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Sample records for paediatric practice impact

  1. 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.

  2. Diagnostic omission errors in acute paediatric practice: impact of a reminder system on decision-making

    PubMed Central

    Ramnarayan, Padmanabhan; Winrow, Andrew; Coren, Michael; Nanduri, Vasanta; Buchdahl, Roger; Jacobs, Benjamin; Fisher, Helen; Taylor, Paul M; Wyatt, Jeremy C; Britto, Joseph

    2006-01-01

    Background Diagnostic error is a significant problem in specialities characterised by diagnostic uncertainty such as primary care, emergency medicine and paediatrics. Despite wide-spread availability, computerised aids have not been shown to significantly improve diagnostic decision-making in a real world environment, mainly due to the need for prolonged system consultation. In this study performed in the clinical environment, we used a Web-based diagnostic reminder system that provided rapid advice with free text data entry to examine its impact on clinicians' decisions in an acute paediatric setting during assessments characterised by diagnostic uncertainty. Methods Junior doctors working over a 5-month period at four paediatric ambulatory units consulted the Web-based diagnostic aid when they felt the need for diagnostic assistance. Subjects recorded their clinical decisions for patients (differential diagnosis, test-ordering and treatment) before and after system consultation. An expert panel of four paediatric consultants independently suggested clinically significant decisions indicating an appropriate and 'safe' assessment. The primary outcome measure was change in the proportion of 'unsafe' workups by subjects during patient assessment. A more sensitive evaluation of impact was performed using specific validated quality scores. Adverse effects of consultation on decision-making, as well as the additional time spent on system use were examined. Results Subjects attempted to access the diagnostic aid on 595 occasions during the study period (8.6% of all medical assessments); subjects examined diagnostic advice only in 177 episodes (30%). Senior House Officers at hospitals with greater number of available computer workstations in the clinical area were most likely to consult the system, especially out of working hours. Diagnostic workups construed as 'unsafe' occurred in 47/104 cases (45.2%); this reduced to 32.7% following system consultation (McNemar test, p

  3. Chvostek's sign in paediatric practice.

    PubMed

    Hasan, Zeeshaan U; Absamara, Rania; Ahmed, Mas

    2014-01-01

    Chvostek's Sign was first described in 1876, as a clinical clue associated with patients who suffered from latent tetany, and is induced by percussion of the angle of the jaw. However, over the years many clinicians have called into question the strength of the association with latent tetany, particularly in paediatric practice. This review examines the variation in techniques used to elicit the sign in studies conducted on this phenomenon in children as well as how differences in the classification of a positive Chvostek's sign have lead to varied reports on the strength of the association. Furthermore, an appraisal of the literature regarding the proposed mechanism of Chvostek's sign is reported alongside analysing other diseases which have been associated with Chvostek's sign to uncover any unifying mechanism for the presence of this clinical sign in children.

  4. A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection

    PubMed Central

    Fruhwirth, M; Karmaus, W; Moll-Schuler, I; Brosl, S; Mutz, I

    2001-01-01

    AIMS—To examine the disease burden and epidemiology of community acquired rotavirus gastroenteritis in Austrian children treated in a paediatric practice.
METHODS—A prospective, population based, multicentre study in four paediatric practices and two children's hospitals (Innsbruck and Leoben). Children ⩽ 48 months of age presenting with gastroenteritis during a six month period of rotavirus peak between December 1997and May 1998 were included. Prospective testing of stool samples for rotavirus was performed using ELISA.
RESULTS—A total of 6969 children were enrolled; 171 (2.4%) had community acquired gastroenteritis. Of 144 children who could be included in further analysis, 49 (34%; median age 16.7 months) were rotavirus positive, and 95 (66%; median age 17.0 months) were rotavirus negative. Three of the rotavirus positive children (median age 14.6 months) were hospitalised. The severity of rotavirus positive gastroenteritis was significantly higher than that of rotavirus negative gastroenteritis. The incidence of community acquired gastroenteritis was 4.67 per 100 children per year, and of rotavirus positive gastroenteritis 1.33 per 100 children per year.
CONCLUSION—Rotavirus is a relevant cause of community acquired gastroenteritis in children aged 4 years and younger treated by a paediatrician. The data can be used as a basis for developing strategies to prevent infection.

 PMID:11316680

  5. Citation context and impact of 'sleeping beauties' in paediatric research.

    PubMed

    Završnik, Jernej; Kokol, Peter; Del Torso, Stefano; Blažun Vošner, Helena

    2016-12-01

    Objectives 'Sleeping beauties', i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results Two paediatric sleeping beauties, addressing medical homes and the transition from paediatric to adult health care, respectively, awakened in response to organizational needs. Both presented novel concepts of paediatric service organization that became important because of an increased need for optimization of services. Conclusion All sleeping beauties bring new knowledge that becomes important only after several years. Paediatric sleeping beauties exhibited unique characteristics; however, their presence in paediatric research shows that knowledge acquisition in paediatrics resembles that in other disciplines.

  6. The impact of the Italian guidelines on antibiotic prescription practices for acute otitis media in a paediatric emergency setting.

    PubMed

    Palma, Silvia; Rosafio, Cristiano; Del Giovane, Cinzia; Patianna, Viviana Dora; Lucaccioni, Laura; Genovese, Elisabetta; Bertolani, Paolo; Iughetti, Lorenzo

    2015-05-07

    Acute otitis media (AOM) is one of the most common childhood infectious diseases. The recent Italian Pediatric Guidelines for the treatment of AOM constitutes a step forward in the management of children with uncomplicated AOM. The aim of this study was to evaluate antibiotic prescription patterns for AOM in a Pediatric Emergency Department (PED) after those guidelines were introduced and to assess the relationship between implementation of the "watchful waiting" strategy and the incidence of acute mastoiditis in the PED. This retrospective study was conducted between 1st January 2007 to 31st December 2013 at the PED of the University of Modena and Reggio Emilia in Modena (Italy). All children between 0 and 14 years who were examined because of symptoms and/or signs of AOM and acute mastoiditis were enrolled. Pearson's chi-squared test was used to evaluate if introduction of the Italian Paediatric Guidelines was associated with a reduction in the antibiotic prescription pattern in children with AOM and/or with an increase in mastoiditis frequency. 4,573 (89.4%) patients were included in our analysis, antibiotics were prescribed to 81% cases of the children diagnosed with AOM. The frequency of antibiotic prescribing continued to be stable after the Italian guidelines were introduced (82% versus 81%). Forty children were admitted to hospital with a diagnosis of acute mastoiditis. Our study did not find any association between the number of cases of acute mastoiditis and the percentage of patients treated with antibiotics; the annual incidence of mastoiditis before and after the new guidelines were published was, in fact, stable. Despite the diffusion of clinical guidelines recommending a "watchful waiting" approach for children with AOM, the antibiotic prescription rate continues to be high. It appears to be more difficult to impact the percentage of cases for which antibiotics are prescribed than the type of antibiotic that is utilized. In view of these findings, a

  7. Azithromycin use in paediatrics: A practical overview.

    PubMed

    Ovetchkine, Philippe; Rieder, Michael J

    2013-06-01

    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.

  8. 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

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

    PubMed

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

    2013-12-01

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

  10. Paediatric training for family doctors: principals and practice.

    PubMed

    Melville, C; Wall, D; Anderson, J

    2002-05-01

    There is controversy as to how best to train general practitioners for the paediatric challenges they will meet in practice, in particular what should be included in training, what should be left out and how long should it last? All 615 general practice principals referring to 6 hospitals were surveyed (40% response rate). West Midlands region of England. Postal questionnaire. Quantitative and qualitative assessment of responses. Quantitative responses were analysed by hospital, decade of qualification, and duration of paediatric training. Qualitative responses were analysed using grounded theory. Satisfaction with training was directly related to its duration, with low levels of satisfaction for less than 6 months paediatrics, moderate levels for 6-11 months, and high levels with 12 months or more. The most important item of training was recognition of the sick child. Acute and chronic paediatrics was generally well covered. Psychosocial aspects, public health and immunisation were poorly addressed. Neonatal resuscitation and first day checks were seen as relevant, but neonatal intensive care was not. At least 6 months of paediatrics is necessary for GPs in training, but longer paediatric exposure further increases their satisfaction with training. GPs have a biopsychosocial rather than biomedical approach to their child patients, suggesting potential benefits from a greater emphasis on psychosocial and public health aspects at the expense of neonatal intensive care. Recognition of the sick child is essential, and acute and chronic organic illness should be covered in breadth. Possible future models for GP training in paediatrics are discussed.

  11. Advanced practice in paediatric intensive care: a review.

    PubMed

    Heward, Yvonne

    2009-02-01

    Advanced nursing roles are one way of encouraging experienced nurses to stay in clinical practice so they can provide expert care, develop practice and be role models for junior staff. A search for literature about advanced nurse practice in paediatric intensive care units in the UK identified just four articles, including one survey, but no reports of empirical research. There is some consensus on the nature and educational requirements for advanced practice but delays in agreeing a regulatory framework and failure to recognise the potential contribution of advanced roles mean that development is hindered. Although several UK units have developed or are developing the role, more insight and better evidence is needed on how nursing can be advanced in paediatric intensive care settings.

  12. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    PubMed

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan

    2017-01-01

    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  13. Citation context and impact of ‘sleeping beauties’ in paediatric research

    PubMed Central

    Završnik, Jernej; del Torso, Stefano; Blažun Vošner, Helena

    2016-01-01

    Objectives ‘Sleeping beauties’, i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results Two paediatric sleeping beauties, addressing medical homes and the transition from paediatric to adult health care, respectively, awakened in response to organizational needs. Both presented novel concepts of paediatric service organization that became important because of an increased need for optimization of services. Conclusion All sleeping beauties bring new knowledge that becomes important only after several years. Paediatric sleeping beauties exhibited unique characteristics; however, their presence in paediatric research shows that knowledge acquisition in paediatrics resembles that in other disciplines. PMID:27834306

  14. How does the introduction of a pain and sedation management guideline in the paediatric intensive care impact on clinical practice? A comparison of audits pre and post guideline introduction.

    PubMed

    Larson, Grace E; Arnup, Sarah J; Clifford, Michael; Evans, Janine

    2013-08-01

    Despite the use of guidelines to inform practice for pain and sedation management there are few evaluations of the effect of their introduction on clinical practice. Previous evaluations of the protocols and guidelines used to manage pain and sedation in the paediatric intensive care unit (PICU) report increases in pain and sedation medication administration post guideline introduction. In most reported cases the guideline was accompanied by a treatment algorithm. To our knowledge there is no published data on the effect of introducing a guideline without a treatment algorithm on pain and analgesia administration. To evaluate the impact the introduction of a pain and sedation guideline will have on clinical practice. A 19 bed PICU was audited for one month prior to the introduction of a guideline and one month post. The proportion of patients receiving oral Clonidine increased (p=0.001) and the administration of Ketamine, particularly via bolus (p=0.003), reduced after the introduction of the guideline. The use of a validated pain tool to assess pain increased by 25% and communication of management plans increased by 25%. The documentation of the use of boluses increased by 36%. The introduction of a clinical practice guideline for pain and sedation management in PICU contributes to changes in medication administration, use of validated pain assessments, improved documentation of boluses and communication of management plans. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  15. Impact of child death on paediatric trainees.

    PubMed

    Hollingsworth, Clare E; Wesley, Carla; Huckridge, Jaymie; Finn, Gabrielle M; Griksaitis, Michael J

    2017-08-18

    To assess the prevalence of symptoms of acute stress reactions (ASR) and post-traumatic stress disorder (PTSD) in paediatric trainees following their involvement in child death. A survey designed to identify trainees' previous experiences of child death combined with questions to identify features of PTSD. Quantitative interpretation was used alongside a χ(2) test. A p value of <0.05 was considered significant. 604 surveys were distributed across 13 UK health education deaneries. 303/604 (50%) of trainees completed the surveys. 251/280 (90%) of trainees had been involved with the death of a child, although 190/284 (67%) had no training in child death. 118/248 (48%) of trainees were given a formal debrief session following their most recent experience. 203/251 (81%) of trainees reported one or more symptoms or behaviours that could contribute to a diagnosis of ASR/PTSD. 23/251 (9%) of trainees met the complete criteria for ASR and 13/251 (5%) for PTSD. Attending a formal debrief and reporting feelings of guilt were associated with an increase in diagnostic criteria for ASR/PTSD (p=0.036 and p<0.001, respectively). Paediatric trainees are at risk of developing ASR and PTSD following the death of a child. The feeling of guilt should be identified and acknowledged to allow prompt signposting to further support, including psychological assessment or intervention if required. Clear recommendations need to be made about the safety of debriefing sessions as, in keeping with existing evidence, our data suggest that debrief after the death of a child may be associated with the development of symptoms suggestive of ASR/PTSD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Assessing quality of life in paediatric clinical practice.

    PubMed

    Morrow, Angela M; Quine, Susan; Heaton, Maria D; Craig, Jonathan C

    2010-06-01

    The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome.

  17. Paediatric pain management practice and policies across Alberta emergency departments.

    PubMed

    Ali, Samina; Chambers, Andrea L; Johnson, David W; Craig, William R; Newton, Amanda S; Vandermeer, Ben; Curtis, Sarah J

    2014-04-01

    Many children requiring acute care receive suboptimal analgesia. To describe paediatric pain management practices and policies in emergency departments (EDs) in Alberta. A descriptive survey was distributed to each of the EDs in Alberta. A response rate of 67% (72 of 108) was obtained. Seventy-one percent (42 of 59) of EDs reported the use of a pain tool, 29.3% (17 of 58) reported mandatory pain documentation and 16.7% (10 of 60) had nurse-initiated pain protocols. Topical anesthetics were reported to be used for intravenous line insertion by 70.4% of respondents (38 of 54) and for lumbar puncture (LP) by 30.8% (12 of 39). According to respondents, infiltrated anesthetic was used for LP by 69.2% (27 of 39) of respondents, and oral sucrose was used infrequently for urinary catheterization (one of 46 [2.2%]), intravenous line insertion (zero of 54 [0%]) and LP (one of 39 [2.6%]). Few Alberta EDs use policies and protocols to manage paediatric pain. Noninvasive methods to limit procedural pain are underutilized. Canadian paediatricians must advocate for improved analgesia to narrow this knowledge-to-practice gap.

  18. Accuracy of tympanic and forehead thermometers in private paediatric practice.

    PubMed

    Teller, J; Ragazzi, M; Simonetti, G D; Lava, S A G

    2014-02-01

    To compare infrared tympanic and infrared contact forehead thermometer measurements with traditional rectal digital thermometers. A total of 254 children (137 girls) aged one to 24 months (median 7 months) consulting a private paediatric practice because of fever were prospectively recruited. Body temperature was measured using the three different devices. The median and interquartile range for rectal, tympanic and forehead thermometers were 37.6 (37.1-38.4)°C, 37.5 (37.0-38.1)°C and 37.5 (37.1-37.9)°C, respectively (p < 0.01). The limits of agreement in the Bland-Altman plots were -0.73 to +1.04°C for the tympanic thermometer and -1.18 to +1.64°C for the forehead thermometer. The specificity of both the tympanic and forehead thermometers for detecting fever above 38°C was good, but sensitivity was low. Forehead measurements were susceptible to the use of a radiant warmer. Both the tympanic and forehead devices recorded lower temperatures than the rectal thermometers. The limits of agreement were particularly wide for the forehead thermometer and considerable for the tympanic thermometer. In the absence of valid alternatives, because of the ease to use and little degree of discomfort, tympanic thermometers can still be used with some reservations. Forehead thermometers should not be used in paediatric practice. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  19. Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

    PubMed

    Zani-Ruttenstock, Elke; Zani, Augusto; Bullman, Emma; Lapidus-Krol, Eveline; Pierro, Agostino

    2015-01-01

    Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current

  20. Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery.

    PubMed

    Ó Mír, M; O'Sullivan, C

    2017-05-06

    One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

  1. Diagnosing autism: Contemporaneous surveys of parent needs and paediatric practice.

    PubMed

    Hennel, Sabine; Coates, Cathy; Symeonides, Christos; Gulenc, Alisha; Smith, Libby; Price, Anna Mh; Hiscock, Harriet

    2016-05-01

    Concurrence between parents' information needs and clinicians' practice when diagnosing autism is unknown but may influence families' uptake of management and adjustment. We aimed to compare parents' experience and preferences with paediatrician report of (i) diagnosis delivery and (ii) information given at diagnosis and identify types and usefulness of resources accessed by families post-diagnosis. The design used for the study are parent and paediatrician surveys. Participants are parents of children aged 1.5-18 years, diagnosed with autism between 01 January 2010 and 30 September 2012 and their paediatricians who are members of the Australian Paediatric Research Network. Study-designed quantitative and qualitative questions about diagnosis delivery and information given at diagnosis (written and spoken vs. neither) and parent perceived importance and harms of information accessed post-diagnosis. Paediatricians (53/198 (27%)) identified 1127 eligible families, of whom 404 (36%) participated. Parents were more likely to report receiving adequate time to discuss diagnosis than paediatricians (71 vs. 51%). Parents (98%) rated information about accessing allied health professionals and the meaning of diagnosis as most important, yet paediatricians offered written or spoken information about each infrequently (allied health: 22%; diagnosis: 42%). Post-diagnosis, allied health was the most important source of information (83%). Harmful resources conveyed helplessness or non-evidenced-based therapies, but few parents (14%) reported this. Parents want more information than can be conveyed in a single diagnostic consultation. Developing a tailored 'autism action plan' with written materials could improve parents' understanding of and satisfaction with children's autism diagnoses. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  2. Paediatric homoeopathy in general practice: where, when and why?

    PubMed Central

    Ekins-Daukes, Suzie; Helms, Peter J; Taylor, Michael W; Simpson, Colin R; McLay, James S

    2005-01-01

    practices where none of the partners practiced homoeopathy. Conclusions In primary care paediatric prescribing of homoeopathic medicines most commonly occurs for self-limiting conditions in infants less than 1 year of age. Although the current level of homoeopathic prescribing is low, the widespread use in the community suggests that at least some knowledge of the main indications for homoeopathy and the preparations used would be of benefit to registered medical practitioners. PMID:15948942

  3. Paediatric homoeopathy in general practice: where, when and why?

    PubMed

    Ekins-Daukes, Suzie; Helms, Peter J; Taylor, Michael W; Simpson, Colin R; McLay, James S

    2005-06-01

    partners practiced homoeopathy. In primary care paediatric prescribing of homoeopathic medicines most commonly occurs for self-limiting conditions in infants less than 1 year of age. Although the current level of homoeopathic prescribing is low, the widespread use in the community suggests that at least some knowledge of the main indications for homoeopathy and the preparations used would be of benefit to registered medical practitioners.

  4. Social paediatrics.

    PubMed

    Spencer, Nick; Colomer, Concha; Alperstein, Garth; Bouvier, Paul; Colomer, Julia; Duperrex, Olivier; Gokcay, Gulbin; Julien, Gilles; Kohler, Lennart; Lindström, Bengt; Macfarlane, Aidan; Mercer, Raul; Panagiotopoulos, Takis; Schulpen, Tom

    2005-02-01

    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.

  5. 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

  6. 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.

  7. Maintenance intravenous fluid prescribing practices among paediatric residents.

    PubMed

    Freeman, M A; Ayus, J C; Moritz, M L

    2012-10-01

      To investigate the sodium composition of maintenance intravenous fluids (mIVF) used by paediatric residents throughout the United States in common clinical scenarios of arginine vasopressin (AVP) excess.   We distributed an online survey to paediatric residency programmes asking what type of mIVF (0.2%, 0.45%, 0.9% NaCl or lactated Ringer's solution) they would administer in four common clinical scenarios of AVP excess (gastroenteritis, pneumonia, meningitis and postoperative) in both a 6-month-old (mo) and a 13-year-old (yo) child.   We had 472 responses, representing 5% of the total paediatric residency population in the United States. Hypotonic mIVF were selected in 78% of children (88.2% of 6 mo and 68.5% of 13 yo). Isotonic mIVF were selected approximately twice as often for patients with meningitis as for those without (21.4% vs. 8.7% 6 mo and 42.8% vs. 27.7% 13 yo; p < 0.001).   The majority of US paediatric residents would prescribe hypotonic mIVF in disease states associated with AVP excess. However, a significant number of residents are using isotonic mIVF. Isotonic fluids are more likely to be prescribed in older children and children with meningitis. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

  8. Paediatric nurses' postoperative pain management practices in hospital based non-critical care settings: a narrative review.

    PubMed

    Twycross, Alison; Forgeron, Paula; Williams, Anna

    2015-04-01

    To investigate paediatric nurses' postoperative pain management practices with the aim of identifying the factors associated with undermanaged paediatric postoperative pain. Systematic search and review. PsychInfo, CINAHL, PubMed, EMBASE and hand searching. English peer-reviewed quantitative, qualitative, or mixed methods research articles published between 1990 and 2012 exploring registered nurses' paediatric postoperative pain management practices were included. Articles with a primary focus on nurses' pain management practices in the neonatal or paediatric intensive care units, recovery room, and/or focused on children with cognitive impairment were excluded. The search terms used were: postoperative pain; nurs*; paediatrics; pediatrics; children; pain assessment; non-pharm*; analges*. Titles and abstracts were used for initial screening. Two researchers conducted data extraction and assessment of rigour for each paper. From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses' pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; non-pharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children's behaviour appears to influence nurses' pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based. The

  9. 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

  10. Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

    PubMed

    Naik, Ronak J; Patel, Neil R; Wang, Ming; Shah, Nishant C

    2016-08-01

    In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

  11. Good practice guidelines for clinical psychologists working in paediatric cochlear implant teams.

    PubMed

    Bathgate, Fionna; Bennett, Emily; Cropper, Jenny; Edwards, Lindsey; Emond, Alice; Gamble, Caroline; Kentish, Rosie; Samuel, Victoria

    2013-11-01

    There are relatively few clinical psychologists working in paediatric cochlear implant centres in the UK and in this respect we lag behind other countries such as the USA and The Netherlands. In an effort to promote the added value our profession can offer teams, the clinical psychologists working in paediatric CI centres have put together good practice guidelines. This article outlines the rationale for putting together the guidelines, highlights the unique contribution clinical psychologists can offer, outlines the evidence base for psychological input in this clinical population, and offers a fictional case study for illustration.

  12. 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.

  13. 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.

  14. Practical approach to catheter-related bloodstream infections in paediatrics

    PubMed Central

    Robinson, Joan

    2005-01-01

    Catheter-related bloodstream infections (CRBIs) are a common problem in paediatrics. Sterile insertion and proper care of the catheter is likely more important than the type of catheter in determining the rate of CRBIs. The accuracy of the diagnosis of CRBIs can be improved by comparing the time to positivity or the concentration of organisms in blood drawn through the catheter with blood drawn from other sites, or by changing the catheter over a guidewire and culturing the removed catheter. When a CRBI is suspected, the catheter should be removed if it is no longer required, the child is hemodynamically unstable, there are metastatic foci of infection, the infecting organism is Candida or a mycobacterium, or there is a tunnel infection. The necessity for catheter removal is controversial if the infecting organism is Staphylococcus aureus or a Gram-negative organism. In most other situations, the catheter only needs to be removed if bacteremia persists despite appropriate antibiotic use. PMID:19668658

  15. [Teledermatology in Paediatrics. Observations in daily clinical practice].

    PubMed

    Batalla, Ana; Suh-Oh, Hae Jin; Abalde, Teresa; Salgado-Boquete, Laura; de la Torre, Carlos

    2016-06-01

    Teledermatology is a technique that is increasingly being developed. There are many studies that assess this discipline in the general population, but few studies analyse the paediatric population exclusively. The aims of this study are to describe the distribution of diseases consulted through teledermatology, the use of this technique to avoid face-to-face consultations, and the agreement between virtual and face-to-face diagnoses, in the paediatric population. The work consisted of an observational and retrospective study of the virtual consultations made between May 2011 and January 2015 through a store-and-forward teledermatology programme, involving patients from 0 to 15 years. We collected demographic data, as well as the diagnoses made by the paediatrician who made the virtual consultation, and by the dermatologists who assessed the virtual and the face-to-face consultations, the indication given by the dermatologist who assessed the virtual consultation (discharge or referral), reason for referral, and diagnostic agreement rate. A total of 183 virtual consultations were analysed. The most frequent diagnoses were inflammatory diseases (39%), benign pigmented lesions (23%), and infectious diseases (20%). Almost half of the virtual consultations (48%) were referred for a face-to-face diagnosis. Diagnostic agreement between the dermatologist who evaluated the virtual consultation and the dermatologist who evaluated the face-to-face consultation was 89%, and 66% between the paediatrician who made the virtual consultation and the dermatologist who assessed it. Virtual consultations have a similar disease distribution to conventional (face-to-face) referrals. Approximately half of the virtual consultations do not require a subsequent face-to-face visit. The agreement rate between the diagnoses given by both dermatologists (virtual and face-to-face diagnoses) is high. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All

  16. Complementary and alternative medicine in paediatrics in daily practice--a European perspective.

    PubMed

    Längler, Alfred; Zuzak, Tycho J

    2013-04-01

    Complementary and alternative medicine (CAM) is used by both adults and children in Europe. Diverse cultural, ethnic and historical preconditions in European countries result in broad differences between the types of CAM practiced, prevalence of CAM use and integration in the health system. To date, no survey of CAM availability to paediatric patients in Europe exists. We present an overview of CAM integration within the different levels of the European paediatric health systems as a narrative review. Paediatric CAM specialists in 20 European countries provided information about CAM integration in their countries in semi-structured interviews. Data from 20 European countries were available, representing 68% of the European population. CAM is offered in private practices in all 20 (100%) countries, and 80% described some form of CAM training for health professionals. While CAM is offered in outpatient clinics treating adults in 80% of these countries, only 35% offer CAM in paediatric outpatient clinics. Dedicated CAM inpatient wards exist in 65% of the countries for adults, but only in Germany and the Netherlands for children. Groups conducting some CAM research or CAM research focussed on paediatrics exist in 65% and 50% of the 20 countries, respectively. Homeopathy, acupuncture and anthroposophic medicine were most often named. Every child in Europe has access to CAM treatment, mainly in private practices, whereas CAM outpatient clinics and inpatient services for children are rare. This is in contrast to adult treatment facilities, many of which offer CAM services, and the high percentage of European children using CAM. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Sedation practice for paediatric nuclear medicine procedures in Denmark related to EANM guidelines.

    PubMed

    Andersson, Linda; Andersen, Trine Borup; Petersen, Lars J

    2015-01-01

    The objective of this study was to examine sedation practices for paediatric nuclear medicine examinations. A questionnaire was sent to all nuclear medicine departments in Denmark about sedation practices during 2012. The response rate was 100% (18 departments). Three departments did not examine children at all. The total number of paediatric examinations among the remaining 15 sites varied from 20 to 1,583 (median 191). Sedation practice showed that approximately 50% of the sites regularly (>50% of the patients) used pharmacological sedation for renography in children aged 6-12 months and 1-3 years. A minority of centres (∼15%) regularly used sedation in children aged 0-6 months, and no sites regularly used sedation in children aged and 4-6 years. Similar findings were found for renal scintigraphy. However, one large site used no sedation in children aged 1-3 years for renography but approximately 50% of patients used it in the same age group receiving renal scintigraphy with SPET. There was a trend for reduced use of sedation with increasing total number of paediatric medicine procedures. The most frequently used agents were benzodiazepines and barbiturates. The most common route of administration was rectal, oral, and intravenous. The sedation practices varied considerably among Danish nuclear medicine departments. The sedation of children in clinical practice seemed to be more prevalent than is recommended by guidelines.

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

    PubMed

    Seruya, Francine M; Hinojosa, Jim

    2010-09-01

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

  19. Model-Driven Paediatric Cardiomyopathy Pathways - A Clinical Impact Assessment.

    PubMed

    Stroetmann, Karl A; Thiel, Rainer

    2017-01-01

    Intermediate results from an ongoing health technology assessment exercise of a simulation model of paediatric cardiomyopathy are reported. Comprehensive data on paediatric cardiomyopathy/heart failure, treatment options, incidence and prevalence, prognoses for different outcomes to be expected were collected. Based on this knowledge, a detailed clinical pathway model was developed and validated against the clinical workflow in a tertiary paediatric care hospital. It combines three disease stages and various treatment options with estimates of the probabilities of a child moving from one stage to another. To reflect the complexity of initial decision taking by clinicians, a three-stage Markov model was combined with a decision tree approach - a Markov decision process. A Markov Chain simulation tool was applied to compare estimates of transition probabilities and cost data of present standard of care treatment options for a cohort of children over ten years with expected improvements from using a clinical decision support tool based on the disease model under development. Early results indicate a slight increase of overall costs resulting from the extra cost of using such a tool in spite of some savings to be expected from improved care. However, the intangible benefits in life years saved of severely ill children and the improvement in QoL to be expected for moderately ill ones should more than compensate for this.

  20. Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons.

    PubMed

    Al-Essa, Rakan S; Aljahdali, Fares H; Alkhilaiwi, Rakan M; Philip, Winnie; Jawadi, Ayman H; Khoshhal, Khalid I

    2017-01-01

    Developmental dysplasia of the hip (DDH) is one of the prevalent musculoskeletal conditions in young adults and is a leading cause of hip osteoarthrosis in this age group. The optimum age for surgical intervention when needed is not well established in the literature and the lack of management guidelines and standard practice of DDH leads to different practices worldwide. This study aims to investigate the current practice of paediatric orthopaedic surgeons in diagnosing and treating DDH worldwide and identify points of agreement and disagreement. A cross-sectional study utilizing an online questionnaire was designed to examine the different points of view and current practice of paediatric orthopaedic surgeons worldwide regarding DDH diagnosis and treatment. Ninety-one surgeons responded, with an overall response of 45.5%. The vast majority of respondents use ultrasonography in children less than 3 months of age and pelvic radiography in over 3 months to diagnose DDH. Pavlik harness is the most popular DDH treatment for children younger than 6 months. For older children, closed reduction with hip spica cast is the most preferable treatment. The maximum duration of first-line treatment has a broad range. The treatment of bilateral DDH varies widely among surgeons. This study shows clearly that paediatric orthopaedic surgeons do not agree on the diagnosis and treatment protocol of DDH, hence different approaches to this common disease are practised. The lack of an international guideline should motivate paediatric orthopaedic surgeons to discuss and formulate a uniform and evidence-based protocol for the diagnosis and treatment of DDH.

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

    PubMed

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

    2008-03-01

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

  2. Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice.

    PubMed

    Gupta, Asheeta; Campion-Smith, Joanna; Hayes, Wesley; Deal, Jane E; Gilbert, Rodney D; Inward, Carole; Judd, Brian A; Krishnan, Rajesh G; Marks, Stephen D; O'Brien, Catherine; Shenoy, Mohan; Sinha, Manish D; Tse, Yincent; Tyerman, Kay; Mallik, Meeta; Hussain, Farida

    2016-04-01

    Paediatric renal biopsy standards introduced in the UK in 2010 were intended to reduce variation and improve practice. A concurrent national drive was aimed at building robust paediatric nephrology networks to ensure services cater for the needs of the family and minimise time away from home. We aimed to identify current national practice since these changes on behalf of the British Association for Paediatric Nephrology. All UK paediatric nephrology centres were invited to complete a survey of their biopsy practice, including advance preparation. From 1 January to 30 June 2012, a national prospective audit of renal biopsies was undertaken at participating centres comparing practice with the British Association for Paediatric Nephrology (BAPN) standards and audit results from 2005. Survey results from 11 centres demonstrated increased use of pre-procedure information leaflets (63.6 % vs 45.5 %, P = 0.39) and play preparation (90.9 % vs 9.1 %, P = 0.0001). Audit of 331 biopsies showed a move towards day-case procedures (49.5 % vs 32.9 %, P = 0.17) and reduced major complications (4.5 % vs 10.4 %, P = 0.002). Biopsies with 18-gauge needles had significantly higher mean pass rates (3.2 vs 2.3, P = 0.0008) and major complications (15.3 % vs 3.3 %, P = 0.0015) compared with 16-gauge needles. Percutaneous renal biopsy remains a safe procedure in children, thus improving family-centered service provision in the UK.

  3. [Consensus-based approach for severe paediatric asthma in routine clinical practice].

    PubMed

    Plaza, A M; Ibáñez, M D P; Sánchez-Solís, M; Bosque-García, M; Cabero, M J; Corzo, J L; García-Hernández, G; de la Hoz, B; Korta-Murua, J; Sánchez-Salguero, C; Torres-Borrego, J; Tortajada-Girbés, M; Valverde-Molina, J; Zapatero, L; Nieto, A

    2016-02-01

    Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines. An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results. Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids. This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

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

    PubMed Central

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

    2007-01-01

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

  5. Paediatric concussion: Knowledge and practices of school speech-language pathologists.

    PubMed

    Duff, Melissa C; Stuck, Sarah

    2015-01-01

    To characterize paediatric concussion knowledge and the management practices of school-based speech-language pathologists (SLPs) in the US to establish a baseline upon which changes in SLP training, knowledge and best practices can be measured. A survey was developed to assess current knowledge and management of paediatric concussion allowing for comparison to previous and future surveys on SLP knowledge and practice in other areas of brain injury. One thousand surveys were distributed to school-based SLPs from 10 states. Two hundred and eighty SLPs from Minnesota, Wisconsin, New York, Massachusetts, Georgia, Florida, Texas, Tennessee, California and Arizona responded to the survey. Compared to previous survey results, SLPs from the current sample indicate an increase in general brain injury training, but confidence in providing clinical services to brain-injured students remains low. SLPs have a mix of accurate and inaccurate concussion knowledge and uncertainty about their role in concussion management. Findings suggest that increasing communication with other school personnel about concussion, increased training in paediatric TBI and concussion improved access to appropriate assessments tools and implementation of long-term concussion management will improve service delivery to school-aged children with concussion.

  6. Developing a Culture to Facilitate Research Capacity Building for Clinical Nurse Consultants in Generalist Paediatric Practice

    PubMed Central

    Wilkes, Lesley; Cummings, Joanne; McKay, Nicola

    2013-01-01

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

  7. Clinical value of stool culture in paediatric oncology patients: hospital evaluation and UK survey of practice.

    PubMed

    O'Connor, O; Cooke, R P D; Cunliffe, N A; Pizer, B

    2017-01-01

    Diarrhoea is a frequently occurring symptom in paediatric oncology patients. The role of routine testing for enteric bacteria in hospitalized patients with diarrhoea is considered limited, but the diagnostic value of testing in children with oncological conditions has not been reported. Therefore, we conducted a five-year retrospective service evaluation in our tertiary paediatric oncology unit together with a national survey of 21 centres to estimate the utility of stool cultures in oncology patients with diarrhoea and the national approach to testing. Our local survey demonstrated very low diagnostic yield using routine enteric stool cultures with only one sample out of 842 (0.1%) testing positive. The national survey demonstrated considerable variation in practice. There is little evidence to support the use of conventional stool culture for enteric bacteria in children with cancer in our centre. These findings should inform national testing policies.

  8. 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

  9. [Aims and methodology of the Polish National programme for Standardisation of Clinical Practices in Neonatology and Paediatric Intensive Care. Edition 2007/2008].

    PubMed

    Swietliński, Janusz; Zejda, Jan E; Piróg, Maciej; Dobrzańska, Anna; Helwich, Ewa; Ksiazyk, Janusz; Migdał, Marek; Szczapa, Jerzy; Brozek, Grzegorz; Musialik-Swietlińska, Ewa

    2008-01-01

    In this paper we outline the aims and methods of the Polish National Programme for Standardisation of Clinical Practice in Neonatology and Paediatric Intensive Care, with special reference to infants with low and extremely low birth weight. The aim of this Programme is to adjust the diagnostic and therapeutic procedures to the latest guide lines and recommendations. The first stage consisted of a national level survey in order to identify the diversity of procedures implemented in Medical University Clinical Departments, Neonatology Units and Paediatric Intensive Care Units. The survey also served to confront the legitimacy of the used procedures with the current clinical knowledge and research. It is planned to repeat the survey 24 months after the implementation of the latest recommendations with the aim to assess the impact of the Programme on clinical practice. Partial stages of the Programme were started since 2006. The survey is coordinated by an independent statistics unit. The recommendations are developed on published standards.

  10. Clinical Practice Audit: Perioperative Antibiotic Prophylaxis in Paediatric Cancer Patients with Broviac Catheter Implantation.

    PubMed

    Weiss, K; Simon, A; Graf, N; Schöpe, J; Meier, C M

    2016-05-01

    Perioperative antimicrobial prophylaxis (PAP) is an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients face an increased risk of surgical site infection (SSI) after implantation of long term central venous catheters (CVAD). All PATIENTS<18 years admitted to the paediatric oncology centre (POC) with implantation of a CVAD. Systematic audit in 2 groups: retrospective (Jan 01, 2012 - March 31, 2014) and prospective (April 01, 2014 - March 31, 2015) referring to an internal PAP guideline, invented in Jan 2014. Surveillance of SSI up to 30 days after the operation. In total, 97 CVAD implantations were analysed in 89 paediatric oncology patients (Broviac in 94%). The detailed analysis of PAP revealed lower Cefuroxim doses than requested (30 vs. 50 mg/kg). In addition, Cefotaxim was used in 1 case and in 3 cases Clindamycin was given without a medical history of Penicillin hypersensitivity. In the retrospective audit group PAP was administered in 22% for≤24 h); this was the case in 91% of the prospective group (p<0.001). No SSI was detected. This first comprehensive audit of PAP in a German POC outlines significant opportunities for improvement in terms of correct dosing, correct choice of the antibiotic, and shorter duration of PAP. In addition our results illustrate the challenges of optimising standard workflows in clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

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

    PubMed Central

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

    2016-01-01

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

  12. Developing a policy for paediatric biobanks: principles for good practice.

    PubMed

    Hens, Kristien; Van El, Carla E; Borry, Pascal; Cambon-Thomsen, Anne; Cornel, Martina C; Forzano, Francesca; Lucassen, Anneke; Patch, Christine; Tranebjaerg, Lisbeth; Vermeulen, Eric; Salvaterra, Elena; Tibben, Aad; Dierickx, Kris

    2013-01-01

    The participation of minors in biobank research can offer great benefits for science and health care. However, as minors are a vulnerable population they are also in need of adequate protective measures when they are enrolled in research. Research using biobanked biological samples from children poses additional ethical issues to those raised by research using adult biobanks. For example, small children have only limited capacity, if any, to understand the meaning and implications of the research and to give a documented agreement to it. Older minors are gradually acquiring this capacity. We describe principles for good practice related to the inclusion of minors in biobank research, focusing on issues related to benefits and subsidiarity, consent, proportionality and return of results. Some of these issues are currently heavily debated, and we conclude by providing principles for good practice for policy makers of biobanks, researchers and anyone involved in dealing with stored tissue samples from children. Actual implementation of the principles will vary according to different jurisdictions.

