively breast fed for the first three months. 33% were fully vaccinated. Overall 75.7% improved and discharged, 15% discharged against medical advice and 9.3% died. We concluded that prevalence and mortality among children with acute severe malnutrition at Omdurman paediatrics hospital were high, and the current management strategies require review to identify the causes. We recommended adopting policies to manage malnutrition in the community and hospitals. PMID:27651550

  16. Prevalence and outcome of severe malnutrition in children less than five-year-old in Omdurman Paediatric Hospital, Sudan

    PubMed Central

    Swar, Mohammed Osman

    2016-01-01

    This is a retrospective observational hospital-based study aimed to determine the prevalence and outcome of severe acute malnutrition in children less than five years admitted to Omdurman Paediatric Hospital during the period January 2014 to December 2014. Data was collected from patient’s hospital records during the study period. Ethical approval and permission to access patients’ record were obtained. A total of 593 children with severe malnutrition were identified; 305 of cases were male (51.4%) with a male: female ratio of 1:0.9. The mean age these children was 22.3 months. Children 36–59 months were least affected. 35.4% were classified as low socioeconomic class, 22.9% classified as an average class and there were no sufficient data to classify the remaining. The overall prevalence of severe malnutrition was 6.5%, and the general mortality rate was 2.4% while mortality rate among children with severe malnutrition was 9.3%. Among the 593 admitted children with malnutrition, 407 (68.6%) had marasmus, 141 (23.8%) had kwashiorkor and 45 (7.6%) had marasmic-kwashiorkor. The highest prevalence and mortality rate occurred in September. The most common clinical presentations were gastroenteritis, malaria, urinary tract infections, giardiasis, tuberculosis and AIDS. Only 10.8% of the admitted children were exclusively breast fed for the first three months. 33% were fully vaccinated. Overall 75.7% improved and discharged, 15% discharged against medical advice and 9.3% died. We concluded that prevalence and mortality among children with acute severe malnutrition at Omdurman paediatrics hospital were high, and the current management strategies require review to identify the causes. We recommended adopting policies to manage malnutrition in the community and hospitals.

  17. Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society.

    PubMed Central

    1996-01-01

    OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external

  18. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study

    PubMed Central

    2014-01-01

    Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p < 0.001). The level of cPCO2 was significantly reduced after 4 h in both groups; 1.1 kPa (paediatric ward) (p < 0.001) and 1.3 kPa (ICU) (p = 0.002). Two infants on the ICU did not respond to CPAP (increasing cPCO2 and severe apnoe) and were given mechanical ventilation, otherwise no side effects were observed in either group treated with CPAP. Conclusion Treatment with CPAP for infants with bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed. PMID:24886569

  19. Clinical competence in developmental-behavioural paediatrics: raising the bar.

    PubMed

    O'Keeffe, Mick

    2014-01-01

    For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental-behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency-based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace-based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended.

  20. Global challenges in the development and delivery of paediatric antiretrovirals.

    PubMed

    Bowen, Asha; Palasanthiran, Pamela; Sohn, Annette H

    2008-06-01

    By the end of 2006, compared with 28% coverage for adults, only 15% of children with HIV that needed antiretroviral treatment were receiving it. Major challenges in delivering treatment include the lack of paediatric antiretrovirals that can be dosed in small children and limited studies examining safety and efficacy for existing antiretroviral formulations. The high costs of treatment have been reduced through the use of generic, fixed-dose combination drugs. Evidence-based strategies for managing resistance and the scale-up of pharmacological trials for children in low- and middle-income countries are crucial to the success and future development of paediatric antiretrovirals.

  1. The Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors in Obese Children and Adolescents in Dalmatia: A Hospital Based Study

    PubMed Central

    Milić, Lukrecija; Unić, Ivana; Škrabić, Veselin

    2016-01-01

    Obesity and metabolic syndrome (MS) are one of the biggest public health issues in child and adolescent population. To the best of the authors' knowledge, this hospital based study is the first report on the prevalence of MS in obese children and adolescents in Dalmatia, the Mediterranean part of Croatia. The objectives of this study were to determine the prevalence of individual cardiovascular risk factors and MS. Between January 2009 and June 2014, 201 obese subjects aged 6 to 18 were analyzed retrospectively from our Pediatric Endocrine Unit database. The subjects were then classified in two groups of obesity; subjects with BMI z score 2.0–3.0 were classified as moderately obese and subjects with BMI z score > 3.0 were classified as severely obese. The overall prevalence of MS using the modified IDF criteria was 30.3%. The most common component of MS in both groups was arterial hypertension, while impaired fasting glucose was the least common component of MS. Our finding of high prevalence of MS underlines the importance of early childhood obesity treatment. PMID:27752263

  2. Moral distress in nurses in oncology and haematology units.

    PubMed

    Lazzarin, Michela; Biondi, Andrea; Di Mauro, Stefania

    2012-03-01

    One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral distress. The items with the highest mean intensity in the sample were almost all connected with medical and nursing competence and have considerably higher values than frequency. The instrument was found to be reliable. The results confirmed the validity of the MDS-PV (Cronbach's alpha = 0.959). This study represents the first small-scale attempt to validate MDS-PV for use in paediatric oncology-haematology nurses in Italy.

  3. Burnout, psychological morbidity, job satisfaction, and stress: a survey of Canadian hospital based child protection professionals

    PubMed Central

    Bennett, S; Plint, A; Clifford, T

    2005-01-01

    Aims: (1) To measure the prevalence of burnout, psychological morbidity, job satisfaction, job stress, and consideration of alternate work among multidisciplinary hospital based child and youth protection (CYP) professionals; (2) to understand the relations between these variables; and (3) to understand the reasons for leaving among former programme members. Methods: Mailed survey of current and former members of all Canadian academic hospital based CYP programmes. Surveys for current members contained validated measures of burnout, psychological morbidity, job satisfaction/stress, and questions about consideration of alternate work. Surveys for former members examined motivation(s) for leaving. Results: One hundred and twenty six of 165 current members (76.4%) and 13/14 (92.9%) former members responded. Over one third (34.1%) of respondents exhibited burnout while psychological morbidity was present in 13.5%. Job satisfaction was high, with 68.8% finding their job "extremely" or "quite" satisfying, whereas 26.2% found their job "extremely" or "quite" stressful. Psychological morbidity, job satisfaction, and job stress were not associated with any of the demographic variables measured, but burnout was most prevalent among non-physician programme members. Almost two thirds of current members indicated that they had seriously considered a change in work situation. Former members indicated that burnout and high levels of job stress were most responsible for their decision to leave and that increasing the number of programme staff and, consequently, reducing the number of hours worked would have influenced their decision to stay. Conclusions: Current levels of burnout and the large proportion of individuals who have contemplated leaving the service suggest a potential crisis in Canadian hospital based CYP services. PMID:16243862

  4. Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal

    PubMed Central

    Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan

    2016-01-01

    Introduction Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. Methods A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. Results The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of “days of work loss” were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Conclusion Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated

  5. Costing of a hospital-based outbreak of poultry-borne salmonellosis.

    PubMed

    Yule, B F; Macleod, A F; Sharp, J C; Forbes, G I

    1988-02-01

    Poultry-borne salmonellosis is the most common form of foodborne infection in Scotland for which the vehicle can be identified, yet little is known about the costs imposed on society by this disease, or the costs of preventing it. The present study identifies and values the costs of a hospital based outbreak of poultry-borne salmonellosis. Account is taken of costs falling on individuals, the health services and society as a whole. Depending on assumptions made about the value of 'intangibles', the cost of the outbreak is estimated to be between pounds 200,000 and pounds 900,000. PMID:3338505

  6. Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum.

    PubMed

    Almroth, Lars; Bedri, Hibba; El Musharaf, Susan; Satti, Alia; Idris, Tayseer; Hashim, M Sir K; Suliman, Gaafar I; Bergström, Staffan

    2005-08-01

    To explore paediatric complications of female genital mutilation (FGM), 255 consecutive girls aged 4-9 years presenting to an emergency ward in Sudan were included in this clinical study. Full examination, including inspection of genitalia, was performed. Dipsticks for nitrite and leucocytes were used to diagnose suspected urinary tract infection (UTI). Girls with a form of FGM narrowing vulva had significantly more UTI than others, and among girls below the age of seven there was a significant association between FGM and UTI. Only 8% of girls diagnosed as having UTI reported urogenital symptoms. In spite of the fact that 73% of the girls subjected to FGM were reported to have been bedridden for one week or more after the operation, only 10% stated immediate complications. We conclude that FGM contributes significantly to morbidity among girls, a large share of which does not come to medical attention.

  7. Paediatric ventriculoperitoneal shunt infection caused by Actinomyces neuii.

    PubMed

    Anderson, Ian A; Jarral, Fazain; Sethi, Kavita; Chumas, Paul D

    2014-05-23

    We present the first reported case of ventriculoperitoneal shunt infection secondary to Actinomyces neuii in a paediatric patient. Our patient was managed with temporary shunt removal, intrathecal antibiotics and a prolonged course of intravenous and then oral antibiotics. She went on to make a complete recovery. Subsequent cerebrospinal fluid analysis at 5 months post-treatment demonstrated no evidence of residual infection.

  8. Measuring adherence to treatment of paediatric HIV/AIDS.

    PubMed

    Naar-King, S; Frey, M; Harris, M; Arfken, C

    2005-04-01

    Parent, child, physician report and pill counts were used to measure adherence in paediatric HIV. Relationships to viral load were assessed. Pill counts were considered invalid. Adherence measures did not correlate with one another. Physicians reported lower adherence than parents, but parent and physician report correlated with viral load. The clinical and research utility of the various measures are discussed.

  9. IMMUNE ACTIVATION AND PAEDIATRIC HIV-1 DISEASE OUTCOME

    PubMed Central

    Roider, J; Muenchhoff, M; Goulder, PJR

    2016-01-01

    Purpose of review The paediatric HIV epidemic is changing. Over the past decade, new infections have substantially reduced whilst access to antiretroviral therapy (ART) has increased. Overall this success means that numbers of children living with HIV are climbing. In addition, the problems in adults of chronic inflammation resulting from persistent immune activation even following ART-mediated suppression of viral replication are magnified in children infected from birth. Recent findings Features of immune ontogeny favor low immune activation in early life, whilst specific aspects of paediatric HIV infection tend to increase it. A subset of ART-naïve non-progressing children exists in whom normal CD4 counts are maintained in the setting of persistent high viremia and yet in the context of low immune activation. This sooty mangabey-like phenotype contrasts with non-progressing adult infection characterized by the expression of protective HLA class I molecules and low viral load. The particular factors contributing to raised or lowered immune activation in paediatric infection, and that ultimately influence disease outcome, are discussed. Summary Novel strategies to circumvent the unwanted long-term consequences of HIV infection may be possible in children in whom natural immune ontogeny in early life militates against immune activation. Defining the mechanisms underlying low immune activation in natural HIV infection would have applications beyond paediatric HIV. PMID:26679413

  10. Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives.

    PubMed

    Persico, Antonio M; Arango, Celso; Buitelaar, Jan K; Correll, Christoph U; Glennon, Jeffrey C; Hoekstra, Pieter J; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro

    2015-10-01

    Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.

  11. Surveillance biopsies after paediatric kidney transplantation: A review.

    PubMed

    Rose, Edward M; Kennedy, Sean E; Mackie, Fiona E

    2016-09-01

    Kidney transplantation is the most effective means of treating children with end-stage kidney disease, and yet, there continues to be a limited "life span" of transplanted kidneys in paediatric recipients. Early graft monitoring, using the surveillance biopsy, has the potential to extend renal allograft survival in paediatric recipients. The surveillance biopsy provides important and timely information about acute and chronic graft pathology, particularly SCR and calcineurin inhibitor-induced nephrotoxicity, which can subsequently guide management decisions and improve long-term graft survival. The ostensible value of the surveillance biopsy is furthered by the limitations of conventional renal functional studies. However, there is still much debate surrounding the surveillance biopsy in paediatric recipients, particularly in regard to its overall utility, safety and timing. This review discusses the current literature regarding the utility, safety, and potential predictive value of surveillance biopsies for guiding post-transplant management in paediatric renal allograft recipients, as well as the viability of other potentially newer non-invasive strategies for renal allograft monitoring. PMID:27306873

  12. [The nurse consultation in a Swiss university paediatric emergency department].

    PubMed

    Yersin, Corinne; Hemme, Denis; Gehri, Mario; Pittet, Anne; Rey-Bellet Gasser, Céline

    2015-01-01

    In Switzerland, overcrowding in tertiary emergency departments is a frequent problem, resulting in lengthy waiting times, lower satisfaction on the part of families and a risk for patient's safety. The setting up of a nurse consultation in a university paediatric emergency centre has helped to improve the quality of care in this context. PMID:26573404

  13. How readable are Australian paediatric oral health education materials?

    PubMed Central

    2014-01-01

    Background The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. Methods Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). Results Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term. Conclusion Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested. PMID:25183234

  14. Assessment and medication management of paediatric obsessive-compulsive disorder.

    PubMed

    Stewart, S Evelyn; Hezel, Dianne; Stachon, Andrea C

    2012-05-01

    Paediatric obsessive-compulsive disorder (OCD) is a common, yet under-recognized, neuropsychiatric illness in both clinical and community settings. Symptoms tend to be hidden or misunderstood by affected youth, and parents may inadvertently accommodate OCD, thus worsening its severity. These symptoms may include compulsive reassurance seeking, confessing and 'just right' rituals, in addition to more classic OCD behaviours. Fortunately, numerous psychometric measures are available to assist in clinical assessment of this disorder and its sequelae. Once properly diagnosed, paediatric OCD is highly treatable with empirically proven approaches including cognitive-behaviour therapy (CBT) and serotonin reuptake inhibitor (SRI) medications. Clinically meaningful symptom improvement is the norm following these strategies, although full remission is not, as symptoms tend to wax and wane over time. Paediatric OCD is highly co-morbid with other anxiety disorders, tic disorders, depression and attention-deficit hyperactivity disorder, which also require specific attention. For moderate to severe OCD, an interdisciplinary approach combining individual and family CBT with SRI trials is recommended. For severe treatment-refractory illness, early evidence supports the benefit of augmenting agents, such as atypical antipsychotics and potentially those with glutamatergic activity. Clinical outcome assessment in paediatric OCD should always include broad domains of individual and family functioning, in addition to symptom improvement.

  15. The Infancy of an International Paediatric Pharmacy Network

    PubMed Central

    Knoppert, David; Arenas-Lopez, Sara; McArtney, Rowena

    2008-01-01

    There are several pharmacy and clinical pharmacology organizations in which pediatrics is one of many special interest groups and a few whose focus is entirely pediatric drug therapy. Recently the foundation for the establishment of an International Network of Paediatric Pharmacists has been laid. This paper describes that network. PMID:23055865

  16. Aetiology of Intellectual Disability in Paediatric Outpatients in Northern India

    ERIC Educational Resources Information Center

    Jauhari, Prashant; Boggula, Raju; Bhave, Anupama; Bhargava, Roli; Singh, Chandrakanta; Kohli, Neera; Yadav, Rajesh; Kumar, Rashmi

    2011-01-01

    Aim: To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination. Method: Over a 1-year period, the first three children presenting to the paediatric outpatients department (OPD) on 2 selected weekdays with developmental delay, suspected intellectual disability, or…

  17. Improving infant sleep safety through a comprehensive hospital-based program.

    PubMed

    Goodstein, Michael H; Bell, Theodore; Krugman, Scott D

    2015-03-01

    We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys. Supine sleep knowledge was 99.8% at HD; 94.8% of families planned to always use this position. At F/U, 97.3% retained supine knowledge, and 84.9% maintained this position exclusively (P < .01). Knowledge of crib as safest surface was 99.8% at HD and 99.5% F/U. Use in the parents' room fell to 91.9% (HD) and 68.2% (F/U). Compared to the National Infant Sleep Position Study, the F/U group was more likely to use supine positioning and a bassinette or crib. Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines. PMID:25670685

  18. Improving infant sleep safety through a comprehensive hospital-based program.

    PubMed

    Goodstein, Michael H; Bell, Theodore; Krugman, Scott D

    2015-03-01

    We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys. Supine sleep knowledge was 99.8% at HD; 94.8% of families planned to always use this position. At F/U, 97.3% retained supine knowledge, and 84.9% maintained this position exclusively (P < .01). Knowledge of crib as safest surface was 99.8% at HD and 99.5% F/U. Use in the parents' room fell to 91.9% (HD) and 68.2% (F/U). Compared to the National Infant Sleep Position Study, the F/U group was more likely to use supine positioning and a bassinette or crib. Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.

  19. Hospital-based nurse practitioner roles and interprofessional practice: a scoping review.

    PubMed

    Hurlock-Chorostecki, Christina; Forchuk, Cheryl; Orchard, Carole; van Soeren, Mary; Reeves, Scott

    2014-09-01

    This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty-nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital-based nurse practitioner role.

  20. The decision to add a second hospital-based EMS helicopter.

    PubMed

    Friedman, R; Leicht, M J; Brotman, S

    1989-11-01

    An analysis of the first seven years of performance of our hospital-based emergency medical services (EMS) helicopter was conducted to evaluate the possible need for a second aircraft. A survey of seven hospitals currently operating two or more helicopters resulted in a consensus that one helicopter can effectively perform only 70 to 90 flights per month. The number of requests for our helicopter service has increased 148% from 610 to 1,512 in seven years while the number of completed missions has increased only 92% from 486 (40.5/month) to 935 (78/month). Requests denied due to inclement weather (265 in 1988) cannot be captured with a second visual-flight-rated (VFR) EMS helicopter; however, those missed due to maintenance requirements of the helicopter and overlapping requests (232 in 1988) can be captured. The need for a second aircraft exists when the number of requests for the service grows while the number of captured flights plateaus. Our data and industry survey suggests this will occur at 75 captured flights per month. Affordability and continued overall growth of trauma and other critical care referrals to the base hospital(s) is mandatory. This study provides a model for hospital-based EMS helicopter operators to apply to the decision whether to add a second aircraft. PMID:10296622

  1. Exploring information systems outsourcing in U.S. hospital-based health care delivery systems.

    PubMed

    Diana, Mark L

    2009-12-01

    The purpose of this study is to explore the factors associated with outsourcing of information systems (IS) in hospital-based health care delivery systems, and to determine if there is a difference in IS outsourcing activity based on the strategic value of the outsourced functions. IS sourcing behavior is conceptualized as a case of vertical integration. A synthesis of strategic management theory (SMT) and transaction cost economics (TCE) serves as the theoretical framework. The sample consists of 1,365 hospital-based health care delivery systems that own 3,452 hospitals operating in 2004. The findings indicate that neither TCE nor SMT predicted outsourcing better than the other did. The findings also suggest that health care delivery system managers may not be considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. It is consistent with previous literature to suggest that the high cost of IS may be the main factor driving the outsourcing decision.

  2. Hospital-based nurse practitioner roles and interprofessional practice: a scoping review.

    PubMed

    Hurlock-Chorostecki, Christina; Forchuk, Cheryl; Orchard, Carole; van Soeren, Mary; Reeves, Scott

    2014-09-01

    This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty-nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital-based nurse practitioner role. PMID:24330003

  3. A concept analysis of holistic nursing care in paediatric nursing.

    PubMed

    Tjale, A A; Bruce, J

    2007-12-01

    Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has

  4. An overview of moral distress and the paediatric intensive care team.

    PubMed

    Austin, Wendy; Kelecevic, Julija; Goble, Erika; Mekechuk, Joy

    2009-01-01

    A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared. PMID:19103691

  5. Update in paediatric asthma management: where is evidence challenging current practice?

    PubMed

    Robinson, Paul D; Van Asperen, Peter

    2013-05-01

    Extrapolation of management strategies based on results from predominantly adult asthma studies frequently occurs in paediatric asthma despite increasing evidence that paediatric asthma and, in particular, pre-school recurrent wheeze are very different disease entities. Response to medications in paediatric subjects is often different from that seen in their older adolescent and adult counterparts. In this update, we discussed recent studies that have had important implications for future paediatric asthma management. The overuse of combination inhaled steroid and long-acting beta2 agonist inhalers in paediatric asthma despite ongoing safety concerns is an increasing trend in paediatric asthma, and recent evidence has helped clarify how they should be used in children. Other aspects discussed include the role of oral corticosteroids in pre-school viral-induced wheeze and the utility of leukotriene receptor antagonists in exercise-induced asthma.

  6. 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

  7. 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

  8. Primary immunodeficiency disorders in the developing world: data from a hospital-based registry in India.

    PubMed

    Chinnabhandar, Vasant; Yadav, Satya Prakash; Kaul, Dinesh; Verma, I C; Sachdeva, Anupam

    2014-04-01

    Primary immunodeficiency disorders (PID) are under-reported from the developing world. We present data regarding diagnosis and outcome from a hospital-based registry in India. Forty-seven patients fulfilled diagnostic criteria. Majority were males. Subgroups were disorders of immune dysregulation-29%, B&T-cell abnormalities-28%, predominant antibody deficiencies-23%, other well-defined immunodeficiencies-15%, and phagocyte disorders-4%. Molecular diagnosis was attempted in 12 and was positive in seven. Overall 24 children died. Only three out of 28 children needing stem cell transplant (SCT) underwent the same. Registry data highlights that molecular diagnosis and SCT are a rarity for children with PIDs in the developing world and mortality is high.

  9. A multidisciplinary hospital-based antimicrobial use program: Impact on hospital pharmacy expenditures and drug use.

    PubMed

    Salama, S; Rotstein, C; Mandell, L

    1996-03-01

    The authors' hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour. PMID:22514426

  10. A multidisciplinary hospital-based antimicrobial use program: Impact on hospital pharmacy expenditures and drug use

    PubMed Central

    Salama, Suzette; Rotstein, Coleman; Mandell, Lionel

    1996-01-01

    The authors’ hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour. PMID:22514426

  11. The challenge of sustaining a hospital-based biobank and core molecular laboratory: the Beaumont experience.

    PubMed

    Wilson, George D; D'Angelo, Kirsten; Pruetz, Barbara L; Geddes, Timothy J; Larson, Dianna M; Akervall, Jan

    2014-10-01

    The Beaumont Health System BioBank was established in 2008, not only to leverage the potential to collect biospecimens for translational research, but to undertake such research in a seamless facility that combined high quality biobanking with state-of-the-art laboratory platforms geared towards biospecimen-based research. This report describes the challenge of sustaining a hospital-based biobank with an operating budget exceeding $1,000,000 in a financial climate that favors short-term fiscal goals rather than long-term scientific ambitions. Some of the key areas that are discussed include grants, philanthropy, accreditation, process improvement and commercialization of samples and services. We conclude that grants are not a feasible avenue, in our case, to support a biobank and that philanthropy and commercialization represent the best options for external funding to support stalling internal support, in order to sustain the operations of the BioBank. PMID:25314610

  12. Hospital-based patient education programs and the role of the hospital librarian.

    PubMed Central

    Harris, C L

    1978-01-01

    This paper examines current advances in hospital-based patient education, and delineates the role of the hospital librarian in these programs. Recently, programs of planned patient education have been recognized by health care personnel and the public as being an integral part of health care delivery. Various key elements, including legislative action, the advent of audiovisual technology, and rising health care costs have contributed to the development of patient education programs in hospitals. As responsible members of the hospital organization, hospital librarians should contribute their expertise to patient education programs. They are uniquely trained with skills in providing information on other health education programs; in assembling, cataloging, and managing collections of patient education materials; and in providing documentation of their use. In order to demonstrate the full range of their skills and to contribute to patient care, education, and research, hospital librarians should actively participate in programs of planned patient education. PMID:418835

  13. The challenge of sustaining a hospital-based biobank and core molecular laboratory: the Beaumont experience.

    PubMed

    Wilson, George D; D'Angelo, Kirsten; Pruetz, Barbara L; Geddes, Timothy J; Larson, Dianna M; Akervall, Jan

    2014-10-01

    The Beaumont Health System BioBank was established in 2008, not only to leverage the potential to collect biospecimens for translational research, but to undertake such research in a seamless facility that combined high quality biobanking with state-of-the-art laboratory platforms geared towards biospecimen-based research. This report describes the challenge of sustaining a hospital-based biobank with an operating budget exceeding $1,000,000 in a financial climate that favors short-term fiscal goals rather than long-term scientific ambitions. Some of the key areas that are discussed include grants, philanthropy, accreditation, process improvement and commercialization of samples and services. We conclude that grants are not a feasible avenue, in our case, to support a biobank and that philanthropy and commercialization represent the best options for external funding to support stalling internal support, in order to sustain the operations of the BioBank.

  14. Proton linac for hospital-based fast neutron therapy and radioisotope production

    SciTech Connect

    Lennox, A.J.; Hendrickson, F.R.; Swenson, D.A.; Winje, R.A.; Young, D.E.; Rush Univ., Chicago, IL; Science Applications International Corp., Princeton, NJ; Fermi National Accelerator Lab., Batavia, IL )

    1989-09-01

    Recent developments in linac technology have led to the design of a hospital-based proton linac for fast neutron therapy. The 180 microamp average current allows beam to be diverted for radioisotope production during treatments while maintaining an acceptable dose rate. During dedicated operation, dose rates greater than 280 neutron rads per minute are achievable at depth, DMAX = 1.6 cm with source to axis distance, SAD = 190 cm. Maximum machine energy is 70 MeV and several intermediate energies are available for optimizing production of isotopes for Positron Emission Tomography and other medical applications. The linac can be used to produce a horizontal or a gantry can be added to the downstream end of the linac for conventional patient positioning. The 70 MeV protons can also be used for proton therapy for ocular melanomas. 17 refs., 1 fig., 1 tab.

  15. Prevalence of dry eye diseases in hospital-based population in West Bengal, Eastern India.

    PubMed

    Basak, Samar K; Pal, Partha Pratim; Basak, Soham; Bandyopadhyay, Abhijit; Choudhury, Sumit; Sar, Suchanda

    2012-11-01

    To determine the prevalence of dry eye diseases in general clinical ophthalmic practice in a hospital-based population in West Bengal, Eastern India, a cross-sectional study was undertaken among 3023 subjects with the age of > or = 30 years, attending general ophthalmic clinic in a tertiary eye hospital. Demographics, detailed history and 6-items McMonnies' dry eye questionnaire were asked. Tear film break-up time (TBUT), Schirmer-I test, Rose Bengal (RB) staining, slit lamp examination and Meibomian gland dysfunction (MGD) were studied. Dry eye diseases were significantly higher in women than in men ie, 51.9% versus 48.1% (p < 0.01). Symptom-based dry eye (one or more symptoms present often or most of the time) was diagnosed in 1234 subjects (40.8%). With symptoms and at least one sign [TBUT < 10 seconds, RB staining (van Bjisterveld score: 4 or more) and Schirmer-I test = 5 mm in 5 minutes], the prevalence of dry eye was 786 (26%). Different grades of MeibOmian gland dysfunction (MGD) were detected in 957 cases (31.7%). Primary Sjogren syndrome was found in 21.5%; and 10.9% patients of dry eye had some form of systemic collagen vascular disorders. Using computers was not a risk factor in this geographical area. No significant correlation was seen between significant symptoms and positive signs in the study population. The prevalence of dry eye disease is high in West Bengal, Eastern India in hospital-based population. The risk is higher with age, female gender, systemic collagen diseases and with oral antidepressant/anxiolytic medication. Meibomian gland dysfunction is found to be common among dry eye subjects.