  13. Developing a policy for paediatric biobanks: principles for good practice

    PubMed Central

    Hens, Kristien; Van El, Carla E; Borry, Pascal; Cambon-Thomsen, Anne; Cornel, Martina C; Forzano, Francesca; Lucassen, Anneke; Patch, Christine; Tranebjaerg, Lisbeth; Vermeulen, Eric; Salvaterra, Elena; Tibben, Aad; Dierickx, Kris

    2013-01-01

    The participation of minors in biobank research can offer great benefits for science and health care. However, as minors are a vulnerable population they are also in need of adequate protective measures when they are enrolled in research. Research using biobanked biological samples from children poses additional ethical issues to those raised by research using adult biobanks. For example, small children have only limited capacity, if any, to understand the meaning and implications of the research and to give a documented agreement to it. Older minors are gradually acquiring this capacity. We describe principles for good practice related to the inclusion of minors in biobank research, focusing on issues related to benefits and subsidiarity, consent, proportionality and return of results. Some of these issues are currently heavily debated, and we conclude by providing principles for good practice for policy makers of biobanks, researchers and anyone involved in dealing with stored tissue samples from children. Actual implementation of the principles will vary according to different jurisdictions. PMID:22713814

  14. Paediatric robotic surgery in clinical practice: a cost analysis.

    PubMed

    Anderberg, M; Kockum, C C; Arnbjornsson, E

    2009-10-01

    Since 2006 we have used robotic assistance when performing minimally invasive laparoscopic fundoplications in children. We compared the costs of robotic surgery with the costs for open and laparoscopic surgery to test our hypothesis that the increased costs of the new technology are acceptable. Costs were calculated using the regional hospital prices for our first 14 fundoplications in children, performed with the aid of the da Vinci Surgical System from Intuitive Surgical. We compared these costs with those of our ten latest fundoplications performed using open and laparoscopic surgery, respectively. There were no differences in the demographic data, work-up or indications for surgery between the three groups of children. The mean cost of robotic surgical fundoplications (EUR 9 584) was 7% higher than the mean cost of laparoscopic surgery (EUR 8 982) and 9% lower than the mean costs for open surgical procedures (EUR 10 521). These differences can be explained by the increased cost of robotic instruments (EUR 2 081 per operation). The duration of the operation and the duration of in-hospital stay are comparable to those of laparoscopic surgical interventions. The time required for the operative intervention was considerably longer than for the open surgical procedure; the duration of the in-hospital stay was only half of that of the open surgical procedure. The patients seemed to benefit from the use of robotic instruments with less morphine (as a marker of less postoperative pain) and a shorter hospital stay. The introduction of robotic assistance into surgical practice involves increased in-hospital costs, mainly because of the cost of the new instruments. This increase in cost can be offset by the shorter hospital stay compared to open surgery. After laparoscopic surgery the hospital stay is about the same as after operations performed with robotic assistance. Cheaper instruments and shorter operating time will make robotic surgery cost efficient in the future

  15. The impact of an operative note proforma at a paediatric surgical centre.

    PubMed

    Chan, Benjamin K Y; Exarchou, Klaire; Corbett, Harriet J; Turnock, Rick R

    2015-02-01

    With expectations for standardization and evidence-based practice, the Royal College of Surgeons (RCS) published the 'Good Surgical Practice' in 2008. The document sets standards for operative records anticipating improved documentation, audits, medico-legal review and quality and safety of handover. We evaluated (1) documentation against RCS standards; (2) whether RCS standards are applicable to and adequate for paediatric surgery; and (3) the impact of a standardized operative proforma. All general surgery and urology admissions during July 2011 and August 2012 were retrospectively reviewed using 23 set criteria. An operative note proforma was introduced in February 2012. Results were compared and statistically analysed using two-tailed Fisher's exact test, with Bonferroni correction where appropriate (SPSS 20.0, IBM SPSS Statistics, Armonk, NY, USA). There were 345 children admitted; 63.2% underwent an operation (119 in 2011 versus 99 in 2012); 55% of operations were day cases. The initial audit noted poor documentation in 7 of 23 criteria. Following introduction of the operative note proforma, documentation improved significantly: patient identifiers by 12.3%, procedure time 43.3%, assistant's name 31.9%, procedure type 21.4%, closure 6.2%, anaesthetist's name 15.9%, anaesthetic type 56.8% and surgeons grade 65.8% (P<0.05). Subgroup analysis in the latter cohort shows most of these effects to be related to the use of the proforma rather than education alone (P<0.05). Quality of documentation was better by consultants versus trainees in 2 of 23 criteria (P<0.05). We have demonstrated a simple and cost-effective way of improving the quality of operative documentation, in line with guidelines set out by the RCS, in a climate of increasing economic austerity. © 2014 John Wiley & Sons, Ltd.

  16. Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients

    PubMed Central

    Sahu, Amitkumar; Kambalimath, Halaswamy V; Panchakshari, Bharath Kashetty; Jain, Manish

    2016-01-01

    Introduction Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry. Aim To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients. Materials and Methods A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study. Results Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001). Conclusion Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved. PMID:28209009

  17. Speech-language pathology in paediatric palliative care: A scoping review of role and practice.

    PubMed

    Krikheli, Lillian; Mathisen, Bernice A; Carey, Lindsay B

    2017-06-30

    Attempts have been made within the literature to clarify the role and scope of speech-language pathologists (SLPs) within paediatric palliative care (PPC). As SLP literature regarding adult/geriatric populations is gaining traction, it is fitting to investigate the role of SLPs in the management of infants and children in end-of-life care. Arksey and O'Malley's ( 2005 ) scoping review method was utilised for searching multiple databases. Two database searches were undertaken. The first located literature in which SLP PPC intervention is specifically addressed. The second search utilised internationally recognised SLP scope of practice areas. Manual searching of reference lists was also utilised. Themes identified included management of communication, feeding, upper-airway and oral health as well as the role of SLPs within a multidisciplinary PPC team. There is acknowledgement that SLPs have a role in PPC. However, there is little information identifying SLP involvement in the diagnosis and management of swallowing, cognition/communication, oral hygiene and upper airway issues. The available literature predominantly relies on limited adult palliative care research and does not address age-specific management approaches across the paediatric life-stage. Given an absence of SLP PPC guidelines, further research is warranted to explicitly define SLP scope of practice within this population.

  18. Paediatric manpower.

    PubMed

    Liberman, M M; Bellman, M H

    1982-09-01

    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.

  19. 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

  20. Five challenges to ethical communication for interprofessional paediatric practice: A social work perspective.

    PubMed

    Delany, Clare; Richards, Angela; Stewart, Helen; Kosta, Lauren

    2017-03-13

    In paediatric clinical care, what is said to a parent or carer as well as when, where, and how it is said, directly advances or diminishes parents' capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia. Data were collected via semi-structured interviews with nine social workers and analysed thematically. Participants described two main communication-based roles: to support families through information provision and to contribute collaboratively to the interprofessional team involved in caring for a child and family. We grouped participants' descriptions of conflict between these roles into five main "communication challenges": (1) holding troublesome knowledge; (2) the need for diplomacy; (3) conciliation; (4) every man and his dog in family meetings; and (5) systems and processes presenting a brick wall. The five communication challenges provide empirically derived examples of how communication occurring within interprofessional health teams and between individual clinicians and parents can act to diminish or enhance parents' experience of care for their hospitalised child. Identifying these challenges may help to inform how communication within interprofessional teams and between clinicians and patients can benefit children and their parents.

  1. Paediatric non-alcoholic fatty liver disease: a practical overview for non-specialists.

    PubMed

    Mann, Jake P; Goonetilleke, Rajiv; McKiernan, Pat

    2015-07-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common paediatric liver disease with a prevalence of almost 10%; therefore, the majority of affected patients are under the care of general practitioners and non-specialists. The condition is caused by central obesity with insulin resistance with additional factors influencing inflammatory activity (steatohepatitis). Ongoing inflammation leads to fibrosis and end-stage liver disease, though this will usually occur after children have transitioned into adult care. However, their main morbidity and mortality is from type 2 diabetes and complications of atherosclerosis. The minority of children undergo biopsy but currently there is no other method to accurately assess the stage of disease. Management is focused at weight loss through a combination of diet and exercise. Here, we present a current review of paediatric NAFLD aimed at non-specialists, with practice points for implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Paediatric fever management: continuing education for clinical nurses.

    PubMed

    Walsh, Anne M; Edwards, Helen E; Courtney, Mary D; Wilson, Jenny E; Monaghan, Sarah J

    2006-01-01

    This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

  3. Interventional Radiology in Paediatrics.

    PubMed

    Chippington, Samantha J; Goodwin, Susie J

    2015-01-01

    As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

  4. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology.

    PubMed

    O'Kelly, F; Nason, G J; Manecksha, R P; Cascio, S; Quinn, F J; Leonard, M; Koyle, M A; Farhat, W; Leveridge, M J

    2017-04-21

    Social media (SoMe) comprises a number of internet-based applications that have the capability to disseminate multimodal media and allow for unprecedented inter-user connectivity. The role of Twitter has been studied in conferences and education; moreover, there is increasing evidence that patients are more likely to use social media for their own health education. The aim of this study was to assess the impact of social media platforms on the impact factor of both urological and paediatric journals that publish on paediatric urology, and to assess parental awareness of social media in paediatric urology. A filtered Journal of Citation Reports (JCR) search was performed for the period 2012-16 for journals that published articles on paediatric urology. Journals were ranked according to impact factor, and each individual journal website was accessed to assess for the presence of social media. Parents in paediatric urology clinics and non-paediatric urology patients also filled out a questionnaire to assess for awareness and attitudes to social media. All statistical analysis was performed using Prism 6 software (Prism 6, GraphPad Software, California, USA). Overall, there were 50 urological journals and 39 paediatric journals with a mean impact factor of 2.303 and 1.766, respectively. There was an overall average increase in impact factor across all urological journals between 2012 and 16. The presence of a Twitter feed was statistically significant for a rise in impact factor over the 4 years (P = 0.017). The cohort of parents was statistically more likely to have completed post-secondary education, to have and access to a social media profile, use it for health education, and use it to access journal/physician/hospital social media accounts. This study examined, for the first time, the role of social media in paediatric urology, and demonstrated that SoMe use is associated with a positive influence in impact factor, but also a parental appetite for it

  5. Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis.

    PubMed

    Kavirayani, Akhila; Foster, Helen E

    2013-12-01

    To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

  6. Ethical principles and operational guidelines for good clinical practice in paediatric research. Recommendations of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP).

    PubMed

    Gill, Denis

    2004-02-01

    A child has the full right of protection of his/her life by provision of optional medical care. There is a need in paediatrics for better evidence based practice founded on quality research into efficacy and safety of children's medications. To protect the best interests of the child one must balance the ethical demand to do clinical studies with the necessity to avoid doing harm. To achieve this end good clinical practice in paediatric research demands that studies comply with the Declaration of Helsinki, ICH topic E11, EU Directives and other relevant international guidelines. Evident differences in physiology, pharmacology, pharmacokinetics and pharmacodynamics between children of differing ages and between children and adults demand properly constructed and conducted studies that respect the special somatic, emotional and mental needs of children. To justify any research project one must balance the benefit/risk ratio, provide experienced, competent personnel and infracture, obtain adequate informed consent/assent, and have the study evaluated and approved by an ethics committee containing expertise on the rights and needs of children.

  7. Assessing the impact of paediatric oncology publications using three citation databases.

    PubMed

    Arora, Ramandeep S; Eden, Tim O B

    2011-01-01

    Despite some reported limitations, Web of Science has been the standard source to assess the impact of individual articles, and consequently journals. By analysing the citations to articles published in the field of paediatric oncology, we demonstrate that Scopus and Google Scholar, the two new citation databases, retrieve more citations than Web of Science. The strength of Scopus lies in identifying non-English literature from Western and Eastern Europe, while Google Scholar is proficient at identifying English and non-English literature from Africa, Asia and Central and South America. These findings have implications for researchers, journals and health libraries.

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

    PubMed

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

    2016-06-01

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

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

    PubMed

    Rangroo, Vinita

    2008-05-01

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

  10. Health care professionals’ views of paediatric outpatient non-attendance: implications for general practice

    PubMed Central

    Pattison, Helen

    2014-01-01

    Background. Non-attendance at paediatric hospital outpatient appointments poses potential risks to children’s health and welfare. Prevention and management of missed appointments depends on the perceptions of clinicians and decision makers from both primary and secondary care, including general practitioners (GPs) who are integral to non-attendance follow-up. Objectives. To examine the views of clinical, managerial and executive health care staff regarding occurrence and management of non-attendance at general paediatric outpatient clinics. Methods. A qualitative study using individual semi-structured interviews was carried out at three English Primary Care Trusts and a nearby children’s hospital. Interviews were conducted with 37 staff, including GPs, hospital doctors, other health care professionals, managers, executives and commissioners. Participants were recruited through purposive and ‘snowball’ sampling methods. Data were analysed following a thematic framework approach. Results. GPs focused on situational difficulties for families, while hospital-based staff emphasized the influence of parents’ beliefs on attendance. Managers, executives and commissioners presented a broad overview of both factors, but with less detailed views. All groups discussed sociodemographic factors, with non-attendance thought to be more likely in ‘chaotic families’. Hospital interviewees emphasized child protection issues and the need for thorough follow-up of missed appointments. However, GPs were reluctant to interfere with parental responsibilities. Conclusion. Parental motivation and practical and social barriers should be considered. Responsibilities regarding missed appointments are not clear across health care sectors, but GPs are uniquely placed to address non-attendance issues and are central to child safeguarding. Primary care policies and strategies could be introduced to reduce non-attendance and ensure children receive the care they require. PMID:24243869

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

    PubMed

    Pearn, John

    2005-01-01

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

  12. Treatment of paediatric scalp psoriasis with calcipotriene/betamethasone dipropionate scalp formulation: effectiveness, safety and influence on children's quality of life in daily practice.

    PubMed

    Oostveen, A M; de Jong, E M G J; Donders, A R T; van de Kerkhof, P C M; Seyger, M M B

    2015-06-01

    Evidence on efficacy and safety of topical treatments for paediatric scalp psoriasis is lacking. This study aims to evaluate the effectiveness and safety of calcipotriene/betamethasone dipropionate scalp formulation for paediatric scalp psoriasis in daily clinical practice. The influence of this formulation on the quality of life (QoL) was assessed as well. Data of children treated with the scalp formulation were extracted from a prospective observational daily clinical practice registry of children with psoriasis, called Child-Continuous Assessment of Psoriasis Treatment Use Registry. Severity was expressed by Psoriasis Scalp Severity Index (PSSI) and the impact on the QoL was reflected by the validated Children's Scalpdex in Psoriasis (CSP). Eighty-four treatment episodes were analysed. Significant improvements of PSSI score (18.7 ± 11.8 to 12.7 ± 9.4) were demonstrated in the first 12 weeks and this result was well maintained during 48 weeks of follow-up. Three patients (4.1%) developed striae of the skin (arms, trunk and legs), which are possibly related to the scalp formulation. CSP scores (79.0-46.3) declined significantly after 3 months. In a daily clinical practice cohort of children with scalp psoriasis, calcipotriene/betamethasone dipropionate scalp formulation was effective with a 32.1% improvement of PSSI at week 12 and a maintenance of this effect until 48 weeks of follow-up, in combination with improvement of QoL. © 2014 European Academy of Dermatology and Venereology.

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  15. The diagnosis of attention-deficit/hyperactivity disorder in Australian children: Current paediatric practice and parent perspective.

    PubMed

    Efron, Daryl; Sciberras, Emma; Hiscock, Harriet; Jongeling, Brad; Lycett, Kate; Bisset, Matthew; Smith, Grant

    2016-04-01

    In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD. cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis. private/public paediatric practices in Western Australia and Victoria, Australia. paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire. Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD. Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician. © 2016 The Author. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  16. Factors influencing plasma transfusion practices in paediatric intensive care units around the world.

    PubMed

    Karam, O; Demaret, P; Duhamel, A; Shefler, A; Spinella, P C; Tucci, M; Leteurtre, S; Stanworth, S J

    2017-02-01

    Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres. Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product transfusion policies and processes. The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local transfusion services were not identified as significant relevant factors. Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research. © 2017 International Society of Blood Transfusion.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  18. Calcipotriol/betamethasone dipropionate ointment in mild-to-moderate paediatric psoriasis: long-term daily clinical practice data in a prospective cohort.

    PubMed

    van Geel, M J; Mul, K; Oostveen, A M; van de Kerkhof, P C M; de Jong, E M G J; Seyger, M M B

    2014-08-01

    Psoriasis in children has a significant negative impact on the quality of life (QoL) and effective treatment can improve this. The two-compound ointment calcipotriol 50 μg g(-1) and betamethasone dipropionate 0·5 mg g(-1) is an effective treatment option for moderate-to-severe psoriasis in adults. To study prospectively the effectiveness and safety of calcipotriol/betamethasone dipropionate ointment in paediatric patients with mild-to-moderate plaque psoriasis in daily clinical practice and to investigate the influence on QoL. Data were obtained from a prospective, longitudinal paediatric psoriasis registry, called Child-CAPTURE. Severity was assessed using the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). The Children's Dermatology Life Quality Index (CDLQI) was used to assess QoL and visual analogue scores (VAS) for pain and itch were collected. For safety data the number of (serious) adverse events was recorded. Seventy-three patients (mean age 10·8 years, range 3-18) were treated for a median time of 35·0 weeks (range 1·0-176·0). At week 12, mean PASI decreased 15·4% (from 5·2 to 4·4), BSA barely changed, and median CDLQI decreased significantly from 5·5 to 4·0. VAS scores for pain and itch declined. At week 24, mean PASI decreased to 4·3 (17·3%). No related serious adverse events were observed. In this daily clinical practice study in paediatric psoriasis, calcipotriol/betamethasone dipropionate ointment initially improved mild-to-moderate psoriasis and then maintained its effect. In addition, it improved QoL, with few adverse events. © 2014 British Association of Dermatologists.

  19. 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. © 2015 The Author. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  20. Debriefing after failed paediatric resuscitation: a survey of current UK practice.

    PubMed

    Ireland, S; Gilchrist, J; Maconochie, I

    2008-06-01

    Debriefing is a form of psychological "first aid" with origins in the military. It moved into the spotlight in 1983, when Mitchell described the technique of critical incident stress debriefing. To date little work has been carried out relating to the effectiveness of debriefing hospital staff after critical incidents. The aim of this study was to survey current UK practice in order to develop some "best practice" guidelines. This study was a descriptive evaluation based on a structured questionnaire survey of 180 lead paediatric and emergency medicine consultants and nurses, selected from 50 UK trusts. Questions collected data about trust policy and events and also about individuals' personal experience of debrief. Free text comments were analyzed using the framework method described for qualitative data. Overall, the response rate was 80%. 62% said a debrief would occur most of the time. 85% reported that the main aim was to resolve both medical and psychological and emotional issues. Nearly all involve both doctors and nurses (88%); in over half (62%) other healthcare workers would be invited, eg, paramedics, students. Sessions are usually led by someone who was involved in the resuscitation attempt (76%). This was a doctor in 80%, but only 18% of responders said that a specifically trained person had led the session. Individuals' psychological issues would be discussed further on a one-to-one basis and the person directed to appropriate agencies. Any strategic working problems highlighted would be discussed with a senior member of staff and resolved via clinical governance pathways. Little is currently known about the benefits of debriefing hospital staff after critical incidents such as failed resuscitation. Debriefing is, however, widely practised and the results of this study have been used to formulate some best practice guidelines while awaiting evidence from further studies.

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

    PubMed

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

    2016-08-01

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

  2. [Palliative care in paediatric oncology: perceptions, expertise and practices from the perspective of the multidisciplinary team].

    PubMed

    Silva, Adriana Ferreira da; Issi, Helena Becker; Motta, Maria da Graça Corso da; Botene, Daisy Zanchi de Abreu

    2015-06-01

    To reveal the perceptions, expertise and practices of multi-professional teams providing palliative care to children in a paediatric oncology unit. The research questions were based on everyday care, facilitations and difficulties, essential aspects of professional approaches, and the inter-disciplinary focus of care for children in palliative care and their families. Qualitative, exploratory and descriptive research. Data were collected from June to October 2013 from nine professional multidisciplinary team members by means of a semi-structured interview submitted to thematic analysis. The following four themes emerged from analysis: palliative care: conceptions of the multi-professional team; the construction of singular care; the facilitations and difficulties experienced by the team and significant lessons learned. The subjects revealed that the team also suffers with the death of a child and, like the family, moves toward the construction of coping mechanisms for the elaboration of mourning. Paradoxically, the team shares knowledge to determine the foundations of a singular therapeutic project and inserts the family in this process so that it can be the protagonist of the child's care.

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

    PubMed Central

    Allin, Benjamin; Knight, Marian

    2016-01-01

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

  4. Impact of the physical environment in paediatric hospitals on health outcomes: a systematic review.

    PubMed

    Watts, Robin; Wilson, Sally

    2009-01-01

    Nesmith identified two roles for the physical settings in which health care is provided. One is as a tool to support productivity and effectiveness and the second is as healer: "… they are an end in themselves - aiding in the healing and wellness process through psychological and physiological effect…" (p. 671). Research to confirm this statement has been slowly accumulating over the last two decades, but primarily in the area of adult care. Although there are a plethora of articles describing the various creative and innovative approaches to physical design in paediatric hospitals, very few of these innovations have been evaluated in terms of their impact on the health outcomes of children and their families. The objective of this review was to determine from the available evidence the impact of the physical paediatric hospital environment on health outcomes of children and adolescents. Using a defined search and retrieval method, a wide range of indexes of periodical articles were accessed for the period 1980 to 2008 including both health and architectural databases. Unpublished studies from 1991 were sought using a variety of sources including Dissertation Abstracts, Index to Theses, conference proceedings, research and clinical trials registers and web sites of relevant professional associations. The review considered studies using either quantitative or qualitative methodologies or mixed methods that assessed the impact of physical design elements of a paediatric hospital environment including architectural, interior design, ambient features and /or features that supported patient and family centred care. The primary outcomes of interest were clinical or psychological, with other outcomes of interest being patient - family perceptions, including safety and security. Each study was assessed independently by two reviewers prior to inclusion in the review using standardised critical appraisal instruments developed by the Joanna Briggs Institute. As both

  5. ASSESSING THE IMPACT OF A NEWLY INTRODUCED ELECTRONIC PRESCRIBING SYSTEM ACROSS A PAEDIATRIC DEPARTMENT - LESSONS LEARNED.

    PubMed

    Tsyben, Anastasia; Gooding, Nigel; Kelsall, Wilf

    2016-09-01

    Prescribing audits have shown that the Women's and Children's Directorate reported higher number of prescription errors on the paediatric and neonatal wards compared to other areas in the Trust. Over the last three years a multidisciplinary prescribing team (PT), which included senior clinicians, pharmacists and trainees introduced a number of initiatives to improve the quality of prescribing. Strategies included structured departmental inductions, setting up of designated prescribing areas and reviewing errors with the prescriber. Year on year there were fewer prescribing errors.1 With the introduction of a new electronic prescribing system in October 2014 prescribing error rates were expected to decrease further, eradicating omissions around allergy recording, ward location and drug names. The aim of this abstract is to highlight the impact of the new system and describe lessons learned. In the summer of 2014, all inpatient drug charts across the department were reviewed on three non-consecutive days over a period of three weeks. Prescribing errors were identified by the ward pharmacist. Errors were grouped according to type and further analyzed by the PT. Errors deemed to have no clinical significance were excluded. Error rates were compared to the previous audits performed with identical methodology. Following the introduction of the electronic prescribing system, the ward pharmacists continued to review prescription charts on daily basis and generate regular error reports to notify the staff of new challenges. There were 174 (14%) errors out of 1225 prescriptions on 181 drug charts. The most commonly made mistakes included drug name errors, strength of preparation, allergies and ward documentation, prescriber's signature omissions, and antibiotic review and end dates. The introduction of an electronic system has eliminated drug name, strength of preparation, allergy recording and ward errors. However, serious challenges have been identified: entering of an

  6. 'Let's talk about sex' - A Knowledge, Attitudes and Practice study among Paediatric Nurses about Teen Sexual Health in Hong Kong.

    PubMed

    Yip, Benjamin Hon-Kei; Sheng, Xiao-Tong; Chan, Vivian Wai-Yen; Wong, Lilian Hiu-Lei; Lee, Susanna Wai-Yee; Abraham, Anisha Anna

    2015-09-01

    To explore the knowledge, attitudes and practices of paediatric nurses in Hong Kong towards adolescent sexual health issues. In Hong Kong, teens are becoming more sexually permissive. As a result, early sexual activity, Sexually transmitted diseases (STD) and unplanned pregnancies among adolescents are increasing. Paediatric nurses are potentially excellent sexual health educators; however, studies in other countries have reported that nurses have inadequate knowledge and skills about sexual health. Little is known about the knowledge, attitudes and practices of nurses in Hong Kong related to teen sexual health. This is a cross-sectional survey study. The survey was developed after an extensive literature review and partially adapted from previously validated questionnaires on nursing needs, knowledge, attitude and practice. An anonymous self-administered questionnaire in Chinese was distributed to 500 nurses in Hong Kong attending a local paediatric conference. Participants (n = 394) were recruited using convenience sampling methods. Survey data were analysed using descriptive statistics, correlation tests and logistic regression analyses. The majority of nurses had a high awareness of the importance of sexual healthcare, but rarely felt knowledgeable or comfortable discussing sexual health issues with adolescents. Higher comfort level was associated with higher frequency of practice with an average adjusted odds ratios of 2·64. Inadequate or lack of training (39·4%) was the most significant barrier in providing adolescent sexual health screening and counselling. Nurses' clinical practices towards adolescent's sexual health issues were influenced by their perceived comfort level followed by their self-ranked knowledge and training experience. Further specific training on communication, counselling and general sexual health should be provided to nurses in Hong Kong. Nurses' comfort level was the most important factor influencing their clinical practice with teens

  7. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department.

    PubMed

    Patterson, Mary D; Geis, Gary L; LeMaster, Thomas; Wears, Robert L

    2013-05-01

    Cincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error. To improve patient safety in a paediatric ED by implementing a multidisciplinary, simulation-based curriculum emphasising teamwork and communication. Subjects included all healthcare providers in the ED. Multidisciplinary teams participated in simulation-based training focused on teamwork and communication behaviours in critical clinical scenarios. The Safety Attitudes Questionnaire, tests of knowledge and evaluations of critical simulations and actual performance in the ED resuscitation bay were assessed. Methods to sustain improvements included mandatory participation of all new staff in simulation-based training and the introduction of routine in situ simulations. 289 participants attended the initial training. 151 participants attended the re-evaluation at a mean of 10.2 months later. Sustained improvements in knowledge and attitudes were demonstrated. Knowledge tests at baseline, postintervention and re-evaluation had scores of 86%, 96% and 93%, respectively. Friedman's test analysis of SAQ scores at baseline, postintervention and re-evaluation indicated significant attitude changes. The ED with a preintervention baseline of 2-3 patient safety events per year has now sustained more than 1000 days without a patient safety event. This improvement occurred even though the time required in initial simulation training has been condensed from 12 to 4 h. Simulation training is an effective tool to modify safety attitudes and teamwork behaviours in an ED. Sustaining cultural and behavioural changes requires repeated practice opportunities.

  8. Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study.

    PubMed

    McLeod, Hugh; Heath, Gemma; Cameron, Elaine; Debelle, Geoff; Cummins, Carole

    2015-06-01

    In line with a national policy to move care 'closer to home', a specialist children's hospital in the National Health Service in England introduced consultant-led 'satellite' clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders. Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs. Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics' contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics. Outpatient clinics were relocated in pragmatically chosen community settings using a 'drag and drop' service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity. Published by the BMJ Publishing Group Limited. For permission to

  9. Knowledge, opinions and factors influencing practices regarding sugar in oral paediatric medications: a survey of Dunedin pharmacy staff.

    PubMed

    Chow, M; Costain, S; Brosnan, M; Murray, C

    2016-06-01

    Sugar, a known aetiological factor in dental decay, has been used in paediatric medications as a bulking agent, preservative and to improve taste. Although artificial sweeteners have largely replaced sugar, some prescribed and over-the-counter (OTC) paediatric medications and supplements containing sugar are still available in New Zealand. Little is currently known about the knowledge, opinions and practices of staff in NZ pharmacies regarding sugar-containing paediatric medications. This study was carried out to investigate these factors. After ethical approval was obtained, questionnaires were delivered to all staff members at pharmacies in the greater Dunedin area. Quantitative statistical analysis was carried out using SPSS version 22.0 with the alpha value set at 0.05. Qualitative data were analysed using a general inductive technique. A total of 58 questionnaires were returned giving a pharmacy response rate of 63.0%. Some 29.9% of respondents thought the inclusion of sugar in medications necessary and 77.6% agreed that sugar in paediatric medications can contribute to dental decay. Most of the 67.2% who reported that they do not give advice to customers regarding sugar in medications and oral health, felt it was not a priority. Parental request was the main factor determining provision or recommendations regarding sugar-free options (87.9%). Although choice of a sugar-free medication can be limited by many factors, inter-professional collaboration and knowledge sharing on this topic would be advantageous. In addition, the provision of more formalised education, either as part of undergraduate pharmacy curricula or as part of continuing education, should be considered.

  10. Setting up a Paediatric Rapid Access Outpatient Unit: Views of general practice teams

    PubMed Central

    Williams, Lisa; Fryer, Jane; Andrew, Rachel; Powell, Colin; Pink, Jim; Elwyn, Glyn

    2008-01-01

    Background Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs), nurse practitioners and practice nurses) on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about the unit's facilities

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

    PubMed

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

    2015-10-23

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

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

    PubMed Central

    2014-01-01

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

  13. Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population.

    PubMed

    de Bock, Martin; Gunn, Alistair Jan; Holt, Jean-Ann; Derraik, José G B; Reed, Peter; Cutfield, Wayne; Mouat, Fran; Hofman, Paul; Jefferies, Craig

    2012-03-01

    To examine the clinical impact of insulin-pump therapy for children with type 1 diabetes mellitus (T1DM) in a regional paediatric service, Auckland, New Zealand. Retrospective analysis of children with T1DM from the Starship paediatric diabetes database who started on insulin-pump therapy from 2002 to 2008 compared with the whole T1DM population and with an equal number of non-pump patients matched by age, sex, ethnicity and duration of diabetes. From 621 subjects with 6680 clinic visits, 75 children were treated with insulin-pump therapy for more than 12 months. Transitioning to insulin-pump treatment was associated with an improvement in HbA1c compared with baseline (-0.3%/year, P < 0.001) for up to 3 years. In contrast, despite similar deprivation scores, non-pump controls showed a continuing trend to higher HbA1C values (+0.2%/year, P < 0.01). The risk of severe hypoglycaemia fell after pump start (from 27 (0-223) to 5 (0-0.91) events/100 patient years) with no change in non-pump controls; the rate of diabetic ketoacidosis remained low in both groups. In a pump-naïve regional paediatric population, insulin-pump therapy for T1DM was safe and effective, and associated with sustained improvements in HbA1c and lower risk of hypoglycaemia. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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

    PubMed

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

    2015-02-01

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

  15. A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (2) Testing reliability and practicability.

    PubMed

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

    2015-05-01

    A five-domain multisource feedback (MSF) tool was previously developed in 2009-2010 by the authors to assess senior paediatric trainees' ward round leadership skills. To determine whether this MSF tool is practicable and reliable, whether individuals' feedback varies over time and trainees' views of the tool. The MSF tool was piloted (April-July 2011) and field tested (September 2011-February 2013) with senior paediatric trainees. A focus group held at the end of field testing obtained trainees' views of the tool. In field testing, 96/115 (84%) trainees returned 633 individual assessments from three different ward rounds over 18 months. The MSF tool had high reliability (Cronbach's α 0.84, G coefficient 0.8 for three raters). In all five domains, data were shifted to the right with scores of 3 (good) and 4 (excellent). Consultants gave significantly lower scores (p<0.001), as did trainees for self-assessment (p<0.001). There was no significant change in MSF scores over 18 months but comments showed that trainees' performance improved. Trainees valued these comments and the MSF tool but had concerns about time taken for feedback and confusion about tool use and the paediatric assessment strategy. A five-domain MSF tool was found to be reliable on pilot and field testing, practicable to use and liked by trainees. Comments on performance were more helpful than scores in giving trainees feedback. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  18. Impact of obesity on outcomes of paediatric acute pancreatitis based on a national administrative database.

    PubMed

    Murata, A; Ohtani, M; Muramatsu, K; Kobori, S; Tomioka, S; Matsuda, S

    2016-06-01

    Insufficient information is available on the relationship between obesity and outcome of paediatric patients with acute pancreatitis. This study aimed to investigate the effect of obesity on outcomes of paediatric patients with acute pancreatitis based on a national administrative database. A total of 500 cases in 416 paediatric patients with acute pancreatitis (aged 5-17 years) were referred from 260 hospitals between 2010 and 2012 in Japan. Patients were divided into two groups according to the presence of obesity: with obesity (n = 65) and without obesity (n = 435). Patient data were collected from the administrative database to compare the prevalence of severe acute pancreatitis, in-hospital mortality, length of stay (LOS) and medical costs between the groups. Both prevalence of severe acute pancreatitis and in-hospital mortality were significantly higher in paediatric patients with obesity than those without (36.9% vs. 16.3% and 3.1% vs. 0.0%; P < 0.001, respectively). Longer LOS and higher medical costs were also observed in paediatric patients with obesity (25.7 vs. 15.2 days, P < 0.001 and 14 169.5 vs. 7457.7 US dollars, P < 0.001, respectively). This study demonstrated that obesity significantly influenced the outcomes of paediatric acute pancreatitis. © 2015 World Obesity.

  19. The ability of environmental healthcare design strategies To impact event related anxiety in paediatric patients: A comprehensive systematic review.

    PubMed

    Norton-Westwood, Deborah; Pearson, Alan; Robertson-Malt, Suzanne

    2011-01-01

    sought from the period of 1980 to 2010.Methods of the Review Data for each study was extracted and assessed by two independent reviewers for methodological validity prior to inclusion in the review using the Joanna Briggs Institute standardised critical appraisal instruments for Qualitative data (JBI-QARI) and for the Meta Analysis of Statistics Assessment (JBI-MAStARI).Results Twenty studies were reviewed, seven of a descriptive experimental design, three of mixed methodologies and thirteen of various qualitative research design methodologies inclusive of Observational, Grounded Theory, Ethnography and Phenomenology.Conclusions The design of the built environment does have the ability to impact either positively or negatively the level of anxiety and fear that children experience when exposed to a healthcare setting. The coping strategies engaged by and unique to each paediatric age group need to not only be understood but supported and reflected in the built environment.Implications for research Architects and healthcare researchers need to collaborate to establish a solid base of evidence related to this important area of interest. Irrespective of the challenges that researchers face in attempting to randomise, manipulate and control the numerous environmental variables that impact a question such as this, such challenges need not, nor should not, prevent or discourage future research. An innovative solution to the challenges faced by researchers in this field is the use of computer modelling and/ or simulation of the hospital environment. Through the use of simulated environments researchers can directly observe user preferences and/ physiological responses.Implication for practice This review highlights an insightful look into the preferences of children as consumers. Although sample sizes were small and results were not quantified in measurable outcomes, the ability for such studies to inform design should not be underestimated. Design strategies both from a

  20. Implementation of clinical practices to reduce return visits within 72 h to a paediatric emergency department.

    PubMed

    Jeong, Jin Hee; Hwang, Seung Sik; Kim, Kyuseok; Lee, Jin Hee; Rhee, Joong Eui; Kang, Changwoo; Lee, Soo Hoon; Kim, Hooyoung; Im, Yeon Sook; Lee, Boeknam; Byeon, Young Im; Lee, Ji Sook

    2015-06-01

    Return visits to the paediatric emergency department (PED) are an important measure of quality of healthcare and are associated with patients' and parents'/guardians' satisfaction. Previous studies have been limited to describing characteristics and factors related to return visits. The objectives of this study were to develop new clinical practices to reduce return visits to the PED and to see whether implementation of these practices had the desired effect. This was a controlled before-and-after study. New clinical practices were developed by analysing data for patients visiting in 2011 (before) and by surveying emergency physicians and nurses in the PED. New clinical practices were implemented between 16 July and 4 November 2012 (after). The rate of return visits and admission rates after return visits were compared between matched periods in 2011 and 2012. We also investigated return visits at three independent hospitals to overcome the limitation of the intervention application to a single hospital. The new clinical practices included five protocols: set orders for common symptoms; management plans for patients at high risk of a return visit; a daily physician feedback system; protocolised discharge instructions; early planned visits to clinics. After implementation, the rate of return visits was reduced significantly, from 4.4% to 2.6% (p<0.01). The admission rate for return visits was also reduced, but not significantly so, from 22.3% to 17.5% (p=0.37). Return visits at the other hospitals were similar or significantly increased in 2012 compared with 2011. The development and implementation of clinical practices were effective in reducing return visits of paediatric patients to the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Reflecting on paediatric oncology nursing practice using Benner's Helping Role as a framework to examine aspects of caring.

    PubMed

    Reynolds, Mandy

    2002-03-01

    This paper uses Benner's helping domain (Benner 1984) to reflect on two aspects of paediatric oncology nursing practice. Exemplars of care will illustrate the use of therapeutic touch and bereavement skills whilst caring for two children with cancer. Children need to be given time and opportunity to express their feelings, fears and anxiety to enable them to understand and cope with their loss. They may also need support of a familiar adult and the multi-disciplinary team. In establishing a commitment to a healing relationship touch can be a valuable tool. Touch is a complex form of non-verbal communication that can be used to convey warmth, empathy and comfort. It is important that nurses are aware of both the types and meaning so it can be used therapeutically and appropriately. Paediatric oncology nurses are ideally placed to establish meaningful relationships with children who have cancer and their families but must be aware of their own limitations. To further improve care we must continue to reflect on the richness of our practical experiences and chart our expert knowledge.

  2. Paediatric biobanking: Dutch experts reflecting on appropriate legal standards for practice.

    PubMed

    Kranendonk, Elcke J; Hennekam, Raoul C; Ploem, M Corrette

    2017-01-01

    Large sets of data and human specimens, such as blood, tumour tissue and DNA, are deposited in biobanks for research purposes, preferably for long periods of time and with broadly defined research aims. Our research focuses on the retention of data and biological materials obtained from children. However important such paediatric biobanks may be, the privacy interests of the children involved and the related risks may not be ignored. The privacy issues arising from paediatric biobanks are the central focus of this article. We first review the international regulations that apply to biobanks and then summarise viewpoints expressed by experts in a round-table discussion. We confine ourselves here to two normative questions: (1) How much control should children's parents or legal representatives, and later the children themselves, have over the stored materials and data? (2) What should be done if research findings emerge that have serious implications for a child's health?

  3. Childhood circumcision in Northern Ireland: a barometer of the current practice of general paediatric surgery.

    PubMed

    Groves, H; Bailie, A; McCallion, W

    2010-05-01

    Studies undertaken in England and Scotland have identified a decrease in the number of circumcision operations being performed during childhood. The aims of this study were two-fold. Firstly, to determine the trend in circumcision operations performed in boys in Northern Ireland over a ten year period. Secondly, to compare the number of operations performed by paediatric surgeons with the number performed by general surgeons over the same period. Data were collected from the Northern Ireland Department of Health and Social Services and Public Safety. A retrospective analysis was conducted of the number of circumcisions performed in boys aged between 0 and 13 years for the year beginning 1(st) September 1991 to the 1(st) of September 1992 and for the year beginning 1(st) September 2001 until the 1(st) of September 2002. 769 circumcisions were performed in the year 1991 to 1992 compared with 264 in the year 2001 to 2002, representing a 66% decrease. In the ten year study period, the number of circumcisions performed by general surgeons fell by 71% whilst specialist paediatric surgeons performed 56% less. The decrease in rates of circumcision in boys aged 0 to 13 years in Northern Ireland is consistent with trends in the remainder of the United Kingdom. The results also suggest a greater decrease in the proportion of circumcisions being performed by general surgeons in district general hospitals compared to those performed by paediatric surgeons.

  4. Childhood Circumcision in Northern Ireland: A barometer of the current practice of general paediatric surgery

    PubMed Central

    Groves, H; Bailie, A; McCallion, W

    2010-01-01

    Purpose: Studies undertaken in England and Scotland have identified a decrease in the number of circumcision operations being performed during childhood. The aims of this study were two-fold. Firstly, to determine the trend in circumcision operations performed in boys in Northern Ireland over a ten year period. Secondly, to compare the number of operations performed by paediatric surgeons with the number performed by general surgeons over the same period. Method: Data were collected from the Northern Ireland Department of Health and Social Services and Public Safety. A retrospective analysis was conducted of the number of circumcisions performed in boys aged between 0 and 13 years for the year beginning 1st September 1991 to the 1st of September 1992 and for the year beginning 1st September 2001 until the 1st of September 2002. Results: 769 circumcisions were performed in the year 1991 to 1992 compared with 264 in the year 2001 to 2002, representing a 66% decrease. In the ten year study period, the number of circumcisions performed by general surgeons fell by 71% whilst specialist paediatric surgeons performed 56% less. Conclusions: The decrease in rates of circumcision in boys aged 0 to 13 years in Northern Ireland is consistent with trends in the remainder of the United Kingdom. The results also suggest a greater decrease in the proportion of circumcisions being performed by general surgeons in district general hospitals compared to those performed by paediatric surgeons. PMID:21116424

  5. A conceptual and practical approach to haemostasis in paediatric liver disease.

    PubMed

    Magnusson, Maria; Ignjatovic, Vera; Hardikar, Winita; Monagle, Paul

    2016-09-01

    Children with liver disease can develop severe bleeding episodes and thrombosis. Liver failure usually results in decreased levels of procoagulant and anticoagulant factors. Additional risk factors, including changes in vascular flow and endothelial function, are of importance for the development of bleeding or thrombosis in individual vascular beds. Detailed studies of haemostatic disturbances in the setting of paediatric liver disease are sparse and extrapolation from adult studies is common. The spectrum of liver diseases and the haemostatic system differs between children and adults. Specific paediatric liver diseases are reported to have more distinctive effects on haemostasis and the risk of bleeding and/or thrombosis. we propose a model regarding haemostasis in paediatric liver disease, taking into account a number of specific variables and mechanisms, as well as the type of liver disease, which will provide a framework for clinical decision-making in these complex patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. [Restraint in paediatric care].

    PubMed

    Estrade, Marie; Tessier-Levêque, Mélanie; Wanquet-Thibault, Pascale

    2016-01-01

    Restraint in general, and particularly when giving paediatric care, is a sensitive subject. This practice continues to appear often as a solution when children are disorientated or struggle during care. However, it is generally traumatic for the different care agents: the child, the parent and the care-giver. Reflection on this subject has been carried out after exchanges with professionals about the use of restraint with children aged 2-4 during paediatric emergency care.

  7. Impact of implementing French antibiotic guidelines for acute respiratory-tract infections in a paediatric emergency department, 2005-2009.

    PubMed

    Angoulvant, F; Skurnik, D; Bellanger, H; Abdoul, H; Bellettre, X; Morin, L; Aptecar, M; Galli-Gibertini, G; Bourdon, O; Doit, C; Faye, A; Mercier, J-C; Cohen, R; Alberti, C

    2012-07-01

    Acute respiratory tract infections (ARTIs) are the main reason for antibiotic prescription in children. In 2005, the French Drug Agency published guidelines to minimise inappropriate use of antibiotics for ARTI. The purpose of this study was to assess the impact of implementing these guidelines in a paediatric emergency department. We retrospectively analysed data collected prospectively in a French paediatric emergency department from November 2005 (date of guideline implementation) to October 2009. For each child diagnosed with ARTI, we collected age, diagnosis, and prescribed antibiotics. We computed antibiotic prescription rates in the study population. During the study period, 53,055 children were diagnosed with ARTI and 59% of the 22,198 antibiotic prescriptions given at discharge were related to ARTI. The proportion of ARTI patients given antibiotic prescriptions fell from 32.1% during the first year to 21% in year 4 (p<10(-4), Cochran-Armitage test). Amoxicillin-clavulanic acid and amoxicillin accounted for 50% and 34% of antibiotic prescriptions for ARTI, respectively. French antibiotic guidelines led to significant decreases in antibiotic prescription for ARTI in our paediatric emergency department.

  8. Medical professionals convicted of accessing child pornography--presumptive lifetime prohibition on paediatric practice? Health Care Complaints Commission v Wingate.

    PubMed

    Shats, Kathy; Faunce, Thomas

    2008-05-01

    Health Care Complaints Commission v Wingate [2007] NSWCA 326 concerns an appeal from the New South Wales Medical Tribunal regarding its findings on professional misconduct outside the practice of medicine in relation to a doctor convicted of possessing child pornography. The latest in a number of cases on this issue in Australia, it highlights the complexity of such decisions before medical tribunals and boards, as well as the diversity of approaches taken. Considering both this case and the recent Medical Practitioners Board of Victoria case of Re Stephanopoulos [2006] MPBV 12, this column argues that Australian tribunals and medical boards may not yet have achieved the right balance here in terms of protecting public safety and the reputation of the profession as a whole. It makes the case for a position statement from Australian professional bodies to create a presumption of a lifetime prohibition on paediatric practice after a medical professional has been convicted of accessing child pornography.

  9. Horner's syndrome in patients admitted to the paediatric intensive care unit: epidemiology, diagnosis and clinical practice.

    PubMed

    Lazar, I; Cavari, Y; Rosenberg, E; Knyazer, B

    2013-01-01

    Horner's syndrome appears when the three-neuron sympathetic pathway is interrupted anywhere from the posterior-lateral nuclei of the hypothalamus through the spinal cord to the eye. In children, Horner's syndrome can be either congenital or acquired, but overall it is a rare finding. There are several causes of Horner's syndrome, some of iatrogenic. Although uncommon in the paediatric population, prompt recognition of the syndrome and immediate treatment may prevent permanent damage to the neuronal pathway. Awareness of the risk of developing iatrogenic Horner's syndrome and early detection of signs are recommended to minimise future disability.

  10. [Analysis of the scientific productivity and impact of Spanish paediatrics (2006-2010)].

    PubMed

    Alonso-Arroyo, A; González de Dios, J; Bolaños-Pizarro, M; Castelló-Cogollos, L; González-Alcaide, G; Navarro-Molina, C; Vidal-Infer, A; Coronado-Ferrer, S; González-Muñoz, M; Málaga-Guerrero, S; Aleixandre-Benavent, R

    2013-06-01

    The aim of this paper is to quantify, by means of bibliometric indicators, the scientific production of Spanish researchers and institutions publishing in national and international paediatric journals, as well as multidisciplinary and other knowledge areas publications during the period 2006-2010, and to determine their impact. The articles were obtained by applying specific search strategies in databases including, Science Citation Index-Expanded, Scopus, Índice Médico Español, and Índice Bibliográfico Español en Ciencias de la Salud. A total of 7971 articles were published in 971 journals, in which 142 were from Spain and 829 were international. The most productive journals were Anales DE PEDIATRÍA (n=1257), Acta Pediátrica Española (n=456) and Evidencias en Pediatría (n=358). Articles were published mostly in English (41.04%) and in Spanish (38.18%), with the participation of 17 874 different authors from 3302 institutions. Approximately 60% of the papers were cited at least once, and 39.81% were never cited. The mean number of citations per document was 4.28 (SD=9.54). The most cited journals were Pediatrics (n=770), Pediatric Infectious Disease Journal, and Journal of Clinical Endocrinology and Metabolism (n=553). The number of articles progressively increased from 2006 to 2010, which confirms the consolidation and growth of Spanish pediatric research, where the results are published in a wide range of Spanish and international journals, among which stands out is the ANALES DE PEDIATRÍA, the only Spanish pediatric journal with an impact factor. The increasing internationalization of Spanish Pediatrics is also confirmed, since a sustained growth of articles published in international journals is observed, where a quarter was published in US or British journals, as well as the importance of the publication in English. There is a concern about the fact that almost 40% of the articles did not receive a citation, which should encourage authors to

  11. [Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study].

    PubMed

    Martín Martín, Raquel; Sánchez Bayle, Marciano

    2017-08-09

    To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care. An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013-2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40μg/m(3.) RESULTS: During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40μg/m(3). In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691-6.570), and negative with temperature (-5,957, 95% CI: -8.665 to -3.248). NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  12. Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice.

    PubMed

    Teran, C G; Torrez-Llanos, J; Teran-Miranda, T E; Balderrama, C; Shah, N S; Villarroel, P

    2012-07-01

    Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents. A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer. Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up. The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices. © 2011 Blackwell Publishing Ltd.

  13. Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies

    PubMed Central

    Mohan, Shaun; Dharamraj, Kavita; Dindial, Ria; Mathur, Deepti; Parmasad, Vishala; Ramdhanie, Joseph; Matthew, Jason; Pinto Pereira, Lexley M

    2004-01-01

    Background Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (≤ 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. Methods A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50%), the most common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics for the common cold (p = 0.014). Severity (95.7%) and duration of illness (82.5%) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75%) and concern for secondary bacterial infections (70%). Physicians do not request laboratory investigations primarily because they are unnecessary (86%) and the waiting time for results is too long (51%). Conclusions Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin

  14. Media coverage of youth suicides and its impact on paediatric mental health emergency department presentations.

    PubMed

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

    2014-01-01

    To examine mental health (MH) presentations to the emergency department (ED) of a paediatric hospital following two highly publicized local teen suicides. Youths aged 12-18 years with a MH chief complaint and/or diagnosis were included. Differences in frequencies were analyzed using chi-square tests, and relative risks were evaluated using generalized linear modelling. Significant increases in the number of ED presentations were found within the months of the publicized suicides compared to the same months of previous years. No differences were found in symptom acuity, suicidal status and psychiatric hospitalization rates. Significant increases were found in relative risk of presenting to the ED 28 and 90 days post both publicized suicides. RESULTS suggest there was an association between highly publicized suicides and an increase in the number of MH presentations to the local paediatric ED. Considerations of media's potentially positive role in MH awareness are needed. Copyright © 2014 Longwoods Publishing.

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

    PubMed Central

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

    2014-01-01

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

  16. Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development, implementation and evaluation of an online toolkit for health professionals.

    PubMed

    Glegg, Stephanie M N; Livingstone, Roslyn; Montgomery, Ivonne

    2016-01-01

    Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting. EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring. The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy's inception in January 2011. The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians' use of EBP in order to meet the needs of the clients and families whom they support. Implications for Rehabilitation A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level. Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources. EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

  17. Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

    PubMed

    Parry, Yvonne Karen; Ullah, Shahid; Raftos, Jeremy; Willis, Eileen

    2016-01-01

    This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care. Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care. Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care. © 2015 John Wiley & Sons Ltd.

  18. The aetiology and impact of malnutrition in paediatric inflammatory bowel disease.

    PubMed

    Gerasimidis, K; McGrogan, P; Edwards, C A

    2011-08-01

    Disease-associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn's disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro-inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron-deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.

  19. Current prescribing practices and opinions about growth hormone therapy: results of a nationwide survey of paediatric endocrinologists.

    PubMed

    Hardin, Dana S; Woo, Jason; Butsch, Robert; Huett, Beverley

    2007-01-01

    With the advent of several new treatment indications for recombinant hGH, endocrinologists are being asked to make some difficult decisions regarding eligibility for treatment. The purpose of this study was to summarize prevailing attitudes about GH diagnosis and treatment among paediatric endocrinologists. We sent surveys to all active US members of the Lawson Wilkins Pediatric Endocrine Society (LWPES) listed in the 2004-05 directory (excluding our own group of physicians). Thirty-eight per cent of the surveys were returned and 182 met eligibility for analysis. Surveys were divided into four parts: demographic data, answers reflecting current diagnosis practices for GH deficiency and treatment with GH, attitudes and clinical practice for the idiopathic short stature (ISS) diagnosis, and four case studies. Through a series of questions, we elicited the influence towards prescribing GH of current height, growth velocity, predicted height, pubertal progression and other variables. Results were entered into a Microsoft Access database and statistical evaluation was conducted. Eighty-eight per cent of respondents answered 'no' to the statement that there is good consensus on who should be treated with GH and over 90% answered 'no' to the statement that secretagogue testing was the best way to determine if a child would benefit from GH. Factors listed by respondents as important for prescribing GH include: growth velocity less than the 25th percentile, target height less than the 5th percentile and pubertal stage greater than Tanner 2. Current height was also important; however, answers varied as to what height percentile indicated the need for treatment. When queried about prescribing practices for nonstraightforward cases, 62% of respondents answered that the cost of GH influenced their decision to treat, 55% responded that concerns of future unknown side-effects affected their decision and 37% noted family persistence influenced their decision. In response to

  20. Medical literature search practice in paediatric junior medical staff: a questionnaire survey.

    PubMed

    Shirkhedkar, P; Day, A S

    2008-03-01

    With increasing medical knowledge and emphasis upon evidence-based medicine, it is essential for practitioners to have optimal literature searching skills. There are limited data regarding the use of online information retrieval (IR) systems by paediatric junior medical officers (JMO). The aims of this questionnaire-based study of a group of JMO were to assess the accessibility, frequency of use and preferences for electronic information resources, and to ascertain their perceived adequacy of training and expertise in online searching. Questionnaires were distributed to 319 JMO at two Australian children's hospitals. A total of 106 questionnaires were returned (33.2% response rate). Twenty-four-hour access to electronic medical databases was available to almost 90% of respondents at work or home. Five or less online searches per month were performed by 53.7% of respondents. Previous formal training in database searching was reported by 72.4% of respondents, but over half felt it had been inadequate. Most JMO (91.5%) acknowledged a need for further training in search skills. In spite of widespread availability of online resources, use of these resources was sub-optimal in this group of trainee doctors. Most respondents reported a need for further training in electronic searching. Continuing targeted education in electronic database searching is required to ensure that future doctors develop skills to ensure optimal use of medical literature.

  1. The impact of 12 months treatment with ivacaftor on Scottish paediatric patients with cystic fibrosis with the G551D mutation: a review.

    PubMed

    Dryden, Carol; Wilkinson, Jane; Young, David; Brooker, Richard John

    2016-06-10

    We reviewed the impact of ivacaftor on Scottish paediatric patients with cystic fibrosis ≥6 years of age after 12 months of treatment. Statistically significant improvements in FEV1 and body mass index and a reduction in sweat chloride, all comparable with previously published data were observed. The findings also suggested reduced use of intravenous antibiotics and oral antibiotics. No significant adverse effects were observed but a possible association with cataract formation could not be excluded. This review suggests that, in the short term at least, ivacaftor is effective and safe in paediatric patients ≥6 years of age with G551D.

  2. The impact of child restraint legislation on the incidence of severe paediatric injury in Chile.

    PubMed

    Nazif-Muñoz, J Ignacio; Gariépy, Geneviève; Falconer, James; Gong, Annie; Macpherson, Alison

    2017-10-01

    The objective of this study is to determine the association between Chile's 2005 child restraint legislation (CRL) and the incidence of severe paediatric motor vehicle-related injury. We analysed motor vehicle injury data from Chile's Road Safety Commission from 2000 to 2012 to determine the association between Chile's 2005 CRL and severe paediatric injury. Using Poisson time-series models we assessed the effect of the law on two outcome variables: (1) severely injured children per vehicle fleet; and (2) severely injured children per population. Chile's 2005 CRL is significantly associated with a 24% reduction in severely injured children per vehicle, and 19% reduction in severely injured children per population in the 1st year of its enactment. In 2007 this law is also significantly associated with a 17% decrease in severely injured children per vehicle, and with an 11% decrease in severely injured children per population. However, this legislation had a short-term effect since no reductions in severely injured children per vehicle were observed after 2009 and no reductions for severely injured children per population were registered after 2008. This is the first study to examine the association between CRL and severe paediatric injury in a Latin-American country. This study suggests that Chile's CRL was only effective in the short term. To support this type of reforms in the long term, other measures such as police enforcement, public information campaigns and involvement of public health professionals in educating parents about the benefits of using child restraints should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    PubMed

    Mitra, Aparajita; Bajpai, Minu

    2016-04-01

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

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

    PubMed Central

    Bajpai, Minu

    2016-01-01

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

  5. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. [Individualised parent counselling in paediatric practices for the reduction of second-hand smoke exposure of their children: a feasibility study].

    PubMed

    Haug, S; Biedermann, A; Ulbricht, S; John, U

    2015-05-01

    The aim of this study was to test the feasibility of a web-based programme provided by paediatric practices for counselling parents to reduce second-hand smoke exposure of their children. Accompanying persons of children were systematically screened concerning tobacco smoking at their home in 2 Swiss paediatric practices. They were invited for programme participation if they or their partners smoked at home regularly. The web-based programme provided at least 1 computer-tailored counselling letter. Upto 3 additional counselling letters could be requested online by the participants over a period of 3 months. The letters were tailored according to the indoor smoking behaviour of the parents and considered individual barriers and resources for the establishment of a smoke-free home. Additionally, further information and advice could be requested on the programme website. Feasibility indicators were the participation rate, programme use, and programme evaluation by the participants. 3 055 (82.3%) of 3 712 accompanying persons of children in the paediatric practices were screened concerning tobacco smoking at their home. 96 (56.8%) of 169 eligible persons participated in the programme. 68 (70.8%) of the 96 programme participants could be reassessed at post assessment. 9 (15.0%) of 60 participants who provided a valid e-mail address requested more than one counselling letter. The counselling letters and the web-based programme were evaluated positively by the programme participants. Systematic screening combined with the provision of individually tailored counselling letters for parents to reduce second-hand smoke exposure of their children was feasible in paediatric practices. Possible strategies to in-crease the use and reach of the programme are -discussed. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland

    PubMed Central

    Bernstein, Judith; Gebel, Christina; Vargas, Clemencia; Geltman, Paul; Walter, Ashley; Garcia, Raul; Tinanoff, Norman

    2017-01-01

    Objectives To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers. Sample Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. Design Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. Measurements Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. Results Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records. Conclusions NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children. PMID:28360245

  8. Paediatrics in Amsterdam.

    PubMed

    Eber, Ernst; Aurora, Paul; Lødrup Carlsen, Karin C; Lindblad, Anders; Dankert-Roelse, Jeannette E; Ross-Russell, Robert I; Turner, Steve W; Midulla, Fabio; Hedlin, Gunilla

    2012-07-01

    The aim of this update is to describe the paediatric highlights from the 2011 European Respiratory Society (ERS) Annual Congress in Amsterdam, the Netherlands. Abstracts from all seven groups of the ERS Paediatric Assembly (Paediatric Respiratory Physiology, Paediatric Asthma and Allergy, Cystic Fibrosis, Paediatric Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Paediatric Respiratory Epidemiology, and Paediatric Bronchology) are presented in the context of current literature.

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

    PubMed

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

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

  10. Editorial: cardiovascular drug therapy in paediatric age: from metabolomics to clinical practice.

    PubMed

    Bassareo, Pier Paolo; Fanos, Vassilios

    2014-01-01

    In adult patients, cardiovascular drugs are widely administered in the treatment of numerous diseases. The indications and doses are strictly codified by international Guidelines, which are periodically updated by the American and European Societies of Cardiology. In paediatric patients, however, the situation is substantially different. The lack of large interventional studies on the use of these compounds has led to a greater uncertainty, with a less extensive administration and more limited indications. Furthermore, some important differences in therapeutic approach for the same diseases are present between the U.S. and Europe. The purpose of this Special Issue is to review the pharmacological treatment of certain heart diseases, such as heart failure, and arterial blood pressure, which can result in both adult and pediatric patients [1, 2]. Differences and similarities have been highlighted. Regarding the differences in medical treatment for the same disease in the U.S. and Europe, it has been emphasized that the regulation of drugs is largely determined not only by scientific considerations, but also by other concerns - legal, cultural - which vary in different parts of the world. Such discrepancies are found even in the informational documents provided by pharmaceutical companies (different in USA and Europe for the same drug) and drug agencies (different between FDA and equivalent agencies in Europe). In this issue of Current Medicinal Chemistry, a specific paper is dedicated to the pharmacological treatment of the patency of ductus arteriosus in neonates, which is still a controversial issue. In fact, notwithstanding ibuprofen appears to be lesser dangerous for newborns than indomethacin, with a similar efficacy in closing the ductus; in a number of countries the latter is still administered to all preterm subjects as a prophylactic tool [3]. An unusual case report is the interesting starting point to perform an extensive literature review about the new

  11. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

    PubMed

    Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

    In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    PubMed Central

    Peeraully, R; Henderson, K; Davies, B

    2016-01-01

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

  13. Canadian Paediatric Neurology Workforce Survey and Consensus Statement.

    PubMed

    Doja, Asif; Orr, Serena L; McMillan, Hugh J; Kirton, Adam; Brna, Paula; Esser, Michael; Tang-Wai, Richard; Major, Philippe; Poulin, Chantal; Prasad, Narayan; Selby, Kathryn; Weiss, Shelly K; Yeh, E Ann; Callen, David Ja

    2016-05-01

    Little knowledge exists on the availability of academic and community paediatric neurology positions. This knowledge is crucial for making workforce decisions. Our study aimed to: 1) obtain information regarding the availability of positions for paediatric neurologists in academic centres; 2) survey paediatric neurology trainees regarding their perceptions of employment issues and career plans; 3) survey practicing community paediatric neurologists 4) convene a group of paediatric neurologists to develop consensus regarding how to address these workforce issues. Surveys addressing workforce issues regarding paediatric neurology in Canada were sent to: 1) all paediatric neurology program directors in Canada (n=9) who then solicited information from division heads and from paediatric neurologists in surrounding areas; 2) paediatric neurology trainees in Canada (n=57) and; 3) community paediatric neurologists (n=27). A meeting was held with relevant stakeholders to develop a consensus on how to approach employment issues. The response rate was 100% from program directors, 57.9% from residents and 44% from community paediatric neurologists. We found that the number of projected positions in academic paediatric neurology is fewer than the number of paediatric neurologists that are being trained over the next five to ten years, despite a clinical need for paediatric neurologists. Paediatric neurology residents are concerned about job availability and desire more career counselling. There is a current and projected clinical demand for paediatric neurologists despite a lack of academic positions. Training programs should focus on community neurology as a viable career option.

  14. Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession.

    PubMed

    Hunter, Cathleen; Maciver, Donald; Howden, Stella; Forsyth, Kirsty; Adamson, Amanda; Bremner, Lynne

    2013-03-01

    Children with additional support needs (ASNs) often require physiotherapy intervention to help maximise their participation within the primary school setting. The aim of this research was to investigate paediatric physiotherapy practice in supporting primary school aged children with ASNs, in order to identify a language to describe this, which could be used to support communication with teachers, parents and others outside the profession. Using a qualitative research multiple methods design, 2 focus groups and 5 structured interviews were held to investigate physiotherapy practice for this group. Senior paediatric physiotherapists (n=13) from a range of specialities, with experience of supporting primary school aged children with ASNs. Focus groups and interviews were digitally recorded, transcribed verbatim and analysed to establish links and patterns: followed by a cyclical process of respondent validation, and expert review. Eight targets for physiotherapy intervention and twelve technique headings were synthesised from the data. The language used for labelling and description of these was aimed to be easily understood by colleagues outside the profession. The findings clearly identified the role of the paediatric physiotherapist as being to support primary school aged children with ASNs to acquire aspects of postural control, mobility and cardio-respiratory function. By grouping the data into eight areas of challenge as the focus of intervention, and twelve commonly used techniques, the researchers generated a language which can be used by paediatric physiotherapists to support communication with teachers, parents and others outside the profession, when describing their intent and interactions regarding these children. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  15. Impact of Prominent Themes in Clinician-Patient Conversations on Caregiver's Perceived Quality of Communication with Paediatric Dental Visits.

    PubMed

    Wong, Hai Ming; Bridges, Susan Margaret; McGrath, Colman Patrick; Yiu, Cynthia Kar Yung; Zayts, Olga A; Au, Terry Kit Fong

    2017-01-01

    Patients' perceived satisfaction is a key performance index of the quality health care service. Good communication has been found to increase patient's perceived satisfaction. The purpose of this study was to examine the impact of the prominent themes arising from clinician-patient conversations on the caregiver's perceived quality of communication during paediatric dental visits. 162 video recordings of clinical dental consultations for 62 cases attending the Paediatric Dentistry Clinic of The Prince Philip Dental Hospital in Hong Kong were captured and transcribed. The patients' demographic information and the caregiver's perceived quality of communication with the clinicians were recorded using the 16-item Dental Patient Feedback on Consultation skills questionnaires. Visual text analytics (Leximancer™) indicated five prominent themes 'disease / treatment', 'treatment procedure related instructions', 'preparation for examination', 'positive reinforcement / reassurance', and 'family / social history' from the clinician-patient conversation of the recorded videos, with 60.2% of the total variance in concept words in this study explained through principal components analysis. Significant variation in perceived quality of communication was noted in five variables regarding the prominent theme 'Positive reinforcement / reassurance': 'number of related words' (p = 0.002), 'number of related utterances' (p = 0.001), 'percentage of the related words in total number of words' (p = 0.005), 'percentage of the related utterances in total number of utterances' (p = 0.035) and 'percentage of time spent in total time duration' (p = 0.023). Clinicians were perceived to be more patient-centered and empathetic if a larger proportion of their conversation showed positive reinforcement and reassurance via using related key words. Care-giver's involvement, such as clinicians' mention of the parent, was also seen as critical to perceptions of quality clinical experience. The study

  16. Impact of magnetic resonance urography and ultrasonography on diagnosis and management of hydronephrosis and megaureter in paediatric patients.

    PubMed

    Wildbrett, Peer; Langner, Sönke; Lode, Holger; Abel, Jürgen; Otto, Sylke; Hosten, Norbert; Barthlen, Winfried

    2012-01-01

    (1) To evaluate the diagnostic value of magnetic resonance urography (MRU) in comparison with ultrasonography (US) to determine the extent of upper urinary tract dilation and (2) to evaluate the impact of MRU on therapy management. From January 2005 to December 2010, paediatric patients with hydronephrosis or megaureter who underwent MRU in addition to standard work-up imaging were included. Data were retrospectively collected and analysed in comparison with the data obtained from results by US. Forty-five patients with upper urinary tract dilatation were included into the study. Twenty-six patients (58%) had a hydronephrosis and 19 patients (42%) presented with a megaureter. Diagnosis was established in all patients by multimodulary imaging work-up including micturating cysto-urethrography, MAG3 renography, US and MRU and could be confirmed in all patients who underwent surgery (n = 28). Hydronephrosis was detected in 26 of 26 patients by US (100% sensitivity) and in 25 of 26 patients (96%) by MRU (Not significant (n.s.)). Megaureter was detected in 17 of 19 patients (sensitivity 89%) by US and in 18 of 19 patients (sensitivity 95%) by MRU (n.s.). In all 45 patients, MRU had no impact on surgical or conservative management of hydronephrosis or megaureter. In our experience, MRU was not superior to US in detecting hydronephrosis or megaureter and had no impact on the surgical or conservative management of upper urinary tract dilation.

  17. AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY HOSPITAL IN SOUTHEAST NIGERIA.

    PubMed

    Ughasoro, M D; Ikefuna, A N; Emodi, I J; Ibeziako, S N; Nwose, S O

    2013-01-01

    To determine the indications, practices and outcomes of transfusion on children. A descriptive retrospective study. Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria. Children one month to 18 years that received blood transfusion. Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events. The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were the main types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%). Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare.

  18. A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice.

    PubMed

    Richey, Roberta H; Hughes, Clare; Craig, Jean V; Shah, Utpal U; Ford, James L; Barker, Catrin E; Peak, Matthew; Nunn, Anthony J; Turner, Mark A

    2017-02-25

    This study sought to determine whether there is an evidence base for drug manipulation to obtain the required dose, a common feature of paediatric clinical practice. A systematic review of the data sources, PubMed, EMBASE, CINAHL, IPA and the Cochrane database of systematic reviews, was used. Studies that considered the dose accuracy of manipulated medicines of any dosage form, evidence of safety or harm, bioavailability, patient experience, tolerability, contamination and comparison of methods of manipulation were included. Case studies and letters were excluded. Fifty studies were eligible for inclusion, 49 of which involved tablets being cut, split, crushed or dispersed. The remaining one study involved the manipulation of suppositories of one drug. No eligible studies concerning manipulation of oral capsules or liquids, rectal enemas, nebuliser solutions, injections or transdermal patches were identified. Twenty four of the tablet studies considered dose accuracy using weight and/or drug content. In studies that considered weight using adapted pharmacopoeial specifications, the percentage of halved tablets meeting these specifications ranged from 30% to 100%. Eighteen studies investigated bioavailability, pharmacokinetics or clinical outcomes following manipulations which included nine delayed or modified release formulations. In each of these nine studies the entirety of the dosage form was administered. Only one of the 18 studies was identified where drugs were manipulated to obtain a proportion of the dosage form, and that proportion administered. The five studies that considered patient perception found that having to manipulate the tablets did not have a negative impact on adherence. Of the 49 studies only two studies reported investigating children. This review yielded limited evidence to support manipulation of medicines for children. The results cannot be extrapolated between dosage forms, methods of manipulation or between different brands of the same

  19. Child sexual abuse and sexually transmitted infections: review of joint genitourinary medicine and paediatric examination practice.

    PubMed

    Kawsar, M; Long, S; Srivastava, O P

    2008-05-01

    Joint examination by doctors with complementary skills and screening for sexually transmitted infections (STIs) are recommended in children who may have been sexually abused or have been found to have an STI. Our study showed that criminal proceedings were more likely to be brought in cases with physical signs of sexual abuse. It could be difficult to prove whether sexual abuse had taken place or not with microbiological evidence alone, in the absence of other evidence. Significance of viral STIs in the context of sexual abuse should be evaluated carefully. The review of our practice re-enforced the importance of joint examination of children with suspected STIs.

  20. Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia?

    PubMed

    Zachariah, R; Bienvenue, B; Ayada, L; Manzi, M; Maalim, A; Engy, E; Jemmy, J P; Ibrahim Said, A; Hassan, A; Abdulrahaman, F; Abdulrahman, O; Bseiso, J; Amin, H; Michalski, D; Oberreit, J; Draguez, B; Stokes, C; Reid, T; Harries, A D

    2012-09-01

    In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians. A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians. Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value. The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians. © 2012 Blackwell Publishing Ltd.

  1. A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA)

    PubMed Central

    2013-01-01

    Introduction There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). Results A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. Conclusions In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented. PMID:23336728

  2. Emotional impact of genetic trials in progressive paediatric disorders: a dose-ranging exon-skipping trial in Duchenne muscular dystrophy.

    PubMed

    Garralda, M E; McConachie, H; Le Couteur, A; Sriranjan, S; Chakrabarti, I; Cirak, S; Guglieri, M; Bushby, K; Muntoni, F

    2013-05-01

    Gene-modifying trials offer hope for improvement in chronic paediatric disorders, but they may also lead to disappointment and have an adverse emotional effect on families. This study aimed to examine emotional impact on participants in a paediatric exon-skipping trial. Nineteen male children with Duchenne muscular dystrophy (DMD), and their parents, taking part in a dose-ranging study of an i.v. administered morpholino splice-switching oligomer (which can restore the reading frame in DMD and induce dystrophin expression) underwent a psychosocial/psychiatric examination at trial entry. Emotional impact was assessed at trial completion using questionnaires. The mean child age was 8.9 years (SD 2.1); 13(68%) were attending mainstream school. Most families were well adjusted psychosocially at trial entry. Post-trial median child emotional impact scores were 5/10 (n= 18), but impact was rated as positive by 6/14 (42%), neutral/mixed by 5 (35%) and negative by 3 (21%). Median post-trial psychosocial/psychiatric change scores in children and parents were minimal. Actual post-trial negative impact was statistically significantly associated with higher expected impact at trial entry, at which time the families of the three children displaying actual negative impact reported higher family stress levels in combination with a variety of other psychosocial risks factors. In carefully selected families with low levels of psychosocial stress/distress at trial entry, and with good support from paediatric research units (including psychiatric input when required), genetic trials in progressive disorders such as DMD can have a predominantly positive or neutral emotional impact. Nevertheless, negative impact is reported by a minority of families and possible psychosocial predictors deserving further scrutiny have been identified. © 2012 Blackwell Publishing Ltd.