  16. The use of hospital-based nurses for the surveillance of potential disease outbreaks.

    PubMed Central

    Durrheim, D. N.; Harris, B. N.; Speare, R.; Billinghurst, K.

    2001-01-01

    OBJECTIVE: To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiencies in the system of notification for infectious conditions that have the potential for causing outbreaks. METHODS: Hospital-based infection control nurses in all of Mpumalanga's 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. FINDINGS: Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. No secondary cases followed detection and prompt response to 14 patients with meningococcal disease. By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. CONCLUSION: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action. PMID:11217663

  17. Patient disclosure of medical errors in paediatrics: A systematic literature review.

    PubMed

    Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah

    2016-05-01

    Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.

  18. Sentinel lymph node biopsy in paediatric melanoma. A case series.

    PubMed

    Sánchez Aguilar, M; Álvarez Pérez, R M; García Gómez, F J; Fernández Ortega, P; Borrego Dorado, I

    2015-01-01

    The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity.

  19. Are we ready for universal influenza vaccination in paediatrics?

    PubMed

    Principi, Nicola; Esposito, Susanna

    2004-02-01

    Recent studies have suggested that paediatric influenza is a greater medical problem than usually thought because it can cause excess hospitalisations, medical visits, and antibiotic prescriptions even in healthy children, especially those under 2 years. Furthermore, influenza in otherwise healthy children may have substantial socioeconomic consequences for the children and their household contacts. These findings have led many experts to encourage the more widespread use of influenza vaccine in childhood. Although the immunogenicity of the available vaccines is good and they are safe, well-tolerated, and highly effective in preventing influenza and its complications, economic data support universal vaccination only when indirect effectiveness is considered. However, infants aged 6-23 months, children with recurrent acute otitis media or respiratory-tract infections, and healthy children attending day-care centres or elementary schools should be included among the paediatric groups requiring vaccination. PMID:14871631

  20. [Clinical basics of supraglottic airway management in paediatric anaesthesia].

    PubMed

    Goldmann, Kai

    2013-04-01

    The low invasiveness and simplicity of use of the LMA-Classic™ contributed substantially to the supraglottic airway management acquiring a special role in the anaesthesia care of neonates and children. Due to the introduction of new supraglottic airway devices and the expansion of indications, this form of airway management has a predominant role in paediatric anaesthesia in many institutions nowadays. As securing the airway "above the glottis" differs substantially in some aspects from securing the airway using the endotracheal tube it is mandatory to acknowledge special aspects in routine clinical practice in order to avoid complications. The following article describes basic aspects of supraglottic airway management in paediatric anaesthesia and illustrates, where possible, the available scientific evidence in the use of different supraglottic airway devices in this regard. PMID:23633257

  1. The role of communication in paediatric drug safety

    PubMed Central

    Stebbing, Claire; Wong, Ian C K; Kaushal, Rainu; Jaffe, Adam

    2007-01-01

    Medication errors cause substantial harm to patients, and considerable cost to healthcare systems. Evidence suggests that communication plays a crucial role in the generation, management and prevention of such incidents. This review identifies how paediatric medication errors can be managed, and in particular focuses on the pathway of steps that can operationalise the current research findings. Furthermore, the current data suggesting how communication can help to prevent errors occurring in the first place is examined. From this data, it is apparent that there are three domains in which communication could play an important preventative role: first, patient doctor communication, and second interprofessional communication and finally researcher/professional dialogue. This review is an attempt to identify the importance of communication in paediatric mediation safety and to allow practical application of these findings. PMID:17449527

  2. Realities of paediatric pharmacotherapy in the developing world.

    PubMed

    Hoppu, Kalle; Sri Ranganathan, Shalini; Dodoo, Alex N O

    2011-08-01

    Diseases causing high mortality in children under 5 years of age in resource limited settings (RLS) could be treated if children in these countries had access to existing medicines. It took 30 years before the WHO Essential Medicines List (EML) considered the issue of medicines for children, with the first EML for children being published in 2007. Recent data indicate that less than half of the key paediatric essential medicines are available in countries of sub-Saharan Africa. Problems include substandard medicines, irrational use of medicines, inefficiency and even possible corruption in pharmaceutical management systems. These are global issues which affect RLS most. Clinical trials in developing countries for the benefit of children are needed but challenging in several ways. In this review, the authors will consider the following areas where progress could improve paediatric pharmacotherapy in RLS: registration and regulation of medicines, rational use of medicines, clinical trials in children and restriction of corruption in pharmaceutical management systems.

  3. Learning preference and personality type: their association in paediatric residents.

    PubMed

    Greenberg, L W; Goldberg, R M; Foley, R P

    1996-07-01

    The objective of this study was to determine if there is a relationship between the learning preferences and personality types of residents in paediatrics. As part of a study to teach residents in paediatrics how to teach, the authors administered the Learning Preference Inventory (LPI) and Fundamental Interpersonal Relationship Orientation (FIRO-B) instruments to 55 residents in paediatrics at all three levels of training. The instruments provided data that were used to provide feedback to residents on their learning preferences and interaction styles, as well as how these factors might affect teaching and learning in the clinical setting. The Pearson correlation coefficient was used to determine relationships between the LPI and the FIRO-B. Fifty-two of the 55 residents (95%) completed the instruments. The results revealed that residents' learning preferences were significantly related to their personality types. For example, residents with high inclusion and affection scores on the FIRO-B preferred learning with others, which was significantly related to their high interpersonal scores on the LPI. Residents with low inclusion and affection scores were more likely to prefer independent learning (high individual and student-structured scores on the LPI) and abstract learning at statistically significant levels. The scores obtained by residents in paediatrics on the LPI were strongly correlated with those obtained on the FIRO-B. These data may have important implications for the way in which staff recruit, counsel and teach residents. The fact that the LPI is easy to administer and does not purport to measure personality styles makes it an acceptable educational tool that can be used in many areas of training.

  4. 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

  5. [Treatment of acute otitis media in paediatrics: a meta-analysis].

    PubMed

    Esposito, Silvano; Novelli, Andrea; Noviello, Silvana

    2005-06-01

    Otitis represents the second most common infection of the upper respiratory tract, its treatment being the most common cause for prescribing antibiotics in the United States. A large number of antimicrobials, especially beta-lactams and macrolides, are generally used for treating acute otitis media (AOM) in paediatric patients, owing to their antibacterial spectrum including the main aetiological pathogens. Efficacy, safety and compliance of Cefaclor were compared with those of other antibiotics in the treatment of paediatric AOM in a meta-analysis of randomized controlled trials published between 1981 and 2004. Overall, evaluations were performed on 24 studies (Medline/PubMed, keywords "Cefaclor and otitis") which proved eligible (jadad score > or = 1); sixteen out of the 24 studies were multicentre, seven were double-blind. Mostly, the comparator agent was a beta-lactam, in four and three cases it was a macrolide or the association trimethoprim-sulfamethoxazole, respectively. Efficacy and safety were end-points of all studies whereas only 9 studies evaluated compliance. For the majority of studies (16/24) Cefaclor was administered for 10-day course. The analysis was based on a 2 x 2 contingency table with classification by treatment and number of improvements/cures, side-effects, and compliance of individual studies. The global estimate of the effective treatments was obtained with the weighted mean of the log OR (Odd Ratio) according to Mantel-Haenszel and associated confidence intervals (CI) at 95%. All the calculations were performed using SAS v.8. Chi-square test was performed. Clinical efficacy evaluation, number of improvements/cures, did not evidence a statistically significant difference among Cefaclor and comparators (86.8% vs 88.7%; Odds Ratio 0.77, IC 0.61/0.94). In the Cefaclor-treated patients, adverse events were observed in a statistically significant lower percentage compared to other antibiotics: 13.3% vs 19.4% (P < 0.0001), diarrhoea and gastro

  6. Conflict escalation in paediatric services: findings from a qualitative study

    PubMed Central

    Forbat, Liz; Teuten, Bea; Barclay, Sarah

    2015-01-01

    Objective To explore clinician and family experiences of conflict in paediatric 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 paediatric 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 practical, evidence-based framework to identify the warning signs of conflict in paediatrics. PMID:25940425

  7. Paediatric intraocular lens implants: accuracy of lens power calculations.

    PubMed

    O'Gallagher, M K; Lagan, M A; Mulholland, C P; Parker, M; McGinnity, G; McLoone, E M

    2016-09-01

    PurposeThis study aims to evaluate the accuracy of lens prediction formulae on a paediatric population.MethodsA retrospective case-note review was undertaken of patients under 8 years old who underwent cataract surgery with primary lens implantation in a regional referral centre for paediatric ophthalmology, excluding those whose procedure was secondary to trauma. Biometric and refractive data were analysed for 43 eyes, including prediction errors (PE). Statistical measures used included mean absolute error (MAE), median absolute error (MedAE), Student's t-test and Lin's correlation coefficient.ResultsThe mean PE using the SRK-II formula was +0.96 D (range -2.47D to +2.41 D, SD 1.33 D, MAE 1.38 D, MedAE 1.55, n=15). The mean PE was smaller using SRK/T (-0.18 D, range -3.25 D to +3.95 D, SD 1.70 D, MAE 1.30 D, MedAE 1.24, n=27). We performed an analysis of the biometry data using four different formula (Hoffer Q, Holladay 1, SRK-II and SRK/T). Hoffer Q showed a smaller MedAE than other formulae but also a myopic bias.ConclusionOur clinical data suggest SRK/T was more accurate in predicting post-operative refraction in this cohort of paediatric patients undergoing cataract surgery. Hoffer Q may have improved accuracy further.

  8. RADIATION DOSE IN PAEDIATRIC COMPUTED TOMOGRAPHY: RISKS AND BENEFITS

    PubMed Central

    Ogbole, G.I.

    2010-01-01

    Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. However as the number of CT procedures performed globally have continued to increase; with growing concerns about patient protection. Currently, no system is in place to track patient doses and the lifetime cumulative dose from medical sources. The widespread use of CT even in developing countries has raised questions regarding the possible threat to public health especially in children. The best available risk estimates suggest that paediatric CT will result in significantly increased lifetime radiation risk over adult CT. Studies have shown that lower milliampere-second (mAs) settings can be used for children without significant loss of information. Although the risk–benefit balance is still strongly tilted toward benefit, there is still need for caution. Furthermore since the frequency of paediatric CT examinations is rapidly increasing, and estimates suggest that quantitative lifetime radiation risks for children are not negligible, efforts should be made toward more active reduction of CT exposure settings in paediatric patients. This article hopes to address this concerns and draw attention to the fact that children are not ‘small adults ’ and should therefore be treated differently. PMID:25161479

  9. Burn epidemiology and cost of medication in paediatric burn patients.

    PubMed

    Koç, Zeliha; Sağlam, Zeynep

    2012-09-01

    Burns are common injuries that cause problems to societies throughout the world. In order to reduce the cost of burn treatment in children, it is extremely important to determine the burn epidemiology and the cost of medicines used in burn treatment. The present study used a retrospective design, with data collected from medical records of 140 paediatric patients admitted to a burn centre between 1 January 2009 and 31 December 2009. Medical records were examined to determine burn epidemiology, medication administered, dosage, and duration of use. Descriptive statistical analysis was completed for all variables; chi-square was used to examine the relationship between certain variables. It was found that 62.7% of paediatric burns occur in the kitchen, with 70.7% involving boiling water; 55.7% of cases resulted in third-degree burns, 19.3% required grafting, and mean duration of hospital stay was 27.5 ± 1.2 days. Medication costs varied between $1.38 US dollars (USD) and $14,159.09, total drug cost was $46,148.03 and average cost per patient was $329.63. In this study, the medication cost for burn patients was found to be relatively high, with antibiotics comprising the vast majority of medication expenditure. Most paediatric burns are preventable, so it is vital to educate families about potential household hazards that can be addressed to reduce the risk of a burn. Programmes are also recommended to reduce costs and the inappropriate prescribing of medication.

  10. 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.

  11. Thyroid abnormalities in paediatric patients with vitiligo: retrospective study

    PubMed Central

    Borlu, Murat; Çınar, Salih Levent; Kesikoğlu, Ayten; Utaş, Serap

    2016-01-01

    Introduction The association between vitiligo and thyroid disease is not fully investigated especially in paediatric patients. Aim To determine the incidence of vitiligo and thyroid disorders in children. This is the first report from middle Anatolia and the second report from Turkey. Material and methods A retrospective chart review was performed to examine the presence of thyroid abnormalities in paediatric patients who had been admitted to the dermatology department with vitiligo. Results A total of 155 paediatric patients, including 80 (52%) male and 75 (48%) female patients were included. The mean age was 8.6 years. Non segmental vitiligo was the most common type of the disease in 140 (90%) reviewed patients, while segmental vitiligo appeared only in 15 (10%) patients. The mean onset of vitiligo was 5.6 ±0.9 years. A family history of vitiligo was found in 14 (9%) children. Thirty-four (22%) patients had thyroid function tests and/or thyroid autoantibody abnormality. All of these patients had non segmental vitiligo. It was statistically significant (p < 0.05) in types of vitiligo and thyroid disease parameters. Conclusions Our results show that it may be useful to screen thyroid in children with non segmental vitiligo. PMID:27512360

  12. 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

  13. Paediatric x-ray examinations in Rio de Janeiro

    NASA Astrophysics Data System (ADS)

    Azevedo, A. C. P.; Osibote, O. A.; Boechat, M. C. B.

    2006-08-01

    This work presents the results of a dose survey performed for paediatric patients and carried out in two large paediatric public hospitals in Rio de Janeiro city. The entrance surface dose (ESD) and the effective dose (ED) were evaluated for chest, skull, abdomen, lumbar spine, cervical spine and pelvis in antero-posterior (AP), postero-anterior (PA) and lateral (LAT) projections. For each examination, four age groups 0-1, 1-5, 5-10 and 10-15 years were studied. The DoseCal software was used to calculate these doses. Wide variations for the same type of examination and projection have been detected. These variations were evident, in Brazil, from previous work. In spite of the present results being still preliminary, they can give an idea of what paediatric ESDs are like in Brazil. Also, with respect to the entrance surface dose, some of the results are above the reference levels, which cause high ED, as well. On the other hand, the wide range of ESD reflects the disparity of radiographic techniques and demonstrates that the ALARA principle is not being applied in Brazilian hospitals and becomes a concern in terms of public health.

  14. Blood and Body Fluid Exposure Related Knowledge, Attitude and Practices of Hospital Based Health Care Providers in United Arab Emirates

    PubMed Central

    Griffiths, Robin; Beshyah, Salem A; Myers, Julie; Zaidi, Mukarram A

    2012-01-01

    Objectives Knowledge, attitudes, and practices of healthcare providers related to occupational exposure to bloodborne pathogens were assessed in a tertiary-care hospital in Middle East. Methods A cross-sectional study was undertaken using a self-administered questionnaire based on 3 paired (infectivity known vs. not known-suspected) case studies. Only 17 out of 230 respondents had an exposure in the 12 months prior to the survey and of these, only 2 had complied fully with the hospital's exposure reporting policy. Results In the paired case studies, the theoretical responses of participating health professionals showed a greater preference for initiating self-directed treatment with antivirals or immunisation rather than complying with the hospital protocol, when the patient was known to be infected. The differences in practice when exposed to a patient with suspected blood pathogens compared to patient known to be infected was statistically significant (p < 0.001) in all 3 paired cases. Failure to test an infected patient's blood meant that an adequate risk assessment and appropriate secondary prevention could not be performed, and reflected the unwillingness to report the occupational exposure. Conclusion Therefore, the study demonstrated that healthcare providers opted to treat themselves when exposed to patient with infectious disease, rather than comply with the hospital reporting and assessment protocol. PMID:23019533

  15. Routine urine microscopy and culture in paediatric surgical outpatients: is it necessary?

    PubMed

    Godbole, P; Johnstone, J M S

    2004-02-01

    Midstream urine culture has been the gold standard for diagnosing a urinary tract infection. But sample collection in children can be time-consuming and frustrating. In our department, a urine sample is routinely collected by the nursing staff prior to the outpatient consultation. We therefore reviewed our practice with respect to correlation with symptoms, change in management occurring as a result of the culture, and financial implications. Case notes of 109 children attending paediatric nephrourology clinics over a three-month period were retrospectively reviewed. Data collected included underlying diagnosis, symptomatology, urine culture results at current and previous outpatient visits, and change in management that occurred as a direct result of the culture. A pure growth of >10(5 )colony-forming units/ml was considered to be a positive result. Of 783 urine samples, only 23 were positive in 15 patients, nine of which required change in management. All of these nine patients were symptomatic at or just preceding the clinic visit. None of the remaining patients in the group had symptoms of a urinary tract infection at the time of the outpatient visit. Change in management therefore occurred in 8.3% of patients, all symptomatic, based on the results of 1.1% of urine samples. At a cost of pound 3.00 per sample during working hours, the cost of processing 783 samples was pound 2349.00. We conclude that urine samples from paediatric surgical outpatients should not be sent routinely unless the patients are symptomatic or a change in management is anticipated. Other techniques to screen for urine samples needing culture may be considered.

  16. A critical ethnographic look at paediatric intensive care nurses and the determinants of nurses' job satisfaction.

    PubMed

    Mahon, Paula R

    2014-02-01

    The aim of this study is to examine key features within the cultural context in a Canadian Paediatric Intensive Care Unit (PICU) environment as experienced by nurses and to identify what these influences are and how they shape nurses' intentions to remain at critically ill children's bedsides for the duration of their careers. This is a qualitative study which follows a critical ethnographic approach. Over 20 hours of observation and face-to-face semi-structured interviews were conducted. Approximately one third of the nursing population at the research site PICU were interviewed (N=31). Participants describe a complex process of becoming an expert PICU nurse that involved several stages. By the time participants became experts in this PICU they believed they had significantly narrowed the power imbalance that exists between nursing and medicine. This study illuminates the role both formal and informal education plays in breaking the power barrier for nurses in the PICU. This level of expertise and mutual respect between professions aids in retaining nurses in the PICU. The lack of autonomy and/or respect shown to nurses by administrators appears to be one of the major stressors in nurses' working lives and can lead to attrition from the PICU. Family Centred Care (FCC) is practiced in paediatrics and certainly accentuated in the PICU as there is usually only one patient assigned per nurse, who thus afforded the time to provide comprehensive care to both the child and the family. This is considered one of the satisfiers for nurses in the PICU and tends to encourage retention of nurses in the PICU. However, FCC was found to be an inadequate term to truly encompass the type of holistic care provided by nurses in the PICU.

  17. Tattoo Practices in North-East India: A Hospital-based Cross-sectional Study

    PubMed Central

    Thakur, Binod Kumar; Verma, Shikha

    2016-01-01

    Background: Tattooing has become increasingly popular, particularly among young people. However, little is known about the tattoo practices in North-East India. Objectives: The primary objective of this study was to know the reasons and motivations of tattoo application and tattoo removal in individuals asking for tattoo removal. The secondary objective was to identify the demography, methods and safety of tattoo practices in these tattooed individuals. Materials and Methods: A hospital-based cross-sectional study was carried out in 212 consecutive individuals seeking tattoo removal. Chi-square and Fisher's exact tests were performed for intergroup comparisons. Results: There were 178 (84%) males and 34 (16%) females. The mean ± standard deviation (SD) age of individuals seeking tattoo removal was 21.8 ± 4 years. The mean ± SD age of doing tattoo was 15.8 ± 3 years. Most individuals possessed an amateur tattoo (94.3%), 4.2% a professional one and 1.4% had a combination. Sewing needle was the most common instrument used for making tattoos in 51.4%. The individuals made their tattoos in an unsterile manner in 49.1%. The most common reason for doing tattoo was for fashion in 87.7%. The participants wanted tattoo removal to qualify for jobs, especially in armed forces in 49.5% and due to regret in 21.7%. Black was the most preferred colour in 37.3% followed by green in 28.3%. The fabric ink was the choice of ink in maximum number of individuals, i.e. 93.9%. Limitations: It was a hospital-based study done only on individuals seeking tattoo removal. It needs caution to generalise the findings in population. In addition, there may be recall bias in the participants. Conclusion: The tattoo was done mostly below 18 years of age in a crude unsterile way. The individuals had poor risk perceptions about various infections and complications of tattooing. There is an urgent need to caution and educate the youngsters and school-going children about safe tattooing and

  18. Hospital-Based Multidisciplinary Teams Can Prevent Unnecessary Child Abuse Reports and Out-of-Home Placements

    ERIC Educational Resources Information Center

    Wallace, Gregory H.; Makoroff, Kathi L.; Malott, Heidi A.; Shapiro, Robert A.

    2007-01-01

    Objective: To determine how often and for what reasons a hospital-based multidisciplinary child abuse team concluded that a report of alleged or suspected child abuse was unnecessary in young children with fractures. Methods: A retrospective review was completed of all children less than 12 months of age who, because of fractures, were referred to…

  19. A statewide nurse training program for a hospital based infant abusive head trauma prevention program.

    PubMed

    Nocera, Maryalice; Shanahan, Meghan; Murphy, Robert A; Sullivan, Kelly M; Barr, Marilyn; Price, Julie; Zolotor, Adam

    2016-01-01

    Successful implementation of universal patient education programs requires training large numbers of nursing staff in new content and procedures and maintaining fidelity to program standards. In preparation for statewide adoption of a hospital based universal education program, nursing staff at 85 hospitals and 1 birthing center in North Carolina received standardized training. This article describes the training program and reports findings from the process, outcome and impact evaluations of this training. Evaluation strategies were designed to query nurse satisfaction with training and course content; determine if training conveyed new information, and assess if nurses applied lessons from the training sessions to deliver the program as designed. Trainings were conducted during April 2008-February 2010. Evaluations were received from 4358 attendees. Information was obtained about training type, participants' perceptions of newness and usefulness of information and how the program compared to other education materials. Program fidelity data were collected using telephone surveys about compliance to delivery of teaching points and teaching behaviors. Results demonstrate high levels of satisfaction and perceptions of program utility as well as adherence to program model. These findings support the feasibility of implementing a universal patient education programs with strong uptake utilizing large scale systematic training programs.

  20. Use of Hospital-Based Food Pantries Among Low-Income Urban Cancer Patients.

    PubMed

    Gany, Francesca; Lee, Trevor; Loeb, Rebecca; Ramirez, Julia; Moran, Alyssa; Crist, Michael; McNish, Thelma; Leng, Jennifer C F

    2015-12-01

    To examine uptake of a novel emergency food system at five cancer clinics in New York City, hospital-based food pantries, and predictors of use, among low-income urban cancer patients. This is a nested cohort study of 351 patients who first visited the food pantries between October 3, 2011 and January 1, 2013. The main outcome was continued uptake of this food pantry intervention. Generalized estimating equation (GEE) statistical analysis was conducted to model predictors of pantry visit frequency. The median number of return visits in the 4 month period after a patient's initial visit was 2 and the mean was 3.25 (SD 3.07). The GEE model showed that younger patients used the pantry less, immigrant patients used the pantry more (than US-born), and prostate cancer and Stage IV cancer patients used the pantry more. Future long-term larger scale studies are needed to further assess the utilization, as well as the impact of food assistance programs such as the this one, on nutritional outcomes, cancer outcomes, comorbidities, and quality of life. Cancer patients most at risk should be taken into particular consideration.

  1. The Impact of Hospital-Based Skilled Nursing Facility Closures on Rehospitalizations

    PubMed Central

    Rahman, Momotazur; Zinn, Jacqueline S; Mor, Vincent

    2013-01-01

    Objective To examine the effect of reductions in hospital-based (HB) skilled nursing facility (SNF) bed supply on the rate of rehospitalization of patients discharged to any SNF from zip codes that lost HB beds. Data Source We used Medicare enrollment records, Medicare hospital and SNF claims, and nursing home Minimum Dataset assessments and characteristics (OSCAR) to examine nearly 10 million Medicare fee-for-service hospital discharges to SNFs between 1999 and 2006. Study Design We calculated the number of HB and freestanding (FS) SNF beds within a 22 km radius from the centroid of all zip codes in which Medicare beneficiaries reside in all years. We examined the relationship between HB and FS bed supply and the rehospitalization rates of the patients residing in corresponding zip codes in different years using zip code fixed effects and instrumental variable methods including extensive sensitivity analyses. Principal Findings Our estimated coefficients suggest that closure of 882 HB homes during our study period resulted in 12,000–18,000 extra rehospitalizations within 30 days of discharge. The effect was largely concentrated among the most acutely ill, high-need patients. Conclusions SNF patient-based prospective payment resulted in closure of higher cost HB facilities that had served most postacute patients. As other, less experienced SNFs replaced HB facilities, they were less able to manage high acuity patients without rehospitalizing them. PMID:23033808

  2. Using lean Six Sigma to improve hospital based outpatient imaging satisfaction.

    PubMed

    McDonald, Angelic P; Kirk, Randy

    2013-01-01

    Within the hospital based imaging department at Methodist Willowbrook, outpatient, inpatient, and emergency patients are all performed on the same equipment with the same staff. The critical nature of the patient is the deciding factor as to who gets done first and in what order procedures are performed. After an aggressive adoption of Intentional Tools, the imaging department was finally able to move from a two year mean Press Ganey, outpatient satisfaction average score of 91.2 and UHC percentile ranking of 37th to a mean average of 92.1 and corresponding UHC ranking of 60th percentile. It was at the 60th percentile ranking that the department flat lined. Using the Six Sigma DMAIC process, opportunity for further improvement was identified. A two week focus pilot was conducted specifically on areas identified through the Six Sigma process. The department was able to jump to 88th percentile ranking and a mean of 93.7. With pay for performance focusing on outpatient satisfaction and a financial incentive to improving and maintaining the highest scores, it was important to know where the imaging department should apply its financial resources to obtain the greatest impact.

  3. A Hospital-Based Interdisciplinary Model for Increasing Nurses' Engagement in Legislative Advocacy.

    PubMed

    Waddell, Ashley; Audette, Kathryn; DeLong, Amy; Brostoff, Marcie

    2016-02-01

    The Legislative Action Interest Group (LAIG) is a hospital-based health policy forum that engages nurses in exploring clinical implications of existing and pending health policies and regulations, while also creating a feedback loop to inform policy makers about the realities nursing practice and patient care. The LAIG is a collaborative effort between the hospital's Department of Nursing and Patient Care Services and the Office of Government Relations at an academic children's hospital. Nurses participating in the LAIG forums build a working knowledge of health policy and can articulate the practice realities for policy decision makers. Participants explore the political context of nursing and pediatric policies while learning about the state legislative process. Beyond the monthly meetings, members build policy advocacy skills and have testified at public hearings, met with state and federal legislators, and led tours for policy makers through the hospital. The LAIG model also benefits the government relations staff by providing time for them to discuss clinical implications of pending policies with nurses from practice settings in the hospital. Forum discussions enhance the ability of the hospital's lobbyists to articulate practice implications of health policy to lawmakers. This case study, describing the origin, structure, operations, and outcomes of the LAIG model, and has implications for nurses in hospitals and academic settings who are interested in engaging in policy work. Opportunities to research the sustainability, replicability, and patient-centered outcomes of LAIG forums represent future work needed to advance nursing's participation in policy. PMID:26880725

  4. Seroprevalence of Cysticercus Antibodies in Japanese Encephalitis Patients in Upper Assam, India: A Hospital Based Study

    PubMed Central

    Mazumdar, Himangshu; Saikia, Lahari

    2016-01-01

    Introduction Co-infection of Japanese Encephalitis (JE) and Cysticercosis is attributed mainly to the common epidemiological features between the two diseases. Not much is known about the clinical implications of one infection over the other. Aim The study aimed at establishing whether JE-Cysticercosis co-infection is prevalent in the Upper Assam districts and to explore additional details about such co-infections both clinically and epidemiologically. Materials and Methods The present study was a retrospective cross-sectional hospital based study conducted between July 2013 and June 2014 and included 272 Acute Encephalitis Syndrome (AES) patients. Out of this, 137 JE positive and 135 non-JE Acute encephalitis patients were taken as cases and controls respectively. The diagnosis of JE and Cysticercosis was established by ELISA. Statistical Analysis EpiInfo ver. 7 was used for statistical analysis. Chi-square was used and p-value < 0.05 was considered to be statistically significant. Results The association of Cysticercosis with JE was found to be statistically significant (14.6%, p = 0.0019) in the cases with reference to the controls (3.7%). Moreover, the co-infections were found to be more common in case of adults (19.32%, p = 0.0360); with males having a greater odds (5.25, p = 0.0008) of harbouring the parasite as compared to females. Conclusion The study proves that the association of Cysticercosis and JE holds true in this region. PMID:27437215

  5. Using lean Six Sigma to improve hospital based outpatient imaging satisfaction.

    PubMed

    McDonald, Angelic P; Kirk, Randy

    2013-01-01

    Within the hospital based imaging department at Methodist Willowbrook, outpatient, inpatient, and emergency patients are all performed on the same equipment with the same staff. The critical nature of the patient is the deciding factor as to who gets done first and in what order procedures are performed. After an aggressive adoption of Intentional Tools, the imaging department was finally able to move from a two year mean Press Ganey, outpatient satisfaction average score of 91.2 and UHC percentile ranking of 37th to a mean average of 92.1 and corresponding UHC ranking of 60th percentile. It was at the 60th percentile ranking that the department flat lined. Using the Six Sigma DMAIC process, opportunity for further improvement was identified. A two week focus pilot was conducted specifically on areas identified through the Six Sigma process. The department was able to jump to 88th percentile ranking and a mean of 93.7. With pay for performance focusing on outpatient satisfaction and a financial incentive to improving and maintaining the highest scores, it was important to know where the imaging department should apply its financial resources to obtain the greatest impact. PMID:23577532

  6. Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders.

    PubMed

    Hewson, I D; Daly, J; Hallett, K B; Liberali, S A; Scott, C L M; Spaile, G; Widmer, R; Winters, J

    2011-06-01

    Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.

  7. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

    PubMed Central

    López-Liria, Remedios; Padilla-Góngora, David; Catalan-Matamoros, Daniel; Rocamora-Pérez, Patricia; Pérez-de la Cruz, Sagrario; Fernández-Sánchez, Manuel

    2015-01-01

    Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. PMID:25961017

  8. Hospital-based surveillance of Japanese encephalitis at a tertiary hospital in Manila.

    PubMed

    Alera, Ma Theresa P; Velasco, John Mark S; Ypil-Cardenas, Charity Ann; Jarman, Richard G; Nisalak, Ananda N; Thaisomboonsuk, Butsaya; Gibbons, Robert V; Dimaano, Efren M; Yoon, In-Kyu

    2013-09-01

    Japanese encephalitis virus (JEV) is endemic in the Philippines but the incidence and burden of disease are not well established. We conducted a prospective hospital-based study at San Lazaro Hospital, a tertiary level hospital in Manila, from September 2005 to December 2006. Cases were determined using an in-house dengue and Japanese encephalitis (JE) enzyme-linked immunosorbent assay in order to detect the proportion of JE cases among the acute encephalitis syndrome (AES) cases admitted to our hospital. Fifteen patients were found to have AES, of whom 6 (40%) had confirmed JE. Of the JE cases, 4 were females and 2 were males with an age range of 3-14 years. Three of the 6 JE cases occurred during July. The most common signs and symptoms on admission among JE cases were: fever, headache, loss of appetite, neck rigidity and altered sensorium. JE likely comprises a significant proportion of hospitalized AES cases among children from Manila and nearby provinces. Further studies on the nation-wide prevalence and distribution of JE in the Philippines are needed to guide health authorities in disease control and prevention strategies.

  9. Depression and Anxiety Disorders among Patients with Psoriasis: A Hospital-Based Case-Control Study.

    PubMed

    Golpour, Masoud; Hosseini, Seyed Hamzeh; Khademloo, Mohammad; Ghasemi, Maryam; Ebadi, Aghdas; Koohkan, Fatemeh; Shahmohammadi, Soheila

    2012-01-01

    Background. Psoriasis is a common, genetically determined inflammatory and proliferative disease of the skin. Psychological stress can exacerbate the disease. This study sought to investigate the depression and anxiety disorders among patients with psoriasis and control group. Method. In this hospital-based case-control study, One hundred patients with psoriasis (case) referred to the dermatology department and 100 patients with otolaryngology problems and dermatological healthy volunteers (control) who referred to the Otolaryngology Department of Bouali Sina Hospital in Sari, Iran, in 2007 were studied. Demographic characteristics were recorded. Beck Depression Inventory and Spielberger State-Trait Anxiety Scale I-II were administered to the patients in both groups. Data were analyzed using SPSS statistical software and descriptive statistical tests. Results. From One-hundred patients in each group, 44 (45%) were men. Depression score was 67% and 12% in psoriatic patients and control, respectively. The Beck depression scores of patients with psoriasis were significantly higher than scores of the control group (P < 0.05). Based on Spielberger State-Trait Anxiety Scale, anxiety was found in 45% of patients in case group and 18% of controls. Conclusion. The results revealed that psoriatic patients reported significantly higher degrees of depression and anxiety than controls. In addition, psoriatic women were more depressed than psoriatic men.

  10. Influence of Food on Paediatric Gastrointestinal Drug Absorption Following Oral Administration: A Review

    PubMed Central

    Batchelor, Hannah K.

    2015-01-01

    The objective of this paper was to review existing information regarding food effects on drug absorption within paediatric populations. Mechanisms that underpin food–drug interactions were examined to consider potential differences between adult and paediatric populations, to provide insights into how this may alter the pharmacokinetic profile in a child. Relevant literature was searched to retrieve information on food–drug interaction studies undertaken on: (i) paediatric oral drug formulations; and (ii) within paediatric populations. The applicability of existing methodology to predict food effects in adult populations was evaluated with respect to paediatric populations where clinical data was available. Several differences in physiology, anatomy and the composition of food consumed within a paediatric population are likely to lead to food–drug interactions that cannot be predicted based on adult studies. Existing methods to predict food effects cannot be directly extrapolated to allow predictions within paediatric populations. Development of systematic methods and guidelines is needed to address the general lack of information on examining food–drug interactions within paediatric populations. PMID:27417362

  11. A Clinical Study of Phenomenology and Comorbidity of Paediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Gupta, Pavan Kumar; T., Sivakumar; Agarwal, Vivek; Sitholey, Prabhat

    2012-01-01

    Background: Considerable controversy exists regarding clinical presentation, diagnosis, and comorbidities especially with Attention Deficit Hyperactivity Disorder (ADHD), in paediatric Bipolar Disorder (BPD). Aims and objectives: To describe phenomenology and comorbidities of paediatric BPD. Method: 78 Subjects (6-16 years) attending child and…

  12. Paediatric Low-Vision Assessment and Management in a Specialist Clinic in the UK

    ERIC Educational Resources Information Center

    Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris

    2007-01-01

    This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…

  13. How Much of the Paediatric Core Curriculum Do Medical Students Remember?

    ERIC Educational Resources Information Center

    Sullivan, Peter B.; Gregg, Nicky; Adams, Emily; Rodgers, Caroline; Hull, Jeremy

    2013-01-01

    Few educational studies have investigated how well information learned by medical students is retained over time. The primary aim of this study was to investigate how much of the paediatric core curriculum undergraduates remembered a year after originally passing their paediatrics examination. In addition, we looked at whether students'…

  14. [Importance of the National Childhood Cancer Registry in the field of paediatric oncology care in Hungary].

    PubMed

    Garami, Miklós; Schuler, Dezső; Jakab, Zsuzsanna

    2014-05-11

    National Childhood Cancer Registry has been operated since 1971 by the Hungarian Paediatric Oncology Network. This Registry collects data on epidemiology, treatment modalities and effectiveness, as well as late follow-up of childhood cancers. An internet-based paediatric cancer registration and communication system for the Hungarian Paediatric Oncology Network has been introduced in April, 2010. The National Childhood Cancer Registry contains data of all paediatric cancer patients (0-18 yrs) who have insurance covered by the Hungarian Social Security Card. Creation (1971) and operation of the National Childhood Cancer Registry have been very important steps in the field of childhood oncology to evaluate the efficiency of paediatric oncology treatments as well as maximize return on medical investment.

  15. Paediatric heart failure research: role of the National Heart, Lung, and Blood Institute.

    PubMed

    Burns, Kristin M

    2015-08-01

    The National Heart, Lung, and Blood Institute, of the National Institutes of Health, is committed to supporting research in paediatric heart failure. The Institute's support of paediatric heart failure research includes both investigator-initiated grants and Institute initiatives. There were 107 funded grants in paediatric heart failure over the past 20 years in basic, translational and clinical research, technology development, and support of registries. Such research includes a broad diversity of scientific topics and approaches. The Institute also supports several initiatives for paediatric heart failure, including the Pediatric Circulatory Support Program, the Pumps for Kids, Infants, and Neonates (PumpKIN) Program, PediMACS, and the Pediatric Heart Network. This review article describes the National Heart, Lung, and Blood Institute's past, present, and future efforts to promote a better understanding of paediatric heart failure, with the ultimate goal of improving outcomes. PMID:26377724

  16. Paediatric heart failure research: role of the National Heart, Lung, and Blood Institute.

    PubMed

    Burns, Kristin M

    2015-08-01

    The National Heart, Lung, and Blood Institute, of the National Institutes of Health, is committed to supporting research in paediatric heart failure. The Institute's support of paediatric heart failure research includes both investigator-initiated grants and Institute initiatives. There were 107 funded grants in paediatric heart failure over the past 20 years in basic, translational and clinical research, technology development, and support of registries. Such research includes a broad diversity of scientific topics and approaches. The Institute also supports several initiatives for paediatric heart failure, including the Pediatric Circulatory Support Program, the Pumps for Kids, Infants, and Neonates (PumpKIN) Program, PediMACS, and the Pediatric Heart Network. This review article describes the National Heart, Lung, and Blood Institute's past, present, and future efforts to promote a better understanding of paediatric heart failure, with the ultimate goal of improving outcomes.

  17. MicroRNAs: a new piece in the paediatric cardiovascular disease puzzle.

    PubMed

    Omran, Ahmed; Elimam, Dalia; Webster, Keith A; Shehadeh, Lina A; Yin, Fei

    2013-10-01

    Cardiovascular diseases in children comprise a large public health problem. The major goals of paediatric cardiologists and paediatric cardiovascular researchers are to identify the cause(s) of these diseases to improve treatment and preventive protocols. Recent studies show the involvement of microRNAs (miRs) in different aspects of heart development, function, and disease. Therefore, miR-based research in paediatric cardiovascular disorders is crucial for a better understanding of the underlying pathogenesis of the disease, and unravelling novel, efficient, preventive, and therapeutic means. The ultimate goal of such research is to secure normal cardiac development and hence decrease disabilities, improve clinical outcomes, and decrease the morbidity and mortality among children. This review focuses on the role of miRs in different paediatric cardiovascular conditions in an effort to encourage miR-based research in paediatric cardiovascular disorders. PMID:23443043

  18. Derivation of Australian diagnostic reference levels for paediatric multi detector computed tomography.

    PubMed

    Hayton, Anna; Wallace, Anthony

    2016-09-01

    Australian National Diagnostic Reference Levels for paediatric multi detector computed tomography were established for three protocols, Head, Chest and AbdoPelvis, across two age groups, Baby/Infant 0-4 years and Child 5-14 years by the Australian Radiation Protection and Nuclear Safety Agency in 2012. The establishment of Australian paediatric DRLs is an important step towards lowering patient CT doses on a national scale. While Adult DRLs were calculated with data collected from the web based Australian National Diagnostic Reference Level Service, no paediatric data was submitted in the first year of service operation. Data from an independent Royal Australian and New Zealand College of Radiologists Quality Use of Diagnostic Imaging paediatric optimisation survey was used. The paediatric DRLs were defined for CTDIvol (mGy) and DLP (mGy·cm) values that referenced the 16 cm PMMA phantom for the Head protocol and the 32 cm PMMA phantom for body protocols for both paediatric age groups. The Australian paediatric DRLs for multi detector computed tomography are for the Head, Chest and AbdoPelvis protocols respectively, 470, 60 and 170 mGy·cm for the Baby/Infant age group, and 600, 110 and 390 mGy·cm for the Child age group. A comparison with published international paediatric DRLs for computed tomography reveal the Australian paediatric DRLs to be lower on average. However, the comparison is complicated by misalignment of defined age ranges. It is the intention of ARPANSA to review the paediatric DRLs in conjunction with a review of the adult DRLs, which should occur within 5 years of their publication. PMID:27350262

  19. MRI of paediatric liver tumours: How we review and report.

    PubMed

    Shelmerdine, Susan C; Roebuck, Derek J; Towbin, Alexander J; McHugh, Kieran

    2016-01-01

    Liver tumours are fortunately rare in children. Benign tumours such as haemangiomas and cystic mesenchymal hamartomas are typically seen in infancy, often before 6 months of age. After that age, malignant hepatic tumours increase in frequency. The differentiation of a malignant from benign lesion on imaging can often negate the need for biopsy. Ultrasound is currently the main screening tool for suspected liver pathology, and is ideally suited for evaluation of hepatic lesions in children due to their generally small size. With increasing research, public awareness and parental anxiety regarding radiation dosage from CT imaging, MRI is now unquestionably the modality of choice for further characterisation of hepatic mass lesions.Nevertheless the cost, length of imaging time and perceived complexity of a paediatric liver MR study can be intimidating to the general radiologist and referring clinician. This article outlines standard MR sequences utilised, reasons for their utilisation, types of mixed hepatocyte specific/extracellular contrast agents employed and imaging features that aid the interpretation of paediatric liver lesions. The two commonest paediatric liver malignancies, namely hepatoblastoma and hepatocellular carcinoma are described. Differentiation of primary hepatic malignancies with metastatic disease and mimickers of malignancy such as focal nodular hyperplasia (FNH) and hepatic adenomas are also featured in this review..Imaging should aim to clarify the presence of a lesion, the likelihood of malignancy and potential for complete surgical resection. Reviewing and reporting the studies should address these issues in a systematic fashion whilst also commenting upon background liver parenchymal appearances. Clinical information and adequate patient preparation prior to MR imaging studies help enhance the diagnostic yield. PMID:27526937

  20. Forecasting paediatric malaria admissions on the Kenya Coast using rainfall

    PubMed Central

    Karuri, Stella Wanjugu; Snow, Robert W.

    2016-01-01

    Background Malaria is a vector-borne disease which, despite recent scaled-up efforts to achieve control in Africa, continues to pose a major threat to child survival. The disease is caused by the protozoan parasite Plasmodium and requires mosquitoes and humans for transmission. Rainfall is a major factor in seasonal and secular patterns of malaria transmission along the East African coast. Objective The goal of the study was to develop a model to reliably forecast incidences of paediatric malaria admissions to Kilifi District Hospital (KDH). Design In this article, we apply several statistical models to look at the temporal association between monthly paediatric malaria hospital admissions, rainfall, and Indian Ocean sea surface temperatures. Trend and seasonally adjusted, marginal and multivariate, time-series models for hospital admissions were applied to a unique data set to examine the role of climate, seasonality, and long-term anomalies in predicting malaria hospital admission rates and whether these might become more or less predictable with increasing vector control. Results The proportion of paediatric admissions to KDH that have malaria as a cause of admission can be forecast by a model which depends on the proportion of malaria admissions in the previous 2 months. This model is improved by incorporating either the previous month's Indian Ocean Dipole information or the previous 2 months’ rainfall. Conclusions Surveillance data can help build time-series prediction models which can be used to anticipate seasonal variations in clinical burdens of malaria in stable transmission areas and aid the timing of malaria vector control. PMID:26842613

  1. The Spectrum of Paediatric Intestinal Obstruction in Kenya

    PubMed Central

    Ooko, Philip Blasto; Wambua, Patricia; Oloo, Mark; Odera, Agneta; Topazian, Hillary Mariko; White, Russell

    2016-01-01

    Introduction Intestinal obstruction (IO) occurs when there is impedance to the flow of intestinal contents due to a congenital or acquired pathology, and is a common paediatric surgical emergency. This study aimed to assess the pattern and outcome of paediatric IO in western Kenya. Methods A retrospective review of all recorded cases of mechanical IO in patients aged 15 years or below admitted at Tenwek Hospital between January 2009 and December 2013. Results The cohort included a total of 217 children (130 boys and 87 girls). The mean age was 6.7 years (range: newborn-15 years), with most (65, 30%) cases aged 1-3 years. Vomiting (161, 74.2%), abdominal pain (152, 70%), abdominal tenderness (113, 52.1%), constipation (111, 51.2%), and abdominal distension (104, 47.9%) were the predominant signs and symptoms. The most common causes of IO were ascariasis (96, 44.2%), adhesions (34, 15.7%), and intussusception (30, 13.8%). Intussusception was the leading cause of IO in children aged ≤ 1 year, ascariasis in children aged 1-5 and 6-10 years, and adhesions in children aged 11-15 years. Operative management was undertaken in 120 (55.3%) cases with 39 (32.5%) of these having gangrenous bowel. The overall mortality rate was 5%. Conclusion The most common causes of mechanical bowel obstruction in this series were ascariasis, adhesions, and intussusception. Ascariasis remains a significant cause of paediatric IO in this region, thus public education, improved sanitation and deworming campaigns may be helpful in reducing the worm burden. PMID:27642384

  2. Evaluating an outreach service for paediatric burns follow up.

    PubMed

    Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q

    2015-09-01

    Complications following paediatric 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 impact 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 paediatric 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 paediatric burns in 18 months, after which if there have not been any complications they can be discharged. PMID:26036205

  3. Evaluating an outreach service for paediatric burns follow up.

    PubMed

    Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q

    2015-09-01

    Complications following paediatric 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 impact 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 paediatric 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 paediatric burns in 18 months, after which if there have not been any complications they can be discharged.

  4. Pattern of congenital anomalies in newborn: a hospital-based study

    PubMed Central

    El Koumi, Mohamed A.; Al Banna, Ehab A.; Lebda, Ibrahim

    2013-01-01

    Birth defects, encountered frequently by pediatricians, are important causes of childhood morbidity and mortality. Birth defects can be classified according to their severity, pathogenic mechanism, or whether they are involving a single system or multiple systems. This hospital-based prospective descriptive study highlights the prevalence of Congenital Anomalies (CAs) in one year among live born neonates delivered in Zagazig University Hospital (Egypt). All women giving birth to viable babies were included. Demographic details, associated risk factors and the type of CAs in all babies were recorded. Diagnosis of CAs was based on clinical evaluation, radiographic examination, ultrasonography, echocardiography and chromosomal analysis of the newborn whenever recommended. The overall incidence of CAs among live born neonates was 2.5%, as most of the cases were referred to Zagazig University Hospital (Egypt) for delivery. The musculoskeletal system (23%) was the most commonly involved followed by the central nervous system (20.3%). Involvement of more than one system was observed in (28.6%) cases. Among maternal and fetal risk factors; parental consanguinity, maternal under nutrition and obesity, positive history of an anomaly in the family, low birth weight, and prematurity were significantly associated with higher frequency of CAs (P<0.05), with non-significant differences for maternal age and the sex of the neonates. The current study highlights the prevalence of congenital anomalies in one year in Zagazig University Hospital. It revealed a high prevalence of congenital anomalies in our locality and stressed the importance of carrying out a thorough clinical examination of all neonates at birth. PMID:23667734

  5. Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study.

    PubMed

    Bhat, Y J; Hassan, I; Bashir, S; Farhana, A; Maroof, P

    2016-03-01

    Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.

  6. Idiopathic pulmonary fibrosis: survival in population based and hospital based cohorts

    PubMed Central

    Mapel, D.; Hunt, W.; Utton, R.; Baumgartner, K.; Samet, J.; Coultas, D.

    1998-01-01

    BACKGROUND—To ascertain whether findings from hospital based clinical series can be extended to patients with idiopathic pulmonary fibrosis (IPF) in the general population, the survival of patients with IPF in a population based registry was compared with that of a cohort of patients with IPF treated at major referral hospitals and the factors influencing survival in the population based registry were identified.
METHODS—The survival of 209 patients with IPF from the New Mexico Interstitial Lung Disease Registry and a cohort of 248 patients with IPF who were participating in a multicentre case-control study was compared. The determinants of survival for the patients from the Registry were determined using life table and proportional hazard modelling methods.
RESULTS—The median survival times of patients with IPF in the Registry and case-control cohorts were similar (4.2 years and 4.1 years, respectively), although the average age at diagnosis of the Registry patients was greater (71.7 years versus 60.6 years, p < 0.01). After adjusting for differences in age, sex, and ethnicity, the death rate within six months of diagnosis was found to be greater in the Registry patients (relative hazard (RH) 6.32, 95% CI 2.19to 18.22) but more than 18 months after diagnosis the death rate was less (RH 0.35, 95% CI 0.19 to 0.66) than in the patients in the case-control study. Factors associated with poorer prognosis in the Registry included advanced age, severe radiographic abnormalities, severe reduction in forced vital capacity, and a history of corticosteroid treatment.
CONCLUSIONS—The adjusted survival of patients with IPF in the general population is different from that of hospital referrals which suggests that selection biases affect the survival experience of referral hospitals.

 PMID:9713446

  7. Local level inequalities in the use of hospital-based maternal delivery in rural South Africa

    PubMed Central

    2014-01-01

    Background There is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa. Methods We used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts. Results In both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery. Conclusions The findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services. PMID:25927416

  8. Profile of HIV infected children: A hospital based study at Eastern Nepal

    PubMed Central

    Poudel, Prakash; Pokharel, Rita; Chitlangia, Mohit; Chaudhary, Shipra

    2014-01-01

    Objective To investigate the clinical, laboratory, epidemiological profiles and outcome in human immunodeficiency virus infected Nepalese children. Methods This was a hospital based prospective study. Human immunodeficiency virus-infected children presenting to pediatric immunology clinic at BP Koirala Institute of Health Sciences were enrolled and followed up. Results Median age at diagnosis among 39 enrolled children was 58 months. All children acquired infection vertically. Unsafe sex (74.4%) and intravenous drug use (25.6%) were the major risk behaviors in fathers. At presentation, 20.8% children were asymptomatic, 54.0% were malnourished, 41.0% were in WHO clinical stage 1, 17.9% were in stage 4, 74.4% were anemic, 17.9% had thrombocytopenia and median CD4 count was 543. Fever, lymphadenopathy, hepatosplenomegaly, skin eruptions and oral lesions were common presenting features (16.2%, 16.2%, 13.5%, 10.8%, and 8.1% respectively out of 74 features). Tuberculosis (16.0%), chronic otitis media (12.0%), scabies (10.7%), bacterial pneumonia (9.3%) and oropharyngeal candidiasis (6.7%) were common opportunistic infections. Antiretroviral treatment was started in 18 (46.2%) cases at median age of 67 months. Median change in CD4 count at follow up was significantly different between the groups receiving and not receiving antiretroviral treatment (+192 vs. -72; P=0.045). Conclusions Infection in children is vertical. Undernutrition, anemia, fever, lymphadenopathy, hepatosplenomegaly, skin eruptions, and ear discharge are common presenting features. Opportunistic infections are common and tuberculosis is the most common opportunistic infection followed by chronic ear infection, scabies, candidiasis and bacterial pneumonia. Timely antiretroviral treatment improves immune response.