  3. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

    PubMed Central

    Furtwängler, Rhoikos; Laux, Carolin; Graf, Norbert; Simon, Arne

    2015-01-01

    Background: During intensive chemotherapy, bloodstream infection (BSI) represents an important complication in paediatric cancer patients. Most patients carry a long-term central venous access device (CVAD). Improved maintenance care of these vascular catheters may decrease the risk of BSI. Methods: Intervention study (adapted CVAD prevention protocol) with two observation periods (P1: 09-2009 until 05-2011; P2: 09-2011 until 05-2013); prospective surveillance of all laboratory confirmed BSIs. In P2, ready to use sterile NaCl 0.9% syringes were used for CVAD flushing and octenidine/isopropanol for the disinfection of catheter hubs and 3-way stopcocks. Results: During P1, 84 patients were included versus 81 patients during P2. There were no significant differences between the two patient populations in terms of median age, gender, underlying malignancy or disease status (first illness or relapse). Nearly all CVADs were Broviac catheters. The median duration from implantation to removal of the CVAD was 192 days (Inter-quartile-range (IQR); 110–288 days) in P1 and 191 days (IQR; 103–270 days) in P2. 28 BSI were diagnosed in 22 patients in P1 (26% of all patients experienced at least one BSI) and 15 BSI in 12 patients in P2 (15% of all patients). The corresponding results for incidence density (ID) were 0.44 (CI95 0.29–0.62) for P1 vs. 0.34 (0.19–0.53) BSI per 100 inpatient days for P2 and for incidence rate (IR) 7.76 (5.16–10.86) in P1 vs. 4.75 (2.66–7.43) BSI per 1,000 inpatient CVAD utilization days. In P1, 9 BSI were caused by CoNS vs. only 2 in P2 (IR 2.49; CI95 0.17–4.17 vs. 0.63; CI95 0.08–1.72). In P1 two BSI (7%) lead to early removal of the device. During P2 one CVAD was prematurely removed due to a Broviac-related BSI (6.7%). Conclusion: The preventive protocol investigated in this study led to a reduction of BSI in paediatric cancer patients. This result was clinically relevant but – due to insufficient power in a single centre observation

  4. ‘Safety by DEFAULT’: introduction and impact of a paediatric ward round checklist

    PubMed Central

    2013-01-01

    Introduction Poor communication is a source of risk. This can be particularly significant in areas of high clinical acuity such as intensive care. Ward rounds are points where large amounts of information must be communicated in a time-limited environment with many competing interests. This has the potential to reduce effective communication and risk patient safety. Checklists have been used in many industries to improve communication and mitigate risk. We describe the introduction of a ward round safety checklist ‘DEFAULT’ on a paediatric intensive care unit. Methods A non-blinded, pre- and post-intervention observational study was undertaken in a 12-bedded Level 3 tertiary PICU between July 2009 and December 2011. Results Ward round stakeholders subjectively liked the checklist and felt it improved communication. Introduction of the ward round checklist was associated with an increase in median days between accidental extubations from 14 (range 2 to 86) to 150 (56 to 365) (Mann–Whitney P <0.0001). The ward round checklist was also associated with an increase in the proportion of invasively ventilated patients with target tidal volumes of <8 ml/kg, which increased from 35 of 71 patients at 08.00 representing a proportion of 0.49 (95% CI 0.38 to 0.60) to 23 of 38 (0.61, 0.45 to 0.74). This represented a trend towards an increased proportion of cases in the target range (z = 1.68, P = 0.09). Conclusions The introduction of a ward round safety checklist was associated with improved communication and patient safety. PMID:24479381

  5. THE IMPACT OF MODE OF ACQUISITION ON BIOLOGICAL MARKERS OF PAEDIATRIC HEPATITIS C VIRUS INFECTION

    PubMed Central

    England, Kirsty; Thorne, Claire; Harris, Helen; Ramsay, Mary; Newell, Marie-Louise

    2012-01-01

    Background Despite the introduction of blood donor screening, worldwide, children continue to become infected with HCV via un-sterile medical injections, receipt of unscreened blood and isolated hospital contamination outbreaks. It is plausible that the natural history and disease progression in these children might differ from that of their vertically infected counterparts. Materials and Methods Vertically and parenterally HCV infected children were prospectively followed within the European Paediatric HCV Network and the UK National HCV Register respectively. Biological profiles were compared. Results Vertically and parenterally HCV infected children differed in terms of some key characteristics including the male:female ratio and the proportion of children receiving therapy. Parenterally infected children were more likely to have at least one hepatomegaly event during follow-up, 20% vs. 10%. Parenteral infection did not significantly affect the odds of being consistently viraemic, AOR 1.14 p=0.703 and there was no significant difference in the odds of having consistently elevated ALT levels and mode of acquisition, AOR 0.83 p=0.748. The proportion of children with 2 or more markers of HCV infection did not differ significantly by mode of acquisition, χ21.13 p=0.288. Conclusions This analysis does not support substantial differences between vertically and parenterally infected groups but there are specific mechanisms identified requiring further investigation. Given the continued parenteral infection of children worldwide it is vital that knowledge of disease progression in this group is accurate and that the differences in comparison to vertically infected children are clarified to inform more accurate and individualised clinical management. PMID:21762285

  6. An environmental scan of weight assessment and management practices in paediatric spina bifida clinics across Canada.

    PubMed

    McPherson, Amy C; Leo, Jennifer; Church, Paige; Lyons, Julia; Chen, Lorry; Swift, Judy

    2014-01-01

    Childhood obesity is a global health concern, but children with spina bifida in particular have unique interacting risk factors for increased weight. To identify and explore current clinical practices around weight assessment and management in pediatric spina bifida clinics. An online, self-report survey of healthcare professionals (HCPs) was conducted in all pediatric spina bifida clinics across Canada (15 clinics). Summary and descriptive statistics were calculated and descriptive thematic analysis was performed on free text responses. 52 responses across all 15 clinics indicated that weight and height were assessed and recorded most of the time using a wide variety of methods, although some HCPs questioned their suitability for children with spina bifida. Weight and height information was not routinely communicated to patients and their families and HCPS identified considerable barriers to discussing weight-related information in consultations. Despite weight and height reportedly being measured regularly, HCPs expressed concern over the lack of appropriate assessment and classification tools. Communication across multi-disciplinary team members is required to ensure that children with weight-related issues do not inadvertently get overlooked. Specific skill training around weight-related issues and optimizing consultation time should be explored further for HCPs working with this population.

  7. Interleukins for the paediatric pulmonologist.

    PubMed

    Rozycki, Henry J; Zhao, Wei

    2014-03-01

    Interleukins are critical immune modulators and since their first description in 1977, there has been a steady increase in the recognition of their roles in many paediatric respiratory diseases. This basic and clinical knowledge is now maturing into both approved and investigational therapies aimed at blocking or modifying the interleukin response. The purpose of this review is to bring up to date what is known about interleukin function in paediatric pulmonology, focusing on nine important lung conditions. This is followed by summaries about 18 interleukins which have been associated with these paediatric pulmonary conditions. Throughout, emphasis is placed on where interventions have been tested. Over the next several years, it is likely that many more treatments based on interleukin biology and function will become available and understanding the basis for these therapies will allow the practicing paediatric pulmonologist to take appropriate advantage of them. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Fifty years of paediatric ethics.

    PubMed

    Gillam, Lynn

    2015-01-01

    In 1965, when the first issue of Journal of Paediatrics and Child Health appeared, medical ethics was just becoming established as a discipline. The sub-speciality of paediatric ethics did not make an appearance until the late 1980s, with the first key texts appearing in the 1990s. Professional concern to practice ethically in paediatrics obviously goes much further back than that, even if not named as such. In clinical areas of paediatrics, the story of the last 50 years is essentially a story of progress - better understanding of disease, better diagnosis, more effective treatment, better outcomes. In paediatric ethics, the story of the last 50 years is a bit more complicated. In ethics, the idea of progress, rather than just change, is not so straightforward and is sometimes hotly contested. There has certainly been change, including some quite radical shifts in attitudes and practices, but on some issues, the ethical debate now looks remarkably similar to that of 40-50 years ago. This is the story of some things that have changed in paediatric ethics, some things that have stayed the same and the key ethical ideas lying beneath the surface.

  9. CHANGING INFUSION PRACTICE GENERATES SIGNIFICANT EFFICIENCIES IN NURSING TIME AND RESOURCE USAGE IN PAEDIATRIC INTENSIVE CARE.

    PubMed

    Sutherland, Adam; Jemmett, Liz; Barber, Rachael

    2016-09-01

    Infusion preparation in British PICUs uses the Rule of Six (ROS) which was developed for administration without infusion devices. This method is inaccurate.1 Regulators recommend standardised approaches to IV infusions to improve patient safety and quality of care.2 Administration set changes also have an association with resource use and central line infections.3 We report the impact of fixed concentration infusions and reduced administration set changes on nursing time and infusion equipment cost. Morphine and midazolam infusions were standardised in September 2014. Direct observation of infusion preparation was carried out beforeand after the introduction of fixed-concentration (FC) infusions to quantify the nursing time required to prepare infusions. Administration was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained (1 month). This data was then scaled up to predict activity over one year. Syringe use and administration set use was calculated. Reducing frequency of administration set changes to 72 hrs in accordance with infection control policy was then calculated retrospectively. It takes 40 minutes (2 nurses×20 minutes) to prepare ROS syringes and 30 minutes (2 nurses×15 minutes) for FC syringes.In total ROS infusions required 2433 hrs of nursing time to prepare. FC infusions reduced this time by 25% (608 hrs) releasing 0.5 WTE nursing time back to patient care.Mean duration of IV sedation in these patients was 100 hrs. The cost associated with replacing administration sets with each syringe was £16,060. By changing every 72 hrs, this cost is reduced to £4,400 - a cost saving of £11,660. FC syringes are more efficient than ROS. FC preparations have released 0.5 WTE nurses back to patient care. Changing administration sets 72 hrly realises significant cost efficiencies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  10. [Rural medical practice at the beginning of the 20th century. Martínez Saldise (1855-1937), honorary member of Paediatric Society of Madrid in 1927].

    PubMed

    Zafra Anta, Miguel Ángel; Flores Martín, Carlos; Ponte Hernando, Fernando Julio; Gil García, Andrés; Gómez López, Ana; Fernández Durán, Carla

    2016-01-01

    On the centenary of the foundation of the Paediatrics Society of Madrid, a tribute is presented to rural medical practice of that time, although there are few documents on the history of rural medicine. The main objective is to describe the context of the rural medical practice in the late 19th and beginning 20th century, while presenting a historical biographical review of Manuel Martínez Saldise, who was medical specialist from Cazalegas (Toledo). He was appointed an Honorary Member by the Paediatrics Society of Madrid in 1927. A search was carried out in repositories of digitized media, web portals of history of medicine, PubMed, IME files of local councils and medical colleges. The family archives were reviewed with the collaboration of his descendants. The hiring of rural doctors was carried out by the municipalities, and the salary largely depended on private practice as well as "retainers". Specialist physicians took part in epidemics, legal medicine, and in hygiene measures. They also had disputes with mayors, chiefs, with colleagues and with protectionism. A summary of the biography and occupational activity of Manuel Martínez Saldise is presented. Rural doctors were subjected to the society of their time, with the issues that arose, denouncing the shortcomings of the local administrations, dedicated efforts to their family and the most disadvantaged. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

    PubMed

    Hinz-Wessels, Annette

    2016-01-01

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

  12. Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children's Acceptability of Oral Formulations (CALF) Study.

    PubMed

    Ranmal, Sejal R; Cram, Anne; Tuleu, Catherine

    2016-11-30

    A lack of evidence to guide the design of age-appropriate and acceptable dosage forms has been a longstanding knowledge gap in paediatric formulation development. The Children's Acceptability of Oral Formulations (CALF) study captured end-user perceptions and practices with a focus on solid oral dosage forms, namely tablets, capsules, chewables, orodispersibles, multiparticulates (administered with food) and mini-tablets (administered directly into the mouth). A rigorous development and testing phase produced age-adapted questionnaires as measurement tools with strong evidence of validity and reliability. Overall, 590 school children and adolescents, and 428 adult caregivers were surveyed across hospitals and various community settings. Attitudes towards dosage forms primarily differed based on age and prior use. Positive attitudes to tablets and capsules increased with age until around 14 years. Preference was seen for chewable and orodispersible preparations across ages, while multiparticulates were seemingly less favourable. Overall, 59.6% of school children reported willingness to take 10mm diameter tablets, although only 32.1% of caregivers perceived this size to be suitable. While not to be taken as prescriptive guidance, the results of this study provide some evidence towards rational dosage form design, as well as methodological approaches to help design tools for further evaluation of acceptability within paediatric studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Practical Collaborations for Positive Impact

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  14. The Impact of Gagne's Theories on Practice.

    ERIC Educational Resources Information Center

    Fields, Dennis

    Robert Gagne's theories and research have had a significant impact on practitioners in general, especially instructional designers. He has influenced teaching and curriculum development and used standard practices as a stimulus for the development of theory. This paper explores Gagne's influence on practice by examining the relationship between…

  15. Sweat testing for the detection of atomoxetine from paediatric patients with attention deficit/ hyperactivity disorder: application to clinical practice.

    PubMed

    Marchei, Emilia; Papaseit, Esther; Garcia-Algar, Oscar; Bilbao, Amaia; Farré, Magí; Pacifici, Roberta; Pichini, Simona

    2013-03-01

    Atomoxetine (ATX) is a selective norepinephrine reuptake inhibitor approved since 2002 for the treatment of attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults as an alternative treatment to methylphenidate. Within the framework of a project evaluating the use of alternative biological matrices for therapeutic monitoring of psychoactive drugs in paediatric and non-paediatric individuals, the excretion of ATX and its principal metabolites has been recently studied in oral fluid and hair. The aim of this study was to describe the excretion profile of ATX and its metabolites 4-hydroxyatomoxetine (4-OH-ATX) and N-desmethylatomoxetine (N-des-ATX) in sweat following the administration of different dosage regimens (60, 40, 35, and 18 mg/day) of ATX to six paediatric patients. Sweat patches were applied to the back of each participant and removed at timed intervals. ATX and its metabolites were measured in patches using a previously validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Independently from the administered dose, ATX appeared in the sweat patches 1 h post administration and reached its maximum concentration generally at 24 h. Peak ATX concentrations ranged between 2.31 and 40.4 ng/patch and did not correlate with the administered drug dose, or with body surface area. Total ATX excreted in sweat ranged between 0.008 and 0.121 mg, corresponding to 0.02 and 0.3% of the administered drug. Neither 4-OH-ATX, nor N-des-ATX was detected in either of the collected sweat patches. Measuring ATX in sweat patches can provide information on cumulative drug use from patch application until removal.

  16. Current attitudes and clinical practice towards the care of pregnant women with underlying CHD: a paediatric cardiology perspective.

    PubMed

    Cribbs, Marc G; Briston, David A; Zaidi, Ali N

    2017-03-01

    The growing number of women with CHD presents unique challenges, including those related to pregnancy, which can lead to significant morbidity and mortality. We sought to evaluate the perception of paediatric cardiologists towards the reproductive health of women with CHD. Paediatric cardiologists in the United States of America were invited to participate in a cross-sectional, anonymous survey. Information solicited included knowledge of contraceptive methods, experience caring for pregnant women with CHD, and referral patterns including the utilisation of high-risk obstetric and adult CHD specialists. A total of 110 cardiologists responded - 90% with an academic affiliation and 70% with ⩾10 years' clinical experience. Although 95% reported an understanding of available contraceptive options, 32% did not feel comfortable recommending birth control. Pregnant women with CHD were seen by 83% of responders, and 37% of the responders reported a low level of comfort in doing so. Among all respondents, 73% indicated that they would refer a pregnant CHD patient to a high-risk obstetrician and 60% to an adult CHD specialist - almost all respondents would not transfer care to a non-adult CHD cardiologist. Among paediatric cardiologists, 81% indicated that they would resume their patient's care following delivery. Our results illustrate a gap in what physicians feel should be done and the care that they feel comfortable providing pregnant women with CHD. As this population continues to grow, training adult CHD cardiologists with specific skills in reproductive health in women with CHD is the first step to closing the care gap that exists in the management of such patients.

  17. The impact of recent legislation on paediatric fireworks injuries in the Newcastle upon Tyne region.

    PubMed

    Edwin, Alexandra F L; Cubison, Tania C S; Pape, Sarah A

    2008-11-01

    Despite the changes to the UK fireworks laws and considerable efforts in prevention, children are still being injured by fireworks. The UK is one of many countries that have altered their firework laws in recent years. We reviewed 54 firework-injured children over the last 10 years and assessed the impact of the two recent UK law changes. Our study outlines past British firework legislation and reviews the literature. In November 1996, there were three deaths in England, Wales and Scotland due to fireworks. The British Government introduced the Fireworks (Safety) Regulations of 1996/1997, primarily banning banger fireworks (known as bangers). We have not seen banger injuries in Newcastle since then. The Fireworks Act 2003 and the Fireworks Regulations 2004 limited the sale of fireworks to the 3 weeks surrounding bonfire night, and banned under 18s from purchasing or possessing fireworks. In our series, we noticed that, in 2004, 83% of children's firework injuries happened in the 3 weeks surrounding Bonfire Night. We conclude that legislation has had an impact, but stricter enforcement of the existing laws and further education of children and the general public into the dangers of fireworks is needed, as children are still being injured.

  18. [Health Promotion and Child Protection in the Paediatric Practice - Paediatricians as Protagonists in an Invitation and Reporting System for Child Health Check-ups].

    PubMed

    Metzner, F; Ravens-Sieberer, U; Schwinn, A; Lietz, J; Pawils, S

    2015-12-01

    Since 1971 routine child health check-ups allow the routine identification of dis-eases in children and adolescents. Paediatricians play a central role in health prevention in childhood and adolescence and are - on account of their acceptance and admission requirements - important actors in child protection. Thus, paediatric practitioners were actively involved in the invitation and reporting system for the routine child health check-ups (U6 and U7), which was introduced to increase participation rates and improve child protection in Hamburg. By means of a questionnaire survey, all paediatric practitioners practicing in Hamburg were asked a year after introduction of the invitation and reporting system to report on their practical experience, and to share their assessment and criticism of the system (response rate 73%). Out of 110 participating pediatricians (M=19.5 years practical experience), 81% evaluated the invitation and reporting system as very useful, useful or rather useful; 83% supported an expansion of the system for routine child health check-ups, and about 18% observed an increased utilisation of routine child health check-ups especially from families with a migrant background and by socially-disadvantaged families. Criticism was made concerning ineffective procedures. The invitation and reporting system for routine child health check-ups in Hamburg shows how pediatricians can be integrated into the network of prevention and child welfare. It also shows their support of this system. Paying more systematic attention and an interdisciplinary network connecting paediatricians may contribute to a more comprehensive prevention and child protection. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Paediatric cardiac CT examinations: impact of the iterative reconstruction method ASIR on image quality--preliminary findings.

    PubMed

    Miéville, Frédéric A; Gudinchet, François; Rizzo, Elena; Ou, Phalla; Brunelle, Francis; Bochud, François O; Verdun, Francis R

    2011-09-01

    Radiation dose exposure is of particular concern in children due to the possible harmful effects of ionizing radiation. The adaptive statistical iterative reconstruction (ASIR) method is a promising new technique that reduces image noise and produces better overall image quality compared with routine-dose contrast-enhanced methods. To assess the benefits of ASIR on the diagnostic image quality in paediatric cardiac CT examinations. Four paediatric radiologists based at two major hospitals evaluated ten low-dose paediatric cardiac examinations (80 kVp, CTDI(vol) 4.8-7.9 mGy, DLP 37.1-178.9 mGy·cm). The average age of the cohort studied was 2.6 years (range 1 day to 7 years). Acquisitions were performed on a 64-MDCT scanner. All images were reconstructed at various ASIR percentages (0-100%). For each examination, radiologists scored 19 anatomical structures using the relative visual grading analysis method. To estimate the potential for dose reduction, acquisitions were also performed on a Catphan phantom and a paediatric phantom. The best image quality for all clinical images was obtained with 20% and 40% ASIR (p < 0.001) whereas with ASIR above 50%, image quality significantly decreased (p < 0.001). With 100% ASIR, a strong noise-free appearance of the structures reduced image conspicuity. A potential for dose reduction of about 36% is predicted for a 2- to 3-year-old child when using 40% ASIR rather than the standard filtered back-projection method. Reconstruction including 20% to 40% ASIR slightly improved the conspicuity of various paediatric cardiac structures in newborns and children with respect to conventional reconstruction (filtered back-projection) alone.

  20. Questionnaire-based survey in a developing country showing noncompliance with paediatric gastro-oesophageal reflux practice guidelines.

    PubMed

    Manasfi, Hayat; Hanna-Wakim, Rima; Akel, Imad; Yazbeck, Nadine

    2017-02-01

    This 2015 study investigated whether Lebanese paediatricians diagnosed and managed gastro-oesophageal reflux disease (GERD) in infants and children in accordance with the 2009 guidelines from the North American and European Societies for Paediatric Gastroenterology, Hepatology and Nutrition. Paediatricians members of the Lebanese Order of Physicians with updated email addresses were invited to complete a web-based survey between September and November 2015, to assess their knowledge and management of GERD. Responses were received from 114 of the 543 paediatricians, and 96 were analysed. Only two respondents complied fully with the international guidelines. The majority diagnosed GERD in infants based solely on their medical history and examination. Moreover, nearly two-thirds of the respondents would start an empiric trial with acid suppression. Around half of the respondents considered proton pump inhibitors to be the mainstay of GERD treatment. This was the first Lebanese study that surveyed the management of paediatric GERD. Only 2.1% of the paediatricians followed the guidelines on the evidence-based management of GERD. This highlights the need for studies to assess barriers to guideline implementation and the development of new guidelines accounting for regional factors, mainly the cost of investigations and prevalence of medical insurance. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  1. Impact of the Hall technique for preformed metal crown placement on undergraduate paediatric dentistry experience.

    PubMed

    Gilchrist, F; Morgan, A G; Farman, M; Rodd, H D

    2013-02-01

    The Hall technique, a novel method of placing preformed metal crowns (PMCs) without local anaesthesia or tooth preparation, was introduced to our undergraduate dental curriculum in 2009. This study aimed to describe student experience of, and attitudes towards, PMCs before and after exposure to this new technique. Clinical data were extracted from student logbooks to determine the number of PMCs placed for cohorts graduating in 2005 (n = 55), 2009 (n = 61) and 2010 (n = 75). Five focus groups were also conducted with 29 final-year dental students. Students graduating in 2005, 2009 and 2010 had placed a mean (range) of 0.03 (0-1), 0.63 (0-5) and 1.15 (0-9) PMCs, respectively. The proportion of students who had placed a PMC increased significantly from only 1.9% in 2005 to 75% in 2010 (P < 0.05, ANOVA). Students reported some positive experiences of the Hall technique. However, concern over perceived lack of future clinical support, an anticipated increase in time and financial pressures, and the ease of use of glass-ionomer cement as an alternative were described as potential barriers to PMC use. Findings suggest that the introduction of the Hall technique has had a marked impact on the use of PMCs as a treatment modality for carious primary teeth.

  2. Current management of paediatric urolithiasis.

    PubMed

    Gnessin, Ehud; Chertin, Leonid; Chertin, Boris

    2012-07-01

    We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.

  3. The prognostic impact of tumour-associated macrophages and Reed-Sternberg cells in paediatric Hodgkin lymphoma.

    PubMed

    Gupta, Sumit; Yeh, Stacy; Chami, Rose; Punnett, Angela; Chung, Catherine

    2013-10-01

    Tumour-associated macrophages (TAM) are associated with treatment failure in adults with Hodgkin lymphoma (HL). Equivalent data in paediatric HL are sparse. We aimed to determine the prognostic significance of TAM and Reed-Sternberg (RS) cells in paediatric HL. All children aged 0-18 with HL between 1980 and 2009 with available diagnostic biopsy material were identified. A treatment failure-enriched cohort was assembled. Demographic, disease and outcome data were abstracted. Tissue microarrays with duplicate cores were constructed from diagnostic biopsy material and stained with immunohistochemical markers for TAM (CD68, CD163) and RS (CD30). A high score was defined as >5% positive cells relative to overall cellularity in any core. The association of candidate variables with event-free survival (EFS) was determined using Cox proportional hazards. The final study cohort comprised 96 patients with a median age of 14 years (interquartile range 11-15). Agreement on scores between cores from the same biopsy revealed weighted kappas of 0.60, 0.68 and 0.73 for CD30, CD68 and CD163 respectively, indicating moderate tumour heterogeneity. In univariate analysis, a high CD30 score was significantly associated with treatment failure (hazard ratio (HR) 2.27; 95th confidence interval 1.01-5.11; p<0.05). High CD68 and CD163 scores were not associated with EFS. Unlike adult HL, a higher percentage of RS cells was associated with poor outcome, while a higher percentage of TAM was not. Adult HL findings may not extend to paediatric HL. Cooperative group trials of paediatric HL should prospectively determine the association of different components of the tumour microenvironment with outcome. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Paediatric eosinophilic oesophagitis presenting to the otolaryngologist.

    PubMed

    Harris, R; Mitton, S; Chong, S; Daya, H

    2010-01-01

    The prevalence of eosinophilic oesophagitis is increasing. A Pubmed search for 'eosinophilic oesophagitis' and 'eosinophilic esophagitis' yielded 345 publications since 1976. Only seven were in otolaryngology journals.1-7 Patients typically present with dysphagia, vomiting, dyspepsia or food impaction and are therefore usually referred to a paediatric gastroenterologist; otolaryngologists are not usually involved in management. A missed diagnosis may result in oesophageal stricture. Two patients, aged two and four years, were referred to the paediatric otolaryngology department with intermittent upper oesophageal food impaction. A paediatric gastroenterologist was involved in the investigation. Histological examination of oesophageal biopsies demonstrated changes consistent with eosinophilic oesophagitis. Both patients were expediently diagnosed, investigated and managed. A diagnosis of eosinophilic oesophagitis must be considered in patients presenting with food bolus impaction. Early involvement of a paediatric gastroenterology team in the diagnosis is recommended in children presenting with oesophageal symptoms, in order to avoid delayed diagnosis.

  5. Doctor of Nursing Practice Education: Impact on Advanced Nursing Practice.

    PubMed

    Paplham, Pamela; Austin-Ketch, Tammy

    2015-11-01

    To discuss how doctoral education, specifically the doctorate of nursing practice (DNP) can promote changes in advanced practice nursing. Medline, CINAHL, PubMed. Variations continue to exist in educational curricula, program plans, and scholarly projects, leading to a lack of consistency in experiential learning. At this point in time it is too early in the DNP implementation process to determine ultimate impact. Continuous program self-assessment and evaluation of DNP education programs will be of paramount importance to assure program quality and optimization of health trajectories. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. 'Down-triage' for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan.

    PubMed

    Takahashi, Takuto; Inoue, Nobuaki; Shimizu, Naoki; Terakawa, Toshiro; Goldman, Ran D

    2016-08-01

    Assessment of abnormal vital signs in triage is a challenge in the paediatric emergency department (PED), since vital signs may reflect anxiety, fever or pain rather than the clinical deterioration of the child. We aimed to evaluate the efficacy of subjective 'down-triage' (change of the initially determined acuity levels) of Japanese Triage and Acuity Scale (JTAS). This is a retrospective cohort study of patients in PED up to 15 years of age at a tertiary paediatric medical centre in Japan during a 1-year period. At the end of every JTAS triage process, PED nurses were allowed to 'down-triage' acuity levels of well-appearing patients with abnormal HR or RR, which were presumably attributable to fever, crying or being upset. We compared predictive performance of the triage system before and after 'down-triage' using admission rate as the primary outcome. Among 37 961 PED visits during the study period, we analysed 37 219 records. A total of 17 089 patients (45.9%) were 'down-triaged' after their initial triage allocation upon arrival. Admission rates after 'down-triage' (83%, 33%, 7%, 1% and 3% for levels 1-5, respectively), compared with those of unmodified initial level (16%, 11%, 6%, 2% and 6% for levels 1-5, respectively), had a better apparent relevance with the anticipated admission rates of Canadian Triage and Acuity Scale. Modification of JTAS through 'down-triage' by experienced staff improves prediction of disposition in a PED. Further research is needed to determine an objective protocol for 'down-triage' to ensure safe practice in a PED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Patent extension policy for paediatric indications: an evaluation of the impact within three drug classes in a state Medicaid programme.

    PubMed

    Nelson, Richard E; McAdam-Marx, Carrie; Evans, Megan L; Ward, Robert; Campbell, Benjamin; Brixner, Diana; Lafleur, Joanne

    2011-05-01

    The Food and Drug Administration Modernization Act (FDAMA) of 1997, Best Pharmaceuticals for Children Act (BPCA) of 2002 and Pediatric Research Equity Act of 2007 provide an extended period of 6 months of marketing exclusivity (i.e. patent extension) to prescription drug manufacturers that conduct paediatric studies. Branded drugs in the statin, ACE inhibitor and selective serotonin reuptake inhibitor (SSRI) classes were three of many classes with drugs granted patent extensions. We estimated the cost impact of the 6-month exclusivity extension policy on the Utah Medicaid drug programme by comparing actual costs to projected costs had the 6-month exclusivity extension not been granted for these drugs and thus less expensive generic alternatives been available sooner. Using these results, we then projected the cost impact of this policy on Medicaid programmes in the US during the 18 months following patent expiration. The Utah Medicaid prescription claims obtained for statins, ACE inhibitors and SSRIs included reimbursement amount, number of units dispensed, days supplied, date of service and drug strength. Actual expenditures for each drug were calculated for the 6 months before and 12 months after generic availability. The percentage difference between the brand name prescription reimbursement amount to Medicaid in the last 2 months of the 6-month extension and the generic prescription reimbursement amount to Medicaid in the first 2 months following exclusivity expiration was then calculated for each drug. This was done using data from the 5 months surrounding the exclusivity expiration by regressing the log-transformed Utah Medicaid reimbursement amount on an indicator for patent expiration, controlling for number of units, volume of sales, month filled and strength. This was used to estimate what the initial generic prescription price would have been without the 6-month patent extension and what costs would have been in the 18 months following the original

  8. Student Success: Identifying High-Impact Practices

    ERIC Educational Resources Information Center

    Waiwaiole, Evelyn N.; Bohlig, E. Michael; Massey, Kristine J.

    2016-01-01

    This chapter discusses the work of the Center for Community College Student Engagement, highlighting institutes the Center hosts and work that comes from these meetings. Examples of interventions that evolved from the High-Impact Practices Institutes conducted by the Center are provided. The chapter concludes with a discussion about implementation…

  9. 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

  10. Improving the practice of the World Health Organisation's surgical pause checklist at a tertiary paediatric surgical unit.

    PubMed

    Montgomery, Kieran; Khan, Imran; Thomson, Kathleen; Wynne, David

    2016-05-01

    The World Health Organisation (WHO) surgical checklist acts as a safety check before surgery. The three components are: sign in, surgical pause and sign out. This study aims to assess and improve the surgical pause at a tertiary paediatric surgical unit. Theatre nurses used as a standardised tool to record how the pause was carried out. All other theatre staff were blinded. Presentation of these data at departmental meetings allowed creation of a checklist poster which was placed in every theatre. Data collection was repeated five months later. Data on 114 operations were initially collected. Fifty-one per cent of operations completed all four steps to guideline. Introduction step met guideline in 61% of operations, identity and procedure in 90%, checklist in 98% and concerns in 71%. Following intervention, data were collected from 39 operations; 77% of operations completed all four steps to guideline. Introduction step met guideline in 87% of operations, identity and procedure in 100%, checklist in 100% and concerns in 90%. This study shows that by engaging with theatre staff to create an acceptable checklist poster, better standard of patient safety in the operating theatre can be achieved. © The Author(s) 2016.

  11. A randomised controlled trial of weaning from mechanical ventilation in paediatric intensive care (PIC). Methodological and practical issues.

    PubMed

    Rushforth, Kay

    2005-04-01

    Most children admitted to the Paediatric Intensive Care Unit (PICU) require assistance with breathing via a mechanical ventilator. Weaning from mechanical ventilation is the transition from ventilatory support to spontaneous breathing. Traditionally weaning has been with the authority of the medical staff. However, current opinion suggests that weaning could be performed by nurses using a standardised protocol [Schultz TR, Lin RJ, Watzman HM, Durning SM, Hales R, Woodson A, et al. Weaning children from mechanical ventilation: A prospective randomised trial of protocol-directed versus physician-directed weaning. Respir Care 2001;46(8):772-82]. The potential advantages of nurse-led (protocol-directed) weaning include: A reduction in weaning time and PICU stay with cost savings. Reduced complications. Improved quality of care. Appropriate use of resources. A Randomised Controlled Trial was performed to test the null hypothesis: there is no difference between the clinical effectiveness of nurse-led versus medical-led weaning of infants from mechanical ventilation. Data was collected for 7 infants and analysed. Results indicated no significant differences between the two study groups. Unfortunately due to recruitment problems few inferences can be drawn from the data. The trial was unsuccessful due to Recruitment issues. Physical constraints. Impractical entry criteria. Limited randomisation service. Ethical constraints. Barriers to parental participation. The methods, the difficulties encountered and the implications for future research are addressed.

  12. PAEDIATRIC CT EXPOSURE PRACTICE IN THE COUNTY OF RIO DE JANEIRO: THE NEED TO ESTABLISH DIAGNOSTIC REFERENCE LEVELS.

    PubMed

    de Jesus, Fillipe M; Magalhães, Luis A G; Kodlulovich, Simone

    2016-11-01

    A pilot study of dose indicators in paediatric computed tomography (CT) was conducted to prove the need to establish diagnostic reference levels (DRLs) for the county of Rio de Janeiro. The dose descriptors were estimated from the beam dosimetry by applying the protocols used in each examination. The total patient sample included 279 children. Regarding the comparison of the dose-length product values among the hospitals, the high-resolution chest CT scans were distinguished among the three types of examinations, due to the discrepancies of 1148 % (1-5 y age group) and 2248 % (5-10 y age group) presented in Hospital A's dose-length product values relative to Hospital D's dose-length product values. The results showed that without DRL, the dose variation can be significant between hospitals in the same county for the same age group in the same examination. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. [Clinical impact of introducing ventilation with high flow oxygen in the treatment of bronchiolitis in a paediatric ward].

    PubMed

    González Martínez, F; González Sánchez, M I; Rodríguez Fernández, R

    2013-04-01

    To analyse the safety and efficacy of high-flow oxygen therapy for treatment of moderate to severe bronchiolitis in children admitted to the paediatric hospital wards. A prospective observational study was conducted on children < 18 months of age with bronchiolitis admitted to the paediatric ward of a tertiary-care teaching hospital during the 2011-12 respiratory season. Children were treated with a high-flow ventilation system (Fisher & Paykel). Clinical and cardio-respiratory parameters were evaluated every hour for the duration of therapy. A total of 25 patients, with a median age of 2 months (range: 0.6-11 months) were included. Respiratory syncytial virus (RSV) was positive in 75% of cases. Indications for high-flow therapy included: progressive respiratory distress (Wood-Downes ≥ 8) (88%), apnoea (8%) and desaturation (4%). Median duration of therapy was 4 days (range: 3-7 days), with a median of 9 days in hospital (range: 8-12 days). High flow therapy was associated with a significant decrease in cardio-respiratory parameters, heart rate, respiratory rate, which resulted in a significant improvement of the Wood-Downes Score (from 10±1.21 to 3±0.77, P=.001). No adverse effects were observed. Five patients (20%) were admitted to the Paediatric Intensive Care Unit (PICU), which represents an 80% reduction of PICU admissions compared with historic data of previous years. High-flow ventilation therapy achieved a significant improvement in heart rate, respiratory rate, and scale of severity in patients with bronchiolitis. This novel therapeutic strategy allows safe management of bronchiolitis patients in the regular ward, reducing admissions to the PICU. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. Treatment of paediatric atopic dermatitis with pimecrolimus (Elidel, SDZ ASM 981): impact on quality of life and health-related quality of life.

    PubMed

    McKenna, S P; Whalley, D; de Prost, Y; Staab, D; Huels, J; Paul, C F; van Assche, D

    2006-03-01

    To report on quality of life (QoL) and health-related quality of life (HRQL) impacts of pimecrolimus (Elidel, Novartis A.G., Basel, Switzerland, SDZ ASM 981) 1% cream in the long-term treatment of paediatric atopic dermatitis. QoL and HRQL data are presented from two 12-month international clinical trials evaluating the efficacy and safety of pimecrolimus 1% cream. Both trials were randomized and double blinded and compared two treatment strategies, one involving the use of emollients, pimecrolimus and topical corticosteroids, the other is 'usual care' (emollients plus topical corticosteroids) with a vehicle cream to maintain study blinding. The first trial (the infant trial) involved patients between ages 3 months and 2 years, whereas the children trial included patients aged 2-17 years. In both trials, QoL of the affected child's parent was evaluated with the parent's index of quality of life in atopic dermatitis (PIQoL-AD). HRQL was assessed in the children trial only with the children's dermatology life quality index (CDLQI). QoL and HRQL assessments were conducted at baseline, 6 weeks, 6 months and 12 months. Generalized linear modelling of PIQoL-AD scores at each post-baseline visit showed a greater impact on parent's QoL for pimecrolimus compared with control at all time-points in both trials. HRQL scores showed a greater improvement from baseline for children in the pimecrolimus group compared with those in the control group at all time-points. The results show a beneficial impact of pimecrolimus on parents' QoL in paediatric atopic dermatitis, confirming findings from earlier shorter term trials. There was also a clear benefit to the HRQL of the children treated.

  15. Enhancing reflective practice through online learning: impact on clinical practice

    PubMed Central

    Sim, J; Radloff, A

    2008-01-01

    Purpose Traditionally, radiographers and radiation therapists function in a workplace environment that is protocol-driven with limited functional autonomy. The workplace promotes a culture of conformity and discourages practitioners from reflective and critical thinking, essential attributes for continuing learning and advancing workplace practices. As part of the first author’s doctoral study, a continuing professional development (CPD) educational framework was used to design and implement an online module for radiation therapists’ CPD activities. The study aimed to determine if it is possible to enhance healthcare practitioners’ reflective practice via online learning and to establish the impact of reflective learning on clinical practice. Materials and methods The objectives of the online module were to increase radiation therapists’ knowledge in planning for radiation therapy for the breast by assisting them engage in reflective practice. The cyclical process of action research was used to pilot the module twice with two groups of volunteer radiation therapists (twenty-six participants) from Australia, New Zealand and Canada. Results The online module was evaluated using Kirkpatrick’s four-level evaluation model. Evidence indicated that participants were empowered as a result of participation in the module. They began reflecting in the workplace while assuming a more proactive role and increased clinical responsibilities, engaged colleagues in collaborative reflections and adopted evidence-based approaches in advancing clinical practices. Conclusion The study shows that it is possible to assist practitioners engage in reflective practice using an online CPD educational framework. Participants were able to apply the reflective learning they had developed in their workplace. As a result of their learning, they felt empowered to continue to effect changes in their workplace beyond the cessation of the online module. PMID:21614319

  16. 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

    2015-12-02

    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.

  17. Diagnostic paediatric imaging

    SciTech Connect

    Hall, C.M.; Lingam, S.

    1986-01-01

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

  18. Paediatric cardiac nursing education: a national collaboration.

    PubMed

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

    2006-02-01

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

  19. Peer teaching in paediatrics - medical students as learners and teachers on a paediatric course.

    PubMed

    Schauseil-Zipf, Ulrike; Karay, Yassin; Ehrlich, Roland; Knoop, Kai; Michalk, Dietrich

    2010-01-01

    Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students. Medical student peers in their 6(th) year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5(th) year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies. The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training. The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors. Paediatric doctors seem to be more

  20. Peer Teaching in Paediatrics - Medical Students as Learners and Teachers on a Paediatric Course

    PubMed Central

    Schauseil-Zipf, Ulrike; Karay, Yassin; Ehrlich, Roland; Knoop, Kai; Michalk, Dietrich

    2010-01-01

    Background: Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students. Methods: Medical student peers in their 6th year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5th year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies. Results: The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training. Conclusions: The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors

  1. Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital.

    PubMed

    Crouse, Heather L; Torres, Francisco; Vaides, Henry; Walsh, Michael T; Ishigami, Elise M; Cruz, Andrea T; Torrey, Susan B; Soto, Miguel A

    2016-08-01

    Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation. Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates

  2. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries.

    PubMed

    Sherr, Jennifer L; Hermann, Julia M; Campbell, Fiona; Foster, Nicole C; Hofer, Sabine E; Allgrove, Jeremy; Maahs, David M; Kapellen, Thomas M; Holman, Naomi; Tamborlane, William V; Holl, Reinhard W; Beck, Roy W; Warner, Justin T

    2016-01-01

    While the use of insulin pumps in paediatrics has expanded dramatically, there is still considerable variability among countries in the use of pump technology. The present study sought to describe differences in metabolic control and pump use in young people with type 1 diabetes using data collected in three multicentre registries. Data for the years 2011 and 2012 from 54,410 children and adolescents were collected from the Prospective Diabetes Follow-up Registry (DPV; n = 26,198), T1D Exchange (T1DX; n = 13,755) and the National Paediatric Diabetes Audit (NPDA; n = 14,457). The modality of insulin delivery, based on age, sex and ethnic minority status, and the impact of pump use on HbA1c levels were compared. The overall mean HbA1c level was higher in the NPDA (8.9 ± 1.6% [74 ± 17.5 mmol/mol]) than in the DPV (8.0 ± 1.6% [64 ± 17.0 mmol/mol], p < 0.001) and T1DX (8.3 ± 1.4% [68 ± 15.4 mmol/mol], p < 0.001). Conversely, pump use was much lower in the NPDA (14%) than in the DPV (41%, p < 0.001) and T1DX (47%, p < 0.001). In a pooled analysis, pump use was associated with a lower mean HbA1c (pump: 8.0 ± 1.2% [64 ± 13.3 mmol/mol] vs injection: 8.5 ± 1.7% [69 ± 18.7 mmol/mol], p < 0.001). In all three registries, those with an ethnic minority status were less likely to be treated with a pump (p < 0.001) and boys were treated with a pump less often compared with girls (p < 0.001). Despite similar clinical characteristics and proportion of minority participants, substantial differences in metabolic control exist across the three large transatlantic registries of paediatric patients with type 1 diabetes, which appears to be due in part to the frequency of insulin pump therapy.

  3. Careers in paediatrics: Community paediatrics revisited

    PubMed Central

    Tonkin, Roger Sherriff

    2012-01-01

    The concept of ‘community paediatrics’, as enunciated by Robert Haggerty in 1968, has informed and shaped many paediatric careers. The principle tenets of inclusiveness: attention to unmet needs; addressing common health problems of children and youth; using and applying preventive and harm-reduction strategies; and securing community input and control, were part of the Haggerty model. The present article revisits Haggerty’s model and describes how the concepts have shaped contemporary paediatrics in North America. PMID:23277752

  4. The impact of intensive health promotion to a targeted refugee population on utilisation of a new refugee paediatric clinic at the children's hospital at Westmead.

    PubMed

    Sheikh, Mohamud; MacIntyre, C Raina

    2009-08-01

    To evaluate the impact of intensive promotion of a new health service to a targeted refugee population, recently resettled in Sydney, and the role of early social connection and membership of social group in promoting health service utilisation of refugees. Descriptive epidemiological study and survey. A paediatric refugee clinic at a children's hospital in Sydney. Newly resettled refugee parents of children seen at the clinic. An intensive health promotion and education campaign using ethnic media and social networks to increase awareness of and encourage utilisation of a new clinical service for refugee children (above and beyond the standard promotion that accompanied the start of the new refugee clinic) to a targeted group of refugees from Sub-Saharan Africa. Rates of attendance and utilisation of the new service in targeted versus non-targeted refugee parents; changes in health beliefs, health-seeking behaviour and utilisation of services following clinic attendance. We interviewed 34 Sub-Saharan African refugee parents (intervention) and 12 non-African refugee parents (non-intervention) attending a paediatric refugee clinic, between June 2005 and May 2006, with a total number of 112 children. The mean ages of the children were 12 and 10 years for the Africans and non-Africans, respectively. Our targeted health promotion campaign appeared to be effective in increasing attendance for target communities compared to the non-targeted communities (OR for African families attending clinic 3.0, 95% CI=1.5-6.2, p<0.001). We observed a significant change in parental knowledge, attitudes and beliefs about infectious diseases after attending the clinic, including decreased stigma around tuberculosis, more awareness of the seriousness of some infections, and increased awareness of the role of immunisation in prevention of infectious diseases. Our study shows that targeted promotion of service to refugee parents is effective. Such efforts may improve access to care for

  5. 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. ©ERS 2014.

  6. 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

  7. [Off-label use of drugs in paediatrics causes uncertainty].

    PubMed

    Hart, Dieter; Mühlbauer, Bernd

    2008-01-01

    The off-label use of drugs in paediatrics is a common practice casting doubts on the adequate safety of drug therapy. Regulatory initiatives of European and national legislators aim to address this paucity of clinical drug trials in paediatrics through clarifying regulations and incentives in pharmaceutical law, thereby promoting an increase in the approval of paediatric drugs, the improvement of drug and thus treatment safety. This paper describes the present situation in paediatrics and the legal status of off-label use in pharmaceutical law, medical malpractice law and statutory health insurance law.

  8. 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.

  9. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

    PubMed

    Schwartz, Seth R; Magit, Anthony E; Rosenfeld, Richard M; Ballachanda, Bopanna B; Hackell, Jesse M; Krouse, Helene J; Lawlor, Claire M; Lin, Kenneth; Parham, Kourosh; Stutz, David R; Walsh, Sandy; Woodson, Erika A; Yanagisawa, Ken; Cunningham, Eugene R

    2017-01-01

    Objective This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include a consumer added to the development group; new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); enhanced information on patient education and counseling; a new algorithm to clarify action statement relationships; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; an enhanced external review process to include public comment and journal peer review; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care. Purpose The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed. The guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal; recurrent otitis externa; keratosis obturans; prior radiation therapy affecting the ear; previous tympanoplasty/myringoplasty, canal wall down mastoidectomy, or other surgery affecting the ear canal. Key Action Statements The panel made a strong

  10. Paediatric diagnostic audiology testing in South Africa.

    PubMed

    Moodley, Selvarani

    2016-03-01

    With the increased emphasis on the importance of early identification of paediatric hearing loss within developing countries such as South Africa and Nigeria there has been a recognition of the ethical obligation to ensure access to timely diagnostic and intervention services for children identified with hearing loss; regardless of their geographic or socioeconomic status. There are limited studies on diagnosis of paediatric hearing loss in a developing world context. The objective of this study was to determine processes used for diagnosis of paediatric hearing loss in South Africa, across the private and public healthcare sectors, and to profile the age of testing for each component of the diagnostic test battery. Diagnostic audiology testing data of 230 children enrolled in an early intervention programme was analysed to profile the reporting of diagnostic audiology testing as well as diagnostic audiology procedures employed. Results were analysed according to province as well as healthcare sector to compare diagnostic services across regions as well as healthcare sectors. The differences in audiology practice and tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape indicates that services across regions and across the public and private sector are not equitable. Each region is equally unlikely to complete a full, comprehensive diagnostic evaluation on paediatric clients. The age of testing highlights the increased age of diagnosis of hearing loss. Paediatric diagnostic audiology is a section of Early Hearing Detection and Intervention services that requires attention in terms of the appropriateness of procedures as well as equity of services. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to international best practice guidelines for paediatric diagnostic audiology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study.

    PubMed

    Gunz, Anna C; Canizares, Mayilee; Mackay, Crystal; Badley, Elizabeth M

    2012-06-12

    Although musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted. Analysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates. 122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions. One in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly

  12. Practice type effects on head impact in collegiate football.

    PubMed

    Reynolds, Bryson B; Patrie, James; Henry, Erich J; Goodkin, Howard P; Broshek, Donna K; Wintermark, Max; Druzgal, T Jason

    2016-02-01

    OBJECT IVE: This study directly compares the number and severity of subconcussive head impacts sustained during helmet-only practices, shell practices, full-pad practices, and competitive games in a National Collegiate Athletic Association (NCAA) Division I-A football team. The goal of the study was to determine whether subconcussive head impact in collegiate athletes varies with practice type, which is currently unregulated by the NCAA. Over an entire season, a cohort of 20 collegiate football players wore impact-sensing mastoid patches that measured the linear and rotational acceleration of all head impacts during a total of 890 athletic exposures. Data were analyzed to compare the number of head impacts, head impact burden, and average impact severity during helmet-only, shell, and full-pad practices, and games. Helmet-only, shell, and full-pad practices and games all significantly differed from each other (p ≤ 0.05) in the mean number of impacts for each event, with the number of impacts being greatest for games, then full-pad practices, then shell practices, and then helmet-only practices. The cumulative distributions for both linear and rotational acceleration differed between all event types (p < 0.01), with the acceleration distribution being similarly greatest for games, then full-pad practices, then shell practices, and then helmet-only practices. For both linear and rotational acceleration, helmet-only practices had a lower average impact severity when compared with other event types (p < 0.001). However, the average impact severity did not differ between any comparisons of shell and full-pad practices, and games. Helmet-only, shell, and full-pad practices, and games result in distinct head impact profiles per event, with each succeeding event type receiving more impacts than the one before. Both the number of head impacts and cumulative impact burden during practice are categorically less than in games. In practice events, the number and cumulative

  13. Magnetic resonance imaging in paediatric psychoneuroendocrinology: a new frontier for understanding the impact of hormones on emotion and cognition.

    PubMed

    Mueller, S C

    2013-08-01

    Mounting magnetic resonance imaging (MRI) research is characterising the neurobiological trajectories of healthy human brain development. In parallel, studies increasingly acknowledge the relevance of perturbations of these trajectories for adolescent and adult psychopathology. Although an influence of steroid hormones on mood and anxiety disorders has been demonstrated in adults, very little is known about how steroid hormones alter human brain development and contribute to adolescent psychopathology. This review focuses on recent evidence obtained from structural and functional MRI in children and adolescents with genetic endocrine disorders and with characteristic fluctuations in androgen or oestrogen levels (familial male precocious puberty, congenital adrenal hyperplasia, Klinefelter syndrome and Turner syndrome). It aims to highlight how neurobiological findings from these paediatric endocrine disorders can provide insight into the contribution of sex steroids with respect to the development of neurocircuitry involved in affective processing (amygdala, hippocampus) and cognitive control (prefrontal cortex, inferior frontal gyrus, striatum). In addition, findings from these populations may also provide important information on aberrant psychological processes relevant for the clinical care and management of these populations. Finally, the findings are discussed within the context of current frameworks in animal models, such as the organisational-activational hypothesis or the aromatisation hypothesis. The review ends with a discussion of open questions for future enquiry with the goal of integrating translational models with current knowledge of endocrine disorders and developmental studies in healthy populations.

  14. Paediatric surgery in Uganda.

    PubMed

    Sekabira, John

    2015-02-01

    The Hugh Greenwood Lecture acknowledges the extremely generous support from Mr Greenwood that has enabled the BAPS to establish funds to advance paediatric surgical training in developing countries. In this Inaugural Lecture, Dr. Sekabira, the first Hugh Greenwood Fellow, describes the influence that this has had on his career and reviews the state of paediatric surgery in Uganda.

  15. Paediatrics in Berlin.

    PubMed

    Barbato, A; Bertuola, F; Kuehni, C; Korppi, M; Kotecha, S; Pijnenburg, M W; Ratjen, F; Seddon, P; Bush, A

    2009-08-01

    The aim of this report is to describe the highlights of the European Respiratory Society annual congress in Berlin, Germany. The best abstracts in asthma and allergy, cystic fibrosis, respiratory infection, paediatric and neonatal intensive care, paediatric investigative techniques (in particular respiratory physiology and bronchoscopy) and respiratory epidemiology are presented and set in the context of the current literature.

  16. Body mass index and dental caries in children aged 5 to 8 years attending a dental paediatric referral practice in the Netherlands.

    PubMed

    de Jong-Lenters, Maddelon; van Dommelen, Paula; Schuller, Annemarie A; Verrips, Erik H W

    2015-12-01

    Obesity and dental caries are widely-recognised problems that affect general health. The prevention of both dental caries and obesity have proven very difficult: children and their parents may need professional support to achieve behaviour change. To find out whether both dental caries and overweight in childhood can be targeted using a common risk factor approach, it is necessary to establish whether the two diseases are indeed linked. The aim of the present study was therefore to use anthropometric data obtained professionally to investigate the association between Body Mass Index and dental caries experience in children aged 5-8 years receiving treatment in a referral centre for paediatric dental care in the Netherlands. Children's dmft and dmfs scores were calculated using dental records and sociodemographic data were also extracted from these records. Dentists were trained to measure standing height and weight in a standardised way. Body Mass Index was calculated by dividing kilograms by height squared (kg/m(2)). Extended International (International Obesity Task Force) body mass index cut-offs were used to define 'no overweight' and 'overweight' (with the latter category including obesity). No statistically significant differences were found between the mean dmft or dmfs scores of the two groups (overweight and non-overweight), even after correction for the effect of the potential confounders sex, socio-economic status and ethnicity. The percentage of caries-active children in the non-overweight group was almost the same as in the overweight group. No statistically significant differences were found. We hypothesised to find a positive association between body mass index and dental caries experience in children aged 5-8 years attending our practice. However, this study did not find a relationship of this kind. A common risk factor approach for the prevention of caries and overweight is therefore not supported by our study.

  17. Current UK practice of pediatric supraglottic airway devices - a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland.

    PubMed

    Bradley, Anthony E D; White, Michelle C; Engelhardt, Thomas; Bayley, Guy; Beringer, Richard M

    2013-11-01

    Over half of general anesthetics in the UK involve supraglottic airway devices (SADs). The National Audit Project 4 undertaken by the Royal College of Anaesthetists demonstrated that aspiration was the most frequent complication relating to SAD use. SADs designed to reduce this risk (second-generation devices) are increasingly recommended in both adults and children. As well as routine use, SADs are recommended for use in cases of 'difficult airway'. This survey assessed current usage of SADs in routine practice and difficult airways. Sixteen questions, approved by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) survey committee, were distributed to all its members. Two hundred and forty-four members responded. Eighty-eight percent preferentially use first-generation rather than second-generation devices. The most important design feature was the availability of a complete range of sizes (84%). Seventy-seven percent felt that randomized controlled trials assessing SAD safety in children are needed. In cases of failed intubation, classically shaped SADs are preferred (79%). Three percent of responders intubate via an SAD routinely. Eighteen percent have employed this technique in an emergency. Thirty-six percent of responders have found an SAD to function poorly. Pediatric anesthesiologists appear slow to embrace second-generation SADs. The role of SADs in the management of difficult airways is widely accepted. Research currently has little influence over the choice of which SAD to use, which is more likely determined by personal choice and departmental preference. There is a risk that some SADs are unsafe. © 2013 John Wiley & Sons Ltd.

  18. Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment Monitoring: From Measuring Process to Impact and Elimination of Mother-to-Child Transmission of HIV.

    PubMed

    Idele, Priscilla; Hayashi, Chika; Porth, Tyler; Mamahit, Awandha; Mahy, Mary

    2017-01-06

    Progress towards achievement of global targets for the prevention of mother-to-child transmission of HIV (PMTCT) and paediatric HIV care and treatment is an integral part of global and national HIV and AIDS responses. This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges. A review of the development of the monitoring and reporting process since 2002-2016 was conducted using existing published literature and taking into account changes in WHO HIV treatment guidelines, global HIV goals and targets, programmatic and methodological developments, and increased need for interagency partnerships, coordination and harmonization of global monitoring and reporting mechanisms. The number and type of indicators reported increased and evolved from monitoring of existence of national policies and guidelines, service delivery sites and trained health workers and coverage of PMTCT and paediatric HIV interventions to measuring outcomes and impact in reducing new HIV infections and AIDS related deaths, including efforts to validate elimination of mother-to-child transmission of HIV. These changes were required to mirror changes in WHO and national PMTCT and HIV treatment guidelines. The number of countries reporting PMTCT coverage increased from 53 in 2003 to over 130 in 2015. National monitoring processes have also expanded in scope and the capacity to report on disaggregated data by type of ARV regimen and for paediatric HIV care and treatment has increased. Monitoring of PMTCT and paediatric HIV programmes has contributed a rich body of evidence that helped monitor how quickly countries were adopting and implementing the latest WHO HIV treatment guidelines for pregnant and breastfeeding women and children. The reported data and experiences were instrumental in shaping global policies, national programmes, and investment choices.

  19. The need of paediatric dentistry specialists in Pakistan.

    PubMed

    Khan, Farhan Raza; Mahmud, Sadia; Rahman, Munawar

    2013-04-01

    In the last decade, a rapid increase has been observed in the number of dentists due to establishment of a number of dental colleges in Pakistan. Very few of these institutions have Paediatric Dentistry Department. Similarly, no postgraduate Paediatric Dentistry training program exists in the two major provinces of the country. The objectives of this study were to map the pattern of paediatric dentistry services provided by the clinicians in teaching institutions and private practices. A cross-sectional study was conducted at dental departments of academic institutions and selected dental practices in Karachi. There was a statistically significant difference in preferences, selection of dental materials and pattern of paediatric dentistry services provided by the teaching dentists compared to the private practitioners. Both the teaching and non-teaching dentists need to update themselves in the provision of Paediatric Dentistry services such as fluoride application and fissure sealant placement.

  20. Anaesthesia for the paediatric outpatient.

    PubMed

    Jöhr, Martin; Berger, Thomas M

    2015-12-01

    The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia. The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients. Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting.

  1. Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions.

    PubMed

    Berrington de Gonzalez, Amy; Salotti, Jane A; McHugh, Kieran; Little, Mark P; Harbron, Richard W; Lee, Choonsik; Ntowe, Estelle; Braganza, Melissa Z; Parker, Louise; Rajaraman, Preetha; Stiller, Charles; Stewart, Douglas R; Craft, Alan W; Pearce, Mark S

    2016-02-16

    We previously reported evidence of a dose-response relationship between ionising-radiation exposure from paediatric computed tomography (CT) scans and the risk of leukaemia and brain tumours in a large UK cohort. Underlying unreported conditions could have introduced bias into these findings. We collected and reviewed additional clinical information from radiology information systems (RIS) databases, underlying cause of death and pathology reports. We conducted sensitivity analyses excluding participants with cancer-predisposing conditions or previous unreported cancers and compared the dose-response analyses with our original results. We obtained information from the RIS and death certificates for about 40% of the cohort (n∼180 000) and found cancer-predisposing conditions in 4 out of 74 leukaemia/myelodysplastic syndrome (MDS) cases and 13 out of 135 brain tumour cases. As these conditions were unrelated to CT exposure, exclusion of these participants did not alter the dose-response relationships. We found evidence of previous unreported cancers in 2 leukaemia/MDS cases, 7 brain tumour cases and 232 in non-cases. These previous cancers were related to increased number of CTs. Exclusion of these cancers reduced the excess relative risk per mGy by 15% from 0.036 to 0.033 for leukaemia/MDS (P-trend=0.02) and by 30% from 0.023 to 0.016 (P-trend<0.0001) for brain tumours. When we included pathology reports we had additional clinical information for 90% of the cases. Additional exclusions from these reports further reduced the risk estimates, but this sensitivity analysis may have underestimated risks as reports were only available for cases. Although there was evidence of some bias in our original risk estimates, re-analysis of the cohort with additional clinical data still showed an increased cancer risk after low-dose radiation exposure from CT scans in young patients.

  2. Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions

    PubMed Central

    de Gonzalez, Amy Berrington; Salotti, Jane A; McHugh, Kieran; Little, Mark P; Harbron, Richard W; Lee, Choonsik; Ntowe, Estelle; Braganza, Melissa Z; Parker, Louise; Rajaraman, Preetha; Stiller, Charles; Stewart, Douglas R; Craft, Alan W; Pearce, Mark S

    2016-01-01

    Background: We previously reported evidence of a dose–response relationship between ionising-radiation exposure from paediatric computed tomography (CT) scans and the risk of leukaemia and brain tumours in a large UK cohort. Underlying unreported conditions could have introduced bias into these findings. Methods: We collected and reviewed additional clinical information from radiology information systems (RIS) databases, underlying cause of death and pathology reports. We conducted sensitivity analyses excluding participants with cancer-predisposing conditions or previous unreported cancers and compared the dose–response analyses with our original results. Results: We obtained information from the RIS and death certificates for about 40% of the cohort (n∼180 000) and found cancer-predisposing conditions in 4 out of 74 leukaemia/myelodysplastic syndrome (MDS) cases and 13 out of 135 brain tumour cases. As these conditions were unrelated to CT exposure, exclusion of these participants did not alter the dose–response relationships. We found evidence of previous unreported cancers in 2 leukaemia/MDS cases, 7 brain tumour cases and 232 in non-cases. These previous cancers were related to increased number of CTs. Exclusion of these cancers reduced the excess relative risk per mGy by 15% from 0.036 to 0.033 for leukaemia/MDS (P-trend=0.02) and by 30% from 0.023 to 0.016 (P-trend<0.0001) for brain tumours. When we included pathology reports we had additional clinical information for 90% of the cases. Additional exclusions from these reports further reduced the risk estimates, but this sensitivity analysis may have underestimated risks as reports were only available for cases. Conclusions: Although there was evidence of some bias in our original risk estimates, re-analysis of the cohort with additional clinical data still showed an increased cancer risk after low-dose radiation exposure from CT scans in young patients. PMID:26882064

  3. The clinical impact of hip joint centre regression equation error on kinematics and kinetics during paediatric gait.

    PubMed

    Kiernan, D; Malone, A; O'Brien, T; Simms, C K

    2015-01-01

    Regression equations based on pelvic anatomy are routinely used to estimate the hip joint centre during gait analysis. While the associated errors have been well documented, the clinical significance of these errors has not been reported. This study investigated the clinical agreement of three commonly used regression equation sets (Bell et al., Davis et al. and Orthotrak software) against the equations of Harrington et al. Full 3-dimensional gait analysis was performed on 18 healthy paediatric subjects. Kinematic and kinetic data were calculated using each set of regression equations and compared to Harrington et al. In addition, the Gait Profile Score and GDI-Kinetic were used to assess clinical significance. Bell et al. was the best performing set with differences in Gait Profile Score (0.13°) and GDI-Kinetic (0.84 points) falling below the clinical significance threshold. Small deviations were present for the Orthotrak set for hip abduction moment (0.1 Nm/kg), however differences in Gait Profile Score (0.27°) and GDI-Kinetic (2.26 points) remained below the clinical threshold. Davis et al. showed least agreement with a clinically significant difference in GDI-Kinetic score (4.36 points). It is proposed that Harrington et al. or Bell et al. regression equation sets are used during gait analysis especially where inverse dynamic data are calculated. Orthotrak is a clinically acceptable alternative however clinicians must be aware of the effects of error on hip abduction moment. The Davis et al. set should be used with caution for inverse dynamic analysis as error could be considered clinically meaningful.

  4. From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

    PubMed Central

    Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

    2014-01-01

    Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs. PMID:24855416

  5. From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice.

    PubMed

    Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

    2014-04-01

    Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician's ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.

  6. Investigating the experiences in a school-based occupational therapy program to inform community-based paediatric occupational therapy practice.

    PubMed

    Rens, Lezahn; Joosten, Annette

    2014-06-01

    A collaborative approach with teachers is required when providing community-based occupational therapy to educationally at risk children. Collaborators share common goals and interact and support each other but challenges arise in providing collaborative occupational therapy in settings outside the school environment. The aim of this study was to capture experiences of teachers and occupational therapists working within a school-based occupational therapy program to determine if their experiences could inform collaborative practice. In this pilot study, participant responses to questionnaires (n = 32) about their experiences formed the basis for focus groups and individual interviews. Two focus group were conducted, one with teachers (n = 11) and one with occupational therapy participants (n = 6). Individual interviews were conducted with the supervising occupational therapist, school principal and two leading teachers. Descriptive statistics were used to analyse the data from closed questions, and thematic analysis using a constant comparison approach was used to analyse open ended questions, focus groups and interviews. Three main themes emerged: (i) the need for occupational therapists to spend time in the school, to explain their role, build relationships, understand classroom routines and the teacher role; (ii) occupational therapists need to not see themselves as the expert but develop equal partnerships to set collaborative goals and (iii) occupational therapists advocating for all parties to be informed throughout the occupational therapy process. The pilot study findings identified teacher and therapist experiences within the school setting that could inform improved collaborative practice with teachers and community-based occupational therapists and these findings warrant further investigation. © 2013 Occupational Therapy Australia.

  7. Impact of Prominent Themes in Clinician-Patient Conversations on Caregiver’s Perceived Quality of Communication with Paediatric Dental Visits

    PubMed Central

    Bridges, Susan Margaret; McGrath, Colman Patrick; Yiu, Cynthia Kar Yung; Zayts, Olga A.; Au, Terry Kit Fong

    2017-01-01

    Patients’ perceived satisfaction is a key performance index of the quality health care service. Good communication has been found to increase patient’s perceived satisfaction. The purpose of this study was to examine the impact of the prominent themes arising from clinician-patient conversations on the caregiver’s perceived quality of communication during paediatric dental visits. 162 video recordings of clinical dental consultations for 62 cases attending the Paediatric Dentistry Clinic of The Prince Philip Dental Hospital in Hong Kong were captured and transcribed. The patients’ demographic information and the caregiver’s perceived quality of communication with the clinicians were recorded using the 16-item Dental Patient Feedback on Consultation skills questionnaires. Visual text analytics (Leximancer™) indicated five prominent themes ‘disease / treatment’, ‘treatment procedure related instructions’, ‘preparation for examination’, ‘positive reinforcement / reassurance’, and ‘family / social history’ from the clinician-patient conversation of the recorded videos, with 60.2% of the total variance in concept words in this study explained through principal components analysis. Significant variation in perceived quality of communication was noted in five variables regarding the prominent theme ‘Positive reinforcement / reassurance’: ‘number of related words’ (p = 0.002), ‘number of related utterances’ (p = 0.001), ‘percentage of the related words in total number of words’ (p = 0.005), ‘percentage of the related utterances in total number of utterances’ (p = 0.035) and ‘percentage of time spent in total time duration’ (p = 0.023). Clinicians were perceived to be more patient-centered and empathetic if a larger proportion of their conversation showed positive reinforcement and reassurance via using related key words. Care-giver’s involvement, such as clinicians’ mention of the parent, was also seen as critical

  8. Study design and baseline description of the BMI2 trial: reducing paediatric obesity in primary care practices

    PubMed Central

    Resnicow, K.; Mcmaster, F.; Woolford, S.; Slora, E.; Bocian, A.; Harris, D.; Drehmer, J.; Wasserman, R.; Schwartz, R.; Myers, E.; Foster, J.; Snetselaar, L.; Hollinger, D.; Smith, K.

    2012-01-01

    Summary This study will test the efficacy of motivational interviewing (MI) conducted by primary care providers and dieticians among children ages 2-8 years old with a body mass index (BMI) ≥85th and ≤97th percentile. Forty-three practices from the American Academy of Pediatrics, Pediatric Research in Office Settings Network were assigned to one of three groups. Group 1 (usual care) measures BMI percentile at baseline, and at 1- and 2-year follow-ups and received standard health education materials. Group 2 providers deliver three proactive MI counselling sessions with a parent of the index child in Year 1 and one additional ‘booster’ visit in Year 2. Group 3 adds six MI counselling sessions from a trained dietician. The primary outcome is the child’s BMI percentile at 2-year follow-up. Secondary outcomes include parent report of the child’s screen time, physical activity, intake of fruits and vegetables, and sugar-sweetened beverages. We enrolled 584 eligible children whose mean BMI percentile was 92.0 and mean age of 5.1. The cohort was 57% female. Almost 70% of parents reported a household income of ≥$40 000 per year, and 39% had at least a college education. The cohort was 63% White, 23% Hispanic, 7% Black and 7% Asian. Parent self-reported confidence that their child will achieve a healthy weight was on average an 8 (out of 10). To date, several aspects of the study can inform similar efforts including our ability to use volunteer clinicians to recruit participants and their willingness to dedicate their time, without pay, to receive training in MI. PMID:22434735

  9. Study design and baseline description of the BMI2 trial: reducing paediatric obesity in primary care practices.

    PubMed

    Resnicow, K; McMaster, F; Woolford, S; Slora, E; Bocian, A; Harris, D; Drehmer, J; Wasserman, R; Schwartz, R; Myers, E; Foster, J; Snetselaar, L; Hollinger, D; Smith, K

    2012-02-01

    This study will test the efficacy of motivational interviewing (MI) conducted by primary care providers and dieticians among children ages 2-8 years old with a body mass index (BMI) ≥ 85th and ≤ 97th percentile. Forty-two practices from the American Academy of Pediatrics, Pediatric Research in Office Settings Network were assigned to one of three groups. Group 1 (usual care) measures BMI percentile at baseline, and at 1- and 2-year follow-ups and receives standard health education materials. Group 2 providers deliver three proactive MI counselling sessions with a parent of the index child in Year 1 and one additional 'booster' visit in Year 2. Group 3 adds six MI counselling sessions from a trained dietician. The primary outcome is the child's BMI percentile at 2-year follow-up. Secondary outcomes include parent report of the child's screen time, physical activity, intake of fruits and vegetables, and sugar-sweetened beverages. We enrolled 633 eligible children whose mean BMI percentile was 92.0 and mean age of 5.1. The cohort was 57% female. Almost 70% of parents reported a household income of ≥ $40,000 per year, and 39% had at least a college education. The cohort was 63% white, 23% Hispanic, 7% black and 7% Asian. Parent self-reported confidence that their child will achieve a healthy weight was on average an 8 (out of 10). To date, several aspects of the study can inform similar efforts including our ability to use volunteer clinicians to recruit participants and their willingness to dedicate their time, without pay, to receive training in MI. © 2011 The Authors Pediatric Obesity © 2011 International Association for the Study of Obesity.

  10. The clinical impact of IKZF1 deletions in paediatric B-cell precursor acute lymphoblastic leukaemia is independent of minimal residual disease stratification in Nordic Society for Paediatric Haematology and Oncology treatment protocols used between 1992 and 2013.

    PubMed

    Olsson, Linda; Ivanov Öfverholm, Ingegerd; Norén-Nyström, Ulrika; Zachariadis, Vasilios; Nordlund, Jessica; Sjögren, Helene; Golovleva, Irina; Nordgren, Ann; Paulsson, Kajsa; Heyman, Mats; Barbany, Gisela; Johansson, Bertil

    2015-09-01

    Paediatric B-cell precursor acute lymphoblastic leukaemias (BCP ALL) with IKZF1 deletions (∆IKZF1) are associated with a poor outcome. However, there are conflicting data as to whether ∆IKZF1 is an independent risk factor if minimal residual disease (MRD) and other copy number alterations also are taken into account. We investigated 334 paediatric BCP ALL, diagnosed 1992-2013 and treated according to Nordic Society for Paediatric Haematology and Oncology ALL protocols, with known IKZF1 status based on either single nucleotide polymorphism array (N = 218) or multiplex ligation-dependent probe amplification (N = 116) analyses. ∆IKZF1, found in 15%, was associated with inferior 10-year probabilities of event-free (60% vs. 83%; P < 0·001) and overall survival (pOS; 73% vs. 89%; P = 0·001). Adjusting for known risk factors, including white blood cell (WBC) count and MRD, ∆IKZF1 was the strongest independent factor for relapse and death. ∆IKZF1 was present in 27% of cases with non-informative cytogenetics ('BCP-other') and a poor 10-year pOS was particularly pronounced in this group (58% vs. 90%; P < 0·001). Importantly, neither MRD nor WBC count predicted events in the ∆IKZF1-positive cases. Co-occurrence of pseudoautosomal region 1 (PAR1) deletions in Xp22.33/Yp11.32 (P2RY8-CRLF2) and ∆IKZF1 increased the risk of relapse (75% vs. 30% for cases with only ∆IKZF1; P = 0·045), indicating that BCP-other ALL with both P2RY8-CRLF2 and ∆IKZF1 constitutes a particularly high-risk group.

  11. Measuring the Expertise of Paediatric Rehabilitation Therapists

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  12. Measuring the Expertise of Paediatric Rehabilitation Therapists

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  13. Paediatric CT scan usage and referrals of children to computed tomography in Germany--a cross-sectional survey of medical practice and awareness of radiation related health risks among physicians.

    PubMed

    Merzenich, Hiltrud; Krille, Lucian; Hammer, Gael; Kaiser, Melanie; Yamashita, Shunichi; Zeeb, Hajo

    2012-02-25

    Computed tomography (CT) is a major source of ionizing radiation exposure in medical diagnostic. Compared to adults, children are supposed to be more susceptible to health risks related to radiation. The purpose of a cross-sectional survey among office-based physicians in Germany was the assessment of medical practice in paediatric CT referrals and to investigate physicians' knowledge of radiation doses and potential health risks of radiation exposure from CT in children. A standardized questionnaire was distributed to all paediatricians and surgeons in two defined study areas. Furthermore, the study population included a random sample of general practitioners in the two areas. The questionnaire covered the frequency of referrals for paediatric CT examinations, the medical diagnoses leading to paediatric CT referrals, physicians' knowledge of radiation doses and potential health risks of radiation exposure from CT in children. A total of 295 (36.4%) physicians responded. 59% of the doctors had not referred a child to CT in the past year, and approximately 30% referred only 1-5 children annually. The most frequent indications for a CT examination in children were trauma or a suspected cancer. 42% of the referrals were related to minor diagnoses or unspecific symptoms. The participants underestimated the radiation exposure due to CT and they overestimated the radiation exposure due to conventional X-ray examinations. In Germany, the frequency of referrals of children to computed tomography is moderate. The knowledge on the risks from radiation exposure among office-based physicians in our sample varied, but there was a tendency to underestimate potential CT risks. Advanced radiological training might lead to considerable amendments in terms of knowledge and practice of CT referral.

  14. Where should paediatric surgery be performed?

    PubMed

    Arul, G S; Spicer, R D

    1998-07-01

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

  15. Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratorytract infections in Trinidad and Tobago: a cross-sectional study

    PubMed Central

    Parimi, Neeta; Pereira, Lexley M Pinto; Prabhakar, P

    2004-01-01

    Background Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. Methods In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. Results Of the 417 caregivers, 70% were female and between 18–40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (≥ 12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). Conclusions In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use

  16. [A Paediatric Orthopaedic outpatient clinic referral patterns].

    PubMed

    Moraleda, L; Castellote, M

    2015-08-01

    The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  17. The impact of post-registration education on midwifery practice.

    PubMed

    Webster-Benwell, Frances

    2014-09-01

    National guidelines require midwives to undertake effective post-registration education which is relevant to practice. However, there is minimal research investigating the impact of education on practice, most of which originates from nursing and allied professions. A small-scale phenomenological pilot study, involving four experienced midwives, was undertaken to explore their experiences and opinions regarding the impact of midwifery post-registration educational courses upon practice. The research highlighted two key areas: practical engagement in continuing professional development (CPD) and midwives' reasons for their educational choices. The midwives valued the practical relevance and applicability of CPD to practice and the use of interprofessional learning in narrowing the theory-practice gap; educational choices were affected by accessibility, flexibility, mandatory attendance, cost and conflict with employers' objectives. The study suggests further research into the impact of CPD upon midwifery practice and what factors would better engage and motivate midwives to undertake more clinically effective post-registration education.

  18. Impact of Stand Management Practices on Beetle Diversity

    Treesearch

    Stephen P. Cook

    2004-01-01

    Abstract - Insects are useful indicators of change within ecosystems because of their abundance, richness and functional importance. Stand management practices impact the insect community within a forest. Therefore, the objective of the project is to determine the impact of various stand management practices on the diversity of beetles within...

  19. Cardiac arrhythmias in paediatric practice.

    PubMed

    Chan, K Y; Loke, K Y; Yip, W C; Tay, J S

    1989-01-01

    Clinical data of patients with cardiac arrhythmias managed between May 1986 and March 1988 were reviewed to determine their mode of presentation and clinical course. Of the 5,768 admissions, 62 (1.07%) patients had arrhythmias. During the same period, 21 patients were managed as outpatients with 13 being new referrals. Thirty-eight patients had undergone corrective cardiac procedures, 8 others had congenital heart lesions, 3 were associated with acquired cardiac pathology and the remaining had isolated arrhythmias. The cardiac arrhythmias were: right bundle branch block 36, premature atrial and ventricular contractions 15, supraventricular tachycardia (SVT) 15, atrioventricular (AV) block 7, sinus bradycardia 3, atrial fibrillation 2, ventricular tachycardia and fibrillation 2, Wolff-Parkinson-White syndrome without SVT 2, bradytachyarrhythmia 1. There were 3 patients with foetal SVT, one persisting till day 1. High grade AV block occurred in 2 patients post-surgically and needed pacing. Only 2 others were symptomatic. Other than the 38 patients who underwent corrective procedures (2 had balloon valvuloplasty for pulmonary stenosis), 8 others had structural heart disease. There was 1 sudden death and 5 died from their primary heart disease.

  20. Drill-specific head impact exposure in youth football practice

    PubMed Central

    Campolettano, Eamon T.; Rowson, Steven; Duma, Stefan M.

    2017-01-01

    OBJECTIVE Although 70% of football players in the United States are youth players (6–14 years old), most research on head impacts in football has focused on high school, collegiate, or professional populations. The objective of this study was to identify the specific activities associated with high-magnitude (acceleration > 40g) head impacts in youth football practices. METHODS A total of 34 players (mean age 9.9 ± 0.6 years) on 2 youth teams were equipped with helmet-mounted accelerometer arrays that recorded head accelerations associated with impacts in practices and games. Videos of practices and games were used to verify all head impacts and identify specific drills associated with each head impact. RESULTS A total of 6813 impacts were recorded, of which 408 had accelerations exceeding 40g (6.0%). For each type of practice drill, impact rates were computed that accounted for the length of time that teams spent on each drill. The tackling drill King of the Circle had the highest impact rate (95% CI 25.6–68.3 impacts/hr). Impact rates for tackling drills (those conducted without a blocker [95% CI 14.7–21.9 impacts/hr] and those with a blocker [95% CI 10.5–23.1 impacts/hr]) did not differ from game impact rates (95% CI 14.2–21.6 impacts/hr). Tackling drills were observed to have a greater proportion (between 40% and 50%) of impacts exceeding 60g than games (25%). The teams in this study participated in tackling or blocking drills for only 22% of their overall practice times, but these drills were responsible for 86% of all practice impacts exceeding 40g. CONCLUSIONS In youth football, high-magnitude impacts occur more often in practices than games, and some practice drills are associated with higher impact rates and accelerations than others. To mitigate high-magnitude head impact exposure in youth football, practices should be modified to decrease the time spent in drills with high impact rates, potentially eliminating a drill such as King of the

  1. Drill-specific head impact exposure in youth football practice.

    PubMed

    Campolettano, Eamon T; Rowson, Steven; Duma, Stefan M

    2016-11-01

    OBJECTIVE Although 70% of football players in the United States are youth players (6-14 years old), most research on head impacts in football has focused on high school, collegiate, or professional populations. The objective of this study was to identify the specific activities associated with high-magnitude (acceleration > 40g) head impacts in youth football practices. METHODS A total of 34 players (mean age 9.9 ± 0.6 years) on 2 youth teams were equipped with helmet-mounted accelerometer arrays that recorded head accelerations associated with impacts in practices and games. Videos of practices and games were used to verify all head impacts and identify specific drills associated with each head impact. RESULTS A total of 6813 impacts were recorded, of which 408 had accelerations exceeding 40g (6.0%). For each type of practice drill, impact rates were computed that accounted for the length of time that teams spent on each drill. The tackling drill King of the Circle had the highest impact rate (95% CI 25.6-68.3 impacts/hr). Impact rates for tackling drills (those conducted without a blocker [95% CI 14.7-21.9 impacts/hr] and those with a blocker [95% CI 10.5-23.1 impacts/hr]) did not differ from game impact rates (95% CI 14.2-21.6 impacts/hr). Tackling drills were observed to have a greater proportion (between 40% and 50%) of impacts exceeding 60g than games (25%). The teams in this study participated in tackling or blocking drills for only 22% of their overall practice times, but these drills were responsible for 86% of all practice impacts exceeding 40g. CONCLUSIONS In youth football, high-magnitude impacts occur more often in practices than games, and some practice drills are associated with higher impact rates and accelerations than others. To mitigate high-magnitude head impact exposure in youth football, practices should be modified to decrease the time spent in drills with high impact rates, potentially eliminating a drill such as King of the Circle

  2. Theory and Practice of Environmental Impact Analysis

    ERIC Educational Resources Information Center

    Mason, Peter F.