  9. How to make a hospital-based wound center financially viable: the Georgetown University Hospital model.

    PubMed

    Attinger, Christopher E; Hoang, Han; Steinberg, John; Couch, Kara; Hubley, Katherine; Winger, Linda; Kugler, Margaret

    2008-11-01

    As the medical need and expenditure for chronic wound care have increased markedly over the past decade, wound centers have grown exponentially throughout the country. They can be community-based or hospital-based, and in either case, can be run by the facility or by a national chain. The wound center's viability is dependent on generated revenue, and its clinical effectiveness is based on a multidisciplinary approach to wound care. By incorporating the wound center into an existing hospital system, one can take advantage of the hospital's resources to effectively treat the more complex patients. Additionally, by focusing on limb salvage, the hospital attracts the critical limb ischemia and other complex patients that often require inpatient admission. We examined the Georgetown University Hospital Center for Wound Healing performance over the first 6 years of operation. Since opening the wound center in 1999, the number of outpatient visits has doubled, the wound care inpatient census has doubled, and the operative cases have increased 3-fold. Because the outpatient segment of the wound center can at best cover its direct cost, it cannot financially justify its existence. Hyperbaric oxygen (HBO) can increase the revenue to the point where the indirect costs are covered as well and the wound center can be revenue neutral. Due to the medical complexity of limb salvage patients, the inpatient collections are much higher than those of the outpatient wound center and therefore can serve as justification for the latter's financial viability. More importantly, with the wound center in place, the hospital can provide the local/regional community with a comprehensive service that can effectively treat the most challenging wounds. The success is built on a multidisciplinary team approach, use of evidence-based treatment protocols, efficient clinical structure, and a supportive hospital system. The beneficiaries include the patient with a healed wound, the physician with a

  10. Trends and characteristics of injuries in the State of Qatar: hospital-based study.

    PubMed

    Bener, Abdulbari; Abdul Rahman, Yassir S; Abdel Aleem, Eltayib Y; Khalid, Muayad K

    2012-01-01

    Injuries account for a large burden of mortality and morbidity in the State of Qatar. No comprehensive study has been conducted on all types of injuries in the State of Qatar. The objective of this study was to determine the trend in the number, incidence and pattern of injuries in the State of Qatar. This hospital-based study is a retrospective analysis of 53,366 patients treated at the accident and emergency and trauma centres for injuries during the period from 2006 to 2010. Injuries were determined according to the ICD 10 criteria. The details of the entire trauma patients who were involved in occupational/domestic injuries were extracted from the database of the Emergency Medical Services (EMS), Hamad Medical Corporation. Our results demonstrated that the rates of injury remained relatively stable in the State of Qatar over the five-year period. Those most at risk of injury were non-Qatari males who were below 30 years. Road traffic accidents (RTA) (36.7%) followed by falls causing back injuries (11.0%) were the most common types of injuries during the period. Most of the injuries occurred at the head for both males (17.7%) and females (13.5%); this was consistently the case across all of the age groups. The greatest proportion of RTA (21.2%), industrial machinery injuries (16.4%), construction injuries (15.5%), recreational sporting injuries (20.5%) and beach/sea/ocean injuries (15.0%) resulted in head injuries. Intervention efforts need to be aimed at reducing occupational injuries, RTA injuries and work-related hazards in the State of Qatar. PMID:22455450

  11. Support for hospital-based HIV testing and counseling: a national survey of hospital marketing executives.

    PubMed Central

    Boscarino, J A; Steiber, S R

    1995-01-01

    Today, hospitals are involved extensively in social marketing and promotional activities. Recently, investigators from the Centers for Disease Control and Prevention (CDC) estimated that routine testing of hospital patients for human immunodeficiency virus (HIV) could identify more than 100,000 patients with previously unrecognized HIV infections. Several issues are assessed in this paper. These include hospital support for voluntary HIV testing and AIDS education and the impact that treating AIDS patients has on the hospital's image. Also tested is the hypothesis that certain hospitals, such as for-profit institutions and those outside the AIDS epicenters, would be less supportive of hospital-based AIDS intervention strategies. To assess these issues, a national random sample of 193 executives in charge of hospital marketing and public relations were surveyed between December 1992 and January 1993. The survey was part of an ongoing annual survey of hospitals and included questions about AIDS, health education, marketing, patient satisfaction, and hospital planning. Altogether, 12.4 percent of executives indicated their hospital had a reputation for treating AIDS patients. Among hospitals without an AIDS reputation, 34.1 percent believed developing one would be harmful to the hospital's image, in contrast to none in hospitals that had such a reputation (chi 2 = 11.676, df = 1, P = .0006). Although 16.6 percent did not know if large-scale HIV testing should be implemented, a near majority (47.7 percent) expressed some support. In addition, 15 percent reported that HIV-positive physicians on the hospital's medical staff should not be allowed to practice medicine, but 32.1 percent indicated that they should.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7638335

  12. Epigenetics: What does it mean for paediatric practice?

    PubMed Central

    Hall, Judith G

    2014-01-01

    ‘Epigenetics’ involves the study of gene expression and the environmental exposures that influence expression. In paediatrics, it is recognized that different physiological and developmental stages of the young individual are affected by both genetic control and environmental influence. It appears that changes in gene expression – not changes in the DNA itself – can be passed on from one generation to another. The importance for paediatricians is recognizing disorders involving epigenetics, recording events during childhood that could affect epigenetic control of gene expression, and being aware of new therapies as they become available. Paediatricians need to be able to recognize the relevant risk factors. PMID:24627653

  13. The rise of the rats: A growing paediatric issue

    PubMed Central

    Khatchadourian, Karine; Ovetchkine, Philippe; Minodier, Philippe; Lamarre, Valérie; Lebel, Marc H; Tapiéro, Bruce

    2010-01-01

    Rat bite fever (RBF), a systemic infection of Streptobacillus moniliformis or Spirillum minus characterized by fever, arthralgias and petechial-purpuric rash on the extremities, carries a mortality rate of 7% to 10% if untreated. In Canada, one adult and two paediatric cases of RBF have been reported since 2000. In recent years, pet rats have become quite popular among children, placing them at an increased risk for RBF. Thus, paediatricians need to be more wary of the potential for RBF in their patients. In the present report, a culture-confirmed case of RBF and two additional cases of suspected infection are described. PMID:21358889

  14. Clinical features of paediatric pulmonary hypertension: a registry study

    PubMed Central

    Berger, Rolf M F; Beghetti, Maurice; Humpl, Tilman; Raskob, Gary E; Ivy, D Dunbar; Jing, Zhi-Cheng; Bonnet, Damien; Schulze-Neick, Ingram; Barst, Robyn J

    2012-01-01

    Summary Background Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about demographics, treatment, and outcomes in paediatric pulmonary hypertension. Methods Consecutive patients aged 18 years or younger at diagnosis with pulmonary hypertension and increased pulmonary vascular resistance were enrolled in TOPP at 31 centres in 19 countries from Jan 31, 2008, to Feb 15, 2010. Patient and disease characteristics, including age at diagnosis and at enrolment, sex, ethnicity, presenting symptoms, pulmonary hypertension classification, comorbid disorders, medical and family history, haemodynamic indices, and functional class were recorded. Follow-up was decided by the patients’ physicians according to the individual’s health-care needs. Findings 362 of 456 consecutive patients had confirmed pulmonary hypertension (defined as mean pulmonary artery pressure ≥25 mm Hg, pulmonary capillary wedge pressure ≤12 mm Hg, and pulmonary vascular resistance index ≥3 WU/m32). 317 (88%) patients had pulmonary arterial hypertension (PAH), which was idiopathic [IPAH] or familial [FPAH] in 182 (57%), and associated with other disorders in 135 (43%), of which 115 (85%) cases were associated with congenital heart disease. 42 patients (12%) had pulmonary hypertension associated with respiratory disease or hypoxaemia, with bronchopulmonary dysplasia most frequent. Finally, only three patients had either chronic thromboembolic pulmonary hypertension or miscellaneous causes of pulmonary hypertension. Chromosomal anomalies, mainly trisomy 21, were reported in 47 (13%) of patients with confirmed disease. Median age at diagnosis was 7 years (IQR 3–12); 59% (268 of 456) were female. Although dyspnoea and fatigue were the most frequent symptoms, syncope

  15. Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi.

    PubMed

    Thornhill, J A; Moran, K; Mooney, E E; Sheehan, S; Smith, J M; Fitzpatrick, J M

    1990-06-01

    The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.

  16. [Paediatric gynaecological outpatient department--a report on 600 patients].

    PubMed

    Grünberger, W; Fischl, F

    1982-11-26

    Problems arising during the examination and treatment of paediatric gynaecological patients are described. 387 out of 600 girls seen at the outpatient department for infants and juveniles of the 1st Department of Obstetrics and Gynaecology of the University of Vienna were premenarchal and 213 were post-menarchal (average age 7.45 years). The most frequent diagnosis was vulvovaginitis (43%), followed by pathological vaginal bleeding (12%), vulval disorders (6%) and pubertas praecox (5%); about twenty additional conditions were diagnosed. Absolute and extended indications for gynaecological and vaginoscopic examinations are demonstrated. PMID:7164465

  17. Transition of care from paediatric to adult services in haematology

    PubMed Central

    Bolton‐Maggs, Paula H B

    2007-01-01

    The need for adequate preparation for transition for young people with health care needs who require long term follow‐up in the adult sector has long been recognised and is a required part of the national service framework for children. The Royal College of Paediatrics and Child Health and the Royal College of Nursing have endorsed this need for improvement in services for adolescents. In 2006 the Department of Health launched guidelines with a wealth of recommendations. Despite these initiatives only slow progress has been made (usually by enthusiasts) and much work is needed to develop good programmes in many specialties, including non‐malignant haematology. PMID:17715443

  18. Medical management of paediatric burn injuries: best practice.

    PubMed

    Kim, Leo K P; Martin, Hugh C O; Holland, Andrew J A

    2012-04-01

    Burns commonly occur in children and their first aid remains inadequate despite burn prevention programmes. While scald injuries predominate, contact and flame burns remain common. Although typically less severe injuries overall than those in adults, hypertrophic scarring complicating both the burn wound and even donor sites occur more frequently in children. The heterogeneous nature of burn wounds, coupled with the difficulties associated with the early clinical assessment of burn depth, has stimulated the application of novel technologies to predict burn wound outcome. This review explores current best practice in the management of paediatric burns, with a focus on prevention, optimal first aid, resuscitation, burn wound prediction and wound management strategies.

  19. Weaning from mechanical ventilation in paediatrics. State of the art.

    PubMed

    Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo

    2014-03-01

    Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In paediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgement, although some additional measurements could facilitate this decision.

  20. Weaning from mechanical ventilation in paediatrics. State of the art.

    PubMed

    Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo

    2014-03-01

    Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In paediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgement, although some additional measurements could facilitate this decision. PMID:23542044

  1. Cystic change in primary paediatric optic nerve sheath meningioma.

    PubMed

    Narayan, Daniel; Rajak, Saul; Patel, Sandy; Selva, Dinesh

    2016-08-01

    Primary optic nerve sheath meningiomas (PONSM) are rare in children. Cystic meningiomas are an uncommon subgroup of meningiomas. We report a case of paediatric PONSM managed using observation alone that underwent cystic change and radiological regression. A 5-year-old girl presented with visual impairment and proptosis. Magnetic resonance (MR) imaging demonstrated a PONSM. The patient was left untreated and followed up with regular MR imaging. Repeat imaging at 16 years of age showed the tumour had started to develop cystic change. Repeat imaging at 21 years of age showed the tumour had decreased in size. PMID:27310300

  2. [The Spanish Society of Paediatric Infectious Diseases (SEIP) recommendations on the diagnosis and management of invasive candidiasis].

    PubMed

    Figueras, C; Díaz de Heredia, C; García, J J; Navarro, M; Ruiz-Contreras, J; Rossich, R; Rumbao, J; Frick, M A; Roselló, E M

    2011-05-01

    Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching 20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient.

  3. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease--the perspective of cardiology.

    PubMed

    Jenkins, Kathy J; Beekman Iii, Robert H; Bergersen, Lisa J; Everett, Allen D; Forbes, Thomas J; Franklin, Rodney C G; Klitzner, Thomas S; Krogman, Otto N; Martin, Gerard R; Webb, Catherine L

    2008-12-01

    This review includes a brief discussion, from the perspective of the pediatric cardiologist, of the rationale for creation and maintenance of multi-institutional databases of outcomes of the treatment of patients with congenital and paediatric cardiac disease, together with a history of the evolution of such databases, and a description of the current state of the art. A number of projects designed to have broad-based impact are currently in the design phase, or have already been implemented. Not surprisingly, most of the efforts thus far have focused on catheterization procedures and interventions, although some work examining other aspects of paediatric cardiology practice is also beginning. This review briefly describes several European and North American initiatives related to databases for pediatric and congenital cardiology including the Central Cardiac Audit Database of the United Kingdom, national database initiatives for pediatric cardiology in Switzerland and Germany, various database initiatives under the leadership of the Working Groups of The Association for European Paediatric Cardiology, the IMPACT Registry (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry of The American College of Cardiology Foundation and The Society for Cardiovascular Angiography and Interventions (SCAI), the Mid-Atlantic Group of Interventional Cardiology (MAGIC) Catheterization Outcomes Project, the Congenital Cardiac Catheterization Project on Outcomes (C3PO), the Congenital Cardiovascular Interventional Study Consortium (CCISC), and the Joint Council on Congenital Heart Disease (JCCHD) National Quality Improvement Initiative. These projects, each leveraging multicentre data and collaboration, demonstrate the enormous progress that has occurred over the last several years to improve the quality and consistency of information about nonsurgical treatment for congenital cardiac disease. The paediatric cardiology field is well

  4. EPI-CT: design, challenges and epidemiological methods of an international study on cancer risk after paediatric and young adult CT.

    PubMed

    Bosch de Basea, Magda; Pearce, Mark S; Kesminiene, Ausrele; Bernier, Marie-Odile; Dabin, Jérémie; Engels, Hilde; Hauptmann, Michael; Krille, Lucian; Meulepas, Johanna M; Struelens, Lara; Baatout, Sarah; Kaijser, Magnus; Maccia, Carlo; Jahnen, Andreas; Thierry-Chef, Isabelle; Blettner, Maria; Johansen, Christoffer; Kjaerheim, Kristina; Nordenskjöld, Arvid; Olerud, Hilde; Salotti, Jane A; Andersen, Tina Veje; Vrijheid, Martine; Cardis, Elisabeth

    2015-09-01

    Computed tomography (CT) has great clinical utility and its usage has increased dramatically over the years. Concerns have been raised, however, about health impacts of ionising radiation exposure from CTs, particularly in children, who have a higher risk for some radiation induced diseases. Direct estimation of the health impact of these exposures is needed, but the conduct of epidemiological studies of paediatric CT populations poses a number of challenges which, if not addressed, could invalidate the results. The aim of the present paper is to review the main challenges of a study on the health impact of paediatric CTs and how the protocol of the European collaborative study EPI-CT, coordinated by the International Agency for Research on Cancer (IARC), is designed to address them. The study, based on a common protocol, is being conducted in Belgium, Denmark, France, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom and it has recruited over one million patients suitable for long-term prospective follow-up. Cohort accrual relies on records of participating hospital radiology departments. Basic demographic information and technical data on the CT procedure needed to estimate organ doses are being abstracted and passive follow-up is being conducted by linkage to population-based cancer and mortality registries. The main issues which may affect the validity of study results include missing doses from other radiological procedures, missing CTs, confounding by CT indication and socioeconomic status and dose reconstruction. Sub-studies are underway to evaluate their potential impact. By focusing on the issues which challenge the validity of risk estimates from CT exposures, EPI-CT will be able to address limitations of previous CT studies, thus providing reliable estimates of risk of solid tumours and leukaemia from paediatric CT exposures and scientific bases for the optimisation of paediatric CT protocols and patient protection. PMID:26226081

  5. Symmetry of foot alignment and ankle flexibility in paediatric Charcot-Marie-Tooth disease

    PubMed Central

    Burns, Joshua; Ouvrier, Robert; Estilow, Tim; Shy, Rosemary; Laurá, Matilde; Eichinger, Kate; Muntoni, Francesco; Reilly, Mary M.; Pareyson, Davide; Acsadi, Gyula; Shy, Michael E.; Finkel, Richard S.

    2012-01-01

    Background Charcot-Marie-Tooth disease is the most common inherited nerve disorder and typically presents with pes cavus foot deformity and ankle equinus during childhood. Level in the variation of symmetry of musculoskeletal lower limb involvement across the clinical population is unknown, despite early reports describing gross asymmetry. Methods We measured foot alignment and ankle flexibility of the left and right limbs using accurate and reliable standardised paediatric outcome measures in 172 patients aged 3–20 years with a variety of disease subtypes recruited from the United States, United Kingdom, Italy and Australia. Findings While a large range of differences existed between left and right feet for a small proportion of children, there was no overall significant difference between limbs. Interpretation There are two important implications of these findings. Children with Charcot-Marie-Tooth disease generally exhibit symmetrical foot alignment and ankle flexibility between limbs. As such, analysing one limb only for biomechanical-related research is appropriate and satisfies the independence requirements for statistical analysis. However, because there are large differences between feet for a small proportion of children, an individualised limb-focused approach to clinical care is required. PMID:22424781

  6. What Do We Know about Knowledge Brokers in Paediatric Rehabilitation? A Systematic Search and Narrative Summary

    PubMed Central

    Verrier, Molly C.; Landry, Michel D.

    2014-01-01

    ABSTRACT Purpose: To conduct a systematic review of the literature related to the use of knowledge brokers within paediatric rehabilitation, and specifically to determine (1) how knowledge brokers are defined and used in paediatric rehabilitation and (2) whether knowledge brokers in paediatric rehabilitation have demonstrably improved the performance of health care providers or organizations. Methods: The MEDLINE, CINAHL, EMBASE, and AMED databases were systematically searched to identify studies relating to knowledge brokers or knowledge brokering within paediatric rehabilitation, with no restriction on the study design or primary aim. Following review of titles and abstracts, those studies identified as potentially relevant were assessed based on the inclusion criteria that they: (1) examined some aspect of knowledge brokers/brokering in paediatric rehabilitation; (2) included sufficient descriptive detail on how knowledge brokers/brokering were used; and(3) were peer-reviewed and published in English. Results: Of 1513 articles retrieved, 4 met the inclusion criteria, 3 of which referenced the same knowledge broker initiative. Two papers used mixed methods, one qualitative methodology, and one case presentation. Because of the different methods used in the included studies, the findings are presented in a narrative summary. Conclusions: This study provides an overview of the limited understanding of knowledge brokers within paediatric rehabilitation. Knowledge broker initiatives introduced within paediatric rehabilitation have been anchored in different theoretical frameworks, and no conclusions can be drawn as to the optimum combination of knowledge brokering activities and methods, nor about optimal duration, for sustained results. PMID:24799751

  7. The emerging global epidemic of paediatric inflammatory bowel disease--causes and consequences.

    PubMed

    Malmborg, P; Hildebrand, H

    2016-03-01

    Two decades ago, paediatric inflammatory bowel disease (IBD) drew only modest interest from the international paediatric community. Since then, dramatically globally increasing incidence rates have made childhood-onset IBD a priority for most paediatric gastroenterologists. The emerging pandemia of paediatric IBD has fuelled a quest to identify the recent changes in early life exposures that could explain the increasing risk for IBD amongst today's children. Treatment of children with IBD should aim for symptom control but should also target restoration of growth and prevention of pubertal delay. The paediatric IBD phenotype seems to be characterized by more extensive disease location, and some comparative studies have suggested that childhood-onset IBD also represents a more severe phenotype than the adult-onset IBD form. In this review, we analyse recent global incidence trends of paediatric IBD. We present an update on the known and suggested risk factors that could explain the emerging global epidemia of paediatric IBD. We also draw attention to differences in treatment between children and adults with IBD. Finally, we highlight latest follow-up studies that question the proposed dynamic and aggressive nature of childhood-onset IBD.

  8. Global child health priorities: what role for paediatric oncologists?

    PubMed

    Kellie, Stewart J; Howard, Scott C

    2008-11-01

    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 paediatric 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 impact of international paediatric oncology collaboration to improve childhood cancer care worldwide. PMID:18799306

  9. Dealing with paediatric cholesteatoma: how we changed our management.

    PubMed

    Sergi, B; Galli, J; Battista, M; De Corso, E; Paludetti, G

    2014-04-01

    We reviewed our series of surgeries for paediatric cholesteatoma to assess outcomes and functional results considering the extension of disease and surgical techniques. Between January 2003 and December 2009, 36 patients (range 6-14 years) were operated on for cholesteatoma. We considered the sites involved by the cholesteatoma (mastoid, antrum, attic, middle ear, Eustachian tube), surgical techniques used (intact canal wall, canal wall down) and how our habits changed over the years; moreover, we evaluated ossicular chain conditions and how we managed the ossiculoplasty. As outcomes, we considered the percentage of residual and recurrent cholesteatoma for each technique and hearing function (air bone gap closure, high frequencies bone conduction hearing loss) at follow-up. Intact canal wall was performed in 20 patients and canal wall down in 13 patients, in 9 as first surgery. In both groups, we observed improvement of the air bone gap; in the intact canal wall group, a residual cholesteatoma was observed in 6 patients whereas, during follow-up, 2 patients who underwent a canal wall down showed a recurrent cholesteatoma that was treated in an outpatient setting. Eradication of cholesteatoma and restoration of hearing function in paediatric patients present unique surgical challenges. Our experience shows an increased choice of intact canal wall over the years. Therefore, it is important for the surgeon to counsel parents about the probable need for multiple surgeries, especially if an intact canal wall mastoidectomy is performed. PMID:24843225

  10. Cell migration in paediatric glioma; characterisation and potential therapeutic targeting

    PubMed Central

    Cockle, J V; Picton, S; Levesley, J; Ilett, E; Carcaboso, A M; Short, S; Steel, L P; Melcher, A; Lawler, S E; Brüning-Richardson, A

    2015-01-01

    Background: Paediatric high grade glioma (pHGG) and diffuse intrinsic pontine glioma (DIPG) are highly aggressive brain tumours. Their invasive phenotype contributes to their limited therapeutic response, and novel treatments that block brain tumour invasion are needed. Methods: Here, we examine the migratory characteristics and treatment effect of small molecule glycogen synthase kinase-3 inhibitors, lithium chloride (LiCl) and the indirubin derivative 6-bromoindirubin-oxime (BIO), previously shown to inhibit the migration of adult glioma cells, on two pHGG cell lines (SF188 and KNS42) and one patient-derived DIPG line (HSJD-DIPG-007) using 2D (transwell membrane, immunofluorescence, live cell imaging) and 3D (migration on nanofibre plates and spheroid invasion in collagen) assays. Results: All lines were migratory, but there were differences in morphology and migration rates. Both LiCl and BIO reduced migration and instigated cytoskeletal rearrangement of stress fibres and focal adhesions when viewed by immunofluorescence. In the presence of drugs, loss of polarity and differences in cellular movement were observed by live cell imaging. Conclusions: Ours is the first study to demonstrate that it is possible to pharmacologically target migration of paediatric glioma in vitro using LiCl and BIO, and we conclude that these agents and their derivatives warrant further preclinical investigation as potential anti-migratory therapeutics for these devastating tumours. PMID:25628092

  11. Paediatric femur fractures at the emergency department: accidental or not?

    PubMed

    Hoytema van Konijnenburg, Eva M M; Vrolijk-Bosschaart, Thekla F; Bakx, Roel; Van Rijn, Rick R

    2016-01-01

    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information.

  12. Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

    PubMed Central

    Fusch, C.; Bauer, K.; Böhles, H. J.; Jochum, F.; Koletzko, B.; Krawinkel, M.; Krohn, K.; Mühlebach, S.

    2009-01-01

    There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions. PMID:20049070

  13. 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

  14. Bounded rationality alters the dynamics of paediatric immunization acceptance.

    PubMed

    Oraby, Tamer; Bauch, Chris T

    2015-06-02

    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 impact of such cognitive effects in the context of paediatric 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 paediatric 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 impacts on the predictions of behaviour-disease models, and further study of such processes in the context of vaccination is thus warranted.

  15. Caring and curing: paediatric cancer services since 1960.

    PubMed

    Barnes, E

    2005-09-01

    This paper traces the history of the specialist meanings of 'cure' in paediatric oncology in the UK, how they have changed with increasing organization of the discipline, ever-rising survival rates for all childhood cancers, and with feedback from patients and families. It examines the differing ways in which those involved in researching, treating, and raising funds for work on childhood cancers have understood and used the language of cure, and speculates as to why talking about the 'cure' of survivors of childhood cancers is so problematic. The paper discusses the particular importance of holistic care in the development of paediatric oncology. Psychosocial support is delivered alongside surgery, radiotherapy and chemotherapy. The focus for support is the patient's whole family, building a tenet of palliative care into curative treatment. The concept of the 'truly cured child' is argued to have been crucial in the discipline's decision in the 1970s and 1980s to make the psychosocial needs of patients and their families central in the programme of curing children with cancer. PMID:16098123

  16. Global child health priorities: what role for paediatric oncologists?

    PubMed

    Kellie, Stewart J; Howard, Scott C

    2008-11-01

    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 paediatric 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 impact of international paediatric oncology collaboration to improve childhood cancer care worldwide.

  17. Critical Incidents of Nonadherence with Standard Precautions Guidelines Among Community Hospital-based Health Care Workers

    PubMed Central

    Ferguson, Kristi J; Waitzkin, Howard; Beekmann, Susan E; Doebbeling, Bradley N

    2004-01-01

    OBJECTIVE To identify, categorize, and assess critical incidents of nonadherence to standard precautions. DESIGN Qualitative and quantitative analysis of a written, mail-out survey. SETTING Community hospitals. PARTICIPANTS Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE Responses to the question: “Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere.” RESULTS Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available

  18. Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital

    PubMed Central

    Escobedo, Angel A; Almirall, Pedro; Ávila, Ivonne; Salazar, Yohana; Alfonso, Maydel

    2014-01-01

    Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine care-seeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88.6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0–15 days). The pattern of care-seeking behaviour was variable; 41 (47.7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1–5 contacts) and of the 128 contact visits, 94 (73.4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29.8, 95% confidence interval (CI): 3.71–239.4, P = 0.001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3.84, 95% CI: 1.57–9.40, P = 0.003). Efforts should be made to increase doctors’ awareness of- and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers’ awareness about giardiasis. PMID:25253040

  19. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.

    PubMed

    Young, Simon; Hutchinson, Adrian; Nguyen, Van Tu; Le, Thanh Hai; Nguyen, Dich Van; Vo, Thi Kim Hue

    2008-06-01

    In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country.

  20. Financial advantages of operating a skilled nursing unit.

    PubMed

    Fogel, L A

    1994-07-01

    Hospitals may accrue specific financial advantages from the operations of a skilled nursing unit (SNU), such as the ability to allocate some fixed costs to a hospital-based unit that receives cost-based reimbursement from Medicare. The level of reimbursement SNUs receive from Medicare, however, can be optimized by obtaining an exemption or an exception to routine cost limits.

  1. Creating a unique, multi-stakeholder Paediatric Oncology Platform to improve drug development for children and adolescents with cancer.

    PubMed

    Vassal, Gilles; Rousseau, Raphaël; Blanc, Patricia; Moreno, Lucas; Bode, Gerlind; Schwoch, Stefan; Schrappe, Martin; Skolnik, Jeffrey; Bergman, Lothar; Bradley-Garelik, Mary Brigid; Saha, Vaskar; Pearson, Andy; Zwierzina, Heinz

    2015-01-01

    Seven years after the launch of the European Paediatric Medicine Regulation, limited progress in paediatric oncology drug development remains a major concern amongst stakeholders - academics, industry, regulatory authorities, parents, patients and caregivers. Restricted increases in early phase paediatric oncology trials, legal requirements and regulatory pressure to propose early Paediatric Investigation Plans (PIPs), missed opportunities to explore new drugs potentially relevant for paediatric malignancies, lack of innovative trial designs and no new incentives to develop drugs against specific paediatric targets are some unmet needs. Better access to new anti-cancer drugs for paediatric clinical studies and improved collaboration between stakeholders are essential. The Cancer Drug Development Forum (CDDF), previously Biotherapy Development Association (BDA), with Innovative Therapy for Children with Cancer Consortium (ITCC), European Society for Paediatric Oncology (SIOPE) and European Network for Cancer Research in Children and Adolescents (ENCCA) has created a unique Paediatric Oncology Platform, involving multiple stakeholders and the European Union (EU) Commission, with an urgent remit to improve paediatric oncology drug development. The Paediatric Oncology Platform proposes to recommend immediate changes in the implementation of the Regulation and set the framework for its 2017 revision; initiatives to incentivise drug development against specific paediatric oncology targets, and repositioning of drugs not developed in adults. Underpinning these changes is a strategy for mechanism of action and biology driven selection and prioritisation of potential paediatric indications rather than the current process based on adult cancer indications. Pre-competitive research and drug prioritisation, early portfolio evaluation, cross-industry cooperation and multi-compound/sponsor trials are being explored, from which guidance for innovative trial designs will be

  2. The impact of remifentanil on incidence and severity of postoperative nausea and vomiting in a university hospital-based ambulatory surgery center: a retrospective observation study

    PubMed Central

    Hara, Risa; Sato, Masami; Tanabe, Hiroko; Yazawa, Tomoko; Habara, Toshie; Fukuda, Kazuhiko

    2013-01-01

    Background Ambulatory surgery, including short-stay surgery, has become a common choice in clinical practice. For the success of ambulatory surgery, perioperative care with safe and effective anesthesia and postoperative analgesia, which can reduce the occurrence of postoperative nausea and vomiting (PONV), is essential. The effect of remifentanil on the occurrence and severity of PONV has not been thoroughly examined, particularly, in an ambulatory surgery setting. Here, we investigate whether remifentanil influences the occurrence and severity of PONV in a university hospital-based ambulatory unit. Methods We retrospectively analyzed a total of 1,765 cases of patients who had undergone general anesthesia at our ambulatory surgery unit. Parameters, such as occurrence and severity of nausea, vomiting or retching, use of antiemetic drugs, amount of postoperative analgesic and patient satisfaction, were extracted from the records and analyzed between the groups that received and not received remifentanil. Results Within 565 patients of the RF group, 39 patients (6.6%) experienced nausea, 7 patients (1.2%) experienced vomiting or retching, and 10 patients (1.8%) were given antiemetic; in addition, the maximum VAS value for nausea was 12.1 mm. In 1,200 patients of the non RF group, 102 patients (8.5%) experienced nausea, 19 patients (1.6%) experienced vomiting or retching, and 34 patients (2.8%) were given antiemetic, and the maximum VAS value was 13.2 mm. There were no statistically significant differences between the two groups. Conclusions Our results indicate that remifentanil did not increase the occurrence of PONV in patients within the ambulatory surgery unit. PMID:24023997

  3. Autism comes to the hospital: the experiences of patients with autism spectrum disorder, their parents and health-care providers at two Canadian paediatric hospitals.