    1974-01-01

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

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

    PubMed

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

    2016-01-01

    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). 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. 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. 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.

  4. 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

  5. Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials.

    PubMed

    Snowdon, Claire; Brocklehurst, Peter; Tasker, Robert; Ward Platt, Martin; Harvey, Sheila; Elbourne, Diana

    2014-07-01

    Researchers have seldom included bereaved parents in studies of participants' views of randomised controlled trials (RCTs); hence our understanding of the impact of trials is based on skewed and incomplete samples. Little is known about parental experiences of the death of a child subsequent to their enrolment in a trial or of provision made for this experience by clinicians and trial teams. The Bereavement and RAndomised ControlLEd Trials (BRACELET) study was funded to consider bereavement in the context of paediatric intensive care (PIC) and neonatal intensive care (NIC) trials. The study comprised three interlinked components: a quantitative survey of RCT activity in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), UK RCT recruitment and mortality rates, and provision for bereavement during 2002-6; a qualitative interview study involving 51 bereaved parents and 59 clinicians and trial team members associated with five neonatal trials; and a methodological study to inform future research. Fifty RCTs were identified as having enrolled babies or children from 2002 to 2006. Approximately 50% of UK NICUs and PICUs (54 NICUs, six PICUs) participated in at least one of these trials. Collectively they enrolled over 3000 children. Most enrolled small numbers, the majority of participants being enrolled by a small group of academic medical units. The proportion of deaths following trial enrolment was 17% in NIC trials and 6% in PIC trials. The qualitative study showed that trial-related decisions were made in a range of circumstances, some after extremely preterm births, others after complicated term deliveries, often under time pressures and in escalating crises. Parents' interest in trials appeared to recede initially but could re-emerge over time. They often valued opportunities to engage with a trial and were interested in more contact and information than they actually received. Clinicians often saw NICU bereavement policies as

  6. Systematic reviews in paediatric multiple sclerosis and Creutzfeldt-Jakob disease exemplify shortcomings in methods used to evaluate therapies in rare conditions.

    PubMed

    Unkel, Steffen; Röver, Christian; Stallard, Nigel; Benda, Norbert; Posch, Martin; Zohar, Sarah; Friede, Tim

    2016-02-20

    Randomized controlled trials (RCTs) are the gold standard design of clinical research to assess interventions. However, RCTs cannot always be applied for practical or ethical reasons. To investigate the current practices in rare diseases, we review evaluations of therapeutic interventions in paediatric multiple sclerosis (MS) and Creutzfeldt-Jakob disease (CJD). In particular, we shed light on the endpoints used, the study designs implemented and the statistical methodologies applied. We conducted literature searches to identify relevant primary studies. Data on study design, objectives, endpoints, patient characteristics, randomization and masking, type of intervention, control, withdrawals and statistical methodology were extracted from the selected studies. The risk of bias and the quality of the studies were assessed. Twelve (seven) primary studies on paediatric MS (CJD) were included in the qualitative synthesis. No double-blind, randomized placebo-controlled trial for evaluating interventions in paediatric MS has been published yet. Evidence from one open-label RCT is available. The observational studies are before-after studies or controlled studies. Three of the seven selected studies on CJD are RCTs, of which two received the maximum mark on the Oxford Quality Scale. Four trials are controlled observational studies. Evidence from double-blind RCTs on the efficacy of treatments appears to be variable between rare diseases. With regard to paediatric conditions it remains to be seen what impact regulators will have through e.g., paediatric investigation plans. Overall, there is space for improvement by using innovative trial designs and data analysis techniques.

  7. Paediatric musculoskeletal interventional radiology

    PubMed Central

    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. PMID:26235144

  8. [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.

  9. Evaluation of the health promotion activities of paediatric nurses: is the Ottawa Charter for Health Promotion a useful framework?

    PubMed

    Roden, Janet; Jarvis, Lynda

    2012-06-01

    Researchers were involved in an evaluative approach to examine the health promotion activities of paediatric nurses from a paediatric tertiary hospital centre (N = 83) and five paediatric non-tertiary hospital centres (N = 48) from Sydney, Australia. The aims of this study were to understand the nature of heath promotion in paediatric nursing practice by examining nurses' attitudes, investigating paediatric nurses' involvement in the five action area of the Ottawa Charter, and identifying barriers to the implementation of health promotion in practice. The researchers developed a health promotion survey based around the Ottawa Charter for Health Promotion (World Health Organisation, 1986a), and a literature review of nurses' involvement in health promotion. Results showed that tertiary paediatric nurses undertook more varied health promotion activities such as creating supportive environments (CSE), reorienting health services (RHS) and building healthy public policy (BHPP) than did non-tertiary paediatric nurses who were involved in only one action area of the Charter, that of developing personal skills (DPS). This research revealed that within paediatric nursing practice the action areas of the Ottawa Charter of BHPP and CSE were important; and that there is support for the advocacy role of paediatric nurses. There is also evidence that paediatric nurses may have health promotion knowledge deficits associated with the Ottawa Charter, and that the environment of multidisciplinary allied health professionals in a tertiary paediatric centre may positively influence senior paediatric nurses and their capacity to be involved in varied health promotion activities associated with the Ottawa Charter.

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

    PubMed

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

    2010-08-01

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

  11. 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.

  12. Contextual Factors Impacting Practice Beliefs and Practice Behaviors among Social Workers with Lesbian and Gay Clients.

    PubMed

    Mullins, Mary H

    2015-01-01

    In this study the author explores contextual factors that impact practice beliefs and behaviors among social workers with lesbian and gay clients. The Gay Affirmative Practice scale was used to measure levels of gay affirmative practice beliefs and practice behaviors among social workers in a medical setting. A model is presented that illustrates how contextual factors related to education, training, relationships with lesbian and gay individuals, and religiosity affects social workers' practice behaviors. The results illustrate the importance of educational exposure and affirming practice beliefs on practice behaviors.

  13. 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

  14. Impact of the introduction of rotavirus vaccination on paediatric hospital admissions, Lothian, Scotland: a retrospective observational study.

    PubMed

    Forrest, Ruth; Jones, Laura; Willocks, Lorna; Hardie, Alison; Templeton, Kate

    2017-04-01

    Rotavirus (RV) vaccination was introduced into the UK vaccination schedule in July 2013. This retrospective observational study assessed, in a UK setting, the impact of the vaccination programme on the number of RV gastroenteritis (RVGE) admissions, the complications of RVGE in hospitalised children, and the impact on hospital-acquired RVGE. Over a 3 year period, 1-year before and 2 years after the introduction of the vaccine, children under 13 years of age in Lothian region with RV+ve stool sample by PCR were identified, retrospectively, and admission data (length of stay, complications) and vaccination status analysed. Viral strain (vaccine/wild type) was typed using PCR-based methods in vaccinated children. Vaccination uptake in the first 2 years of the programme was 93-94%. In the 2 years following vaccine introduction, the annual number of confirmed RVGE admissions fell by 84.7% (95% CI 75.4 to 91.0), from 131 to 20, bed days reduced by 91.1% (86.9 to 94.1), from 325 to 29, and suspected hospital-acquired infections reduced by 95.7% (73.5-99.5), from 23 to 1. The reduction in admissions was seen across all age groups despite the vaccination only being administered to infants. Despite the reduction in incidence, complication rates in children admitted with RVGE remained unchanged across the three study years. A frequent incidental finding was RV vaccine strain in the stools of vaccinated children, up to 43 days after last immunisation. There has been no concurrent increase in rate of intussusception in the region. These results provide encouraging initial evidence of the public health benefit, including to the unimmunised population, of the RV vaccination programme in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Five High-Impact Teaching Practices

    ERIC Educational Resources Information Center

    Fink, L. Dee

    2016-01-01

    If we want our teaching to have a major impact on student learning, what are some ideas that can help us do that? Since 1990, the scholars of teaching and learning have been generating a wealth of new ideas about college-level teaching. All of these are good ideas, but which ones have the most potential to have a high impact on student engagement…

  16. 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

  17. Current educational status of paediatric rheumatology in Europe: the results of PReS survey.

    PubMed

    Demirkaya, E; Ozen, S; Türker, T; Kuis, W; Saurenmann, R K

    2009-01-01

    To understand the status of education and problems in paediatric rheumatology practice in Europe, through a survey. A 26-item questionnaire was conducted during the 14th Congress of the Paediatric Rheumatology European Society in Istanbul, 2007. Physicians who were practicing or studying within the field of paediatric rheumatology for at least one year were included in the survey. One hundred and twenty eight physicians, 79 paediatric rheumatologists (including 5 paediatric immunologists and 10 paediatric nephrologists), 34 paediatric rheumatology fellows and 15 adult rheumatologists completed the survey. The physicians were from: Europe 95 (81.9%), South America 12 (10.4%), Middle East 5 (4.3%), Asia 2 (1.7%), Africa 2 (1.7%). The duration of training for paediatric rheumatology ranged between 1-5 years (mean: 3.12+/-1.11). Sixty physicians scored their education as unsatisfactory and among those, 48 physicians were from Europe. Physicians reported good skills in the following items; intraarticular injections (83.3%); soft tissue injections (47.6%); evaluation of radiographs (67.5%); whereas competence in the evaluation of computed tomography/magnetic resonance imaging (30.5%); and musculoskeletal sonography (16.7%) was much lower. A need for improved basic science and rotations among relevant fields were specifically expressed. Being a relatively new speciality in the realm of paediatrics, paediatric rheumatology education at the European level needs to be further discussed, revised and uniformed.

  18. Training Research: Practical Recommendations for Maximum Impact

    PubMed Central

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

    2011-01-01

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

  19. Vitamin D deficiency: a paediatric orthopaedic perspective.

    PubMed

    Clarke, Nicholas M P; Page, Jonathan E

    2012-02-01

    At the turn of the last century, rickets (vitamin D deficiency) was one of the most common musculoskeletal diseases of the paediatric population presenting to physicians. Today, the most common referral pathway for these patients ends in a paediatric orthopaedic outpatient clinic. Vitamin D deficiency is a clinical entity that can affect all children and should be looked for in all children with musculoskeletal symptoms. The child at risk of rickets is now white, breastfed, protected from the sun and obese. Vitamin D deficiency can present as atypical muscular pain, pathological fractures or slipped upper femoral epiphysis. Obesity is linked with lower vitamin D levels; however, in the paediatric population, this does not necessarily equal clinical disorder. Vitamin D supplements can be used to reduce the risk of pathological fractures in the cerebral palsy child. It should also form part of the differential diagnosis in the work-up of nonaccidental injuries. Children with a low vitamin D present with a higher incidence of fractures from normal activities. Vitamin D levels need to be assessed before any form of orthopaedic surgery, as it can affect growth, both in the diaphysis of the bone and in the growth plate. Vitamin D levels are a key element in the successful practice of paediatric orthopaedics. It is not just the possible cause of disorder presenting to the clinician but also extremely important in ensuring the successful postoperative recovery of the patient.

  20. The paediatric story of human papillomavirus (Review)

    PubMed Central

    MAMMAS, IOANNIS N.; SOURVINOS, GEORGE; SPANDIDOS, DEMETRIOS A.

    2014-01-01

    Human papillomavirus (HPV) is composed of a particularly heterogeneous family of DNA viruses, which has gained much attention in recent years due to the discoveries of Professor Harald zur Hausen, who first identified a connection between HPV and cervical cancer. Professor Harald zur Hausen, the ‘Father of HPV Virology’, was the recipient of the 2008 Nobel Prize. HPV can be transmitted through physical contact via autoinoculation or fomites, sexual contact, as well as vertically from the HPV-positive mother to her newborn, causing subclinical or clinical infections. In infancy and childhood, HPV-associated clinical infections include skin warts, genital warts and juvenile recurrent respiratory papillomatosis, while cervical squamous intraepithelial lesions have also been reported among adolescent girls. To date, several research teams, worldwide, have extensively investigated HPV from the paediatric point of view. This primitive effort has been performed before the recent great expansion of paediatric HPV research due to the vaccination programmes against HPV, which were introduced into clinical practice in 2006. In this review article, we present a brief overview of paediatric HPV research after the first report in 1978 involving children in the research of HPV until the time point of this great expansion. In the future, it is expected that further unresolved issues will be addressed and clarified, as the paediatric story of HPV remains a challenging research target. PMID:25013461

  1. Paediatric psychological problems.

    PubMed

    Pollack, Allan; Harrison, Christopher; Charles, Janice; Britt, Helena

    2014-04-01

    A 2011 BEACH-based study showed that over the past 40 years there has been increasing general practitioner (GP) involvement in the management of paediatric mental health in Australia. There has also been a changing mix of psychological conditions managed, including increased management of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).

  2. Safe paediatric intensive care. Part 2: workplace organisation, critical incident monitoring and guidelines.

    PubMed

    Frey, Bernhard; Argent, Andrew

    2004-07-01

    In order to optimise safety within the paediatric intensive care unit (PICU), it is essential to optimise organisation, identify problem areas and implement standards and guidelines for safe practice (with appropriate monitoring). Organisational issues have a major impact on safety: the introduction and-recently-centralisation of paediatric intensive care, the appointment of dedicated paediatric intensivists, nursing staffing, handovers, rounds, the number of work hours and night shifts with the associated problems of disturbed circadian rhythms. The technique of voluntary, anonymous, non-punitive critical incident reporting has the potential to identify incidents and latent errors before they become self-evident through a major incident. This systems approach focuses on organisational and communication problems. Standards and guidelines may help in weighing up the benefits and risks of invasive procedures, and interventional studies have shown that implementation of standards and guidelines can improve outcome. Mortality prediction models enable us to monitor quality of care and, thus, to investigate the best ways of organising intensive care and monitoring the effects of changes in practice.

  3. Connecting to Experience: High-Impact Practices for Leadership Development.

    PubMed

    Priest, Kerry L; Clegorne, Nicholas A

    2015-01-01

    Leadership educators can leverage high-impact experiences to enhance student leadership development. This chapter describes three key practices--sociocultural conversations with peers, mentoring, and membership in off-campus organizations--as levers of leadership learning. Illustrations of the practice in context and reflections from practitioners and students are also included. The chapter concludes with considerations of context, developmental readiness, and best practices of experiential education. © 2015 Wiley Periodicals, Inc., A Wiley Company.

  4. Examining Internships as a High-Impact Educational Practice

    ERIC Educational Resources Information Center

    Keller, Kerri Day

    2012-01-01

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

  5. Examining Internships as a High-Impact Educational Practice

    ERIC Educational Resources Information Center

    Keller, Kerri Day

    2012-01-01

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

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

    PubMed

    Farre, Albert; Cummins, Carole

    2016-02-03

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

  7. Michigan tax changes: the impact on you and your practice.

    PubMed

    Copping, B D

    1995-08-01

    Governor Engler and the Legislature have been very active over the last year enacting numerous tax changes that have affected both your individual and your practice's "bottom lines." This article will summarize these changes both for your Michigan personal income tax and for the Single Business Tax (SBT). The SBT changes are illustrated later in the article by comparing the SBT liability with and without the impact of the new laws, as they would impact typical solo practitioners; a two-person practice; and a physicians group practice.

  8. Environmental impact assessment in practice: A gender critique

    SciTech Connect

    Kurian, P.A. |

    1995-06-01

    The author evaluates the extent to which environmental impact assessment (EIA) as conceptualized by EIA systems is a gendered process. Through a discourse analysis of in-depth interviews with bureaucrats, technocrats, and activists involved with the Sardar Sarovar dam project in India, the author examines the practice of EIA in a Third World country. She uses a theoretical framework, informed by a theory of gender, to evaluate the interviews. In practice, EIA is marked by gender biases that ignore the gender-specific nature of impacts. Such biases distort the impact assessment process, making environmental sustainability difficult, if not impossible, to achieve.

  9. Impact of peritoneal transport characteristics on cardiac function in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report.

    PubMed

    Bakkaloglu, Sevcan A; Saygili, Arda; Sever, Lale; Aksu, Nejat; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Doganay, Beyza; Yildiz, Nurdan; Akalin, Figen; Caliskan, Salim; Kara, Orhan D; Duzova, Ali; Soylu, Alper; Atalay, Semra

    2010-07-01

    The peritoneal equilibration test (PET) is recommended in paediatric peritoneal dialysis (PD) patients to assist prescription management. Despite contradictory reports, high transporter status is associated with reduced survival rate in adults. Since cardiac disease is one of the main causes of mortality in paediatric PD patients, we aimed to evaluate whether transport features have any effect on biochemical data and cardiac function in this group. One hundred and ten PD patients (13 +/- 5 years, PD vintage: 31 +/- 27 months) were enrolled into the study. Four-hour dialysate/plasma creatinine ratio was used for differentiating PET groups. Thirty-eight patients were high transporters, 29 were high-average transporters and 43 were low-average/low transporters. Echocardiography was performed in all subjects. Age, PD vintage, dialysate glucose concentration, ultrafiltration volume, urine volume and blood pressure levels were similar in all PET groups. No biochemical or echocardiographic data (ejection fraction, fractional shortening, left ventricular mass index, myocardial performance index, power Doppler E/tissue Doppler E ratio reflecting diastolic function) were different among PET groups except lower albumin (P = 0.025) levels in high transporters and higher high-sensitivity C-reactive protein (P = 0.026) levels in high and high-average transporters compared to other transport groups. Cardiac structural and functional abnormalities are highly prevalent among paediatric PD patients. Transport rates did not have a significant effect on biochemical parameters or cardiac structural/functional parameters. It might be suggested that being a high transporter does not provide a disadvantage in terms of atherogenic tendency and cardiac disease in paediatric PD patients. Oligoanuria, anaemia and hypertension were independent predictors of cardiac disease.

  10. The implausibility of 'usual care' in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).

    PubMed

    Blackwood, Bronagh; Tume, Lyvonne

    2015-07-31

    The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention. Using a fieldwork approach, we describe PICU context, 'usual' practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff. Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9% and 4% of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39% of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9% of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74%) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision. We

  11. 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.

  12. Immobilisation in Australian paediatric medical imaging: A pilot study.

    PubMed

    Noonan, S; Spuur, K; Nielsen, S

    2017-05-01

    The primary aim of this study is to document the use of paediatric immobilisation techniques in medical imaging. Secondary aims are to investigate differences between current practice of paediatric and non-paediatric facilities and radiographer gender and to investigate immobilisation protocols. A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) newsletter. Radiographer members of ASMIRT were invited to participate. Frequency percentage analysis was undertaken; as the 'frequency of immobilisation' response was on a Likert scale and the ages categorical, a Fisher's exact test could determine dependency. The use of paediatric immobilisation techniques was determined to be related to age. The most commonly used technique in general X-ray was "other people"; in computed tomography, Velcro, verbal reminders and distraction techniques; and in magnetic resonance imaging, sedation and Velcro. A comparison of immobilisation techniques demonstrated that Velcro use in X-ray was dependent on facility (p = 0.017) with paediatric facilities using it up to 17 years. Immobilisation frequency was dependent in 13-17 years (p = 0.035) with paediatric facilities rarely immobilising and non-paediatric facilities never. No dependencies resulted upon comparing genders. Immobilisation frequency was not dependent between protocols or current practice. The use of paediatric immobilisation technique is related to age with "other people", sedation, Velcro, verbal reminders and distraction techniques being regularly used. The dependency of Velcro use and immobilisation frequency in 13-17 years is for unknown reasons and further investigation is required. A larger study should be carried out to validate these findings. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  13. Medication communication between nurses and doctors for paediatric acute care: An ethnographic study.

    PubMed

    Borrott, Narelle; Kinney, Sharon; Newall, Fiona; Williams, Allison; Cranswick, Noel; Wong, Ian; Manias, Elizabeth

    2017-07-01

    To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. Communication between health professionals influences medication incidents' occurrence and safe care. An ethnographic study was undertaken. Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands

  14. The impact of globalisation on teleradiology practice.

    PubMed

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

    2008-01-01

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

  15. A general dental practice research network: impact of oral health in general dental practice patients.

    PubMed

    Kay, E J; Ward, N; Locker, D

    2003-06-14

    To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. General dental Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.

  16. Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (Part 1 - Procedural nomenclature).

    PubMed

    Bergersen, Lisa; Everett, Allen Dale; Giroud, Jorge Manuel; Martin, Gerard R; Franklin, Rodney Cyril George; Béland, Marie Josée; Krogmann, Otto Nils; Aiello, Vera Demarchi; Colan, Steven D; Elliott, Martin J; Gaynor, J William; Kurosawa, Hiromi; Maruszewski, Bohdan; Stellin, Giovanni; Tchervenkov, Christo I; Walters, Henry Lane; Weinberg, Paul; Jacobs, Jeffrey Phillip

    2011-06-01

    Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and on the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the first part of a two-part series. Part 1 will cover the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. This procedural nomenclature of The International Paediatric and Congenital Cardiac Code will be used in the IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry® of The American College of Cardiology. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.

  17. Population approaches in paediatrics.

    PubMed

    Chatelut, Etienne

    2008-12-01

    Population pharmacokinetic (PK) approach is now often used to evaluate PK characteristics of a new compound during its clinical development. Recently, new legislation governing the development and authorization of medicines for use in children aged 0-17 years was introduced in the European Union. Among the strategies proposed in relation to clinical aspects, use of population PKs is stated. In this manuscript, comparison between standard PK and population PK methods will be briefly addressed to understand why the second is particularly adapted to perform PK studies in paediatrics. Then, specific patients' characteristics (covariates) in paediatrics will be presented. Examples of PK and PK-pharmacodynamic (PK-PD) studies will be finally given. The number of population PK studies published still exceeds largely those of PK-PD.

  18. 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

  19. Paediatric sports injuries.

    PubMed

    Huguenin, Leesa

    2016-07-01

    Paediatric sports injuries are common. Fortunately, most children self-modulate their activity levels when injured until they recover, but some will seek medical help. Injury pattern varies with age, mechanism and the chosen sport. The aim of this article is to give a general overview of some of the more common paediatric sports injuries, including common patterns of pathogenesis, the effects of growth and biomechanics on tissue load, and issues particular to specific sports. The immature body has different strength ratios of bone, muscle and tendon, and is constantly developing coordination and body awareness, which are affected by growth and neurological maturation. When planning the return to sport after an injury, the demands of the chosen sport, hours and periodisation of training, and requirements of schooling need to be considered. Bio-mechanical issues are best addressed early in treatment to improve return-to-activity outcomes.

  20. Paediatric pharmacokinetics: key considerations.

    PubMed

    Batchelor, Hannah Katharine; Marriott, John Francis

    2015-03-01

    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. © 2014 The British Pharmacological Society.

  1. 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.

  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. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. [Diagnosis of tuberculosis in paediatrics].

    PubMed

    Moreno-Pérez, D; Andrés Martín, A; Altet Gómez, N; Baquero-Artigao, F; Escribano Montaner, A; Gómez-Pastrana Durán, D; González Montero, R; Mellado Peña, M J; Rodrigo-Gonzalo-de-Liria, C; Ruiz Serrano, M J

    2010-04-01

    Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.

  4. Possible global environmental impacts of solid waste practices

    SciTech Connect

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

    1994-09-01

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

  5. [Drug administration to paediatric inpatient].

    PubMed

    Fontan, J E; Mille, F; Brion, F; Aubin, F; Ballereau, F; Benoît, G; Brunet, M L; Braguier, D; Combeau, D; Dugast, P; Gérout, A C; May, I; Meunier, P; Naveau-Ploux, C; Proust, V; Samdjee, F; Schlatter, J; Thébault, A; Vié, M

    2004-10-01

    Available commercial drugs in France are often unsuitable for children. The aim of this study was, for every medicinal form orally or parenterally administered, to identify and to quantify difficulties met by the nurses administering drugs to paediatric inpatients and to propose solutions to main identified problems. The study was realized in 14 hospitals by direct observation. The observer, provided with a questionnaire, followed during a time slot of at least 2 h for one or several nurses and raised all the oral or injectable administrations. One thousand and nine hundred forty-six observations were performed. The children were 12.6 +/- 17 months old, and weighed 8.5 +/- 9.4 kg. Injectable drugs: half of the observations showed a posology and a mode of dilution not corresponding to the summary of product characteristics. Eight percent of orally administered drugs were injectable drugs. In 35.5% of cases, administered amount was lower than the quarter of the present quantity in the therapeutic unity. The rest of the therapeutic unity was thrown (77.2% of cases). Liquid oral forms: liquid oral forms were ready for use regarding 83.8% of cases. The medicine was readministered to the same patient (23.5%), and/or administered to other patients (80.0%). Capsules: 66.9% of the administered capsules were prepared by the hospital pharmacies. The pharmacies organized with an unit dose drug dispensing system produced significantly more preparations than those working by global distribution (P < 0.0001). In 58.4% of cases, the administered capsule was an off-label drug. Tablets: 46% of drug administration concerned a tablet without pediatric indication. 46.7% of tablets were cut, 74% were crushed. Bags: in 35.2% of observations, the bag was not administered in its entirety. Our study confirms the unsuitability of drugs to paediatric inpatients, the necessity of recommendations of good practices in the administration of drugs to paediatric inpatients, and proposes corrective

  6. Cost Impact Assessment of Cost Accounting Practice Changes.

    DTIC Science & Technology

    1980-09-01

    7A0-A092 434 NAVAL POSTGRADUATE SCHOOL MONTEREY CA F/0 5/1 COST IMPACT ASSESSMENT OF COST ACCOUNTING PRACTICE CHANGES.(UlNL S EP 80 J S ANDERSONUN CL...MNGER 4. TITLE (mod Su&CEI* I. Tyss[ of REPORT & 11.1110 Coyenea Cost Impact Assessment of Cost Accounting Master’ s Thesis; September Practice Chages... Accounting ," IICASB,’I "Audits," IV"DCASŕ "Decision Models." 20. ASTMAC T (CO.COuMMO 10 GW 0ewr 0 Ite 00404.....VI 0114 id..CEF of 001111 inmb,) *This

  7. 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.

  8. Denominator estimation: approaches in the Hamburg paediatric sentinel network.

    PubMed Central

    Kellerhof, M; Gritz, K; Brand, H

    1995-01-01

    STUDY OBJECTIVE--The aims were to develop an estimator for the size of paediatric practices to be used as a denominator for purposes of comparison; to analyse the age structure of the patients attending paediatric practices and to check the necessity for an age specific denominator; and to validate the denominator information by other available data. DESIGN--This was an observational study. SETTING/PARTICIPANTS--A sentinel network was set up comprising 26 self selected paediatric practices. Weekly patient contacts in relation to age and sex were counted three times during the study period of two years. In addition, accounting data, including the total number of children treated in a given three month period (quarter), were available. MAIN RESULTS--Weekly patient contact counts were stable over time, not in terms of the absolute number of contacts but in the rank positions of the practices (rs = 0.86) and in their age structure. The age distribution of weekly patient contacts differed significantly between the practices. Cross validation of the weekly contact count by means of the quarterly accounting data resulted in a rank correlation of rs = 0.90. CONCLUSIONS--Sentinel networks with paediatric practices should use age specific denominator information. Weekly contact group, estimated by counts in a sample of weeks, is a stable and easily available denominator for sentinel practices in the context of the German health care system. Images PMID:7561666

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

    ERIC Educational Resources Information Center

    Tukibayeva, Malika; Gonyea, Robert M.

    2014-01-01

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

  10. The Impact of Action Learning Experience on Reflective Practice

    ERIC Educational Resources Information Center

    Harris, Nicole S.

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Tukibayeva, Malika; Gonyea, Robert M.

    2014-01-01

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

  12. The Impact of Postgraduate Studies on the Teachers' Practice

    ERIC Educational Resources Information Center

    Ion, Georgeta; Iucu, Romita

    2016-01-01

    This paper analyses the perceptions of teachers involved in postgraduate studies of the importance of their study programme for their profession, describes the benefits of postgraduate studies for their practice and examines the strategies used to enhance the impact research they undertake on their teaching. A questionnaire was administered to 161…

  13. NHS Lanarkshire's leadership development programme's impact on clinical practice.

    PubMed

    Sutherland, Angela M; Dodd, Frances

    2008-01-01

    The purpose of this paper is to explore the effect of a clinical leadership programme on senior clinicians within National Health Service Lanarkshire, in terms of key constituents for fostering leadership development, specific skills developed and impact this has had on clinical practice. A qualitative research design was employed over several stages, involving 44 senior clinical managers, with member validation substantiating findings and thematic analysis used to analyse data collected. The programme's impact was evident in acknowledged change to participants' attitude, behaviour and performance with examples conveyed to demonstrate both the effect on clinical practice and perceived organisational benefits gained. The use of role play, scenario planning and enquiry-based learning approaches were deemed critical in achieving such change. Time constraints merited two different cohorts being examined simultaneously during the various stages of the programme. A longitudinal study is underway encompassing the evaluations of several cohorts through various stages of the programme to enable time-based comparisons to be made and enhance the rigour and scrutiny of the programme's impact on clinical practice. The paper is foremost in determining structure and processes employed on the programme, specific leadership skills developed, subsequent effect on clinical practice and perceived organisational benefits gained but not necessarily contemplated by staff prior to embarking on the programme, such as the emergence of communities of practice.

  14. Lessons Learned from IMPACTing Technology Integration Practices: Four IMPACT Model Case Studies

    ERIC Educational Resources Information Center

    Sugar, William; Kester, Diane D.

    2007-01-01

    This article describes the efforts of four North Carolina schools that implemented the state's IMPACT model into their respective schools. The primary emphasis of this IMPACT model focuses on the efforts of a technology facilitator in facilitating effective technology integration practices with public school teachers. Outcomes of this evaluation…

  15. The evaluation and management of paediatric headaches

    PubMed Central

    Dooley, JM

    2009-01-01

    The management of patients with headaches is a major component of every paediatric practice. In a nationally representative sample of Canadian adolescents, it was found that 26.6% of those 12 to 13 years of age and 31.2% of those 14 to 15 years of age reported that they experienced headaches at least once per week. The diagnosis of headaches in children and adolescents is established through a headache history in the vast majority of patients. Specific questions can identify those at most risk for headaches secondary to underlying pathology. Similarly, the examination should be tailored to identify those who require further investigation. Investigations are not routinely indicated for paediatric headache, but neuroimaging should be considered in children whose headaches do not meet the criteria for one of the primary headache syndromes and in those with an abnormal neurological examination. The optimal treatment of primary headaches should begin with nonpharmacological methods. Preventive pharmacological therapy should be considered when headaches significantly impair the patient’s quality of life. Flunarizine may be valuable in paediatric headache prevention, and ibuprofen, acetaminophen and nasal sumatriptan may be effective in the acute management of headaches. PMID:19436460

  16. Injuries in the competitive paediatric motocross athlete.

    PubMed

    Arena, C B; Holbert, J A; Hennrikus, W L

    2017-06-01

    The purpose of this study is to report the spectrum of injuries sustained by competitive paediatric motocross athletes at a level I trauma centre. A retrospective study of paediatric competitive motocross injuries treated at a level I trauma centre between 2004 and 2014 was performed. Athletes were included if aged less than 18 years and injured while practising or competing on a competitive motocross track. Medical records were reviewed for age, gender, race, location of accident, use of safety equipment, mechanism of injury, injury type and severity, Glasgow Coma Score at hospital presentation and Injury Severity Score (ISS). In total, 35 athletes were studied. The average age was 14 years. One athlete died. Thirty athletes were injured during competition; five were injured during practice. Twenty-four athletes (69%) suffered an orthopaedic injury with a total of 32 fractures and two dislocations. Two fractures were open (6.3%). Lower extremity fractures were twice as common as upper extremity fractures. Surgery was more common for lower extremity fractures-83% versus 30%. The most common fractures were femoral shaft (18.8%), fibula (12.5%), clavicle (12.5%), tibial shaft (9.4%) and forearm (9.4%). Competitive paediatric motocross athletes suffer serious, potentially life-threatening injuries despite the required use of protective safety equipment. Femoral shaft, fibula and clavicle were found to be the most commonly fractured bones. Further prospective research into track regulations, protective equipment and course design may reduce the trauma burden in this athlete population.

  17. Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma.

    PubMed

    Cranage, Simone; Banwell, Helen; Williams, Cylie M

    2016-01-01

    Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0-18 years. Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics(©) survey platform. The first round of the survey consisted of open-ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures. There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma. The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist

  18. Improving paediatric asthma care in Zambia.

    PubMed

    Wa Somwe, Somwe; Jumbe-Marsden, Emilia; Mateyo, Kondwelani; Senkwe, Mutale Nsakashalo; Sotomayor-Ruiz, Maria; Musuku, John; Soriano, Joan B; Ancochea, Julio; Fishman, Mark C

    2015-10-01

    In 2008, the prevalence of paediatric asthma in Zambia was unknown and the national treatment guideline was outdated. We created an international partnership between Zambian clinicians, the Zambian Government and a pharmaceutical company to address shortcomings in asthma treatment. We did two studies, one to estimate prevalence in the capital of Lusaka and one to assess attitudes and practices of patients. Based on the information obtained, we educated health workers and the public. The information from the studies was also used to modernize government policy for paediatric asthma management. The health-care system in Zambia is primarily focused on acute care delivery with a focus on infectious diseases. Comprehensive services for noncommunicable diseases are lacking. Asthma management relies on treatment of acute exacerbations instead of disease control. Seven percent of children surveyed had asthma (255/3911). Of the 120 patients interviewed, most (82/120, 68%) used oral short-acting β2-agonists for symptom control; almost half (59/120, 49%) did not think the symptoms were preventable and 43% (52/120) thought inhalers were addictive. These misconceptions informed broad-based educational programmes. We used a train-the-trainer model to educate health-care workers and ran public awareness campaigns. Access to inhalers was increased and the Zambian standard treatment guideline for paediatric asthma was revised to include steroid inhalers as a control treatment. Joint activities were required to change paediatric asthma care in Zambia. Success will depend on local sustainability, and it may be necessary to shift resources to mirror the disease burden.

  19. General practice training environment and its impact on preparedness.

    PubMed

    Wiener-Ogilvie, Sharon; Bennison, Jenny; Smith, Victor

    2014-01-01

    The notion of preparedness for practice is poorly defined in medical education literature. It is unclear what preparedness means and how the training environment impacts on preparedness for practice. This paper aims to explore the meaning that GP trainees and newly qualified GPs attach to the notion of preparedness, and to examine the ways in which they perceive their training environment to impact on preparedness. We used a qualitative interpretive approach and conducted 27 in-depth semi-structured interviews with 15 newly qualified GPs and 12 GP trainees at the end of their training. Two central categories describing preparedness emerged; 'confidence' and 'adaptability'. Inclusive training practices, characterised by non-hierarchical relationships between the doctors, particularly vis-à-vis trainees, were reported to be more 'progressive' and were better at preparing trainees. The way the training practice can impact on preparedness can be explained drawing on Lave and Wenger's theory of 'situated learning'. The role of the trainer was also pivotal in preparing trainees. Supervision tailored to trainees' needs, and guided decision making enhanced confidence of trainees in their ability to work independently in the future. We suggest that for GP trainees to be better prepared it is not enough to extend GP training; rather it is important that GP trainees' time is spent in inclusive training environments.

  20. Collaborative practice and patient satisfaction: impact and selected outcomes.

    PubMed

    Koerner, B L; Cohen, J R

    1985-09-01

    The Collaborative Practice was a demonstration project sponsored by the Hartford Hospital Administration, and the Departments of Medicine and Nursing. A prospective evaluative study was established to measure the impact of collaborative practice on increased patient and family satisfaction with health care, as well as the impact on selected outcome variables. A specific 27-bed medical unit and a comparison unit with identical structural characteristics were chosen for study from March 31, 1982, to March 31, 1983. Results of the study indicate that significant differences in patients' perceptions of care existed between the Collaborative Practice Unit (CPU) and the comparison unit under a traditional team nursing system. More positive ratings from patients on the CPU were found for all selected dimensions: patient-provider interaction; quality of care; health education; knowledge of practitioners; and the environment. In order to assess the impact of collaborative practice on outcome variables, a retrospective audit of randomly selected patient records was done. No significant differences for selected variables were found except for the number of health teaching plans. More documented health teaching was recorded on the Team Nursing Unit.

  1. Practical Models of Human Vulnerability to Impacting Debris

    NASA Astrophysics Data System (ADS)

    Haber, Jerold M.; Linn, Angela M.

    2005-12-01

    We used a combination of biomechanical modeling of human response to impacts, analysis of empirical injury data, and probabilistic modeling of uncertainty mechanisms to build practical models for predicting injuries to various population groups from the fragment environment generated by weapons testing and malfunctions of space launch vehicles. Our effort was designed to provide planners with the ability to design effective mitigations. As a result, we studied the effect of body size, impact location, and injury mechanism on injury severity. An important resulting benefit is to provide better model the vulnerability of children, a significant portion of the population outside of the immediate launch area. They tend to be more vulnerable to impact injuries than adults and present different impact geometry. These models are currently used in risk analysis models being employed in the United States by the U.S. Air Force, Navy and the Associate for Space Transportation in the Federal Aviation Administration.