    PubMed

    Muskat, Barbara; Burnham Riosa, Priscilla; Nicholas, David B; Roberts, Wendy; Stoddart, Kevin P; Zwaigenbaum, Lonnie

    2015-05-01

    Youth with autism spectrum disorder are a vulnerable, often poorly understood patient group, who may experience periodic and chronic health challenges, in addition to their primary developmental social and communication problems. Developmental and behavioural challenges can complicate management of acute health-care needs. To date, there is an absence of empirical research exploring the hospital experiences of children and youth with autism spectrum disorder, their families and their health-care providers. Therefore, the purpose of this study was to understand these experiences in order to inform hospital-based care. A total of 42 participants were interviewed (youth with autism spectrum disorder, their parents and health-care providers) at one of two Canadian paediatric hospitals, representing 20 distinct cases of patients with autism spectrum disorder. Results from the qualitative analyses indicated that patients with autism spectrum disorder faced several challenges in the context of health-care delivery in the hospital setting, as did their families and health-care provider team. Problems identified included communication and sensory challenges, and the degree of flexibility of health-care providers and the hospital organization. Supportive health-care providers were those who acknowledged parents as experts, inquired about the requirements of patients with autism spectrum disorder and implemented strategies that accommodated the unique clinical presentation of the individual patient. These recommendations have wide-reaching utility for hospital and health-care practices involving this patient group.

  4. The relevance of the Goudge inquiry to the practice of child protection/forensic paediatrics.

    PubMed

    Skellern, Catherine; Donald, Terence

    2014-10-01

    In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of 'diagnosis' versus 'opinion'; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments.

  5. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    PubMed

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention. PMID:26728766

  6. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    PubMed

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.

  7. Hospitalization for respiratory syncytial virus in the paediatric population in Spain.

    PubMed Central

    Vicente, D.; Montes, M.; Cilla, G.; Perez-Yarza, E. G.; Perez-Trallero, E.

    2003-01-01

    The aim of this population-based retrospective study was to determine the incidence of hospitalization for community-acquired, laboratory-confirmed respiratory syncytial virus (RSV) infection in an unselected paediatric population from southern Europe. The study was performed in an area with 15,700 children aged less than 5 years attended by a single hospital. The presence of RSV in nasopharyngeal aspirates from children with acute respiratory infection treated in the hospital was investigated in four seasons (July 1996-June 2000). A total of 390 episodes of hospitalization for RSV infection were detected and 83.3% of the children were aged less than 1 year old. The annual hospitalization rate was 37/1000 for infants aged less than 6 months and 25/1000 for those aged less than 1 year. During the study period, 2.5% of the infants younger than 1 year and approximately 5% of those younger than 3 months were hospitalized for RSV infection. The mean length of hospital stay was 5.9 days. Seven per cent of the patients required admission to the intensive care unit and more than half of these children were aged less than 1 month. In Spain, community-acquired RSV infection is a highly frequent cause of hospitalization in young children, especially in those aged less than 1 year. Prevention of RSV infection, through the development of vaccines and/or other strategies, should be a public health priority. PMID:14596527

  8. Conducting a paediatric multi-centre RCT with an industry partner: challenges and lessons learned.

    PubMed

    Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

    2012-11-01

    There are many benefits of multi-centred research including large sample sizes, statistical power, timely recruitment and generalisability of results. However, there are numerous considerations when planning and implementing a multi-centred study. This article reviews the challenges and successes of planning and implementing a multi-centred prospective randomised control trial involving an industry partner. The research investigated the impact on psychosocial functioning of a cosmetic camouflage product for children and adolescents with burn scarring. Multi-centred studies commonly have many stakeholders. Within this study, six Australian and New Zealand paediatric burn units as well as an industry partner were involved. The inclusion of an industry partner added complexities as they brought different priorities and expectations to the research. Further, multifaceted ethical and institutional approval processes needed to be negotiated. The challenges, successes, lessons learned and recommendations from this study regarding Australian and New Zealand ethics and research governance approval processes, collaboration with industry partners and the management of differing expectations will be outlined. Recommendations for future multi-centred research with industry partners include provision of regular written reports for the industry partner; continual monitoring and prompt resolution of concerns; basic research practices education for industry partners; minimisation of industry partner contact with participants; clear roles and responsibilities of all stakeholders and utilisation of single ethical review if available.

  9. Adherence in paediatric renal failure and dialysis: an ethical analysis of nurses' attitudes and reported practice.

    PubMed

    Mellor, Joe Scott; Hulton, Sally-Anne; Draper, Heather

    2015-02-01

    Minors have difficulty adhering to the strict management regimen required whilst on renal dialysis for chronic renal failure. This leads to ethical tensions as healthcare professionals (HCPs) and parents try, in the minor's best interests, to ensure s/he adheres. All 11 dialysis nurses working in a large, regional paediatric dialysis unit were interviewed about their perceptions and management of non-adherence and the ethical issues this raised for them. Participants reported negative attitudes to non-adherence alongside sympathy and feelings of frustration. They discussed the competing responsibilities between nurses, parents and minors, and how responsibility ought to be transferred to the minor as s/he matures; the need for minors to take responsibility ahead of transferring to adult services; and, the process of transferring this responsibility. Our discussion concentrates on the ethical issues raised by the participants' reports of how they respond to non-adherence using persuasion and coercion. We consider how understandings of capacity, traditional individual autonomy, and willpower can be used to comprehend the issue of non-adherence. We consider the relational context in which the minor receives, and participates in, healthcare. This exposes the interdependent triad of relationships between HCP, parent and minor and aids understanding of how to provide care in an ethical way. Relational ethics is a useful alternative understanding for professionals reflecting upon how they define their obligations in this context.

  10. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement.

    PubMed

    Mooney, Emma; Rademaker, Marius; Dailey, Rebecca; Daniel, Ben S; Drummond, Catherine; Fischer, Gayle; Foster, Rachael; Grills, Claire; Halbert, Anne; Hill, Sarah; King, Emma; Leins, Elizabeth; Morgan, Vanessa; Phillips, Roderic J; Relic, John; Rodrigues, Michelle; Scardamaglia, Laura; Smith, Saxon; Su, John; Wargon, Orli; Orchard, David

    2015-11-01

    Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children. PMID:25752907

  11. Outcomes from an orientation model to reduce attrition in paediatric weight management.

    PubMed

    Zenlea, I S; Milliren, C; Herel, S; Thomaseo Burton, E; Askins, N; Ludwig, D S; Rhodes, E T

    2016-10-01

    We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme. PMID:27487780

  12. Female perineal injuries in children and adolescents presenting to a paediatric emergency department.

    PubMed

    Roland, Damian; Lewis, Gareth; Rowlands, Rachel; Davidson, Emmanuel; Davies, Ffion

    2016-01-01

    This retrospective case series determined documentation quality and likelihood of safeguarding issues in girls  aged 0-15 years with perineal and genital injuries presenting to a paediatric emergency department (ED). During the period between 2002 and 2010, cases were identified and clinical information was recorded. Cases were cross-referenced against the hospital's safeguarding unit's records up to 2011. In total, 181 case notes were available for review with 76.2% of patients discharged home from the ED. Fewer than 50% of case notes contained clear anatomical description of the injuries. In 51 (28.2%) cases, child safeguarding issues were considered, with specific referrals made to safeguarding services in 20 of these (11.0%). Only one case involved subsequent child safeguarding proceedings. Clear documentation of injury patterns by medical staff was poor, but medical and nursing staff should not be anxious about dealing with this cohort of patients as they are no different from other incidental injuries needing diligent levels of child safeguarding awareness.

  13. Crowding and visual acuity measured in adults using paediatric test letters, pictures and symbols.

    PubMed

    Lalor, Sarah J H; Formankiewicz, Monika A; Waugh, Sarah J

    2016-04-01

    Crowding refers to the degradation of visual acuity for target optotypes with, versus without, surrounding features. Crowding is important clinically, however the effect of target-flanker spacing on acuity for symbols and pictures, compared to letters, has not been investigated. Five adults with corrected-to-normal vision had visual acuity measured for modified single target versions of Kay Pictures, Lea Symbols, HOTV and Cambridge Crowding Cards, tests. Single optotypes were presented in isolation and with surrounding features placed 0-5 stroke-widths away. Visual acuity measured with Kay Picture optotypes is 0.13-0.19logMAR better than for other test optotypes and varies significantly across picture. The magnitude of crowding is strongest when the surrounding features abut, or are placed 1 stroke-width away from the target optotype. The slope of the psychometric function is steeper in the region just beyond maximum crowding. Crowding is strongest and the psychometric function steepest, with the Cambridge Crowding Cards arrangement, than when any single optotype is surrounded by a box. Estimates of crowding extent are less variable across test when expressed in units of stroke-width, than optotype-width. Crowding for single target presentations of letters, symbols and pictures used in paediatric visual acuity tests can be maximised and made more sensitive to change in visual acuity, by careful selection of optotype, by surrounding the target with similar flankers, and by using a closer target-flanker separation than half an optotype-width.

  14. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement.

    PubMed

    Mooney, Emma; Rademaker, Marius; Dailey, Rebecca; Daniel, Ben S; Drummond, Catherine; Fischer, Gayle; Foster, Rachael; Grills, Claire; Halbert, Anne; Hill, Sarah; King, Emma; Leins, Elizabeth; Morgan, Vanessa; Phillips, Roderic J; Relic, John; Rodrigues, Michelle; Scardamaglia, Laura; Smith, Saxon; Su, John; Wargon, Orli; Orchard, David

    2015-11-01

    Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.

  15. Nutrient needs and feeding of premature infants. Nutrition Committee, Canadian Paediatric Society.

    PubMed Central

    1995-01-01

    OBJECTIVE: To recommend appropriate intake of nutrients, food sources and feeding practices for premature infants. OPTIONS: Unfortified milk from the premature infant's own mother, fortified milk from the premature infant's own mother, formula designed for preterm infants and parenteral nutrition. OUTCOMES: From birth to 7 days, the minimum achievable goal is the provision of sufficient nutrients to prevent deficiencies and catabolism of nutrient substrate in premature infants; from 7 days to discharge from the neonatal intensive care unit, growth and nutrient retention at a rate similar to that which would have been achieved had the infant remained in utero; and for 1 year following discharge, nutrient intake to achieve catch-up growth. EVIDENCE: Few randomized clinical trials of feeding infants specific nutrients or of feeding choices have been conducted. On the basis of a MEDLINE search of the literature, committee members prepared reviews of the available information on each nutrient and feeding choice. The reviews were critically appraised by the committee. Recommendations were based on the consensus of the committee. VALUES: Whenever possible, the evidence was weighed in favour of randomized controlled trials. If such trials were unavailable, cohort studies were considered. If trials of either kind were unavailable, published data were reviewed and recommendations were based on consensus opinion. BENEFITS, HARMS AND COSTS: The advantages of feeding premature infants unfortified milk from their own mothers are psychologic benefits for the mother as well as anti-infective benefits and possibly improved intellectual development for the infant. However, unfortified milk from the infant's own mother is inadequate as a sole source of nutrients. The use of fortified milk from the mother results in faster growth as well as having the other benefits of mother's milk. When formulas designed for premature infants are given in adequate volumes, they provide an intake of

  16. 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

  17. The influence of the European paediatric regulation on marketing authorisation of orphan drugs for children

    PubMed Central

    2014-01-01

    Background Drug development for rare diseases is challenging, especially when these orphan drugs (OD) are intended for children. In 2007 the EU Paediatric Drug Regulation was enacted to improve the development of high quality and ethically researched medicines for children through the establishment of Paediatric Investigation Plans (PIPs). The effect of the EU Paediatric 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 Paediatric 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 Paediatric Drug Regulation did not significantly increase the number of ODDs with potential paediatric indications (58% before vs 64% after 2007 of ODDs, p = 0.1) and did not lead to more MAs for ODs with paediatric 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 paediatric use did not influence the time to MA (Hazard ratio (95% CI) 1.14 (0.77-1.70), p = 0.52). Conclusions The EU Paediatric Drug Regulation had a minor impact on development and availability of ODs for children, was associated with a longer time to MA, but ensured the further paediatric development of drugs still off-label to children. The impact of the Paediatric Drug Regulation on research quantity and quality in children through PIPs is not yet clear. PMID

  18. Evaluation of radiation dose to anthropomorphic paediatric models from positron-emitting labelled tracers

    NASA Astrophysics Data System (ADS)

    Xie, Tianwu; Zaidi, Habib

    2014-03-01

    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 paediatric 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 paediatric population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic paediatric 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 paediatric 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 paediatric phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference paediatric 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 paediatric 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 paediatric patients in clinical practice. This work also contributes

  19. Seroprevalence of occult hepatitis B among Egyptian paediatric hepatitis C cancer patients.

    PubMed

    Raouf, H E; Yassin, A S; Megahed, S A; Ashour, M S; Mansour, T M

    2015-02-01

    Occult hepatitis B infection is characterized by the presence of hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). Prevalence of hepatitis C virus (HCV) infections in Egypt is among the highest in the world. In this study, we aim at analysing the rates of occult HBV infections among HCV paediatric cancer patients in Egypt. The prevalence of occult HBV was assessed in two groups of paediatric cancer patients (HCV positive and HCV negative), in addition to a third group of paediatric noncancer patients, which was used as a general control. All groups were negative for HBsAg and positive for HCV antibody. HBV DNA was detected by nested PCR and real-time PCR. HCV was detected by real-time PCR. Sequencing was carried out in order to determine HBV genotypes to all HBV patients as well as to detect any mutation that might be responsible for the occult phenotype. Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV. Occult HBV infection seems to be relatively frequent in HCV-positive paediatric cancer patients, indicating that HBsAg negativity is not sufficient to completely exclude HBV infection. These findings emphasize the importance of considering occult HBV infection in HCV-positive paediatric cancer patients especially in endemic areas as Egypt.

  20. [Child health and international cooperation: A paediatric approach].

    PubMed

    Sobrino Toro, M; Riaño Galan, I; Bassat, Q; Perez-Lescure Picarzo, J; de Aranzabal Agudo, M; Krauel Vidal, X; Rivera Cuello, M

    2015-05-01

    The international development cooperation in child health arouses special interest in paediatric 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 impact, 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.

  1. Paediatric unplanned reattendance rate: A&E clinical quality indicators.

    PubMed

    O'Loughlin, Kate; Hacking, Katie A; Simmons, Naomi; Christian, William; Syahanee, R; Shamekh, Ahmed; Prince, Nicholas J

    2013-03-01

    The new accident and emergency (A&E) unplanned reattendance rate clinical quality indicator is intended to drive reduction of avoidable reattendances. Validation data for reattendance rates in children are awaited. The aim of this three site observational study is to establish the rate and reasons for unplanned reattendance to UK paediatric A&Es. Each centre undertook retrospective case note review of children attending at least twice within 7 days. Unplanned reattendance rates at the three centres were 5.1%, 5.2% and 4.4%. Reducing unnecessary unplanned reattendances is beneficial for patients, service capacity and efficacy. This study has identified two groups for targeting reattendance reduction: parents of children returning with the same diagnosis, severity unchanged and parents who bypass primary care resources. Clear communication and early involvement of experienced clinicians are paramount. This study has indicated that a 1%-5% unplanned reattendance rate is realistic, achievable and can drive improvement in children's services. PMID:23287643

  2. Unusual presentations of osteoarticular tuberculosis in two paediatric patients

    PubMed Central

    Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung

    2012-01-01

    Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272

  3. Paediatric unplanned reattendance rate: A&E clinical quality indicators.

    PubMed

    O'Loughlin, Kate; Hacking, Katie A; Simmons, Naomi; Christian, William; Syahanee, R; Shamekh, Ahmed; Prince, Nicholas J

    2013-03-01

    The new accident and emergency (A&E) unplanned reattendance rate clinical quality indicator is intended to drive reduction of avoidable reattendances. Validation data for reattendance rates in children are awaited. The aim of this three site observational study is to establish the rate and reasons for unplanned reattendance to UK paediatric A&Es. Each centre undertook retrospective case note review of children attending at least twice within 7 days. Unplanned reattendance rates at the three centres were 5.1%, 5.2% and 4.4%. Reducing unnecessary unplanned reattendances is beneficial for patients, service capacity and efficacy. This study has identified two groups for targeting reattendance reduction: parents of children returning with the same diagnosis, severity unchanged and parents who bypass primary care resources. Clear communication and early involvement of experienced clinicians are paramount. This study has indicated that a 1%-5% unplanned reattendance rate is realistic, achievable and can drive improvement in children's services.

  4. PET/CT in paediatric malignancies - An update.

    PubMed

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Tewari, Anshu

    2016-01-01

    (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT) studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia. PMID:27688605

  5. Paediatric bed fall computer simulation model development and validation.

    PubMed

    Thompson, Angela K; Bertocci, Gina E

    2013-01-01

    Falls from beds and other household furniture are common scenarios stated to conceal child abuse. Knowledge of the biomechanics associated with short-distance falls may aid clinicians in distinguishing between abusive and accidental injuries. Computer simulation is a useful tool to investigate injury-producing events and to study the effect of altering event parameters on injury risk. In this study, a paediatric bed fall computer simulation model was developed and validated. The simulation was created using Mathematical Dynamic Modeling(®) software with a child restraint air bag interaction (CRABI) 12-month-old anthropomorphic test device (ATD) representing the fall victim. The model was validated using data from physical fall experiments of the same scenario with an instrumented CRABI ATD. Validation was conducted using both observational and statistical comparisons. Future parametric sensitivity studies using this model will lead to an improved understanding of relationships between child (fall victim) parameters, fall environment parameters and injury potential.

  6. Anaesthesia alert: an integrated, networked, register of paediatric anaesthetic problems.

    PubMed

    van der Walt, J H; Sainsbury, D A; Pettifer, R

    2001-04-01

    The Paediatric Register of Anaesthetic Problems (PaedRAP) is a network-based anaesthesia hazard alert system. It is integrated with pre-anaesthesia consultations and patient questionnaires. All files, both electronic and on paper, are available 24 hours a day close to the operating theatres. This ensures that pertinent information is readily available when and where it is most needed. The PaedRAP is also linked to the automated theatre booking system to print warnings on the theatre lists. This minimizes the chance that important information goes unnoticed. Documentation of the progression of the various categories of patient problems and evolving management strategies has been useful both for individuals and groups.

  7. [Drugs of abuse acute intoxication in paediatric emergencies].

    PubMed

    García-Algar, O; Papaseit, E; Velasco, M; López, N; Martínez, L; Luaces, C; Vall, O

    2011-06-01

    Documented cases show that acute drugs of abuse intoxication in children usually is the Fritz clinical evidence of a chronic exposure. Published clinical reports of drugs of abuse acute poisonings in children are reviewed, above all those with an underlying chronic exposure to the same or another substance. Biological matrices and exposure biomarkers useful in toxicology analysis in Paediatrics are reviewed. In toxicology, biomarkers refer to original parental substances and its metabolites and matrices refer to body substances where biomarkers are detected. In these matrices acute and chronic (previous days, weeks or months) exposures can be detected. Hair analysis has become the gold standard of drugs of abuse chronic exposure. Recommendation includes to confirm previous chronic exposure to drugs of abuse by hair analysis of children and their parents. This protocol must be applied in all cases with suspicion of acute drugs of abuse intoxication, parental consumption and/or children living in a risk environment.

  8. Paediatric and adolescent sport injury in the wilderness.

    PubMed

    Heggie, T W

    2010-01-01

    Participation in backcountry wilderness recreation has increased in recent years with children and adolescents making up an increasing number of participants visiting wilderness destinations. Engaging in wilderness activity involves the risk of injury, illness and even death. Unfortunately, there is very little research investigating the health challenges facing children and adolescents in the wilderness. With the intent of increasing awareness among the sports medicine community, this review examines reported paediatric and adolescent wilderness injuries reported in the state of Washington and in US National Parks, injuries reported during outdoor wilderness programmes and global youth expeditions, and health challenges in wilderness settings where the threat of acute mountain sickness is elevated. Future studies addressing the challenges of establishing numerator data linked to suitable denominator data and monitoring injured and non-injured children and adolescents in the wilderness are recommended.

  9. [Use of inflammatory markers for monitoring paediatric asthma].

    PubMed

    Vidal G, Alberto

    2015-01-01

    The assessment of asthma control takes into account the symptoms, quality of life, lung function, and inflammatory markers. In the last few years, there has been a large increase in the number of publications related to the study of biomarkers in the management of paediatric asthma. Despite the large variety of inflammatory markers described in research studies, only a small group has shown to be useful in monitoring the disease. Induced sputum eosinophils offer the most solid evidence in assessing asthma control. Exhaled breath condensate and urinary leucotrienes could be useful in the future if there is standardisation in their procedures and interpretation of the results. Nitric oxide, basic eosinophil cationic protein, and bronchial biopsy with bronchoalveolar lavage, only appeared to be useful in a reduced group of patients. PMID:26363862

  10. Research in paediatric neuropsychology--past, present and future.

    PubMed

    Frampton, Ian

    2004-01-01

    Reviews of the research literature in a range of neurodevelopmental disorders and acquired brain injury reveal a remarkably consistent historical transition through three phases, here termed structural, theoretical and dynamic neuropsychology. Of course, any attempt to summarize such a complex and rich history using a simplistic heuristic will inevitably fail to capture the wide diversity of the research effort. Nevertheless, it is argued that looking at three distinct phases in the history of research helps to organize the field and points to possible future directions for applied research. Using examples from an eclectic range of disorders including childhood obsessive compulsive disorder, congenital hemiplegia and disorders implicating mutation of neurodevelopmental control genes, the implications for future efforts in paediatric neurorehabilitation are considered. PMID:14744672

  11. Emergency department overcrowding - implications for paediatric emergency medicine.

    PubMed

    Sinclair, Douglas

    2007-07-01

    Emergency department (ED) overcrowding has been an international phenomenon for more than 10 years. It is important to understand that ED overcrowding is a measure of health system efficiency and is not strictly related to ED volumes or capacity. ED overcrowding is defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time. The major factor resulting in ED overcrowding is the presence of admitted patients in the ED for prolonged periods of time, not a high volume of low-acuity patients. While limited data are available for paediatric EDs, winter respiratory illnesses set the stage for ED overcrowding, which are epidemic in adult or general EDs. Prehospital-, ED- and hospital-related factors are described in the present article, and these may help prevent or manage this important patient safety problem. PMID:19030415

  12. Emergency department overcrowding – implications for paediatric emergency medicine

    PubMed Central

    Sinclair, Douglas

    2007-01-01

    Emergency department (ED) overcrowding has been an international phenomenon for more than 10 years. It is important to understand that ED overcrowding is a measure of health system efficiency and is not strictly related to ED volumes or capacity. ED overcrowding is defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time. The major factor resulting in ED overcrowding is the presence of admitted patients in the ED for prolonged periods of time, not a high volume of low-acuity patients. While limited data are available for paediatric EDs, winter respiratory illnesses set the stage for ED overcrowding, which are epidemic in adult or general EDs. Prehospital-, ED- and hospital-related factors are described in the present article, and these may help prevent or manage this important patient safety problem. PMID:19030415

  13. Paediatric biepicondylar elbow fracture dislocation - a case report.

    PubMed

    Meta, Mahendrakumar; Miller, David

    2010-01-01

    Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments. PMID:20950437

  14. Evaluation and audit in a paediatric disability service.

    PubMed

    Cass, H D; Kugler, B T

    1993-03-01

    Parental and professional responses to questionnaires evaluating a paediatric disability service are reported and the viability of auditing structural, process, and outcome aspects of clinical practice 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 practical 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

  15. Consideration of gene therapy for paediatric neurotransmitter diseases.

    PubMed

    Rotstein, Michael; Kang, Un Jung

    2009-06-01

    The paediatric neurotransmitter diseases (PNDs) are a group of inborn errors of metabolism characterized by abnormalities of neurotransmitter synthesis or metabolism. Although some children may react favourably to neurotransmitter augmentation treatment, optimal response is not universal and other modes of treatment should be sought. The genes involved in many of the currently known monoamine PNDs have been utilized in pre-clinical and in phase I clinical trials in Parkinson disease (PD) and the basic principles could be applied to the therapy of PNDs with some modifications regarding the targeting and distribution of vectors. However, issues that go beyond neurotransmitter replacement are important considerations in PD and even more so in PNDs. Understanding the pathophysiology of PNDs including abnormal development resulting from the neurotransmitter deficiency will be critical for rational therapeutic approaches. Better animal models of PNDs are necessary to test gene therapy before clinical trials can be attempted.

  16. Beyond the guidelines of paediatric septic shock: A focused review.

    PubMed

    Temsah, Mohamad-Hani

    2015-01-01

    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 "Paediatric 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 practical 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.

  17. Cervical vertebral actinomycosis mimicking malignancy in a paediatric patient.

    PubMed

    Prajapati, Shyam; Yoon, Daniel J; Benitez, Carlos L; Buyuk, Arzu

    2016-01-01

    Actinomyces spp are found in the flora of the oral cavity and vagina and may cause infection with abscess formation and draining sinuses. Cervicofacial manifestations of actinomycosis involve head and neck soft tissue, however, spread to the cervical spine is rare. We report a case of an 8-year-old boy, presenting with neck pain for 1 month and denying a history of trauma or procedures. Radiography revealed an ulceration of the posterior oropharyngeal mucosa with a defect extending to the C1-C2 vertebra, mimicking a neoplastic process. The patient underwent laryngoscopy and multiple biopsies were taken from the ulcer and bone, showing severe osteomyelitis and intraosseous filamentous organisms, morphologically consistent with Actinomyces spp. The boy received long-term antibiotics with response to treatment. Actinomycosis has rarely been reported in the cervical vertebrae of paediatric patients. This should be considered as a differential diagnosis for such a presentation as prompt antibiotic treatment may be lifesaving. PMID:27033296

  18. Paediatric oncology in Argentina: medical and ethical issues.

    PubMed

    Scopinaro, Marcelo J; Casak, Sandra J

    2002-02-01

    The process of globalisation is affecting health and health care in Argentina, as it is in many other countries. The full extent of this effect is still unclear, but winners and losers in the world economy are emerging--not only different countries, but also sectors or populations within those countries. There are serious inequalities in health-care provision in Argentina, so that not all children with cancer receive the best possible therapy. What happens to those children who don't? How do staff feel when they have to turn away new patients? Only by asking these questions and examining and understanding the answers can we begin the process of improving the status of paediatric oncology in Argentina.

  19. PET/CT in paediatric malignancies - An update

    PubMed Central

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Tewari, Anshu

    2016-01-01

    18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT) studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia. PMID:27688605

  20. [Use of inflammatory markers for monitoring paediatric asthma].

    PubMed

    Vidal G, Alberto

    2015-01-01

    The assessment of asthma control takes into account the symptoms, quality of life, lung function, and inflammatory markers. In the last few years, there has been a large increase in the number of publications related to the study of biomarkers in the management of paediatric asthma. Despite the large variety of inflammatory markers described in research studies, only a small group has shown to be useful in monitoring the disease. Induced sputum eosinophils offer the most solid evidence in assessing asthma control. Exhaled breath condensate and urinary leucotrienes could be useful in the future if there is standardisation in their procedures and interpretation of the results. Nitric oxide, basic eosinophil cationic protein, and bronchial biopsy with bronchoalveolar lavage, only appeared to be useful in a reduced group of patients.

  1. PET/CT in paediatric malignancies - An update

    PubMed Central

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Tewari, Anshu

    2016-01-01

    18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT) studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia.

  2. Influenza Vaccination Coverage Rate for Medical Staff: Influence of Hospital-Based Vaccination Campaign.

    PubMed

    Zielonka, T M; Szymańczak, M; Jakubiak, J; Nitsch-Osuch, A; Życińska, K

    2016-01-01

    Despite intensive recommendations, influenza vaccination rate in medical staff in Poland ranges from about 20 % in physicians to 10 % in nurses. The objective of this work was to assess the influence of hospital influenza vaccination campaign directed toward health care workers, combined with dispensing free of charge vaccine, on vaccination rate. The campaign was conducted by the Hospital Infection Control Team of the Czerniakowski Hospital in Warsaw, Poland, separately for physicians, nurses, and physiotherapists. Overall, 37 % of medical staff were vaccinated, including 55 % of physicians and 21 % of nurses. Concerning physicians, the greatest vaccination rate was in the orthopedic (80 %) and ophthalmology units (73 %), whereas the lowest rate was in the intensive care (22 %) and neurology units (20 %). Concerning nurses, the greatest vaccination rate was in those working in the outpatient (40 %) and emergency units (29 %), whereas the lowest rate was in the ophthalmology (6 %) and surgery units (11 %). We conclude that the professional knowledge campaign combined with the incentive of free of charge vaccine substantially raises the vaccination rate among medical staff.

  3. Influenza Vaccination Coverage Rate for Medical Staff: Influence of Hospital-Based Vaccination Campaign.

    PubMed

    Zielonka, T M; Szymańczak, M; Jakubiak, J; Nitsch-Osuch, A; Życińska, K

    2016-01-01

    Despite intensive recommendations, influenza vaccination rate in medical staff in Poland ranges from about 20 % in physicians to 10 % in nurses. The objective of this work was to assess the influence of hospital influenza vaccination campaign directed toward health care workers, combined with dispensing free of charge vaccine, on vaccination rate. The campaign was conducted by the Hospital Infection Control Team of the Czerniakowski Hospital in Warsaw, Poland, separately for physicians, nurses, and physiotherapists. Overall, 37 % of medical staff were vaccinated, including 55 % of physicians and 21 % of nurses. Concerning physicians, the greatest vaccination rate was in the orthopedic (80 %) and ophthalmology units (73 %), whereas the lowest rate was in the intensive care (22 %) and neurology units (20 %). Concerning nurses, the greatest vaccination rate was in those working in the outpatient (40 %) and emergency units (29 %), whereas the lowest rate was in the ophthalmology (6 %) and surgery units (11 %). We conclude that the professional knowledge campaign combined with the incentive of free of charge vaccine substantially raises the vaccination rate among medical staff. PMID:26839107

  4. Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial

    PubMed Central

    Ramsay, Pam; Huby, Guro; Merriweather, Judith; Salisbury, Lisa; Rattray, Janice; Griffith, David; Walsh, Timothy

    2016-01-01

    Objectives To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting Two university-affiliated hospitals in Scotland. Participants 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated

  5. Italian contributions to Turkish paediatrics during the Ottoman Empire.

    PubMed

    Yurdakok, Murat; Cataldi, Luigi

    2013-01-01

    The Ottoman Empire maintained close relations with the neighbouring Italian city states in the 16th and 17th century. Yacub Pasha (1425-1481), personal physician of Mehmed II the Conqueror, was an Italian Jew who advanced to the title of pasha and vizier. Domenico Hierosolimitano (ca. 1552-1622), the third physician to Sultan Murad III, was a Jerusalemite rabbi. His book is an important source about everyday life and medical practice in Istanbul at the time. Nuh bin Abd al-Mennab (1627-1707), also of Italian stock, was the Chief Physician of the Ottoman Empire, who translated a pharmacopoeia into Turkish. In the same century, two Italians, Israel Conegliano (Conian) and Tobia Cohen became private physicians to leading Ottoman pashas and the Grand Vizier. A. Vuccino (1829-1893) and Antoine Calleja Pasha (1806-1893) taught at the Istanbul Medical School. Italy was a favoured country for medical education during the early period of Ottoman westernisation. Sanizade Mehmet Ataullah Efendi (1771-1826) translated the first medical book printed in the Ottoman Empire from Italian into Turkish. Mustafa Behcet Efendi (1774-1833), chief physician to the Sultan and the founder of the first western medical school in Turkey, translated several medical books from Italian into Turkish. The first printed pharmacopeia in the Ottoman Empire was also originally Italian In the 19th century, Edouard Ottoni and his son Giuseppe Ottoni were well-known military pharmacists, both under the name of Faik Pasha. Probably the most influential physician of Italian origin was Giovanni Battista Violi (1849-1928), who had practiced paediatrics in Turkey for more than fifty years. Violi was the founder of the first children's hospital, the first vaccine institute, and the first paediatric journal in the Ottoman Empire.

  6. Volunteer activity in specialist paediatric palliative care: a national survey

    PubMed Central

    Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L; Scott, Rosalind; Bravery, Ruth; Candy, Bridget

    2015-01-01

    Objective To assess the involvement of volunteers with direct patient/family contact in UK palliative care services for children and young people. Method Cross-sectional survey using a web-based questionnaire. Setting UK specialist paediatric palliative care services. Participants Volunteer managers/coordinators from all UK hospice providers (n=37) and one National Health Service palliative care service involving volunteers (covering 53 services in total). Main outcomes Service characteristics, number of volunteers, extent of volunteer involvement in care services, use of volunteers’ professional skills and volunteer activities by setting. Results A total of 21 providers covering 31 hospices/palliative care services responded (30 evaluable responses). Referral age limit was 16–19 years in 23 services and 23–35 years in seven services; three services were Hospice at Home or home care only. Per service, there was a median of 25 volunteers with direct patient/family contact. Services providing only home care involved fewer volunteers than hospices with beds. Volunteers entirely ran some services, notably complementary therapy and pastoral/faith-based care. Complementary therapists, school teachers and spiritual care workers most commonly volunteered their professional skills. Volunteers undertook a wide range of activities including emotional support and recreational activities with children and siblings. Conclusions This is the most detailed national survey of volunteer activity in palliative care services for children and young people to date. It highlights the range and depth of volunteers’ contribution to specialist paediatric palliative care services and will help to provide a basis for future research, which could inform expansion of volunteers’ roles. PMID:24644170

  7. Radiation dose and image quality for paediatric interventional cardiology

    NASA Astrophysics Data System (ADS)

    Vano, E.; Ubeda, C.; Leyton, F.; Miranda, P.

    2008-08-01

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 µGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 µGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  8. Diclofenac or paracetamol for analgesia in paediatric myringotomy outpatients.

    PubMed

    Tay, C L M; Tan, S

    2002-02-01

    This prospective, randomized, double-blind study compared the analgesic efficacy of oral diclofenac resinate 0.5 mg.kg(-1) with paracetamol 15 mg/kg(-1) for control of postoperative pain in paediatric patients for outpatient bilateral myringotomy and tube insertion. Paracetamol, the most commonly used oral analgesic for paediatric patients, was compared with a new palatable syrup formulation of diclofenac. Sixty-three ASA 1 orA SA 2 children aged one year and above were randomly assigned to receive diclofenac (Group A) or paracetamol (Group B). The study drug was given 30 to 60 minutes before induction of anaesthesia. Anaesthesia was induced with either inhalational sevoflurane or intravenous thiopentone. All subjects received intravenous fentanyl 1 microg/kg(-1) intraoperatively. Postoperative pain was assessed by a blinded observer using the CHEOPS score on eye-opening, and then at 10, 30 and 60 minutes. Children with a CHEOPS score > 7 received further fentanyl 1 microg x kg(-1). The number of cases requiring this "rescue" analgesia was recorded. Both groups were comparable in demographics, induction technique, duration of anaesthesia and time between premedication and induction of anaesthesia. Overall, CHEOPS scores were low for both groups at all times and did not differ between the groups at any time. Twenty per cent of the diclofenac group and 27% of the paracetamol group required rescue analgesia (not statistically significant). The efficacy of diclofenac 0.5 mg x kg(-1) and paracetamol 15 mg x kg(-1) as oral analgesic premedication for BMT was comparable in children receiving an anaesthetic which included intraoperative administration of fentanyl 1 microg x kg(-1). PMID:11939442

  9. Paediatric femur fractures at the emergency department: accidental or not?

    PubMed

    Hoytema van Konijnenburg, Eva M M; Vrolijk-Bosschaart, Thekla F; Bakx, Roel; Van Rijn, Rick R

    2016-01-01

    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information. PMID:26642309

  10. Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

    PubMed Central

    2011-01-01

    Background As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation. Results Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing

  11. The landscape of somatic mutations in epigenetic regulators across 1,000 paediatric cancer genomes.

    PubMed

    Huether, Robert; Dong, Li; Chen, Xiang; Wu, Gang; Parker, Matthew; Wei, Lei; Ma, Jing; Edmonson, Michael N; Hedlund, Erin K; Rusch, Michael C; Shurtleff, Sheila A; Mulder, Heather L; Boggs, Kristy; Vadordaria, Bhavin; Cheng, Jinjun; Yergeau, Donald; Song, Guangchun; Becksfort, Jared; Lemmon, Gordon; Weber, Catherine; Cai, Zhongling; Dang, Jinjun; Walsh, Michael; Gedman, Amanda L; Faber, Zachary; Easton, John; Gruber, Tanja; Kriwacki, Richard W; Partridge, Janet F; Ding, Li; Wilson, Richard K; Mardis, Elaine R; Mullighan, Charles G; Gilbertson, Richard J; Baker, Suzanne J; Zambetti, Gerard; Ellison, David W; Zhang, Jinghui; Downing, James R

    2014-01-01

    Studies of paediatric cancers have shown a high frequency of mutation across epigenetic regulators. Here we sequence 633 genes, encoding the majority of known epigenetic regulatory proteins, in over 1,000 paediatric tumours to define the landscape of somatic mutations in epigenetic regulators in paediatric cancer. Our results demonstrate a marked variation in the frequency of gene mutations across 21 different paediatric cancer subtypes, with the highest frequency of mutations detected in high-grade gliomas, T-lineage acute lymphoblastic leukaemia and medulloblastoma, and a paucity of mutations in low-grade glioma and retinoblastoma. The most frequently mutated genes are H3F3A, PHF6, ATRX, KDM6A, SMARCA4, ASXL2, CREBBP, EZH2, MLL2, USP7, ASXL1, NSD2, SETD2, SMC1A and ZMYM3. We identify novel loss-of-function mutations in the ubiquitin-specific processing protease 7 (USP7) in paediatric leukaemia, which result in decreased deubiquitination activity. Collectively, our results help to define the landscape of mutations in epigenetic regulatory genes in paediatric cancer and yield a valuable new database for investigating the role of epigenetic dysregulations in cancer.

  12. UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars.

    PubMed

    Kindelan, S A; Day, P; Nichol, R; Willmott, N; Fayle, S A

    2008-11-01

    This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.

  13. Paediatric endoscopy by adult gastroenterologists in Ile-Ife, Nigeria: A viable option to increase the access to paediatric endoscopy in low resource countries

    PubMed Central

    Alatise, Olusegun I.; Anyabolu, Henry Chineme; Sowande, Oludayo; Akinola, David

    2015-01-01

    Background: Paediatric endoscopy performed by adult gastroenterologists is a service delivery model that increases the access of children to endoscopy in countries where paediatric gastroenterologists with endoscopy skills are scarce. However, studies on the usefulness of this model in Nigeria and Sub-Saharan Africa are scarce. We aimed to evaluate the indications, procedures, diagnostic yield and safety of paediatric endoscopy performed by adult gastroenterologists in a Nigerian tertiary health facility. Materials and Methods: It was a retrospective study that evaluated the records of paediatric (≤18 years old) endoscopies carried out in the endoscopy suite of Obafemi Awolowo University Teaching Hospital Complex Ile-Ife, Nigeria from January 2007 to December 2014. Results: A total of 63 procedures were successfully completed in children of whom 4 were repeat procedures which were excluded. Thus, 59 endoscopies performed on children were analysed. Most (49; 83.1%) of these procedures on the children were diagnostic with oesophagogastroduodenoscopy being the commonest (43; 72.9%). Epigastric pain (22; 37.3%), haematemesis (17; 28.8%) and dysphagia (9; 15.3%) were the predominant indication for upper gastrointestinal (GI) endoscopy while haematochezia (9; 15.3%) and rectal protrusion (2; 3.4%) were the indications for colonoscopy. Injection sclerotherapy (3; 5.1%) and variceal banding (2; 3.4%) were the therapeutic upper GI endoscopic procedures conducted while polypectomies were performed during colonoscopy in 5 children (8.5%). Abnormal endoscopy findings were observed in 53 out of the 59 children making the positive diagnostic yield to be 89.8%. No complication, either from the procedure or anaesthesia was observed. Conclusion: Paediatric endoscopy performed by adult gastroenterologists is useful, feasible and safe. It is being encouraged as a viable option to fill the gap created by dearth of skilled paediatric gastroenterologists. PMID:26712292

  14. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke

    PubMed Central

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

    2016-01-01

    Abstract We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P < 0.001). We also found that, although the HR of 30-day mortality in low healthcare technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P < 0.0001), cerebrovascular surgical procedure patients treated in low healthcare technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted. PMID:26986122

  15. Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study.

    PubMed

    Abu Hamad, Kh; Abed, Y; Abu Hamad, B

    2007-01-01

    This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age > or = 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth. PMID:18290407

  16. Establishing an internet-based paediatric cancer registration and communication system for the Hungarian paediatric oncology network.

    PubMed

    Borgulya, Gábor; Jakab, Zsuzsanna; Schuler, Dezso; Garami, Miklós

    2004-01-01

    Cancer registration has developed in Europe over the last 50 years, and in the last decade intensive joint activities between the European Cancer Registries, in response to the need of pan-European harmonization of registration practices, have taken place. The Hungarian Paediatric Cancer Registry has been functioning as the database of the Hungarian Paediatric Oncology Network since 1971, aiming to follow the incidence and the treatment efficacy of malignant diseases. The goals of this globally unique open source information system are the following: 1) to raise the quality of the registration system to the European level by developing an Internet-based registration and communication system, modernizing the database, establishing automatic statistical analyses and adding an Internet website, 2) to support clinical epidemiological studies that we conduct with international collaborators on detailed analyses of the characteristics of patients and their diseases, evaluation of new diagnostic and therapeutic methods, prevention programs, and long-term quality of life and side effects. The benefits of the development of the Internet-based registration and communication system are as follows: a) introduction of an Internet-based case reporting system, b) modernization of the registry database according to international recommendations, c) automatic statistical summaries, encrypted mail systems, document repository, d) application of data security and privacy standards, e) establishment of a website and compilation of educational materials. The overall objective of this scientific project is to contribute towards the improvement of cancer prevention and cancer care for the benefit of the public in general and of cancer patients in particular. PMID:15718593

  17. Systematic meta-analyses and field synopsis of genetic and epigenetic studies in paediatric inflammatory bowel disease

    PubMed Central

    Li, Xue; Song, Peige; Timofeeva, Maria; Meng, Xiangrui; Rudan, Igor; Little, Julian; Satsangi, Jack; Campbell, Harry; Theodoratou, Evropi

    2016-01-01

    We provide a comprehensive field synopsis of genetic and epigenetic associations for paediatric Inflammatory Bowel Disease (IBD). A systematic review was performed and included 84 genetic association studies reporting data for 183 polymorphisms in 71 genes. Meta-analyses were conducted for 20 SNPs in 10 genes of paediatric Crohn’s disease (CD) and for 8 SNPs in 5 genes of paediatric ulcerative colitis (UC). Five epigenetic studies were also included, but formal meta-analysis was not possible. Venice criteria and Bayesian false discovery probability test were applied to assess the credibility of associations. Nine SNPs in 4 genes were considered to have highly credible associations with paediatric CD, of which four variants (rs2066847, rs12521868, rs26313667, rs1800629) were not previously identified in paediatric GWAS. Differential DNA methylation in NOD2 and TNF-α, dysregulated expression in let-7 and miR-124 were associated with paediatric IBD, but not as yet replicated. Highly credible SNPs associated with paediatric IBD have also been implicated in adult IBD, with similar magnitudes of associations. Early onset and distinct phenotypic features of paediatric IBD might be due to distinct epigenetic changes, but these findings need to be replicated. Further progress identifying genetic and epigenetic susceptibility of paediatric IBD will require international collaboration, population diversity and harmonization of protocols. PMID:27670835

  18. Estimation of paediatric organ and effective doses from dental cone beam CT using anthropomorphic phantoms

    PubMed Central

    Theodorakou, C; Walker, A; Horner, K; Pauwels, R; Bogaerts, R; Jacobs Dds, R

    2012-01-01

    Objectives Cone beam CT (CBCT) is an emerging X-ray technology applied in dentomaxillofacial imaging. Previous published studies have estimated the effective dose and radiation risks using adult anthropomorphic phantoms for a wide range of CBCT units and imaging protocols. Methods Measurements were made five dental CBCT units for a range of imaging protocols, using 10-year-old and adolescent phantoms and thermoluminescent dosimeters. The purpose of the study was to estimate paediatric organ and effective doses from dental CBCT. Results The average effective doses to the 10-year-old and adolescent phantoms were 116 μSv and 79 μSv, respectively, which are similar to adult doses. The salivary glands received the highest organ dose and there was a fourfold increase in the thyroid dose of the 10-year-old relative to that of the adolescent because of its smaller size. The remainder tissues and salivary and thyroid glands contributed most significantly to the effective dose for a 10-year-old, whereas for an adolescent the remainder tissues and the salivary glands contributed the most significantly. It was found that the percentage attributable lifetime mortality risks were 0.002% and 0.001% for a 10-year-old and an adolescent patient, respectively, which are considerably higher than the risk to an adult having received the same doses. Conclusion It is therefore imperative that dental CBCT examinations on children should be fully justified over conventional X-ray imaging and that dose optimisation by field of view collimation is particularly important in young children. PMID:22308220

  19. Non-convulsive status epilepticus after ischemic stroke: a hospital-based stroke cohort study.

    PubMed

    Belcastro, Vincenzo; Vidale, Simone; Gorgone, Gaetano; Pisani, Laura Rosa; Sironi, Luigi; Arnaboldi, Marco; Pisani, Francesco

    2014-11-01

    To evaluate in the setting of a stroke unit ward the usefulness of a prolonged (>6 h) video-EEG recording (PVEEG) in identifying non-convulsive status epilepticus (NCSE) in patients with an acute ischemic stroke. Predictors of NCSE were also evaluated. Patients with an acute ischemic stroke, referred to our unit, were included in this prospective observational study. A PVEEG recording was implemented after stroke in all patients during the first week: (a) promptly in those exhibiting a clear or suspected epileptic manifestation; (b) at any time during the routine activity in the remaining patients. After the first week, a standard EEG/PVEEG recording was hooked up only in presence of an evident or suspected epileptic manifestation or as control of a previous epileptic episode. NCSE was identified in 32 of the 889 patients (3.6 %) included in the study. It occurred early (within the first week) in 20/32 (62.5 %) patients and late in the remaining 12. Diagnosis was made on the basis of a specific clinical suspect (n = 19, 59.4 %) or without any suspect (n = 13, 40.6 %). In a multivariate analysis, a significant association of NCSE was observed with NIHSS score, infarct size and large atherothrombotic etiology. NCSE is not a rare event after an acute ischemic stroke and a delayed diagnosis could worsen patient prognosis. Since NCSE can be difficult to be diagnosed only on clinical grounds, implementation of a prompt PVEEG should be kept available in a stroke unit whenever a patient develop signs, although subtle, consistent with NCSE.

  20. Beyond volume: hospital-based healthcare technology as a predictor of mortality for cardiovascular patients in Korea

    PubMed Central

    Kim, Jae-Hyun; Lee, Yunhwan; Park, Eun-Cheol

    2016-01-01

    Abstract To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures. This study used the National Health Insurance Service–Cohort Sample Database from 2002 to 2013, which was released by the Korean National Health Insurance Service. A total of 11,109 cardiovascular surgical procedure patients were analyzed. The primary analysis was based on logistic regression models to examine our hypothesis. After adjusting for hospital volume of cardiovascular surgical procedures as well as for all other confounders, the odds ratio (OR) of 30-day mortality in low healthcare technology hospitals was 1.567-times higher (95% confidence interval [CI] = 1.069–2.297) than in those with high healthcare technology. We also found that, overall, cardiovascular surgical patients treated in low healthcare technology hospitals, regardless of the extent of cardiovascular surgical procedures, had the highest 30-day mortality rate. Although the results of our study provide scientific evidence for a hospital volume–mortality relationship in cardiovascular surgical patients, the independent effect of hospital-based healthcare technology is strong, resulting in a lower mortality rate. As hospital characteristics such as clinical pathways and protocols are likely to also play an important role in mortality, further research is required to explore their respective contributions. PMID:27310998

  1. Experimental observation of acoustic emissions generated by a pulsed proton beam from a hospital-based clinical cyclotron

    SciTech Connect

    Jones, Kevin C.; Solberg, Timothy D.; Avery, Stephen; Vander Stappen, François; Janssens, Guillaume; Prieels, Damien; Bawiec, Christopher R.; Lewin, Peter A.; Sehgal, Chandra M.

    2015-12-15

    Purpose: To measure the acoustic signal generated by a pulsed proton spill from a hospital-based clinical cyclotron. Methods: An electronic function generator modulated the IBA C230 isochronous cyclotron to create a pulsed proton beam. The acoustic emissions generated by the proton beam were measured in water using a hydrophone. The acoustic measurements were repeated with increasing proton current and increasing distance between detector and beam. Results: The cyclotron generated proton spills with rise times of 18 μs and a maximum measured instantaneous proton current of 790 nA. Acoustic emissions generated by the proton energy deposition were measured to be on the order of mPa. The origin of the acoustic wave was identified as the proton beam based on the correlation between acoustic emission arrival time and distance between the hydrophone and proton beam. The acoustic frequency spectrum peaked at 10 kHz, and the acoustic pressure amplitude increased monotonically with increasing proton current. Conclusions: The authors report the first observation of acoustic emissions generated by a proton beam from a hospital-based clinical cyclotron. When modulated by an electronic function generator, the cyclotron is capable of creating proton spills with fast rise times (18 μs) and high instantaneous currents (790 nA). Measurements of the proton-generated acoustic emissions in a clinical setting may provide a method for in vivo proton range verification and patient monitoring.

  2. Application of Jean Piaget's theory of human development for nursing children in an adult intensive therapy unit.

    PubMed

    Green, A

    1991-12-01

    Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU.

  3. Application of Jean Piaget's theory of human development for nursing children in an adult intensive therapy unit.

    PubMed

    Green, A

    1991-12-01

    Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU. PMID:1765639

  4. Effect of reducing the paediatric stavudine dose by half: a physiologically-based pharmacokinetic model.

    PubMed

    Sy, Sherwin K B; Malmberg, Ruben; Matsushima, Aoi; Asin-Prieto, Eduardo; Rosenkranz, Bernd; Cotton, Mark F; Derendorf, Hartmut; Innes, Steve

    2015-04-01

    Owing to significant dose-related toxicity, the adult stavudine dose was reduced in 2007. The paediatric dose, however, has not been reduced. Although the intended paediatric dose is 1 mg/kg twice daily (b.i.d.), the current weight-band dosing approach results in a mean actual dose of 1.23±0.47 mg/kg. Both efficacy and mitochondrial toxicity depend on the concentration of the intracellular metabolite stavudine triphosphate (d4T-TP). We simulated the effect of reducing the paediatric dose to 0.5 mg/kg. A physiologically-based pharmacokinetic model consisting of 13 tissue compartments plus a full ADAM model was used to describe the elimination of stavudine. The volume of distribution at steady-state and apparent oral clearance were simulated and the resulting AUC profile was compared with literature data in adult and paediatric populations. A biochemical reaction model was utilised to simulate intracellular d4T-TP levels for both the standard and proposed reduced paediatric doses. Simulated and observed exposure after oral dosing showed adequate agreement. Mean steady-state d4T-TP for 1.23 mg/kg b.i.d. was 27.9 (90% CI 27.0-28.9) fmol/10(6) cells, 25% higher than that achieved by the 40 mg adult dose. The 0.5 mg/kg dose resulted in d4T-TP of 13.2 (12.7-13.7) fmol/10(6) cells, slightly higher than the adult dose of 20 mg b.i.d. [11.5 (11.2-11.9) fmol/10(6) cells], which has excellent antiviral efficacy and substantially less toxicity. Current paediatric dosing may result in even higher d4T-TP than the original 40 mg adult dose. Halving the paediatric dose would significantly reduce the risk of mitochondrial toxicity without compromising antiviral efficacy.

  5. Electronic medical file exchange between on-duty care providers and the attending paediatrician: a Belgian paediatric pilot project.

    PubMed

    Deneyer, M; Hachimi-Idrissi, S; Michel, L; Nyssen, M; De Moor, G; Vandenplas, Y

    2012-01-01

    The authors propose the introduction of a pilot project: "paediatric core file exchange in emergencies" (PCF-EXEM) which enables the exchange of medical data between the attending paediatrician (AP), holder of the medical record, and on-duty medical units (i.e. general practitioners, paediatricians, surgeons, emergency physicians,...). This project is based on two pillars: a protected server (PCF-server) containing paediatric core files (PCF), with important clinical data that should be available for the physician in order to quickly get a clear insight into the relevant clinical medical history of the child, and secondly, the possibility to provide feedback to the attending physician about the findings recorded during the on-call duty. The permanent availability of health data on the PCF-server and the possibility to provide feedback represent together the PCF-EXEM-project. This project meets the demand of the care providers to have relevant medical information permanently available in order to guarantee high quality care in emergency situations. The frail balance between the right to informative privacy and professional confidentiality on the one hand and the right to quality health care on the other hand has been taken into account. The technical and practical feasibility of this project is described. The objectives and vision of the PCF-EXEM project are conform to Belgian legislation concerning the processing of medical data and are in line with the still under consideration European projects which are focusing on interoperability and the development of a common access control to databanks containing health data for care providers. PCF-EXEM could therefore be a model for other EU countries as well.