  2. Investigation of Preferential Flow in Low Impact Development Practice

    NASA Astrophysics Data System (ADS)

    Liu, L.; Cao, R.; Wang, C.; Jiang, W.; Wang, J.; Xia, Z.

    2016-12-01

    The characteristics of preferential flow in soil affect Low Impact Development (LID) practices in two aspects. On the one hand, preferential flow may facilitate drainage of stormwater by causing non-uniform movement of water through a small portion of media (such as cracks and holes), and thus leading to much faster transport of water and solutes in one specific direction than others. On the other hand, within a certain ranges, preferential flow may weaken the subgrade capacity of pressure and/or shear stress resistance. Therefore, for the purpose of improving LID practices, there may exist an optimum scenario with a high allowable flowrate and least negative impact of resistance capacity for a soil layer. This project aims to assist the LID design by exploring the features of preferential flow in different soil compositions, studying how different flow paths affect the stability of subgrade, preliminarily analyzing the sensitivity of preferential flow impacting on drainage capacity and subgrade stability in the LID, and further optimizing LID practices. Accordingly, the concepts of Essential Direction Path, Unessential Direction Path and the Sensitivity Coefficient are defined and analyzed to simulate a hypothetical funneling scenario in LID practice. Both irrigation apparatus experiments and numerical models are utilized in this research to investigate the features of preferential flow, effective strength and overall shear strength. The main conclusions include: (1) Investigation of preferential flow characteristics in essential direction path and unessential direction path, respectively; (2) Optimum design of preferential flow in LID practice; (3) Transport capacity determination of preferential flow path in different soils; (4) Study of preferential flow impact on roadbed stability. KEY WORDS: Preferential Flow, Subgrade stability, LID, Sensitivity Coefficient, Funneling Preferential Flow Path

  3. Paediatric vocal fold paralysis.

    PubMed

    Garcia-Lopez, Isabel; Peñorrocha-Teres, Julio; Perez-Ortin, Magdalena; Cerpa, Mauricio; Rabanal, Ignacio; Gavilan, Javier

    2013-01-01

    Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. The diagnosis of VFP may be suspected based on the patient's symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  4. The economic impact of rural family physicians practicing obstetrics.

    PubMed

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  5. How participation in surgical mortality audit impacts surgical practice.

    PubMed

    Lui, Chi-Wai; Boyle, Frances M; Wysocki, Arkadiusz Peter; Baker, Peter; D'Souza, Alisha; Faint, Sonya; Rey-Conde, Therese; North, John B

    2017-04-19

    Surgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their experience of participating in the audit and its impact on their professional practice, as well as implications for hospital systems. The study used a descriptive cross-sectional survey design. All surgeons registered in Queensland in 2015 (n = 919) were invited to complete an anonymous online questionnaire between September and October 2015. 184 surgeons completed and returned the questionnaire at a response rate of 20%. Thirty-nine percent of the participants reported that involvement in the audit process affected their clinical practice. This was particularly the case for surgeons whose participation included being an assessor. Thirteen percent of the participants had perceived improvement to hospital practices or advancement in patient care and safety as a result of audit recommendations. Analysis of the open-ended responses suggested the audit experience had led surgeons to become more cautious, reflective in action and with increased confidence in best practice, and recognise the importance of effective communication and clear documentation. This is the first study to examine the impact of participation in a mortality audit process on the professional practice of surgeons. The findings offer evidence for surgical mortality audit as an effective strategy for continuous professional development and for improving patient safety initiatives.

  6. Paediatric nuclear medicine imaging.

    PubMed

    Biassoni, Lorenzo; Easty, Marina

    2017-09-01

    Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. The data presented comes from clinical experience and some milestone papers on the subject. Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at

  7. The influence of the European paediatric regulation on marketing authorisation of orphan drugs for children.

    PubMed

    Kreeftmeijer-Vegter, Annemarie Rosan; de Boer, Anthonius; van der Vlugt-Meijer, Roselinda H; de Vries, Peter J

    2014-08-05

    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. 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. 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). 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.

  8. Training paediatric healthcare staff in recognising, understanding and managing conflict with patients and families: findings from a survey on immediate and 6-month impact.

    PubMed

    Forbat, Liz; Simons, Jean; Sayer, Charlotte; Davies, Megan; Barclay, Sarah

    2017-03-01

    Conflict is a recognised component of healthcare. Disagreements about treatment protocols, treatment aims and poor communication are recognised warning signs. Conflict management strategies can be used to prevent escalation, but are not a routine component of clinical training. To report the findings from a novel training intervention, aimed at enabling paediatric staff to identify and understand the warning signs of conflict, and to implement conflict resolution strategies. Self-report measures were taken at baseline, immediately after the training and at 6 months. Questionnaires recorded quantitative and qualitative feedback on the experience of training, and the ability to recognise and de-escalate conflict. The training was provided in a tertiary teaching paediatric hospital in England over 18 months, commencing in June 2013. A 4-h training course on identifying, understanding and managing conflict was provided to staff. Baseline data were collected from all 711 staff trained, and 6-month follow-up data were collected for 313 of those staff (44%). The training was successful in equipping staff to recognise and de-escalate conflict. Six months after the training, 57% of respondents had experienced conflict, of whom 91% reported that the training had enabled them to de-escalate the conflict. Learning was retained at 6 months with staff more able than at baseline recognising conflict triggers (Fischer's exact test, p=0.001) and managing conflict situations (Pearson's χ(2) test, p=0.001). This training has the potential to reduce substantially the human and economic costs of conflicts for healthcare providers, healthcare staff, patients and relatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. 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. Copyright © 2016. Published by Elsevier Ireland Ltd.

  10. How Policy Impacts on Practice and How Practice Does Not Impact on Policy

    ERIC Educational Resources Information Center

    Coffield, Frank; Edward, Sheila; Finlay, Ian; Hodgson, Ann; Spours, Ken; Steer, Richard; Gregson, Maggie

    2007-01-01

    The TLRP project reported on in this article attempts to understand how the Learning and Skills sector functions. It traces how education and training policy percolates down through many levels in the English system and how these levels interact, or fail to interact. The authors first focus upon how policy impacts upon the interests of three…

  11. Social media use and impact on plastic surgery practice.

    PubMed

    Vardanian, Andrew J; Kusnezov, Nicholas; Im, Daniel D; Lee, James C; Jarrahy, Reza

    2013-05-01

    Social media platforms have revolutionized the way human beings communicate, yet there is little evidence describing how the plastic surgery community has adopted social media. In this article, the authors evaluate current trends in social media use by practicing plastic surgeons. An anonymous survey on the use of social media was distributed to members of the American Society of Plastic Surgeons. Prevalent patterns of social media implementation were elucidated. One-half of respondents were regular social media users. Reasons for using social media included the beliefs that incorporation of social media into medical practice is inevitable (56.7 percent), that they are an effective marketing tool (52.1 percent), and that they provide a forum for patient education (49 percent). Surgeons with a primarily aesthetic surgery practice were more likely to use social media. Most respondents (64.6 percent) stated that social media had no effect on their practice, whereas 33.8 percent reported a positive impact and 1.5 percent reported a negative impact. This study depicts current patterns of social media use by plastic surgeons, including motivations driving its implementation and impressions on its impact. Many feel that social media are an effective marketing tool that generates increased exposure and referrals. A small number of surgeons have experienced negative repercussions from social media involvement. Our study reveals the presence of a void. There is a definite interest among those surveyed in developing best practice standards and oversight to ensure ethical use of social media platforms throughout the plastic surgery community. Continuing discussion regarding these matters should be ongoing as our experience with social media in plastic surgery evolves.

  12. [Teamwork in a paediatric mobile emergency and intensive care service].

    PubMed

    Tison-Chambellan, Camille; Daussac, Élisabeth; Barnet, Lucile; Sirven, Sabine; Bambou, Dominique

    2016-01-01

    A paediatric mobile emergency and intensive care service team comprises several professionals with complementary skills. The cohesion of a team, as well as the listening and communication skills of each of its members, allow it to respond in the best possible way to emergency situations. Feedback sessions on practice and simulation exercises enhance teamwork.

  13. 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

  14. Evidence-based paediatric surgical oncology.

    PubMed

    Losty, Paul D

    2016-10-01

    Surgeons play a pivotal role in the decision-making and multidisciplinary management of childhood solid tumours.(1) Evidence-based medicine-"aims to optimise decision making by emphasising on the use of best evidence from well-designed conducted research." This article offers a brief overview in an effort to demonstrate how a selection of well-conducted, recently published studies can help address some topical and controversial themes in paediatric surgical oncology practice. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed

    Rondeau, K V; Wagar, T H

    2001-08-01

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

  16. Paediatric recurrent herpetic whitlow.

    PubMed

    Patel, Ramnik; Kumar, Hemant; More, Bharat; Patricolo, Mario

    2013-07-31

    We present a case of recurrent painful blisters of middle phalanx of the left ring finger of a 15-month-old previously healthy and immunocompetent female child. These lesions initially were confused with infective bacterial whitlow, treated with incision and drainage, and later with cigarette burns which led to referral to child protection team. Paediatric dermatologist finally diagnosed after scrapping and virology culture. The patient had recovery following full treatment with topical and systemic acyclovir. She presented again at the age of 4 with recurrence which required topical and systemic acyclovir therapy with good recovery. It is important to be aware of the danger of incorrect diagnosis, raising child protection concerns and management leading to danger of cross infection and serious illness especially in the immunocompromised patients.

  17. [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.

  18. 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

  19. Patient doses in paediatric CT: feasibility of setting diagnostic reference levels.

    PubMed

    Järvinen, H; Merimaa, K; Seuri, R; Tyrväinen, E; Perhomaa, M; Savikurki-Heikkilä, P; Svedström, E; Ziliukas, J; Lintrop, M

    2011-09-01

    Despite the fact that doses to paediatric patients from computed tomography (CT) examinations are of special concern, only few data or studies for setting of paediatric diagnostic reference levels (DRLs) have been published. In this study, doses to children were estimated from chest and head CT, in order to study the feasibility of DRLs for these examinations. It is shown that for the DRLs, patient dose data from different CT scanners should be collected in age or weight groups, possibly for different indications. For practical reasons, the DRLs for paediatric chest CT should be given as a continuous DRL curve as a function of patient weight. For paediatric head CT, DRLs for a few age groups could be given. The users of the DRLs should be aware of the calibration phantom applied in the console calibration for different paediatric scanning protocols. The feasibility of DRLs should be re-evaluated every 2-3 y.

  20. An overview of genetics of paediatric rheumatic diseases

    PubMed Central

    Woo, Patricia; Colbert, Robert A.

    2010-01-01

    The evidence so far suggests that the paediatric inflammatory diseases encountered in rheumatology practice may be largely genetic in origin, where common single nucleotide polymorphisms (SNPs) in multiple genes contribute to risk, with real but variable environmental components. As far as genetic susceptibility to common paediatric rheumatic diseases is concerned, only juvenile idiopathic arthritis (JIA) has been investigated in any substantial way so far. This article discusses susceptibility for different types of JIA, the different methods used and their advantages and disadvantages. The genetic code is also modifiable by epigenetic mechanisms and examples of these in immunity and rheumatoid arthritis are given to indicate another area of research in the elucidation of the genetics of paediatric rheumatic diseases. PMID:19853825

  1. Does receiving genetic counseling impact genetic counselor practice?

    PubMed

    Peters, Elizabeth; McCarthy Veach, Patricia; Ward, Erin E; LeRoy, Bonnie S

    2004-10-01

    This study was an investigation of whether genetic counselors have received genetic counseling and if so, how they believe it affects their practice. One thousand genetic counselors were mailed surveys about the nature of genetic counseling services received, impact on their clinical practice, frequency and reasons for disclosing about their receipt of counseling to their clients, and demographics. Ninety-three of the 510 respondents reported receiving genetic counseling. Of these, almost three-fourths were practicing genetic counselors while receiving services. Reasons for services include prenatal concerns, family history of cancer, and history/risk of other genetic conditions. Frequently endorsed effects on practice include increased empathy and understanding of client decisions, feeling more connected with clients, greater emphasis on psychosocial support, and sympathy. Forty-six respondents disclosed to clients about their receipt of genetic counseling. Prevalent reasons include client asked, help clients feel they are not alone, demonstrate counselor understanding, decrease client anxiety, build rapport, and normalize client feelings. Practice and research recommendations are given.

  2. 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. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  3. Big Data and paediatric cardiovascular disease in the era of transparency in healthcare.

    PubMed

    Asante-Korang, Alfred; Jacobs, Jeffrey P

    2016-12-01

    The objectives of this review were to discuss the potential impact of Big Data analytics in paediatric cardiovascular disease and its potential to address the challenges of transparency in delivery of care to this unique population.

  4. Redefining perioperative advanced practice. Scope of practice: measuring impact and sustainability.

    PubMed

    Radford, Mark; Abbassi, Ann; Williamson, Alastair; Johnston, Paul

    2003-12-01

    There are increasing demands placed upon the modern NHS, particularly in emergency care. In combating these demands, new approaches to practice will form an overall strategy for improving care delivered to patients. This is the second in a series by authors from the Good Hope Hospital NHS Trust and explains their experience of developing an innovative approach to the management of surgical emergencies through the specialist nurse role in anaesthesia and emergency surgery. It examines the scope of practice, clinical and operational impact of the role, and future developments.

  5. 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.

  6. Stop the pain! A nation-wide quality improvement programme in paediatric oncology pain control.

    PubMed

    Zernikow, Boris; Hasan, Carola; Hechler, Tanja; Huebner, Bettina; Gordon, Deb; Michel, Erik

    2008-10-01

    Little is known about the impact of translation of pain management clinical practice guidelines on pain control in paediatrics. In an effort to overcome this, a longitudinal, nation-wide, multi-centre paediatric quality improvement (QI) study was initiated by the German Society of Pediatric Haematology and Oncology (GPOH) entitled Schmerz-Therapie in der Onkologischen Paediatrie (STOP). The project's primary major aims were to improve paediatric oncology pain control in Germany, and to evaluate the project's impact on the pain management quality. To achieve these aims, STOP encompassed six sequential phases to evaluate present practice, develop recommendations for practical pain control, actively engage participants in improvement strategies, and assess change. The purpose of this paper is to briefly describe STOP in its entirety, report on comparisons between active quality management (QM) departments that actively participated in the project and non-active QM departments regarding differences in pain control, patients' and parents' perspectives on pain control and health professionals' knowledge, and to discuss the impact of STOP as a whole. Four hypotheses were examined: (1) changes in health care professionals' knowledge on pain in paediatric oncology and pain management after a three-year period (2) impact of active participation in the STOP-project; (3) differences in patients' and parents' perspective in active QM versus non-active QM departments; (4) impact of the STOP-project on the health care professionals' knowledge in active QM versus non-active QM departments. Data included surveys, interviews, and standardised pre-/post-intervention documentation of pain control. All German paediatric oncology departments were invited to participate. The prime means of intervention was education (printed material, passive participation; additional lectures and feed-back, active participation). Quality indicators were defined and compared with regards to the four

  7. Impact of Healthcare Information Technology on Nursing Practice.

    PubMed

    Piscotty, Ronald J; Kalisch, Beatrice; Gracey-Thomas, Angel

    2015-07-01

    To report additional mediation findings from a descriptive cross sectional study to examine if nurses' perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care. The study used a descriptive design. The sample (N = 165) was composed of registered nurses working on acute care hospital units. The sample was obtained from a large teaching hospital in Southeast Michigan in the fall of 2012. All eligible nursing units (n = 19) were included. The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Healthcare Information Technology Scale were used to collect data to test for mediation. Mediation was tested using the method described by Baron and Kenny. Multiple regression equations were used to analyze the data to determine if mediation occurred between the variables. Missed nursing care, the outcome variable, was regressed on the predictor variable, reminder usage, and the mediator variable impact of technology on nursing practice. The impact of healthcare information technology (IHIT) on nursing practice negatively affected missed nursing care (t = -4.12, p < .001), explaining 9.8% of variance in missed nursing care. With IHIT present, the predictor (reminder usage) was no longer significant (t = -.70, p = .48). Thus, the reduced direct association between reminder usage and missed nursing care when IHIT was in the model supported the hypothesis that IHIT was at least one of the mediators in the relationship between reminder usage and missed nursing care. The perceptions of the impact of healthcare information technology mediates the relationship between nursing care reminder use and missed nursing care. The findings are beneficial to the advancement of healthcare technology in that designers of healthcare information technology systems need to keep in mind that perceptions regarding impacts of the technology will influence usage

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

    PubMed

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

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.

  9. The social media: its impact on a vascular surgery practice.

    PubMed

    Turnipseed, William D

    2013-04-01

    Social media has revolutionized interpersonal communication and has become a commonly used public informational resource. This study evaluates the impact of intranet informatics on a specialty practice of vascular surgery. Referral patterns for patients with chronic compartment syndrome (CCS) and popliteal entrapment syndrome (PAES) between 2008 and 2011 were analyzed. Demographics included referral source (physicians, nonphysicians), media resource, and case volume change. Prior to 2008, referrals came from local or regional sports medicine practices (100%). Since 2008 this pattern has changed; local/regional (80%), national (15%), and international (5%). Physician referrals dropped from 97% to 70%, and nonphysician referrals increased from 3% to 30%. Both CCS procedures and PAES procedures increased as remote geographic and public referrals increased. Referral change was associated with social media searches using applications such as PubMed and Google. Social media is an evolving source of medical information and patient referrals which physicians should cautiously embrace.

  10. Paediatric Autoimmune Liver Disease.

    PubMed

    Liberal, Rodrigo; Vergani, Diego; Mieli-Vergani, Giorgina

    2015-01-01

    In paediatrics, there are 2 liver disorders in which liver damage most likely stems from an autoimmune attack: 'classical' autoimmune hepatitis (AIH) and the AIH/sclerosing cholangitis overlap syndrome (also known as autoimmune sclerosing cholangitis, ASC). The presentation of childhood autoimmune liver disease (AILD) is non-specific and can mimic most other liver disorders. AIH is exquisitely responsive to immunosuppressive treatment, which should be instituted promptly to prevent rapid deterioration and promote remission and long-term survival. Difficult-to-treat or non-responsive patients should be treated with mycophenolate mofetil; if this fails then calcineurin inhibitors can be tried. Persistent failure to respond or lack of adherence to treatment result in end-stage liver disease. These patients, and those with fulminant liver failure at diagnosis, will require liver transplantation. ASC responds to the same immunosuppressive treatment used for AIH when treatment is initiated early. Abnormal liver function tests often resolve within a few months of treatment, although medium- to long-term prognosis is worse than that of AIH because bile duct disease continues to progress despite treatment in approximately 50% of patients. Ursodeoxycholic acid is usually added to conventional treatment regimen in ASC, but whether this actually helps arrest the progression of bile duct disease remains to be established. The pathogenesis of paediatric-onset AILD is not fully understood, although there is mounting evidence that genetic susceptibility, molecular mimicry and impaired immunoregulatory networks contribute to the initiation and perpetuation of the autoimmune attack. Liver damage is thought to be mediated primarily by CD4pos T-cells. While Th1 effector cells are associated with hepatocyte damage in both AIH and ASC, Th17 immune responses predominate in the latter where they correlate with biochemical indices of cholestasis, indicating that IL-17 is involved in the

  11. Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period.

    PubMed

    Portelli, Jonathan L; McNulty, Jonathan P; Bezzina, Paul; Rainford, Louise

    2016-12-01

    The aim of this retrospective cohort study was to gain an insight into frequencies by which a range of medical imaging (MI) examinations were performed on paediatric patients at the main acute general teaching hospital in Malta between 2008 and 2014. Frequency data of MI examinations performed on paediatric patients were retrospectively collected from relevant information systems. All data was coded accordingly to facilitate data analysis. A total of 95,805 MI examinations were performed on 39,707 unique paediatric patients (<18 years) between 2008 and 2014. Overall, the total number of paediatric MI examinations performed decreased over time, with use varying depending on modality type and paediatric age. Coincidentally the use of ultrasound and MRI increased year after year. Some paediatric patients underwent at least three MI examinations involving the same anatomical region being scanned, and which may collectively contribute to effective doses exceeding 10 mSv. Knowledge of how MI examinations are used within the paediatric population can help practices evaluate and address any trends highlighted for particular examinations or age category of paediatric patients. Furthermore, awareness of current trends of MI in children can be helpful for the planning of future paediatric radiology departments. • Medical imaging (MI) examinations are commonly performed in paediatric patients. • In 7 years 95,805 examinations were performed on 39,707 paediatric patients. • Use of ultrasound and MRI in paediatric patients increased annually. • Highest frequency of MI examinations was observed in neonates/infants younger than 1 year. • Awareness of MI utilisation patterns and trends can help inform practice.

  12. Do perinatal guidelines have an impact on obstetric practices?

    PubMed

    Vendittelli, F; Rivière, O; Crenn-Hébert, C; Giraud-Roufast, A

    2012-10-01

    The publication of several sets of French guidelines was unfortunately not accompanied by planned assessment of their impact on practices. The goal of this study was to assess the impact of eight French perinatal guidelines on actual obstetric practices. Historical cohort setting in France: the Audipog database of 299,412 pregnancies from 1994 to 2006, from which we extracted a sub-sample by randomLy selecting from each participating maternity ward all births occurring during a single month of each year (n=107,450 pregnancies). The main outcome measure was the incidence of pertinent perinatal indicators related to these guidelines. These included site of delivery for low-birth-weight infants (1998), caesarean delivery (2000), preterm delivery (2002), breastfeeding (2002), smoking and pregnancy (2004), immediate postpartum hemorrhages (2004), early discharge after delivery (2004) and episiotomies (2005). Standardised rates, before and after the year of each guideline, were compared using a Chi(2) test. The percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P<0.0001). The overall caesarean rate climbed slowly but regularly from 1994 through 2006 (P<0.0001). Use of antenatal corticosteroids for women hospitalised for threatened preterm labour and in children born before 33 weeks has fluctuated since the release of the guideline (P>0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P<0.0001). The percentage of deliveries with active management of the third stage of labour rose notably from 1999 to 2006 (P<0.0001), and smoking cessation during pregnancy rose slightly in 2006 (P<0.0001). Since 1994, early discharges have become slowly, slightly, but regularly more frequent for all women (P<0.0001). The guideline on episiotomies has had a slight positive effect in the short term (P<0.0001). Globally, the

  13. Computer aided learning to link evidence to paediatric learning and practice: a pilot in a medical school in a low income setting

    PubMed Central

    Senga, John; Ndiritu, Moses; Osundwa, Juliana; Irimu, Grace; English, Mike

    2010-01-01

    Bridging the gap between research evidence and practice is problematic in low income settings. Wereport medical students' experience with a pilot computer aided learning (CAL) program developed to enable students to explore research evidence supporting national guidelines. We asked 50 students to enter data from pre-set clinical scenarios, diagnose the severity of pneumonia/asthma and suggest treatment and then compare their diagnosis and treatment with that suggested by a computer algorithm based on the guidelines. Links to evidence supporting the guideline-suggested diagnosis and treatment were provided. Brief evidence summaries and video clips were accessed by 92% of students and full text articles by 86%. The majority of the students showed an interest in the CAL approach and suggested the scope of the approach be expanded to other illnesses. Such a system might provide one means to help students understand the link between research and policy and ultimately influence practice. PMID:21151759

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

    NASA Astrophysics Data System (ADS)