  6. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

    PubMed

    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue <125, light blue 125-250, and green 250-440 PU. The thickness of these scars was significantly different between the predominant colours of burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI.

  7. Adherence to treatment in a Western European paediatric population with haemophilia: reliability and validity of the VERITAS-Pro scale.

    PubMed

    Lock, J; Raat, H; Duncan, N; Shapiro, A; Beijlevelt, M; Peters, M; Tamminga, R Y J; Leebeek, F W G; Moll, H A; Cnossen, M H

    2014-09-01

    Treatment adherence in haemophilia is strongly associated with quality of life and the cost-benefit of treatment. Therefore, it is important to quantify and monitor it. This study aimed to validate a translation of the VERITAS-Pro cross-culturally and analyse treatment adherence in a Dutch population of paediatric haemophilia patients. Children aged 1-18 years with haemophilia were included from three Haemophilia Treatment Centres, on prophylactic clotting factor replacement therapy for more than 1 year. Parents and adolescents were analysed separately. The adherence scale for prophylactic therapy (VERITAS-Pro) was translated according to international guidelines. This instrument contains a total of six subscales ('Time', 'Dose', 'Plan', 'Remember', 'Skip' and 'Communicate') each with four items. Lower scores reflect higher adherence. Overall response rate was 85%, leading to a study population of 60 children. Mean age was 10 years (SD 4.1). Internal consistency reliability: Mean Cronbach's alphas were adequate (>0.70) for total score and the subscales 'Skip' and 'Communicate'. Item-own subscale correlations were stronger than most item-other subscale correlations. Convergent validity: Total scores were higher for non-adherent participants compared with adherent participants according to patient infusion logs (n = 48; P < 0.05). Test-retest correlations: Significant for all scales except 'Dose' (n = 58; P < 0.01). This study demonstrates applicability of VERITAS-Pro outside the United States, as total score and most subscales effectively quantified treatment adherence in a Dutch paediatric population on prophylactic therapy. Non-adherent respondents' total scores were significantly higher, demonstrating the ability of VERITAS-Pro to identify non-adherent individuals.

  8. Organization of a hospital-based victim decontamination plan using the incident command structure.

    PubMed

    Powers, Robert

    2007-01-01

    Hospitals are required to have the capability of performing patient decontamination. Incorporating the incident command structure provided by the National Incident Management System and the Hospital Incident Command System into their decontamination plans will enable hospitals to be better organized and efficient in managing events producing contaminated patients. HAZMAT Branch incident command includes the leadership positions of a HAZMAT Branch director and a Victim Decontamination Unit leader, as well as managers for each zone, logistics, triage, medical monitoring, and support roles. Coupling a well-developed decontamination command structure with staff practice in their roles will help to ensure an organized response. This article describes the specific roles and responsibilities included in an incident command system-based hospital decontamination plan than has been used successfully in a multi-hospital system.

  9. Organization of a hospital-based victim decontamination plan using the incident command structure.

    PubMed

    Powers, Robert

    2007-01-01

    Hospitals are required to have the capability of performing patient decontamination. Incorporating the incident command structure provided by the National Incident Management System and the Hospital Incident Command System into their decontamination plans will enable hospitals to be better organized and efficient in managing events producing contaminated patients. HAZMAT Branch incident command includes the leadership positions of a HAZMAT Branch director and a Victim Decontamination Unit leader, as well as managers for each zone, logistics, triage, medical monitoring, and support roles. Coupling a well-developed decontamination command structure with staff practice in their roles will help to ensure an organized response. This article describes the specific roles and responsibilities included in an incident command system-based hospital decontamination plan than has been used successfully in a multi-hospital system. PMID:17996656

  10. Hospital-based prevalence of malaria and dengue in febrile patients in Bangladesh.

    PubMed

    Faruque, Labib I; Zaman, Rashid Uz; Alamgir, A S M; Gurley, Emily S; Haque, Rashidul; Rahman, Mahmudur; Luby, Stephen P

    2012-01-01

    We conducted a nationwide study at six tertiary hospitals from December 2008 through November 2009 to investigate etiologies of febrile illnesses in Bangladesh. Febrile patients meeting a clinical case definition were enrolled from inpatient and outpatient medicine and pediatric units. We assessed 720 febrile patients over 12 months; 69 (9.6%) were positive for IgM antibodies against dengue virus by enzyme-linked immunosorbent assay, and four malaria patients (0.56%) were confirmed with immuno-chromatography and microscopic slide tests. We identified dengue cases throughout the year from rural (49%) and urban areas (51%). We followed-up 55 accessible dengue-infected patients two months after their initial enrollment: 45 (82%) patients had fully recovered, 9 (16%) reported ongoing jaundice, fever and/or joint pain, and one died. Dengue infection is widespread across Bangladesh, but malaria is sufficiently uncommon that it should not be assumed as the cause of fever without laboratory confirmation.

  11. Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).

    PubMed

    Leonard, H L; Swedo, S E

    2001-06-01

    The evidence to date, both published and unpublished, which addresses the validity of the proposed unique subgroup of children with early and abrupt onset of obsessive--compulsive disorder (OCD) and/or tic disorders subsequent to streptococcal infections was reviewed. The aetiology of OCD and tic disorders is unknown, although it appears that both disorders may arise from a variety of genetic and environmental factors. Post-streptococcal autoimmunity has been postulated as one possible mechanism for some. The acronym PANDAS (for paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been given to a subgroup of paediatric patients who meet five inclusionary criteria: presence of OCD and/or tic disorder, pre-pubertal symptom onset, sudden onset or episodic course of symptoms, temporal association between streptococcal infections and neuropsychiatric symptom exacerbations, and associated neurological abnormalities. The proposed model of pathophysiology provides for several unique treatment strategies, including the use of antibiotic prophylaxis to prevent streptococcal-triggered exacerbations, and the use of immunomodulatory interventions (such as intravenous immunoglobulin or therapeutic plasma exchange) in the treatment severe neuropsychiatric symptoms. For the latter study group, long-term (2--5 yr) follow-up revealed continued symptom improvement for the majority of patients, particularly when antibiotic prophylaxis had been effective in preventing recurrent streptococcal infections. In addition, the episodic nature of the subgroup's illness provides for opportunities to study brain structure and function during health and disease, as well as allowing for investigations of the aetiologic role of anti-neuronal antibodies and neuroimmune dysfunction in both OCD and tic disorders. Although much research remains to be done, an increasing body of evidence provides support for the postulate that OCD and tic disorders may arise

  12. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital.

    PubMed

    Gerasimidis, Konstantinos; Keane, Orla; Macleod, Isobel; Flynn, Diana M; Wright, Charlotte M

    2010-09-01

    Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59% of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47% were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (kappa = 0.46) and inter-rater reliability (kappa = 0.53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

  13. Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

    PubMed Central

    Kua, Phek Hui Jade; Wu, Li; Ong, E-Lin Tessa; Lim, Zi Ying; Yiew, Jinmian Luther; Thia, Xing Hui Michelle; Sung, Sharon Cohan

    2016-01-01

    INTRODUCTION A significant percentage of paediatric emergency department (ED) attendances worldwide are nonurgent, adversely affecting patient outcomes and healthcare systems. This study aimed to understand the reasons behind nonurgent ED visits, in order to develop targeted and effective preventive interventions. METHODS In-depth interviews were conducted with 49 caregivers to identify the decision-making factors related to taking children to the ED of KK Women’s and Children’s Hospital, Singapore. Interviews were carried out in the emergency room of the hospital after the children had been diagnosed with nonurgent conditions by the attending physician. Interview transcripts were analysed based on grounded theory principles. RESULTS The demographics of our study cohort were representative of the target population. The main reasons given by the caregivers for attending paediatric EDs included perceived severity of the child’s symptoms, availability of after-hours care, perceived advantage of a paediatric specialist hospital and mistrust of primary care physicians’ ability to manage paediatric conditions. Insurance or welfare was a contributing factor for only a small portion of caregivers. CONCLUSION The reasons provided by Singaporean caregivers for attending paediatric EDs were similar to those reported in studies conducted in Western countries. However, the former group had a unique understanding of the local healthcare system. The study’s findings may be used to develop interventions to change the knowledge, attitudes and behaviours of caregivers in Singapore. PMID:26805668

  14. Paediatric bipolar disorder: international comparisons of hospital discharge rates 2000–2010

    PubMed Central

    Clacey, Joe; Goldacre, Michael

    2015-01-01

    Background Controversy surrounds the diagnosis and prevalence of paediatric bipolar disorder, with estimates varying considerably between countries. Aims To determine the international hospital discharge rates for paediatric bipolar disorder compared with all other psychiatric diagnoses. Method We used national data-sets from 2000 to 2010 from England, Australia, New Zealand, the USA and Germany. Results For those aged under 20 years, the discharge rates for paediatric bipolar disorder per 100 000 population were: USA 95.6, Australia 11.7, New Zealand 6.3, Germany 1.5 and England 0.9. The most marked divergence in discharge rates was in 5- to 9-year-olds: USA 27, New Zealand 0.22, Australia 0.14, Germany 0.03 and England 0.00. Conclusions The disparity between US and other discharge rates for paediatric bipolar disorder is markedly greater than the variation for child psychiatric discharge rates overall, and for adult rates of bipolar disorder. This suggests there may be differing diagnostic practices for paediatric bipolar disorder in the USA. Declaration of interest None. Copyright and usage © 2015 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703743

  15. Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues.

    PubMed

    Rosa, Margherita; De Lucia, Silvana; Rinaldi, Victoria Elisa; Le Gal, Julie; Desmarest, Marie; Veropalumbo, Claudio; Romanello, Silvia; Titomanlio, Luigi

    2015-01-01

    Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.

  16. Publishing ethics in paediatric research: a cross-cultural comparative review.

    PubMed

    Brännström, Inger

    2012-03-01

    The present article aims to scrutinize publishing ethics in the fields of paediatrics and paediatric nursing. Full-text readings of all original research articles in paediatrics from a high-income economy, i.e. Sweden, and from all low-income economies in Sub-Saharan Africa, were reviewed as they were indexed and stored in Web of Science for the search period from 1 January 2007 to 7 October 2009. The application of quantitative and qualitative content analysis revealed a marked discrepancy in publishing frequencies between the two contrasting economies. Authors from 16 low-income economies in Sub-Saharan Africa, with at least one article stored, were obviously closely linked to co-authorships and foreign funding sources, predominantly from Europe and the USA. Statements concerning conflicts of interest were frequently missing (both regions), even when multiple financial sources, including companies, were involved. It is necessary to be aware of possible systematic bias when using electronic databases to search for certain topics and regions. Further research regarding publishing ethics in paediatrics and paediatric nursing is emphasized.

  17. Hypertonic saline in paediatric traumatic brain injury: a review of nine years' experience with 23.4% hypertonic saline as standard hyperosmolar therapy.

    PubMed

    Piper, B J; Harrigan, P W

    2015-03-01

    We describe the protocolised use of 23.4% hypertonic saline solution (HTS) for intracranial hypertension in the context of traumatic brain injury in the paediatric population. This study represents the largest published data on the use of 23.4% HTS in the paediatric population. In this retrospective cohort, we focus on the efficacy, biochemical and metabolic consequences of 23.4% HTS administration in a Level 1 paediatric trauma centre. Mortality in the first seven days was 6% (2/32) with a mean intensive care unit length-of-stay of ten days (range 2 to 25, standard deviation [SD] 6). All-cause hospital mortality was 6%, with no deaths after the seven-day study period. Mean intracranial pressure (ICP) response to HTS was 10 mmHg (range 1 to 30, SD 8). For biochemistry data, the mean highest daily serum sodium was 148 mmol/l (139 to 161, SD 6), mean highest serum chloride was 115 mmol/l (range 101 to 132, SD 8) with matched mean serum base excess of -1.5 mmol/l (range 2 to -8, SD 3) and mean peak serum creatinine was 73 mmol/l (range 32 to 104, SD 32). Glasgow outcome scores of >3 (independent function) were achieved in 74% of patients. We describe the use of 23.4% HTS, demonstrating it to be a practical and efficacious method of delivering osmoles and may be advantageous in minimising total fluid volume. Thus, the bolus versus infusion debate may best be served via combining both approaches. PMID:25735686

  18. Hypertonic saline in paediatric traumatic brain injury: a review of nine years' experience with 23.4% hypertonic saline as standard hyperosmolar therapy.

    PubMed

    Piper, B J; Harrigan, P W

    2015-03-01

    We describe the protocolised use of 23.4% hypertonic saline solution (HTS) for intracranial hypertension in the context of traumatic brain injury in the paediatric population. This study represents the largest published data on the use of 23.4% HTS in the paediatric population. In this retrospective cohort, we focus on the efficacy, biochemical and metabolic consequences of 23.4% HTS administration in a Level 1 paediatric trauma centre. Mortality in the first seven days was 6% (2/32) with a mean intensive care unit length-of-stay of ten days (range 2 to 25, standard deviation [SD] 6). All-cause hospital mortality was 6%, with no deaths after the seven-day study period. Mean intracranial pressure (ICP) response to HTS was 10 mmHg (range 1 to 30, SD 8). For biochemistry data, the mean highest daily serum sodium was 148 mmol/l (139 to 161, SD 6), mean highest serum chloride was 115 mmol/l (range 101 to 132, SD 8) with matched mean serum base excess of -1.5 mmol/l (range 2 to -8, SD 3) and mean peak serum creatinine was 73 mmol/l (range 32 to 104, SD 32). Glasgow outcome scores of >3 (independent function) were achieved in 74% of patients. We describe the use of 23.4% HTS, demonstrating it to be a practical and efficacious method of delivering osmoles and may be advantageous in minimising total fluid volume. Thus, the bolus versus infusion debate may best be served via combining both approaches.

  19. Laboratory diagnosis of paediatric tuberculosis in the European Union/European Economic Area: analysis of routine laboratory data, 2007 to 2011.

    PubMed

    Sanchini, A; Fiebig, L; Drobniewski, F; Haas, W; Richter, E; Katalinic-Jankovic, V; Pimkina, E; Skenders, G; Cirillo, D M; Balabanova, Y

    2014-03-20

    Laboratory confirmation of paediatric tuberculosis (TB) is frequently lacking. We reviewed the range of routine laboratory tests and their performance in different biological samples used to diagnose active TB in children. A questionnaire-based survey was conducted among the European Reference Laboratory Network for TB followed by collection of routine laboratory data on 10,549 paediatric samples tested in 2007 to 2011 at six reference laboratories (in Croatia, Germany, Italy, Latvia, Lithuania and the United Kingdom (UK)). The questionnaire showed that all laboratories used rapid assays. Non-respiratory samples were collected more often in Germany (135/275, 49.1%) and the UK (490/2,140, 22.9%) compared with Croatia (138/2,792, 4.9%), Latvia (222/2,401, 9.2%) and Lithuania (76/1,549, 4.9%). Overall laboratory positivity rates (isolation of Mycobacterium tuberculosis complex and/or identification of its nucleic acids in a sample) were higher in lymph node and gastric aspirate samples (14/203 (6.9%) and 43/1,231 (3.5%)) than in sputum samples (89/4,684 (1.9%)). Pooled sensitivity, specificity, positive and negative predictive values and accuracy of molecular assays assessed against solid or liquid culture were 79.2%, 93.6%, 67.1%, 96.5% and 91.6%, respectively. A more intensive approach in obtaining gastric aspirate and non-respiratory samples may increase laboratory confirmation of paediatric TB. Major effort is needed in optimisation and validation of molecular tests in these samples.

  20. [Prudent use of antibiotics and suggestions for improvement from hospital-based medicine].

    PubMed

    Cisneros, José Miguel; Ortiz-Leyba, Carlos; Lepe, José Antonio; Obando, Ignacio; Conde, Manuel; Cayuela, Aurelio; Gil, María Victoria

    2010-11-01

    The largest consumption of antimicrobials is concentrated in hospitals and within them, the intensive care units. The quality of antimicrobial use is not optimal, with up to 50% of prescriptions being unnecessary or inappropriate. Inappropriate antibiotic use leads to severe consequences, such as increased patient mortality and morbidity and bacterial resistance. The primary reason for inappropriate use is the insufficient knowledge of the increasingly vast and complex information about the diagnosis and treatment of infectious diseases. There is general agreement on the need to improve the use of antimicrobials in hospitals but not on how to improve it. University Hospital Virgen del Rocío (Seville) has launched the Institutional Programme for the Optimisation of Antimicrobial Treatment (PRIOAM), inspired by the recommendations of the Infectious Diseases Society of America and adapted to the structural, functional and cultural characteristics of the hospital. PRIOAM is coordinated by a multidisciplinary team chosen by the Committee on Infections and Antimicrobials and has three basic characteristics: it is an institutional programme that has incentives linked to achieving goals; it is an educational programme in which training and knowledge are the basis for the proper use of antimicrobials; and it is a programme subject to results, in which the main objectives are clinical, not economic, to reduce mortality and morbidity in patients with infections and to delay the development of resistance.

  1. Acinetobacter Infections among Adult Patients in Qatar: A 2-Year Hospital-Based Study

    PubMed Central

    Al Samawi, Musaed Saad; Khan, Fahmi Yousef; Eldeeb, Yasser; Almaslamani, Muna; Alkhal, Abdullatif; Alsoub, Hussam; Ghadban, Wissam; Howady, Faraj; Hashim, Samar

    2016-01-01

    This retrospective study was conducted at Hamad General Hospital, Qatar, to describe the demographic data, clinical features underlying diseases, antimicrobial susceptibility, and outcome of A. baumannii infection. It involved all adult patients 15 years of age or older who were managed at Hamad General Hospital for A. baumannii infection from January 1, 2012, to December 31, 2013. We identified a total of 239 patients with A. baumannii infection, of which 182 (76.2%) were males. The mean age was 49.10 ± 19.57 years. The majority of the episodes (25.1%) occurred in elderly patients (≥65 years) and the most commonly identified site of A. baumannii infection was the respiratory tract, 117 (48.9%). Most episodes of infection, 231 (96.7%), were hospital-acquired and high rate of nosocomial infections occurred in the medical intensive care unit, 66 (28.6%). All patients had underlying medical conditions. Maximum resistance was seen to cefotaxime, 147 (58.3%), and minimum resistance was seen to colistin, 2 (1.4%). Of the 239 isolates, 102 (42.7%) were susceptible and 137 (57.3%) were multidrug-resistant. The in-hospital mortality in our study was 31%. Male gender, multidrug resistance, and septic shock were found to be independent mortality predictors. PMID:27433169

  2. Staff costs of hospital-based outpatient care of patients with cystic fibrosis

    PubMed Central

    2011-01-01

    Background This study identified per patient resource use and staff costs at a cystic fibrosis (CF) outpatient unit from the health care provider's perspective. Methods Personnel cost data were prospectively collected for all CF outpatients (n = 126) under routine conditions at the Charité Medical School Berlin in Germany over a six month study period. Patients were grouped according to age, sex and two severity categories. Ordinary least squares regression analysis was performed to determine the impact of various independent variables on personnel costs. Results The mean staff costs were €142.3 per patient over six months of outpatient service. Services provided by physicians were the biggest contributor to staff costs. Patient age correlated significantly and negatively with mean total costs per patient. Conclusions Age of patient is a significant determinant of staff costs for CF outpatient care. For a cost-covering remuneration of outpatient treatment it seems plausible to create separate reimbursement rates for two or three age groups and to consider additional costs due to tasks carried out by physicians without direct patient contact. The relatively low staff costs identified by our study reflect a staffing level not sufficient for specialist CF outpatient care. PMID:22828269

  3. Perioperative tranexamic acid in day-case paediatric tonsillectomy

    PubMed Central

    Thorning, G

    2014-01-01

    Introduction Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery. Methods A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg. Results Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%. Conclusions Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial. PMID:24780670

  4. Lost among the trees? The autonomic nervous system and paediatrics.

    PubMed

    Rees, Corinne A

    2014-06-01

    The autonomic nervous system (ANS) has been strikingly neglected in Western medicine. Despite its profound importance for regulation, adjustment and coordination of body systems, it lacks priority in training and practice and receives scant attention in numerous major textbooks. The ANS is integral to manifestations of illness, underlying familiar physical and psychological symptoms. When ANS activity is itself dysfunctional, usual indicators of acute illness may prove deceptive. Recognising the relevance of the ANS can involve seeing the familiar through fresh eyes, challenging assumptions in clinical assessment and in approaches to practice. Its importance extends from physical and psychological well-being to parenting and safeguarding, public services and the functioning of society. Exploration of its role in conditions ranging from neurological, gastrointestinal and connective tissue disorders, diabetes and chronic fatigue syndrome, to autism, behavioural and mental health difficulties may open therapeutic avenues. The ANS offers a mechanism for so-called functional illnesses and illustrates the importance of recognising that 'stress' takes many forms, physical, psychological and environmental, desirable and otherwise. Evidence of intrauterine and post-natal programming of ANS reactivity suggests that neonatal care and safeguarding practice may offer preventive opportunity, as may greater understanding of epigenetic change of ANS activity through, for example, accidental or psychological trauma or infection. The aim of this article is to accelerate recognition of the importance of the ANS throughout paediatrics, and of the potential physical and psychological cost of neglecting it.

  5. Paediatric emergency and acute care in resource poor settings.

    PubMed

    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.

  6. Evaluation of the jet injector in paediatric fibreoptic bronchoscopes.

    PubMed

    Sloan, I A; McLeod, M E

    1985-01-01

    The use of the Sanders venturi system during bronchoscopy in adults has been studied extensively. Its use in paediatric bronchoscopy has been limited because small changes in the characteristics of the system may produce large changes in the patient. With jet ventilation, peak inflation pressures and flow rates are influenced by the driving pressure, diameter and shape of the bronchoscope, the diameter of the injector and its length and angle from the axial line of the bronchoscope. Storz 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were evaluated in a test lung with an injector of 1.5 mm internal diameter fixed in the side-arm at 20 degrees to the axial line. Pilling 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were also examined using the standard injector with a 0.89 mm orifice in the axial line. The Storz bronchoscopes produced consistently higher peak inflation pressures and flow rates at all driving pressures in spite of the relatively large angle of the injector from the axial line. Caution is advised in the use of the Storz injector system as excessively high inflation pressures may be reached.

  7. Health-e-Child: a grid platform for european paediatrics

    NASA Astrophysics Data System (ADS)

    Skaburskas, K.; Estrella, F.; Shade, J.; Manset, D.; Revillard, J.; Rios, A.; Anjum, A.; Branson, A.; Bloodsworth, P.; Hauer, T.; McClatchey, R.; Rogulin, D.

    2008-07-01

    The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integration and indicates how these will be resolved in the HeC system. HeC is presented as an example of how computer science (and, in particular Grid infrastructures) originating from high energy physics can be adapted for use by biomedical informaticians to deliver tangible real-world benefits.

  8. Risk Factors for Increased Severity of Paediatric Medication Administration Errors

    PubMed Central

    Sears, Kim; Goodman, William M.

    2012-01-01

    Patients' risks from medication errors are widely acknowledged. Yet not all errors, if they occur, have the same risks for severe consequences. Facing resource constraints, policy makers could prioritize factors having the greatest severe–outcome risks. This study assists such prioritization by identifying work-related risk factors most clearly associated with more severe consequences. Data from three Canadian paediatric centres were collected, without identifiers, on actual or potential errors that occurred. Three hundred seventy-two errors were reported, with outcome severities ranging from time delays up to fatalities. Four factors correlated significantly with increased risk for more severe outcomes: insufficient training; overtime; precepting a student; and off-service patient. Factors' impacts on severity also vary with error class: for wrong-time errors, the factors precepting a student or working overtime significantly increase severe-outcomes risk. For other types, caring for an off-service patient has greatest severity risk. To expand such research, better standardization is needed for categorizing outcome severities. PMID:23968607

  9. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage.

    PubMed

    Di Rienzo Businco, L; Angelone, A M; Mattei, A; Ventura, L; Lauriello, M

    2012-04-01

    The aim of our study was to assess the efficacy and safety of endoscopic coblator adenoidectomy compared to cold curettage in paediatric patients. Forty homogeneous children (4-16 years of age) with adenoid hypertrophy were divided in 2 groups to receive adenoidectomy using cold curettage (A) or coblator (B). After surgery the following outcomes were evaluated: pain score on first day, days reporting pain, analgesic days, liquid diet days, absent from school days, pain score, days with nausea, days with fever, endoscopic adenoid grade and intraoperative bleeding. Forty days after surgery, basal rhinomanometry and nasal decongestion test were measured. The coblation group reported significantly less pain on the first post-operative day, days reporting pain, analgesic days, liquid diet days and absent school days. Patients in group A showed a higher grade of adenoid persistence by rhinoendoscopy, with high values of nasal resistances at the rhinomanometry even after nasal decongestion, consistent with greater adenoid persistence after cold curettage causing air flow obstruction even after turbinate decongestion. Intra-operative bleeding during coblation was significantly less compared the group undergoing cold curettage. Coblator treatment significantly improved patient recovery compared to curettage. Endoscopic coblation adenoidectomy ensures complete removal of adenoids and reduces postoperative adenoid grade. It can also be considered safer because it is under endoscopic control and can reach the cranial portion of the adenoid and its intranasal extension.

  10. Chronic paroxysmal hemicrania in paediatric age: report of two cases.

    PubMed

    Tarantino, Samuela; Vollono, Catello; Capuano, Alessandro; Vigevano, Federico; Valeriani, Massimiliano

    2011-04-01

    Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2-30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children's headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age.

  11. [Vaccination schedule of the Spanish association of paediatrics: recommendations 2010].

    PubMed

    Marès Bermúdez, J; van Esso Arbolave, D; Arístegui Fernández, J; Ruiz Contreras, J; González Hachero, J; Merino Moína, M; Barrio Corrales, F; Alvarez García, F J; Cilleruelo Ortega, M J; Ortigosa Del Castillo, L; Moreno Pérez, D

    2010-06-01

    The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.

  12. Vaccinations in paediatric rheumatology: an update on current developments.

    PubMed

    Groot, Noortje; Heijstek, Marloes W; Wulffraat, Nico M

    2015-07-01

    In 2011, the European League Against Rheumatism (EULAR) published recommendations regarding the vaccination of children with rheumatic diseases. These recommendations were based on a systematic literature review published in that same year. Since then, the evidence body on this topic has grown substantially. This review provides an update of the systematic literature study of 2011, summarizing all the available evidence on the safety and immunogenicity of vaccination in paediatric patients with rheumatic diseases. The current search yielded 21 articles, in addition to the 27 articles described in the 2011 review. In general, vaccines are immunogenic and safe in this patient population. The effect of immunosuppressive drugs on the immunogenicity of vaccines was not detrimental for glucocorticosteroids and methotrexate. Biologicals could accelerate a waning of antibody levels over time, although most patients were initially protected adequately. Overall, persistence of immunological memory may be reduced in children with rheumatic diseases, which shows the need for (booster) vaccination. This update of the 2011 systematic literature review strengthens the evidence base for the EULAR recommendations, and it must be concluded that vaccinations in patients with rheumatic diseases should be advocated.

  13. Suitability of ivy extract for the treatment of paediatric cough.

    PubMed

    Schmidt, M; Thomsen, M; Schmidt, U

    2012-12-01

    Two galenical formulations of an ivy herbal extract, syrup and cough drops, were tested for their efficacy and safety in the paediatric treatment of cough and bronchitis in two independent open, non-interventional studies with identical design. Two-hundred and sixty-eight children aged 0-12 yr were treated with one of the two preparations for up to 14 days. The effects on cough-related symptoms were addressed on a verbal rating scale. At the end of the study the major symptoms rhinitis, cough and viscous mucus, were found to be only mildly expressed or absent in 93, 94.2 and 97.7% of cases. The global effect was rated as 'good' or 'very good' in 96.5% of cases. Tolerability and compliance were found 'good' to 'very good' in 99% (syrup) and 100% (drops) of patients on completion of the study. A subgroup analysis according to four different age and dosing groups did not reveal differences in treatment response. Safety was confirmed and corresponded to literature findings. Five adverse events classified as mild and non-serious were reported (1.9%). In conclusion, ivy leaf extract in the form of syrup and of cough drops was confirmed as an effective and safe treatment of cough in children. PMID:22532491

  14. Pharmaceutical development and optimization of azithromycin suppository for paediatric use.

    PubMed

    Kauss, Tina; Gaubert, Alexandra; Boyer, Chantal; Ba, Boubakar B; Manse, Muriel; Massip, Stephane; Léger, Jean-Michel; Fawaz, Fawaz; Lembege, Martine; Boiron, Jean-Michel; Lafarge, Xavier; Lindegardh, Niklas; White, Nicholas J; Olliaro, Piero; Millet, Pascal; Gaudin, Karen

    2013-01-30

    Pharmaceutical development and manufacturing process optimization work was undertaken in order to propose a potential paediatric rectal formulation of azithromycin as an alternative to existing oral or injectable formulations. The target product profile was to be easy-to-use, cheap and stable in tropical conditions, with bioavailability comparable to oral forms, rapidly achieving and maintaining bactericidal concentrations. PEG solid solution suppositories were characterized in vitro using visual, HPLC, DSC, FTIR and XRD analyses. In vitro drug release and in vivo bioavailability were assessed; a study in rabbits compared the bioavailability of the optimized solid solution suppository to rectal solution and intra-venous product (as reference) and to the previous, non-optimized formulation (suspended azithromycin suppository). The bioavailability of azithromycin administered as solid solution suppositories relative to intra-venous was 43%, which compared well to the target of 38% (oral product in humans). The results of 3-month preliminary stability and feasibility studies were consistent with industrial production scale-up. This product has potential both as a classical antibiotic and as a product for use in severely ill children in rural areas. Industrial partners for further development are being sought.

  15. Paediatric emergency and acute care in resource poor settings.

    PubMed

    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little. PMID:27062627

  16. Pharmaceutical development and optimization of azithromycin suppository for paediatric use

    PubMed Central

    Kauss, Tina; Gaubert, Alexandra; Boyer, Chantal; Ba, Boubakar B.; Manse, Muriel; Massip, Stephane; Léger, Jean-Michel; Fawaz, Fawaz; Lembege, Martine; Boiron, Jean-Michel; Lafarge, Xavier; Lindegardh, Niklas; White, Nicholas J.; Olliaro, Piero; Millet, Pascal; Gaudin, Karen

    2013-01-01

    Pharmaceutical development and manufacturing process optimization work was undertaken in order to propose a potential paediatric rectal formulation of azithromycin as an alternative to existing oral or injectable formulations. The target product profile was to be easy-to-use, cheap and stable in tropical conditions, with bioavailability comparable to oral forms, rapidly achieving and maintaining bactericidal concentrations. PEG solid solution suppositories were characterized in vitro using visual, HPLC, DSC, FTIR and XRD analyses. In vitro drug release and in vivo bioavailability were assessed; a study in rabbits compared the bioavailability of the optimized solid solution suppository to rectal solution and intra-venous product (as reference) and to the previous, non-optimized formulation (suspended azithromycin suppository). The bioavailability of azithromycin administered as solid solution suppositories relative to intra-venous was 43%, which compared well to the target of 38% (oral product in humans). The results of 3-month preliminary stability and feasibility studies were consistent with industrial production scale-up. This product has potential both as a classical antibiotic and as a product for use in severely ill children in rural areas. Industrial partners for further development are being sought. PMID:23220079

  17. Paediatric immunisation: special emphasis on measles and MMR vaccinations.

    PubMed

    Das, M K; Bhattacharyya, N

    2002-05-01

    The dictum, 'prevention is better than cure', is applicable to all ailments but it can be most easily followed for infectious diseases, increasing numbers of which are being contained by specific vaccinations since the first discovery of smallpox vaccine by Edward Jenner in 1796. Advances in immunology and laboratory techniques including cell culture, genetic engineering and animal experiments have contributed significantly to the production of more and more vaccines, used successfully in preventive programmes. Infectious diseases are widely prevalent in the developing countries. The child population is specially vulnerable to many of them. These infections contribute to high morbidity and mortality and immunisation programmes have been undertaken as preventive measures against them at the national level. Paediatricians and experts are actively engaged in formulating and improving these programmes as problems are faced in their implementation. Much new information is continuously being available in the literature, mostly in specialised journals. The general practitioners, particularly those serving in the remote and vast rural areas, are not likely to have access to these recent developments which they need for self-motivation in initiating the parents with confident advice to have their children properly immunised and also for tackling effectively any problem arising out of immunisation. This paper attempts to discuss the subject of paediatric immunisation with special emphasis being laid on measles and MMR vaccinations. PMID:12418635

  18. Paediatric physician-researchers: coping with tensions in dual accountability.

    PubMed

    Boydell, Katherine; Shaul, Randi Zlotnik; D'Agincourt-Canning, Lori; Da Silva, Michael; Simpson, Christy; Czoli, Christine D; Rashkovan, Natalie; Kim, Celine C; Levin, Alex V; Schneider, Rayfel

    2012-01-01

    Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician-researchers must consider and negotiate salient ethical differences between clinical- and research-based obligations (Miller et al, 1998). This paper explores the subjective experiences and perspectives of 30 physician-researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician-researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician-researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice. PMID:24406890

  19. Adult and paediatric cough guidelines: Ready for an overhaul?

    PubMed

    Birring, Surinder S; Kavanagh, Joanne; Lai, Kefang; Chang, Anne B

    2015-12-01

    Cough is one of the most common reasons that patients seek medical attention. Cough guidelines from numerous countries and societies are available to assist the clinician to investigate and manage patients with cough. We review some of the recent progress in the field of cough that may lead to revision of these guidelines. In adults with chronic cough, new causes such as obstructive sleep apnoea have been identified. A new terminology, cough hypersensitivity syndrome (CHS), has been proposed for patients with chronic cough, which emphasises cough reflex hypersensitivity as a key feature. New therapeutic options are now available, particularly for patients with refractory or idiopathic chronic cough, which include gabapentin, speech pathology management and morphine. There has been great progress in the assessment of cough with the development of validated quality of life questionnaires and cough frequency monitoring tools. In children, common aetiologies differ from adults and those managed according to guidelines have better outcomes compared to usual care. New diagnostic entities such as protracted bacterial bronchitis have been described. Paediatric-specific cough assessment tools such as the Parent/Child Quality of Life Questionnaire will help improve the assessment of patients. Further research is necessary to improve the evidence base for future clinical guideline recommendations. Guidelines in future should also aim to reach a wider audience that includes primary care physicians, non-specialists and patients.

  20. Paediatric sports-related mild traumatic brain injury

    PubMed Central

    Keightley, Michelle; Duggan, Catrin Theresa; Reed, Nick; McAuliffe, Jim; Taha, Tim; Faught, Brent; McPherson, Moira; Baker, Joseph; Montelpare, William

    2009-01-01

    Mild traumatic brain injury (mTBI) is a common but relatively understudied childhood injury that can impact cognitive functioning and development. The present report describes a case study of a 14-year-old boy who sustained two consecutive sports-related mTBIs within a 24 h period. Neurocognitive functioning at 2, 6, 8, 55 and 225 days after injury is compared to baseline prior to injury assessment on the same measures. Results from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Conner Continuous Performance Test 2 (CPT-II) and the Attention Network Test (ANT) revealed decreased performance in attention, visual memory functioning and impulsivity, with some measures still not returning to baseline at 225 days post injury. The results are discussed with respect to return to normal activities at 4 days post injury. This case study highlights the need for increased research regarding the clinical management of mTBI in the paediatric population, particularly the potential deleterious effects of cumulative injuries. PMID:21686913

  1. Lost among the trees? The autonomic nervous system and paediatrics.

    PubMed

    Rees, Corinne A

    2014-06-01

    The autonomic nervous system (ANS) has been strikingly neglected in Western medicine. Despite its profound importance for regulation, adjustment and coordination of body systems, it lacks priority in training and practice and receives scant attention in numerous major textbooks. The ANS is integral to manifestations of illness, underlying familiar physical and psychological symptoms. When ANS activity is itself dysfunctional, usual indicators of acute illness may prove deceptive. Recognising the relevance of the ANS can involve seeing the familiar through fresh eyes, challenging assumptions in clinical assessment and in approaches to practice. Its importance extends from physical and psychological well-being to parenting and safeguarding, public services and the functioning of society. Exploration of its role in conditions ranging from neurological, gastrointestinal and connective tissue disorders, diabetes and chronic fatigue syndrome, to autism, behavioural and mental health difficulties may open therapeutic avenues. The ANS offers a mechanism for so-called functional illnesses and illustrates the importance of recognising that 'stress' takes many forms, physical, psychological and environmental, desirable and otherwise. Evidence of intrauterine and post-natal programming of ANS reactivity suggests that neonatal care and safeguarding practice may offer preventive opportunity, as may greater understanding of epigenetic change of ANS activity through, for example, accidental or psychological trauma or infection. The aim of this article is to accelerate recognition of the importance of the ANS throughout paediatrics, and of the potential physical and psychological cost of neglecting it. PMID:24573884

  2. Transdermal iontophoresis of ranitidine: an opportunity in paediatric drug therapy.

    PubMed

    Djabri, Asma; Guy, Richard H; Delgado-Charro, M Begoña

    2012-10-01

    The objective of this study was to examine the use of transdermal iontophoresis for the delivery of ranitidine hydrochloride in children. Constant, direct current, anodal iontophoresis of ranitidine was performed in vitro across dermatomed pig skin. The effect of donor vehicle, current intensity, and drug concentration were first examined using aqueous solutions. It was found that drug delivery was higher at pH 7 (donor: 5mM Tris) than pH 5.6 (donor: water). In the presence of low levels of competing background electrolyte, ranitidine delivery increased linearly with applied current but was independent of the donor drug concentration. The second part of the study evaluated two Pluronic(®) F-127 gels as potential vehicles for ranitidine delivery. The formulations were characterised in terms of apparent viscosity, conductivity and passive permeation measurements. Iontophoretic delivery of ranitidine was only slightly affected when delivered from the gels relative to aqueous solutions. Overall the results demonstrated that therapeutic paediatric doses of ranitidine (neonates: 0.09-0.17 μmol/kg h; 1 month to 12 years: 0.36-0.71 μmol/kg h) could be easily achieved by transdermal iontophoresis with simple gel patches of practical surface area (0.2-1.5 cm(2)/kg).

  3. Identification of systems failures in successful paediatric cardiac surgery.

    PubMed

    Catchpole, K R; Giddings, A E B; de Leval, M R; Peek, G J; Godden, P J; Utley, M; Gallivan, S; Hirst, G; Dale, T

    Patient safety will benefit from an approach to human error that examines systemic causes, rather than blames individuals. This study describes a direct observation methodology, based on a threat and error model, prospectively to identify types and sources of systems failures in paediatric cardiac surgery. Of substantive interest were the range, frequency and types of failures that could be identified and whether minor failures could accumulate to form more serious events, as has been the case in other industries. Check lists, notes and video recordings were employed to observe 24 successful operations. A total of 366 failures were recorded. Coordination and communication problems, equipment problems, a relaxed safety culture, patient-related problems and perfusion-related problems were most frequent, with a smaller number of skill, knowledge and decision-making failures. Longer and more risky operations were likely to generate a greater number of minor failures than shorter and lower risk operations, and in seven higher-risk cases frequently occurring minor failures accumulated to threaten the safety of the patient. Non-technical errors were more prevalent than technical errors and task threats were the most prevalent systemic source of error. Adverse events in surgery are likely to be associated with a number of recurring and prospectively identifiable errors. These may be co-incident and cumulative human errors predisposed by threats embedded in the system, rather than due to individual incompetence or negligence. Prospectively identifying and reducing these recurrent failures would lead to improved surgical standards and enhanced patient safety.

  4. Clinical and experimental advances in congenital and paediatric cataracts

    PubMed Central

    Churchill, Amanda; Graw, Jochen

    2011-01-01

    Cataracts (opacities of the lens) are frequent in the elderly, but rare in paediatric practice. Congenital cataracts (in industrialized countries) are mainly caused by mutations affecting lens development. Much of our knowledge about the underlying mechanisms of cataractogenesis has come from the genetic analysis of affected families: there are contributions from genes coding for transcription factors (such as FoxE3, Maf, Pitx3) and structural proteins such as crystallins or connexins. In addition, there are contributions from enzymes affecting sugar pathways (particularly the galactose pathway) and from a quite unexpected area: axon guidance molecules like ephrins and their receptors. Cataractous mouse lenses can be identified easily by visual inspection, and a remarkable number of mutant lines have now been characterized. Generally, most of the mouse mutants show a similar phenotype to their human counterparts; however, there are some remarkable differences. It should be noted that many mutations affect genes that are expressed not only in the lens, but also in tissues and organs outside the eye. There is increasing evidence for pleiotropic effects of these genes, and increasing consideration that cataracts may act as early and readily detectable biomarkers for a number of systemic syndromes. PMID:21402583

  5. The role of radiology in paediatric soft tissue sarcomas

    PubMed Central

    van Rijn, R.; McHugh, K.

    2008-01-01

    Abstract Paediatric soft tissue sarcomas (STS) are a group of malignant tumours that originate from primitive mesenchymal tissue and account for 7% of all childhood tumours. Rhabdomyosarcomas (RMS) and undifferentiated sarcomas account for approximately 50% of soft tissue sarcomas in children and non-rhabdomyomatous soft tissue sarcomas (NRSTS) the remainder. The prognosis and biology of STS tumours vary greatly depending on the age of the patient, the primary site, tumour size, tumour invasiveness, histologic grade, depth of invasion, and extent of disease at diagnosis. Over recent years, there has been a marked improvement in survival rates in children and adolescents with soft tissue sarcoma and ongoing international studies continue to aim to improve these survival rates whilst attempting to reduce the morbidity associated with treatment. Radiology plays a crucial role in the initial diagnosis and staging of STS, in the long term follow-up and in the assessment of many treatment related complications. We review the epidemiology, histology, clinical presentation, staging and prognosis of soft tissue sarcomas and discuss the role of radiology in their management. PMID:18442956

  6. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    PubMed

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  7. Sentinel Hospital-Based Surveillance for Assessment of Burden of Rotavirus Gastroenteritis in Children in Pakistan

    PubMed Central

    Kazi, Abdul Momin; Warraich, Gohar Javed; Qureshi, Shahida; Qureshi, Huma; Khan, Muhammad Mubashir Ahmad; Zaidi, Anita Kaniz Mehdi

    2014-01-01

    Objectives To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine. Methods A cross-sectional study was carried out over a period of two years from 2006 – 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping. Results 6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593). Conclusions Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths. PMID:25295613

  8. Erectile Dysfunction in Individuals with Neurologic Disability: A Hospital-based Cross-sectional Study

    PubMed Central

    Gervasi, Giuseppe; Naro, Antonino; de Luca, Rosaria; Marullo, Michelangelo; Bramanti, Placido

    2016-01-01

    Objective: Neurogenic erectile dysfunction can be broadly defined as an inability to sustain or maintain a penile erection due to neurologic impairment. Sexual problems can occur due to any lesion affecting the central and peripheral nervous system. The aim of this study was to evaluate the prevalence and causes of erectile dysfunction in a group of hospital inpatients suffering from neurologic disorders. Methods: Three-hundred and twenty six male patients admitted to the Neurorehabilitation Unit of IRCCS Centro Neurolesi “Bonino-Pulejo” in Messina Italy from March 2012 to June 2013 were screened for erectile dysfunction using the International Index of Erectile Function questionnaire. The patients who reported erectile dysfuntion underwent vascular, neurophysiological, and hormonal testing, and were divided into two groups according to their lesion sites: G1 (lesions above the S2-S4 center) and G2 (lesions below the S2-S4 center). Results: Of the 326 admitted patients, 126 patients (38.6%), mean age of 54.56±11.74 years (age range 27-82 years), were affected by erectile dysfunction (i.e., scored ≤21). A statistically significant correlation between International Index of Erectile Function questionnaire scores and location of the neurologic lesions was observed in G2 (r=0.22) with an increased risk of erectile dysfuntion of around 2:1 (odds ratio=1.87) without influences related to aging. Conclusion: The occurence of erectile dysfunction is significantly more prevalent among neurologically disabled men, particularly those with lesions below S2-S4, than among men without neurologic disability. Considering the prevalence of erectile dysfunction among neurologically disabled men, sexual functioning should be regularly evaluated during acute and long-term rehabilitation, and any existing sexual dysfunction should be addressed in the treatment plan. PMID:27413582

  9. A comparison of the cost-effectiveness of hospital-based home care with that of a conventional outpatient follow-up for patients with mental illness.

    PubMed

    Tsai, Sing-Ling; Chen, Mei-Bih; Yin, Teresa J C

    2005-09-01

    The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group posthoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.

  10. Associations between Dietary Allium Vegetables and Risk of Breast Cancer: A Hospital-Based Matched Case-Control Study

    PubMed Central

    Pourzand, Ali; Tajaddini, Aynaz; Asghari-Jafarabadi, Mohammad; Samadi, Nasser; Ostadrahimi, Ali-Reza; Sanaat, Zohre

    2016-01-01

    Purpose The protective effect of Allium vegetables against carcinogenesis has been reported in experimental studies particularly focusing on the gut. Therefore, we conducted a hospital-based matched case-control study to explore the association between dietary Allium consumption and risk of breast cancer among Iranian women in northwest Iran. Methods A validated, quantitative, food frequency questionnaire was completed in 285 women (aged 25–65 years old) newly diagnosed with histopathologically confirmed breast cancer (grade II, III or clinical stage II, III) in Tabriz, northwest Iran, and the completed questionnaires were included in an age- and regional-matched hospital based-control study. The odds ratios (ORs) and 95% confidence intervals (95% CI) were estimated using conditional logistic regression models. Results Multivariate analysis showed that there was a negative association between the consumption of raw onion and risk of breast cancer after adjustment for covariates (OR, 0.63; 95% CI, 0.40–1.00); however, this association was insignificant. On the other hand, there was a positive association between consumption of cooked onion and risk of breast cancer, after adjustment for covariates (OR, 1.54; 95% CI, 1.02–2.32). However, reduced risk of breast cancer was associated with higher consumption of garlic and leek with adjusted ORs of 0.41 (95% CI, 0.20–0.83) and 0.28 (95% CI, 0.15–0.51), respectively. Conclusion Our findings suggest that high consumption of certain Allium vegetables, in particular garlic and leek, may reduce the risk of breast cancer, while high consumption of cooked onion may be associated with an increased risk of breast cancer. PMID:27721879

  11. Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure.

    PubMed

    Philbin, E F; DiSalvo, T G

    1998-07-01

    Race and gender are important determinants of certain clinical outcomes in cardiovascular disease. To examine the influence of race and gender on care process, resource use, and hospital-based case outcomes for patients with congestive heart failure (CHF), we obtained administrative records on all 1995 New York State hospital discharges assigned ICD-9-CM codes indicative of this diagnosis. The following were compared among black and white women and men: demographics, comorbid illness, care processes, length of stay (LOS), hospital charges, mortality rate, and CHF readmission rate. We identified 45,894 patients (black women, 4,750; black men, 3,370; white women, 21,165; white men, 16,609). Blacks underwent noninvasive cardiac procedures more often than whites; procedure and specialty use rates were lower among women than among men. After adjusting for other patient characteristics and hospital type and location, we found race to be an important determinant of LOS (black, 10.4 days; white, 9.3 days; p = 0.0001), hospital charges (black, $13,711; white, $11,074; p = 0.0001), mortality (black-to-white odds ratio = 0.832; p = 0.003), and readmission (black-to-white odds ratio = 1.301; p = 0.0001). Gender was an important determinant of LOS (women, 9.8 days; men, 9.2 days; p = 0.0001), hospital charges (women, $11,690; men, $11,348; p = 0.02), and mortality (women-to-men odds ratio = 0.878; p = 0.0008). We conclude that race and gender influence care process and hospital-based case outcomes for patients with CHF.

  12. Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

    PubMed

    Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

    2014-04-01

    Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients.

  13. Three patients and their drugs: A parallel case paper on paediatric opiate use and withdrawal

    PubMed Central

    Siden, Harold B; Collin, Kathleen

    2005-01-01

    Clinicians are increasingly aware of the important role that opioids play in the management of a variety of paediatric conditions. Frequently, clinicians encounter challenges in initiating opioid therapy and, then, in weaning paediatric patients off opioids. In the present article, three different cases (an infant and two adolescents) are used to illustrate why and how opiates may be used in paediatrics and how they can be discontinued. The presentations include neonatal abstinence syndrome, chronic headache and cystic fibrosis. The cases are meant to emphasize the distinctions rather than the similarities among the cases, which is why this is called a case parallel, rather than a case series. The article downplays the use of rigid rules in managing patients on opioids, and emphasizes a flexible and patient-centred approach. PMID:19675829

  14. Accelerated oral nanomedicine discovery from miniaturized screening to clinical production exemplified by paediatric HIV nanotherapies

    PubMed Central

    Giardiello, Marco; Liptrott, Neill J.; McDonald, Tom O.; Moss, Darren; Siccardi, Marco; Martin, Phil; Smith, Darren; Gurjar, Rohan; Rannard, Steve P.; Owen, Andrew

    2016-01-01

    Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes. PMID:27767027

  15. Management of paediatric tuberculosis in provincial and district hospitals in Afghanistan.

    PubMed

    Delawer, F M; Isono, M; Ueki, H; Zhuben, M; Zafari, M; Seddiq, M K; Habib, H; Ayoubi, M K

    2013-08-01

    Case detection, diagnosis and treatment of tuberculosis 1 B) in children are challenging issues vorldwide. This study in Afghanistan aimed to evaluate paediatric TB case management, including contact investigation, at health facilities where all diagnostic processes were available. In 7 out of 8 regions of the country 1 province was selected. Documents used for management of paediatric TB cases were reviewed in 15 distinct hospitals and 8 provincial hospitals in the selected provinces. The key issues which emerged were: a low suspect rate among total outpatients (0.4%) and a very low suspect rate among children aged < 5 years; low performance of suspect management (68.5% suspects received further examinations); low utilization of other diagnostic methods; a high early defaulter rate (14.0%); and insufficient coverage of contact management (74.0%). This survey indicated that the Afghanistan national TB programme needs to develop plans to improve the quality of diagnosis, suspect management and contact management in paediatric TB cases.

  16. Paediatric leptospirosis: A population based case-control study from Chennai, India.

    PubMed

    Narayanan, R; Sumathi, G; Prabhakaran, S G; Shanmughapriya, S; Natarajaseenivasan, K

    2016-01-01

    The surveillance in Chennai identified 134 children and 443 adults clinically suspected for leptospirosis. Of these, 35 (26.1%) children and 118 (26.6%) adults had laboratory confirmed diagnosis for leptospirosis. The paediatric leptospirosis exhibited a higher frequency of classic features of Weil's disease. The prevalent serovar encountered was Icterohaemorrhagiae with no difference in the pattern of infecting serovars between the two groups. Further, confirmation of diagnosis was achieved by polymerase chain reaction (PCR) with a positivity of 28.4% (specificity 96%). Univariate analysis showed significant association of paediatric leptospirosis with rat infestation (odds ratio 87.4). Thus, PCR facilitates early diagnosis of febrile illness among paediatric cases. PMID:27080780

  17. The role of research for sustainable paediatric cardiac programmes in developing countries.

    PubMed

    Mavroudis, Constantine D; Mavroudis, Constantine; Jacobs, Jeffrey P; Siegel, Allison

    2012-12-01

    Significant challenges face developing countries as a result of the maldistribution of access to healthcare throughout the world, specifically access to paediatric cardiac care. Sustainable paediatric cardiac programmes must be established in developing countries to provide care to all children with congenital heart disease. Education and research are essential components to sustainable paediatric cardiac programmes in developing countries to define local problems and the incidence of disease, and to generate solutions thereto related. Research can contribute to developing local expertise, improving technology, providing opportunities for local talent, generating financial resources, enhancing the dignity of people, and the facilitating resolution of health problems throughout the world. Clinical trials conducted in developing countries should meet the same ethical standards as trials based in developed countries. PMID:23331603

  18. Stress and paediatric obesity: what we know and where to go.

    PubMed

    Wilson, Shana M; Sato, Amy F

    2014-04-01

    Childhood obesity is a public health epidemic and is associated with substantial negative physical and psychosocial health consequences. Stress is thought to be one contributor to the development and maintenance of obesity in children and adolescents, yet the linkage between stress and paediatric obesity is a poorly understood phenomenon. This paper furthers the understanding of stress in the context of paediatric obesity by firstly presenting a focused review of what is known about links between chronic and acute stress and paediatric obesity risk and then synthesizing important areas from the literature. These critical areas of focus include the following: (1) physiological stress reactivity; (2) stress-induced eating; (3) stress and physical activity; (4) parent and family influences; and (5) stress in at-risk populations. This review is geared toward facilitating future research on the stress-obesity connection in youth.

  19. Comparative analysis of trends in paediatric trauma outcomes in New South Wales, Australia.

    PubMed

    Mitchell, Rebecca J; Curtis, Kate; Chong, Shanley; Holland, Andrew J A; Soundappan, S V S; Wilson, Kellie L; Cass, Daniel T

    2013-01-01

    Paediatric trauma centres seek to optimise the care of injured children. Trends in state-wide paediatric care and outcomes have not been examined in detail in Australia. This study examines temporal trends in paediatric trauma outcomes and factors influencing survival and length of stay. A retrospective review was conducted using data from the NSW Trauma Registry during 2003-2008 for children aged 15 years and younger who were severely injured (injury severity score >15). To examine trauma outcomes descriptive statistics and multivariable logistic and linear regression were conducted. There were 1138 children severely injured. Two-thirds were male. Road trauma and falls were the most common injury mechanisms and over one-third of incidents occurred in the home. Forty-eight percent of violence-related injuries were experienced by infants aged less than 1 year. For the majority of children definitive care was provided at a paediatric trauma centre, but less than one-third of children were taken directly to a paediatric trauma centre post-injury. Children who received definitive treatment at a paediatric trauma centre had between 3 and 6 times higher odds of having a survival advantage than if treated at an adult trauma centre. The number of severe injury presentations to the 14 major trauma centres in NSW remains constant. It is possible that injury prevention measures are having a limited effect on severe injury in NSW. This research provides stimulus for change in the provision and co-ordination in the delivery of trauma care for injured children.

  20. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

    PubMed

    Chen, Ming; Chen, Mindy

    2010-01-01

    Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.