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

    2014-09-01

    Background:Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The 'Getting Practical' CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of practical work through initiating changes in teachers' predominantly 'hands-on' approach to practical work to one which manifests a more equitable balance between 'hands-on' and 'minds-on'. Purpose:To evaluate the impact of the Getting Practical: Improving Practical Work in Science CPD programme on teachers' ideas and practice in science practical work in primary and secondary schools in England. Programme description:The CPD programme was designed to improve the effectiveness of science practical work in developing conceptual understanding in primary and secondary schools in England. Sample:Ten teachers of primary science and 20 secondary science teachers. Design and methods:The study employed a condensed fieldwork strategy with data collected using interviews, observational field notes and pre- and post-CPD training observations in practical lessons within 30 schools. Results:Whilst the CPD programme was effective in getting teachers to reflect on the ideas associated with the Getting Practical programme, it was much less effective in bringing about changes in actual teaching practice. Conclusion:The findings suggest that if change, rather than only an enhanced awareness of the issues, is to be brought about in established teaching <span class="hlt">practice</span> then there is a need for ongoing support over an extended period of time. Furthermore, the <span class="hlt">impact</span> of such CPD is more likely to be effective if it is undertaken by a senior member of a department or school with the full support of the SMT.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15051247','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15051247"><span>Life cycle assessment part 2: current <span class="hlt">impact</span> assessment <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pennington, D W; Potting, J; Finnveden, G; Lindeijer, E; Jolliet, O; Rydberg, T; Rebitzer, G</p> <p>2004-07-01</p> <p>Providing our society with goods and services contributes to a wide range of environmental <span class="hlt">impacts</span>. Waste generation, emissions and the consumption of resources occur at many stages in a product's life cycle-from raw material extraction, energy acquisition, production and manufacturing, use, reuse, recycling, through to ultimate disposal. These all contribute to <span class="hlt">impacts</span> such as climate change, stratospheric ozone depletion, photooxidant formation (smog), eutrophication, acidification, toxicological stress on human health and ecosystems, the depletion of resources and noise-among others. The need exists to address these product-related contributions more holistically and in an integrated manner, providing complimentary insights to those of regulatory/process-oriented methodologies. A previous article (Part 1, Rebitzer et al., 2004) outlined how to define and model a product's life cycle in current <span class="hlt">practice</span>, as well as the methods and tools that are available for compiling the associated waste, emissions and resource consumption data into a life cycle inventory. This article highlights how practitioners and researchers from many domains have come together to provide indicators for the different <span class="hlt">impacts</span> attributable to products in the life cycle <span class="hlt">impact</span> assessment (LCIA) phase of life cycle assessment (LCA).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28901568','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28901568"><span>Shared decision-making in the <span class="hlt">paediatric</span> field: a literature review and concept analysis.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Park, Eun Sook; Cho, In Young</p> <p>2017-09-13</p> <p>The concept of shared decision-making is poorly defined and often used interchangeably with related terms. The aim of this study was to delineate and clarify the concept of shared decision-making in the <span class="hlt">paediatric</span> field. Rodgers and Knafl's evolutionary concept analysis was used to delineate and clarify the concept. Following a search of the CINAHL, PubMed and MEDLINE databases and online journals between 1995 and 2016, we included a total of 42 articles that referred to shared decision-making in the <span class="hlt">paediatric</span> field. The attributes included active participation of the three: parents, children and health professionals; collaborative partnership; reaching a compromise; and common goal for child's health. Antecedents were existing several options with different possible outcomes; substantial decisional conflict; recognising child's health situations that decision-making is needed; and willingness to participate in decision-making. Finally, the consequences included decreased decisional conflict; mutual empowerment; improved child health status; and improved quality of <span class="hlt">paediatric</span> health care. This study provides a theoretical understanding of the concept of shared decision-making in the <span class="hlt">paediatric</span> field; furthermore, by integrating this concept into <span class="hlt">paediatric</span> <span class="hlt">practice</span>, it may help to reduce the gap between theory and <span class="hlt">practice</span>. The analysis could also provide nursing researchers with insight into <span class="hlt">paediatric</span> decision-making and establish a foundation to develop future interventions and situation-specific theory for promoting high-quality decision-making in the <span class="hlt">paediatric</span> field. © 2017 Nordic College of Caring Science.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/10812279','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/10812279"><span>Bizarre <span class="hlt">paediatric</span> facial burns.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ho, W S; Ying, S Y; Wong, T W</p> <p>2000-08-01</p> <p>Child abuse and neglect account for a significant number of <span class="hlt">paediatric</span> burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the Burns Unit at the Prince of Wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1779106','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1779106"><span><span class="hlt">Paediatric</span> manpower: towards the 21st century.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Appleyard, W J; Jackson, A D</p> <p>1988-01-01</p> <p>The British <span class="hlt">Paediatric</span> Association (BPA) has carried out a national survey of <span class="hlt">paediatric</span> medical manpower in the hospital and community child health services. The results of the survey relating to England and Wales are presented and compared with Department of Health and Social Security (DHSS) manpower statistics. On the basis of the survey findings and current trends in the pattern of <span class="hlt">paediatric</span> care <span class="hlt">paediatric</span> manpower requirements over the next 10 years are estimated. PMID:3178274</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2813444','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2813444"><span>The <span class="hlt">Impact</span> of Malpractice Liability Claims on Obstetrical <span class="hlt">Practice</span> Patterns</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Gimm, Gilbert W</p> <p>2010-01-01</p> <p>Objectives This paper examines whether malpractice claims have any <span class="hlt">impact</span> on obstetrical <span class="hlt">practice</span> patterns (C-section rates) and physician delivery volume. Data Sources Secondary data from the 1992–2000 Florida Hospital Inpatient Discharge File, the Florida Medical Professional Liability Insurance Claims File, and the American Medical Association's Master File on physician characteristics. Study Design The effects of malpractice claims on C-section rates and physician delivery volume were estimated using panel data and a fixed-effects multivariate model. Data Collection Variables were constructed from each data source and merged into a single panel dataset using consistent physician identifiers. Principal Findings I did not find evidence that physicians changed their <span class="hlt">practice</span> patterns by increasing C-section rates in response to malpractice claims. However, physicians performed six fewer inpatient deliveries 3 years after the closing of a malpractice claim, after controlling for individual- and market-level characteristics. Physicians with high malpractice awards of U.S.$250,000 or more performed 14 fewer deliveries on average. Conclusions Malpractice claims led to a small reduction in physician delivery volume, but they did not have a significant <span class="hlt">impact</span> on C-section rates. PMID:19929964</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25670402','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25670402"><span>Management of <span class="hlt">paediatric</span> spontaneous pneumothorax: a multicentre retrospective case series.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Robinson, Paul D; Blackburn, Carol; Babl, Franz E; Gamage, Lalith; Schutz, Jacquie; Nogajski, Rebecca; Dalziel, Stuart; Donald, Colin B; Druda, Dino; Krieser, David; Neutze, Jocelyn; Acworth, Jason; Lee, Mark; Ngo, Peter K</p> <p>2015-10-01</p> <p><span class="hlt">Paediatric</span> guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). <span class="hlt">Paediatric</span> <span class="hlt">practice</span> is unclear, and evidence for aspiration success rates is urgently required to develop <span class="hlt">paediatric</span>-specific recommendations. Retrospective analysis of PSP and SSP management at nine <span class="hlt">paediatric</span> emergency departments across Australia and New Zealand (2003-2010) to compare PSP and SSP management. 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), p<0.05. An intercostal chest catheter (ICC) was used in 104/219 (47%) episodes. Aspiration was used in more PSP than in SSP episodes with interventions (27% (18% to 37%) vs 9% (3% to 21%), p<0.05). Aspiration success was 52% (33% to 70%) overall and not significantly different between PSP and SSP. Aspiration success was greater in small vs large pneumothoraces (80% (48% to 95%) vs 33% (14% to 61%), p=0.01). Small-bore ICCs were used in 40% of ICCs and usage increased during the study. In this descriptive study of pneumothorax management, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. <span class="hlt">Paediatric</span> prospective studies are urgently required to determine optimal <span class="hlt">paediatric</span> interventional management strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li class="active"><span>16</span></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_16 --> <div id="page_17" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li class="active"><span>17</span></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="321"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26776544','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26776544"><span>Diagnosing autism: Australian <span class="hlt">paediatric</span> research network surveys.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Randall, Melinda; Albein-Urios, Natalia; Brignell, Amanda; Gulenc, Alisha; Hennel, Sabine; Coates, Cathy; Symeonides, Christos; Hiscock, Harriet; Marraffa, Catherine; Silove, Natalie; Bayl, Vivian; Woolfenden, Susan; Williams, Katrina</p> <p>2016-01-01</p> <p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder with reported prevalence of more than 1/100. In Australia, paediatricians are often involved in diagnosing ASD and providing long-term management. However, it is not known how paediatricians diagnose ASD. This study aimed to investigate whether the way Australian paediatricians diagnose ASD is in line with current recommendations. Members of the Australian <span class="hlt">Paediatric</span> Research Network were invited to answer questions about their ASD diagnostic <span class="hlt">practice</span> in a multi-topic survey and also as part of a study about parents needs around the time of a diagnosis of ASD. The majority of the 124 paediatricians who responded to the multi-topic survey and most who responded to the parent needs survey reported taking more than one session to make a diagnosis of ASD. Most paediatricians included information from preschool, child care or school when making a diagnosis, and over half included information from speech pathology or psychology colleagues more than 50% of the time. The main reasons for not including assessment information in the diagnostic process were service barriers such as no regular service available or long waiting lists. More than 70% reported ordering audiology and genetic tests more than half of the time. Not all paediatricians are following current recommendations for diagnosing ASD more than 50% of the time. While there are good reasons why current diagnostic approaches may fall short of expected standards, these need to be overcome to ensure diagnostic validity and optimal services for all children and their families. © 2016 The Authors. Journal of <span class="hlt">Paediatrics</span> and Child Health © 2016 <span class="hlt">Paediatrics</span> and Child Health Division (Royal Australasian College of Physicians).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5548031','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5548031"><span>Injuries in the competitive <span class="hlt">paediatric</span> motocross athlete</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Arena, C. B.; Holbert, J. A.; Hennrikus, W. L.</p> <p>2017-01-01</p> <p>Abstract Purpose The purpose of this study is to report the spectrum of injuries sustained by competitive <span class="hlt">paediatric</span> motocross athletes at a level I trauma centre. Patients and Methods A retrospective study of <span class="hlt">paediatric</span> competitive motocross injuries treated at a level I trauma centre between 2004 and 2014 was performed. Athletes were included if aged less than 18 years and injured while practising or competing on a competitive motocross track. Medical records were reviewed for age, gender, race, location of accident, use of safety equipment, mechanism of injury, injury type and severity, Glasgow Coma Score at hospital presentation and Injury Severity Score (ISS). Results In total, 35 athletes were studied. The average age was 14 years. One athlete died. Thirty athletes were injured during competition; five were injured during <span class="hlt">practice</span>. Twenty-four athletes (69%) suffered an orthopaedic injury with a total of 32 fractures and two dislocations. Two fractures were open (6.3%). Lower extremity fractures were twice as common as upper extremity fractures. Surgery was more common for lower extremity fractures—83% versus 30%. The most common fractures were femoral shaft (18.8%), fibula (12.5%), clavicle (12.5%), tibial shaft (9.4%) and forearm (9.4%). Conclusions Competitive <span class="hlt">paediatric</span> motocross athletes suffer serious, potentially life-threatening injuries despite the required use of protective safety equipment. Femoral shaft, fibula and clavicle were found to be the most commonly fractured bones. Further prospective research into track regulations, protective equipment and course design may reduce the trauma burden in this athlete population. PMID:28828059</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20095186','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20095186"><span><span class="hlt">Paediatric</span> intensive care in the field hospital.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Harris, C C; McNicholas, J J K</p> <p>2009-06-01</p> <p>Our recent experience of <span class="hlt">paediatric</span> critical care during UK military operations in Afghanistan is discussed alongside consideration of the background to the <span class="hlt">paediatric</span> critical care service on deployment. We describe the intensive care unit's capabilities, details of recent <span class="hlt">paediatric</span> critical care admissions during July to September 2008 and some of the ethical issues arising. Some desirable future developments will be suggested.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28074555','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28074555"><span><span class="hlt">Paediatric</span> stress: from neuroendocrinology to contemporary disorders.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Stavrou, Stavroula; Nicolaides, Nicolas C; Critselis, Elena; Darviri, Christina; Charmandari, Evangelia; Chrousos, George P</p> <p>2017-03-01</p> <p>Stress is defined as a state of threatened or perceived as threatened homeostasis. A broad spectrum of extrinsic or intrinsic, real or perceived stressful stimuli, called 'stressors', activates a highly conserved system, the 'stress system', which adjusts homeostasis through central and peripheral neuroendocrine responses. Inadequate, excessive or prolonged adaptive responses to stress may underlie the pathogenesis of several disease states prevalent in modern societies. The development and severity of these conditions primarily depend on the genetic vulnerability of the individual, the exposure to adverse environmental factors and the timing of the stressful event(s), given that prenatal life, infancy, childhood and adolescence are critical periods characterized by increased vulnerability to stressors. We conducted a systematic review of original articles and reviews published in MEDLINE from 1975 through June 2016. The search terms were 'childhood stress', 'pediatric stress', 'stress and disorders' and 'stress management'. In this review, we discuss the historical and neuroendocrine aspects of stress, and we present representative examples of <span class="hlt">paediatric</span> stress system disorders, such as early-life adversity, obesity and bullying. We also discuss the adverse <span class="hlt">impact</span> of a socio-economic crisis on childhood health. The tremendous progress of epigenetics has enabled us to have a deeper understanding of the molecular mechanisms underlying <span class="hlt">paediatric</span> stress-related disorders. The need for early successful stress management techniques to decrease the incidence of <span class="hlt">paediatric</span> stress-related diseases, as well as to prevent the development of several pathologic conditions in adolescence and adulthood, is imperative. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/2703266','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/2703266"><span>Forty years of research--its <span class="hlt">impact</span> on dental <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mandel, I D</p> <p>1989-03-01</p> <p>With the multiple use of fluorides the philosophical basis of dental <span class="hlt">practice</span> shifted from the restoration of the dentition to the prevention of the initiation of dental disease. In the United States, the profound <span class="hlt">impact</span> on caries in children, with 50 per cent of the 5-17 year olds caries-free, has changed the relative distribution of the various dental services and the pattern of dental care. The child orientation has been superceded by greater attention to the restorative and other needs of the middle-aged and geriatric population. The research-generated insights into the role of plaque in the periodontal diseases and the wide-scale efforts to improve oral hygiene via plaque control have resulted in a marked reduction in gingivitis and manageable levels of periodontis in the employed population below the age of 65. More advanced disease can be treated more effectively because of new diagnostic procedures and new technologies as well as the use of anti-bacterial and anti-inflammatory agents. Major research advances in oral biology, oral medicine and oral diagnosis have extended both the depth and breadth of preventive dental <span class="hlt">practice</span>. The scope of preventive dentistry now goes well beyond caries and periodontal disease to include: (1) injury, oro-facial defects, malocclusion and temporomandibular joint dysfunction; (2) oral mucosal lesions; (3) systemic diseases with oral manifestations and (4) hazards associated with dental <span class="hlt">practice</span>. Dentistry is now being practised with an ordered set of priorities.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27680207','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27680207"><span>Definition of important early morbidities related to <span class="hlt">paediatric</span> cardiac surgery.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Brown, Katherine L; Pagel, Christina; Brimmell, Rhian; Bull, Kate; Davis, Peter; Franklin, Rodney C; Hoskote, Aparna; Khan, Natasha; Rodrigues, Warren; Thorne, Sara; Smith, Liz; Chigaru, Linda; Utley, Martin; Wray, Jo; Tsang, Victor; Mclean, Andrew</p> <p>2017-05-01</p> <p>Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is "generally bad for you", and postoperative morbidity linked to <span class="hlt">paediatric</span> cardiac surgery encompasses a range of conditions that may <span class="hlt">impact</span> the patient and are potential targets for quality assurance. As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to <span class="hlt">paediatric</span> cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients. We present a set of definitions of morbidity for use in routine audit after <span class="hlt">paediatric</span> cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity. It is feasible to define a range of <span class="hlt">paediatric</span> cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The <span class="hlt">impact</span> of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17191633','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17191633"><span><span class="hlt">Paediatric</span> deaths in Kuala Lumpur.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kumar, Virendra; Jumali, Ismail Bin</p> <p>2006-10-01</p> <p>The main aim of this study was to determine the causes and epidemiological aspects of <span class="hlt">paediatric</span> death. Data was collected on 143 cases of <span class="hlt">paediatric</span> death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of <span class="hlt">paediatric</span> death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24654480','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24654480"><span>Safe and judicious <span class="hlt">paediatric</span> psychotropic prescribing.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>McNicholas, F; Orakwue, N</p> <p>2014-02-01</p> <p>Psychotropic medications are now a well-established and evidenced based treatment for increasing number of child mental health disorders prescribed at increasing frequencies and by increasing number of professional groups. Clinicians' perceived levels of competence and standardised monitoring lag behind prescribing <span class="hlt">practice</span> and should be addressed by regular continuous professional development. A study specific questionnaire on psychotropic prescribing <span class="hlt">practice</span> in children was mailed to all child psychiatrists and paediatricians working in Ireland and GPs from a selected Dublin CAMHS catchment area. Of the 116 who replied, (39% response rate), antidepressants (58.7%), antipsychotics (57.1%) and ADHD medications (36.5%) were most commonly prescribed. Results suggest increasing trends of monitoring amongst Irish clinicians over time, but with some lack of specificity. Commensurate with the wish of clinicians, ongoing training in <span class="hlt">paediatric</span> psychopharmacology is considered essential in order to benefit from the increasing advances in pharmacology.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27577993','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27577993"><span>Targeted detection of genetic alterations reveal the prognostic <span class="hlt">impact</span> of H3K27M and MAPK pathway aberrations in <span class="hlt">paediatric</span> thalamic glioma.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ryall, Scott; Krishnatry, Rahul; Arnoldo, Anthony; Buczkowicz, Pawel; Mistry, Matthew; Siddaway, Robert; Ling, Cino; Pajovic, Sanja; Yu, Man; Rubin, Joshua B; Hukin, Juliette; Steinbok, Paul; Bartels, Ute; Bouffet, Eric; Tabori, Uri; Hawkins, Cynthia</p> <p>2016-08-31</p> <p><span class="hlt">Paediatric</span> brain tumours arising in the thalamus present significant diagnostic and therapeutic challenges to physicians due to their sensitive midline location. As such, genetic analysis for biomarkers to aid in the diagnosis, prognosis and treatment of these tumours is needed. Here, we identified 64 thalamic gliomas with clinical follow-up and characterized targeted genomic alterations using newly optimized droplet digital and NanoString-based assays. The median age at diagnosis was 9.25 years (range, 0.63-17.55) and median survival was 6.43 (range, 0.01-27.63) years. Our cohort contained 42 and 22 tumours reviewed as low and high grade gliomas, respectively. Five (12 %) low grade and 11 (50 %) high grade gliomas were positive for the H3F3A/HIST1H3B K27M (H3K27M) mutation. Kaplan-Meier survival analysis revealed significantly worse overall survival for patients harbouring the H3K27M mutation versus H3F3A/HIST1H3B wild type (H3WT) samples (log-rank p < 0.0001) with a median survival of 1.02 vs. 9.12 years. Mitogen-activated protein kinase (MAPK) pathway activation via BRAF or FGFR1 hotspot mutations or fusion events were detected in 44 % of patients, and was associated with long-term survival in the absence of H3K27M (log-rank p < 0.0001). Multivariate analysis demonstrated H3K27M status and high grade histology to be the most significant independent predictors of poor overall survival with hazard ratios of 6.945 and 7.721 (p < 0.0001), respectively. In contrast, MAPK pathway activation is a predictor of favourable patient outcome, although not independent of other clinical factors. Importantly, we show that low grade malignancies may harbour H3K27M mutations and that these tumours show a dismal survival compared to low grade H3WT cases. Our data strongly supports the inclusion of targeted genetic testing in childhood thalamic tumours to most accurately stratify patients into appropriate risk groups.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4109373','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4109373"><span>Study motives, career choices and interest in <span class="hlt">paediatric</span> dentistry among final year dental students in Nigeria</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2014-01-01</p> <p>Background Students’ motives for studying Dentistry have been a subject of interest for years because of the potential for understanding the psychological makeup and subsequent job satisfaction for the dentist. It is also useful in identifying expectations of the profession. This study therefore tried to identify study motives and career preferences of dental students especially with respect to the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry. Methods This was a cross-sectional study using a self-administered questionnaire. The final year students in six dental schools in Nigeria were required to fill the questionnaire. Students were asked to rank their motives and career preferences on a Likert like scale with points ranging from 0–5 where 0 represented a factor that had no influence on their decision and 5 represented a very influential factor. The underlying dimensions for study motives, career preference, impression about and motive for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry were identified using factor analysis. Results One hundred and seventy nine of 223 students (80.3%) participated in this study. Motives for the <span class="hlt">practice</span> of dentistry included characteristics of the profession, altruism and intellectual challenges, existence of artistic theme in dentistry and parent’s recommendation. Overall, 67.1% of respondents indicated interest in postgraduate studies and 50.8% were interested in <span class="hlt">paediatric</span> dentistry <span class="hlt">practice</span>. The main motives for showing interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry were ‘personal interest, professional interest and interest of significant others in children’, and ‘family influence’. Significantly more males than females were interested in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry though the motives for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry did not differ significantly by sex or age. Conclusion The non-significant sex difference in the motives for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry is a possible</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24989055','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24989055"><span>Study motives, career choices and interest in <span class="hlt">paediatric</span> dentistry among final year dental students in Nigeria.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Folayan, Morenike O; Sofola, Oyinkan O; Khami, Mohammad R; Esan, Ayodeji O; Popoola, Bamidele O; Orenuga, Omolola O; Folaranmi, Nkiru; Ligali, Taofeek O; Phillips, Abimbola S</p> <p>2014-07-02</p> <p>Students' motives for studying Dentistry have been a subject of interest for years because of the potential for understanding the psychological makeup and subsequent job satisfaction for the dentist. It is also useful in identifying expectations of the profession. This study therefore tried to identify study motives and career preferences of dental students especially with respect to the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry. This was a cross-sectional study using a self-administered questionnaire. The final year students in six dental schools in Nigeria were required to fill the questionnaire. Students were asked to rank their motives and career preferences on a Likert like scale with points ranging from 0-5 where 0 represented a factor that had no influence on their decision and 5 represented a very influential factor. The underlying dimensions for study motives, career preference, impression about and motive for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry were identified using factor analysis. One hundred and seventy nine of 223 students (80.3%) participated in this study. Motives for the <span class="hlt">practice</span> of dentistry included characteristics of the profession, altruism and intellectual challenges, existence of artistic theme in dentistry and parent's recommendation. Overall, 67.1% of respondents indicated interest in postgraduate studies and 50.8% were interested in <span class="hlt">paediatric</span> dentistry <span class="hlt">practice</span>. The main motives for showing interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry were 'personal interest, professional interest and interest of significant others in children', and 'family influence'. Significantly more males than females were interested in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry though the motives for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry did not differ significantly by sex or age. The non-significant sex difference in the motives for interest in the <span class="hlt">practice</span> of <span class="hlt">paediatric</span> dentistry is a possible reflection of changes in strong cultural themes in the</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2829139','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2829139"><span><span class="hlt">Impact</span> of an Introductory Pharmacy <span class="hlt">Practice</span> Experience on Students' Performance in an Advanced <span class="hlt">Practice</span> Experience</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Johnson, Thomas J.; Hedge, Dennis D.</p> <p>2010-01-01</p> <p>Objective To determine the <span class="hlt">impact</span> of an introductory pharmacy <span class="hlt">practice</span> experience (IPPE) on students' clinical skills during their initial advanced pharmacy <span class="hlt">practice</span> experience (APPE). Design A 4-week First Steps course that focused on students developing pharmacy <span class="hlt">practice</span> skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs. Assessment During the third week of the first APPE, faculty members rated students' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01). Conclusion Completion of an IPPE course that focused on critical pharmacy <span class="hlt">practice</span> aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE. PMID:20221362</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15499205','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15499205"><span>Aetiological factors in <span class="hlt">paediatric</span> urolithiasis.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>van't Hoff, William G</p> <p>2004-01-01</p> <p>The aetiology of stones in children differs from that in adults. Young children, especially boys, are prone to infective stones, although this type of calculi is decreasing in frequency over time in prosperous countries. Two monogenic causes, cystinuria and hyperoxaluria, each account for 5-15% of <span class="hlt">paediatric</span> stones. Increased factors for stone formation in children include prematurity, neurological problems, ketogenic diet and reconstructed or augmented bladders. Hypercalciuria is commonly found in <span class="hlt">paediatric</span> stone formers, is usually idiopathic and is only rarely associated with hypercalcaemia. All children with stones should undergo a metabolic evaluation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23988068','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23988068"><span>Oxford Handbook of <span class="hlt">Paediatrics</span>Oxford Handbook of <span class="hlt">Paediatrics</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p></p> <p>2013-06-01</p> <p>THIS EXCITING new edition to the Oxford Handbook Series provides a compact guide to all aspects of acute and chronic <span class="hlt">paediatrics</span>. A team of 23 specialist contributors and medical editors has condensed many years of clinical experience into a pocket-sized compendium of clinical problems and treatment options.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.osti.gov/scitech/biblio/22402355','SCIGOV-STC'); return false;" href="https://www.osti.gov/scitech/biblio/22402355"><span>A <span class="hlt">paediatric</span> X-ray exposure chart</span></a></p> <p><a target="_blank" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p>Knight, Stephen P</p> <p>2014-09-15</p> <p>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 <span class="hlt">paediatrics</span>. This review was based on evidence-based <span class="hlt">practice</span>, 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 <span class="hlt">paediatric</span> imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18660661','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18660661"><span>Anaesthesia for MRI in the <span class="hlt">paediatric</span> patient.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Serafini, Gianpaolo; Zadra, Nicola</p> <p>2008-08-01</p> <p>The purpose of the present review is to focus on the literature in the past year and specifically the development of recent guidelines, the debate on who does the sedation anaesthesia for MRI in a <span class="hlt">paediatric</span> patient, the use of medications and techniques, and the use of monitors and equipment. The revised guidelines of American Academy of Pediatrics and American Academy of Pediatric Dentistry underline the serious risks associated with the sedation of <span class="hlt">paediatric</span> patients and emphasize the need for proper preparation and proper evaluation. Most children require deep sedation for MRI and the practitioner must have appropriate skills to rescue the patient from general anaesthesia. In the debate on 'who does the sedation', the most important goal is to achieve uniformity in the formal training of the practitioners in key <span class="hlt">practice</span> elements (airway management, resuscitation, vascular access, medications). Recent findings about the use of anaesthetic techniques, monitors and equipment, and complications are reported. The MRI suite is a challenging environment for anaesthetists and nonanaesthetists, and has serious risks. A systematic approach, similar to that of anaesthesia provided in the operating room, is mandatory. A well equipped anaesthesia machine, standard monitoring, trained personnel and adequate planning should be standard for all procedures out of the operating room.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26229655','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26229655"><span>A <span class="hlt">paediatric</span> X-ray exposure chart.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Knight, Stephen P</p> <p>2014-09-01</p> <p>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 <span class="hlt">paediatrics</span>. This review was based on evidence-based <span class="hlt">practice</span>, 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 <span class="hlt">paediatric</span> imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12861302','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12861302"><span>[Treatment of pain in hospital <span class="hlt">paediatrics</span>].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Molina, J; Sagaseta de Ilúrdoz, M; Busto, N; Lezáun, I; Cía, M L; Carrascosa, S; Azanza, M J</p> <p>2002-01-01</p> <p>The paper presents a review of pain at the <span class="hlt">paediatric</span> age, which can be considered a question of maximum interest given the novel application of analgesia or other procedures for avoiding and controlling the different types of pain in the course of normal <span class="hlt">practice</span> during childhood. After a brief introduction on the history of pain and the scarce attention that it has received until recently, the concepts and different actions for dealing with pain are set out, which depend on its aetiology and localisation: pain in oncology, post-operational pain, pain in chronic or acute diseases, pain in intensive care, etc. Tables are presented with the normal doses used at these ages in the different situations required by the child and which the professional might find himself facing. The non-pharmacological attitude is set out as this can be of great use in the initial stages of controlling pain at these ages, and the different forms of sedation and analgesia at the <span class="hlt">paediatric</span> age are explained, with regard to the medicines employed, the form of administering them and the importance of a multidisciplinary team: paediatricians, child anaesthetists, nursing personnel as well as the necessary technical support for taking the corresponding action.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4175850','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4175850"><span>A <span class="hlt">paediatric</span> X-ray exposure chart</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Knight, Stephen P</p> <p>2014-01-01</p> <p>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 <span class="hlt">paediatrics</span>. This review was based on evidence-based <span class="hlt">practice</span>, 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 <span class="hlt">paediatric</span> imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes. PMID:26229655</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/14705444','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/14705444"><span>[<span class="hlt">Impact</span> of lack of resources in dialysis <span class="hlt">practice</span> in Quebec].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Saint-Arnaud, Jocelyne; Bouchard, Louise; Loiselle, Carmen G; Verrier, Pierre; Laflamme, Marie-Claude; Audet, Monique</p> <p>2003-01-01</p> <p>The purpose of this descriptive study was to assess the <span class="hlt">impact</span> of limited resources on the <span class="hlt">practice</span> of dialysis in Quebec and to highlight certain ethical issues. Twelve semi-structured interviews were done with nurses in charge of 14 dialysis centres in Quebec. A survey using self-administered questionnaires was also carried out between January 2000 and July 2001, with a convenience sample of 412 patients and 156 other persons involved, including 116 dialysis nurses. Two discussion groups brought together sixteen stakeholders from four dialysis centres. The results presented here were obtained by triangulating methods and data. They show that access to dialysis is not limited by Quebec nephrologists, that patients are increasingly old and sick, that teams are working to the utmost of their ability and that it is difficult for nursing staff to provide optimal care under these conditions.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li class="active"><span>17</span></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_17 --> <div id="page_18" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li class="active"><span>18</span></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="341"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2008AIPC.1064...46S','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2008AIPC.1064...46S"><span><span class="hlt">Impact</span> of Chemistry Teachers' Knowledge and <span class="hlt">Practices</span> on Student Achievement</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Scantlebury, Kathryn</p> <p>2008-10-01</p> <p>Professional development programs promoting inquiry-based teaching are challenged with providing teachers content knowledge and using pedagogical approaches that model standards based instruction. Inquiry <span class="hlt">practices</span> are also important for undergraduate students. This paper focuses on the evaluation of an extensive professional development program for chemistry teachers that included chemistry content tests for students and the teachers and the <span class="hlt">impact</span> of undergraduate research experiences on college students' attitudes towards chemistry. Baseline results for the students showed that there were no gender differences on the achievement test but white students scored significantly higher than non-white students. However, parent/adult involvement with chemistry homework and projects, was a significant negative predictor of 11th grade students' test chemistry achievement score. This paper will focus on students' achievement and attitude results for teachers who are mid-way through the program providing evidence that on-going, sustained professional development in content and pedagogy is critical for improving students' science achievement.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.osti.gov/scitech/servlets/purl/1166033','SCIGOV-STC'); return false;" href="http://www.osti.gov/scitech/servlets/purl/1166033"><span>Resilient Control Systems <span class="hlt">Practical</span> Metrics Basis for Defining Mission <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p>Craig G. Rieger</p> <p>2014-08-01</p> <p>"Resilience” describes how systems operate at an acceptable level of normalcy despite disturbances or threats. In this paper we first consider the cognitive, cyber-physical interdependencies inherent in critical infrastructure systems and how resilience differs from reliability to mitigate these risks. Terminology and metrics basis are provided to integrate the cognitive, cyber-physical aspects that should be considered when defining solutions for resilience. A <span class="hlt">practical</span> approach is taken to roll this metrics basis up to system integrity and business case metrics that establish “proper operation” and “<span class="hlt">impact</span>.” A notional chemical processing plant is the use case for demonstrating how the system integrity metrics can be applied to establish performance, and</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/16700170','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/16700170"><span>The organisation of <span class="hlt">paediatric</span> renal care in different European countries: results of the PAC project.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Knoll, J; Demol, A; Elseviers, M; Harrington, M; De Vos, J Y; Zampieron, A; Ormandy, P; Kafkia, T</p> <p>2006-01-01</p> <p>The <span class="hlt">Paediatric</span> Access Care (PAC) project, organised by the Research Board of EDTNA/ERCA, aimed to study the organisation of <span class="hlt">paediatric</span> renal care in Europe and to investigate the <span class="hlt">practice</span> of access care for both haemodialysis (HD) and peritoneal dialysis (PD) <span class="hlt">paediatric</span> patients. This paper reports on the organisation of <span class="hlt">paediatric</span> renal care. The majority of <span class="hlt">paediatric</span> renal care units were located in specific <span class="hlt">paediatric</span> units of university hospitals. Most of the centres had offered HD, PD and transplantation (Tx) for more than 20 years. Half of nursing staff had qualifications in <span class="hlt">paediatric</span> and renal nursing. Most of the centres offered an extended multidisciplinary team approach with the family actively involved in the care of the patient. PD and HD were equally used. Automatic Peritoneal Dialysis (APD) was offered as the standard PD treatment in 2 out of 3 centres. The HD schedule mostly utilised was 3 x 4 hours a week. Half of the patients were on the Tx waiting list and one third of registered patients were transplanted in 2004.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22221009','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22221009"><span><span class="hlt">Paediatric</span> nurse practitioner managed cardiology clinics: patient satisfaction and appointment access.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Evangelista, Juli-Anne K; Connor, Jean Anne; Pintz, Christine; Saia, Teresa; O'Connell, Cheryl; Fulton, David R; Hickey, Patricia</p> <p>2012-10-01</p> <p>This article summarizes a comparative study of patient/family satisfaction and appointment wait times in physician managed vs. <span class="hlt">paediatric</span> nurse practitioner managed cardiology clinics. Appointment wait times exceeded 40 days in the outpatient cardiology department at a children's hospital. To address the gap in available appointments, <span class="hlt">paediatric</span> nurse practitioner managed cardiology clinics were implemented. A sample of 128 patients who presented concurrently in physician or <span class="hlt">paediatric</span> nurse practitioner managed cardiology clinics from December 2009 through February 2010 was recruited for participation. The hospital's ambulatory patient satisfaction survey was utilized to measure level of patient satisfaction with care. Survey responses were evaluated using Fisher's exact test. Appointment wait times were compared pre and post implementation of <span class="hlt">paediatric</span> nurse practitioner managed clinics. Sixty-five physician families and 63 <span class="hlt">paediatric</span> nurse practitioner families completed the satisfaction survey. There was no statistically significant difference in patient satisfaction between clinic types. Appointment wait time decreased from 46 to 43 days, which was not statistically significant. <span class="hlt">Paediatric</span> nurse practitioner clinics included a statistically higher percentage total of urgent appointments compared to that in physician clinics. <span class="hlt">Paediatric</span> nurse practitioner managed cardiology clinics are a strategic solution for improving patient access and facilitating high quality patient care while earning high levels of patient satisfaction. This healthcare delivery model illustrates the potential for expanded utilization of advanced <span class="hlt">practice</span> nurses. © 2012 Blackwell Publishing Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25320396','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25320396"><span><span class="hlt">Paediatric</span> orofacial tumours: new oral health concern in <span class="hlt">paediatric</span> patients.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Omoregie, F O; Akpata, O</p> <p>2014-03-01</p> <p>This study aims to determine the incidence, age, gender, orofacial sites and histological pattern of <span class="hlt">paediatric</span> orofacial tumours in a Nigerian population. The yearly findings will be analysed to identify the interval for increase in the incidence of <span class="hlt">paediatric</span> orofacial tumours. A 21-year (1990 to 2010) retrospective analysis of <span class="hlt">paediatric</span> orofacial tumours in children younger than 16 years was carried out in the Department of Oral Pathology/Oral Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. Of the 1013 diagnosed lesions within the study period, there were 137 (13.5%) <span class="hlt">paediatric</span> orofacial tumours, among which 71 (51.8%) cases occurred within the last 6 years (2005 to 2010). There was male predilection for the lesions (78 males to 59 females, ratio = 1.3:1). The mean age was 9 + 4.3 years, with peak age group of 11 to 15 years (n=60, 43.8%). The mandible (n=44, 32.1%), followed by the maxilla (n=42, 30.7%) and orofacial soft tissue (n=19, 13.9%) were the most common sites. The benign tumours (n=72, 52.6%) were slightly more than the malignant tumours (n=65, 47.4%). There were more malignant tumours (n=23, 16.8%) than benign tumours (n=20, 14.6%) within the last 3 years (2008 to 2010) under review. Burkitt's lymphoma (n=38, 27.7%) was the commonest malignant lesion. This study showed a recent increase in the incidence of <span class="hlt">paediatric</span> orofacial tumours, particularly due to a higher incidence of Burkitt's lymphoma.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20383834','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20383834"><span>Anaesthesia for ambulatory <span class="hlt">paediatric</span> surgery: common techniques and complications.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Imarengiaye, C O; Osifo, D; Tudjegbe, S; Evbuomwan, I</p> <p>2009-01-01</p> <p>Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory <span class="hlt">paediatric</span> surgical <span class="hlt">practice</span> is not widespread in Nigeria. This report examined clinical indicators for quality care in <span class="hlt">paediatric</span> ambulatory surgery using common outcomes after day case procedures as benchmark. This was a cross-sectional study of children who were presented for ambulatory surgical care in the University of Benin Teaching Hospital. A standardized questionnaire was employed to record the age, gender, indication for surgery, type of anaesthesia, timelines for the surgery and associated complications. A total of 93 patients had surgical procedures on ambulatory basis. The mean age of the patients was 4.1(4.0) yr and duration of surgical procedure 31.3(12.1) min. The male to female ratio was 3:1, and herniotomy was the most frequent procedure on ambulatory <span class="hlt">paediatric</span> surgical care 60 (64.5%). The common anaesthetic techniques employed in the <span class="hlt">paediatric</span> ambulatory setting were spontaneous respiration with face mask 40 (43%), Inhalation technique with tracheal intubations 31 (33.3%), general anaesthesia with relaxant technique five (5.4%), local infiltration with or without sedation eight (8.6%), GA plus caudal block eight(8.6%), and subarachnoid block one(1.1%). The indicators of quality care were unanticipated admission (5.4%), repeat hospital visit (4.3%), readmission (2.2%) and delayed discharge (21.5%). The <span class="hlt">practices</span> of <span class="hlt">paediatric</span> surgery on ambulatory services are feasible in our setting. The observable complications are within acceptable limits. The timelines in the scheduling and discharge appear not to be optimal for an effective ambulatory service.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=Population+AND+Dynamics&pg=4&id=EJ1140062','ERIC'); return false;" href="https://eric.ed.gov/?q=Population+AND+Dynamics&pg=4&id=EJ1140062"><span>The Bryn Mawr College 360° Program: Implementing High-<span class="hlt">Impact</span> Educational <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Cassidy, Kimberly; Theobald, Sarah</p> <p>2017-01-01</p> <p>High-<span class="hlt">impact</span> educational <span class="hlt">practices</span> support student and faculty learning and achievement. By creating an alternative structure through which students have access to these <span class="hlt">practices</span>, and by investing resources to make that structure available to all students, Bryn Mawr College has been able to ensure that participation in high-<span class="hlt">impact</span> <span class="hlt">practices</span> occurs…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21848349','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21848349"><span>Healthy buildings: <span class="hlt">impact</span> on nurses and nursing <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Guenther, Robin; Hall, Anna Gilmore</p> <p>2007-05-31</p> <p>Mounting evidence indicates that buildings can be a significant cause of human illness and environmental degradation. According to the United States (US) Environmental Protection Agency, indoor air pollution is one of the top five environmental risks to public health in the US. This may be related, to a large extent, to the fact that US citizens spend as much as 95% of their time indoors. Health care leaders, designers, and architects, recognizing the connection between health and the buildings in which much time is spent, are engaging in sustainable design and construction for healthy, 'green' buildings. The purpose of this article is to assist nurses in understanding the <span class="hlt">impact</span> that unhealthy buildings can have on nurses and nursing <span class="hlt">practice</span> and to provide tools and resources to assist nurses in transforming the health care industry with the goal of creating healing environments and reducing the negative environmental <span class="hlt">impact</span> of the health care industry. First definitions, current initiatives, and motivations related to sustainable designs will be presented. Next sustainable health care design strategies, such as site planning, clean transportation, water conservation, healthy materials selection, indoor environmental quality, and also the benefits of sustainable design will be discussed. The article will conclude by sharing a variety of resources nurses can use to create healing environments in health care settings.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27075202','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27075202"><span>Pediatric & Congenital Electrophysiology Society: building an international <span class="hlt">paediatric</span> electrophysiology organisation.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cohen, Mitchell; Sanatani, Shubhayan; Stephenson, Elizabeth; Skinner, Jon; Drago, Fabrizio; Davis, Andrew; Janousek, Jan; Rosenthal, Eric; Collins, Kathryn K; Triedman, John</p> <p>2016-08-01</p> <p>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, <span class="hlt">paediatric</span> electrophysiology leaders from within the United States of America and Canada met with over 30 international <span class="hlt">paediatric</span> 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 <span class="hlt">paediatric</span> 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 <span class="hlt">paediatric</span> electrophysiologists have <span class="hlt">practiced</span> within; however, there remain ongoing limitations, and future discussions will be needed to continue to move the PACES global international vision forward.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26166453','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26166453"><span>Unmet needs in <span class="hlt">paediatric</span> psychopharmacology: Present scenario and future perspectives.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>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</p> <p>2015-10-01</p> <p><span class="hlt">Paediatric</span> psychopharmacology holds great promise in two equally important areas of enormous biomedical and social <span class="hlt">impact</span>, 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 <span class="hlt">paediatric</span> 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 <span class="hlt">paediatric</span> psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in <span class="hlt">paediatric</span> 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.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25900208','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25900208"><span>Optimizing treatment in <span class="hlt">paediatric</span> rheumatology--lessons from oncology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Niehues, Tim</p> <p>2015-08-01</p> <p>Treatment of children with cancer, in particular with acute lymphoblastic leukaemia (ALL), has been highly successful in the past two decades owing to the implementation of treatment optimization studies. Study centres appointed by scientific societies design treatment optimization study protocols (TOSPs) that address an investigator-initiated research question and detail treatment procedures according to these aims. Nearly all children with malignant diseases are treated within TOSPs, whereas children with juvenile idiopathic arthritis (JIA) and other common <span class="hlt">paediatric</span> rheumatic diseases are mostly treated outside TOSPs and clinical trials. Despite the differences in natural course and prognosis between malignant and inflammatory diseases, aiming for the recruitment of all children with defined rheumatic diseases into TOSPs or similar protocols would enable the longitudinal collection of crucial clinical data and improve evidence-based approaches. Successful research networks already exist in <span class="hlt">paediatric</span> rheumatology that could facilitate the implementation of this approach. <span class="hlt">Paediatric</span> rheumatic diseases have a considerable <span class="hlt">impact</span> on patients and their families; thus, I propose that research networks in <span class="hlt">paediatric</span> rheumatology should recruit most--if not all--children with rheumatic diseases into study protocols with standardized treatment and outcome measures.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26126678','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26126678"><span><span class="hlt">Paediatric</span> death and dying: exploring coping strategies of health professionals and perceptions of support provision.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Forster, Elizabeth; Hafiz, Alaa</p> <p>2015-06-01</p> <p>Without question a child's death is a devastating event for parents and families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents and families on this painful journey. This is a delicate and sensitive area of <span class="hlt">practice</span> and has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of wellbeing. To explore health professionals' perceptions of bereavement support surrounding the loss of a child. The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of <span class="hlt">paediatric</span> death. Health professional narratives were analysed consistent with Charmarz's (2006) approach. For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical <span class="hlt">impact</span> of support and spiritual beliefs. Analysis of the narratives also revealed health professionals' perceptions of their support provision. Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in <span class="hlt">paediatric</span> palliative care.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23925009','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23925009"><span><span class="hlt">Impact</span> of advanced laparoscopy courses on present surgical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Houck, Jared; Kopietz, Courtni M; Shah, Bhavin C; Goede, Matthew R; McBride, Corrigan L; Oleynikov, Dmitry</p> <p>2013-01-01</p> <p>The introduction of new surgical techniques has made training in laparoscopic procedures a necessity for the <span class="hlt">practicing</span> surgeon, but acquisition of new surgical skills is a formidable task. This study was conducted to assess the <span class="hlt">impact</span> of advanced laparoscopic workshops on caseload patterns of <span class="hlt">practicing</span> surgeons. After we obtained institutional review board approval, a survey of <span class="hlt">practicing</span> surgeons who participated in advanced laparoscopic courses was distributed; the results were analyzed for statistical significance. The courses were held at the University of Nebraska Medical Center between January 2002 and December 2010. Questionnaires were mailed, faxed, and e-mailed to surgeons. Of the 109 surgeons who participated in the advanced laparoscopy courses, 79 received surveys and 30 were excluded from the survey because of their affiliation with the University of Nebraska Medical Center. A total of 47 responses (59%) were received from 41 male and 6 female surgeons. The median response time from completion of the course to completion of the survey was 13.2 months (range, 6.8-19.1 months). The mean age of participating surgeons was 39.2 years (range, 29-51 years). The mean time since residency was 8.4 years (range, 0.8-21 years). Eleven surgeons had completed a minimal number of laparoscopic cases in residency (<50), 17 surgeons had completed a moderate number of laparoscopic procedures in residency (50-200), and 21 surgeons had completed a significant number of cases during residency (>200). Of the surgeons who responded, 94% were in private <span class="hlt">practice</span>. Fifty-seven percent of the participating surgeons who responded reported a change in laparoscopic <span class="hlt">practice</span> patterns after the courses. Of these surgeons, 24% had a limited residency laparoscopy exposure of <50 cases. Surgeons who were exposed to ≥50 laparoscopic cases during their residency showed a statistically significant increase in the number of laparoscopic procedures performed after their class compared with</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2805593','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2805593"><span>Essentials of <span class="hlt">paediatric</span> infection control</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Moore, Dorothy L</p> <p>2001-01-01</p> <p>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 <span class="hlt">paediatric</span> hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and <span class="hlt">paediatric</span> intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general <span class="hlt">paediatric</span> 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 <span class="hlt">paediatrics</span> is an evolving field that must adapt to changes in the <span class="hlt">paediatric</span> patient population and in health care technology. PMID:20084127</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/11989945','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/11989945"><span>Ambulatory <span class="hlt">paediatrics</span>: does it work?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Macleod, C; McElroy, G; O'Loan, D; Kennedy, F; Kerr, R M; Jenkins, J; Lim, J</p> <p>2002-02-01</p> <p>To determine whether a <span class="hlt">paediatric</span> ambulatory assessment service is an effective and acceptable replacement for an inpatient unit. Analysis of hospital <span class="hlt">paediatric</span> medical admissions. Postal questionnaire survey of local general practitioners. Telephone survey of parents of children who had attended the ambulatory service. Rural General Hospital in Northern Ireland. General practitioners. Parents of children referred to assessment service. Number of <span class="hlt">paediatric</span> medical hospital admissions from the local area before and after the introduction of an ambulatory assessment service. General practitioner satisfaction levels. Parental satisfaction levels. Since the introduction of the new service in April 1996 there has been a marked progressive reduction in <span class="hlt">paediatric</span> medical hospital admissions from the local area. By the third year of operation of the ambulatory service (1998/99), a 47% reduction in admissions was recorded, compared to the 1995/96 baseline year. The response rate to the general practitioner questionnaire was 65% (37 of 57) of whom most (31, 84%) found the service beneficial. Of the 37 respondents, 31 had referred patients to the service. The majority of these general practitioners (30, 97%) reported that the service was easy to access, and the same proportion felt that requests for consultation were met promptly. Most felt that feedback was appropriate (29, 94%). A telephone survey of 50 parents showed that most were either very satisfied (38, 76%), or satisfied (11, 22%) with the service. Most parents (41, 82%) felt their child had benefited by not being admitted to hospital. Most (46, 92%) felt they had received adequate information regarding their child's illness. A <span class="hlt">paediatric</span> ambulatory assessment unit can reduce the number of children admitted to hospital and meet the needs of children, their families and general practitioners.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=success&pg=5&id=EJ1112730','ERIC'); return false;" href="http://eric.ed.gov/?q=success&pg=5&id=EJ1112730"><span>What's in a Name? The Challenge and Utility of Defining Promising and High-<span class="hlt">Impact</span> <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Hatch, Deryl K.; Crisp, Gloria; Wesley, Katherine</p> <p>2016-01-01</p> <p>This chapter reviews multiple complementary and divergent descriptions of <span class="hlt">practices</span> that have been identified as holding particular promise for high <span class="hlt">impact</span> on college student success and offers a possible map of <span class="hlt">practices</span> to illustrate key features and relationships.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=maps&pg=5&id=EJ1112730','ERIC'); return false;" href="https://eric.ed.gov/?q=maps&pg=5&id=EJ1112730"><span>What's in a Name? The Challenge and Utility of Defining Promising and High-<span class="hlt">Impact</span> <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Hatch, Deryl K.; Crisp, Gloria; Wesley, Katherine</p> <p>2016-01-01</p> <p>This chapter reviews multiple complementary and divergent descriptions of <span class="hlt">practices</span> that have been identified as holding particular promise for high <span class="hlt">impact</span> on college student success and offers a possible map of <span class="hlt">practices</span> to illustrate key features and relationships.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4360435','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4360435"><span>Therapeutic upper gastrointestinal tract endoscopy in <span class="hlt">Paediatric</span> Gastroenterology</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad</p> <p>2015-01-01</p> <p>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 <span class="hlt">practice</span>, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the <span class="hlt">paediatric</span> upper gastrointestinal tract. PMID:25789087</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26603613','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26603613"><span>Medical thermography (digital infrared thermal imaging - DITI) in <span class="hlt">paediatric</span> forearm fractures - A pilot study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ćurković, S; Antabak, A; Halužan, D; Luetić, T; Prlić, I; Šiško, J</p> <p>2015-11-01</p> <p>Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all <span class="hlt">paediatric</span> fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the <span class="hlt">paediatric</span> population. This type of fracture represents an everyday problem for the <span class="hlt">paediatric</span> surgeon. The three phases of fracture healing in <span class="hlt">paediatric</span> trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday <span class="hlt">practice</span>. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1884862','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1884862"><span>The potential of UK clinical databases in enhancing <span class="hlt">paediatric</span> medication research</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Wong, Ian C K; Murray, Macey L</p> <p>2005-01-01</p> <p>The research potential of many UK clinical databases is not being realized. A recent report published by the Royal College of <span class="hlt">Paediatrics</span> & Child Health stated that there is a need to build research capacity and support in the area of <span class="hlt">paediatric</span> pharmacology, with specific emphasis on the use of clinical databases. This article presents the databases available in the UK for medication research and gives some examples of <span class="hlt">paediatric</span> studies conducted. The databases discussed include the Prescription Pricing Authority database, the General <span class="hlt">Practice</span> Research Database, IMS Health databases (Medical Data Index, MIDAS Prescribing Insights, Disease-Analyser-Mediplus) and the Yellow Card Scheme. Other databases such as the Medicines Monitoring Unit (MEMO) and the Scottish Primary Care Computer System also have research potential in <span class="hlt">paediatric</span> pharmacoepidemiology, but their population sizes are relatively small. PMID:15948943</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li class="active"><span>18</span></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_18 --> <div id="page_19" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li class="active"><span>19</span></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="361"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23292560','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23292560"><span><span class="hlt">Impact</span> of robotic general surgery course on participants' surgical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Buchs, Nicolas C; Pugin, François; Volonté, Francesco; Hagen, Monika E; Morel, Philippe</p> <p>2013-06-01</p> <p>Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the <span class="hlt">impact</span> of robotic general surgery course on the <span class="hlt">practice</span> of participants. Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1 months (range, 2-48), a retrospective review of the participants' surgical <span class="hlt">practice</span> was performed using online research and surveys. Among the 101 participants, there was a majority of general (58.4 %) and colorectal surgeons (10.9 %). Other specialties included urologists (7.9 %), gynecologists (6.9 %), pediatric surgeons (2 %), surgical oncologists (1 %), engineers (6.9 %), and others (5.9 %). Data were fully recorded in 99 % of cases; 46 % of participants started to perform robotic procedures after the course, whereas only 6.9 % were already familiar with the system before the course. In addition, 53 % of the attendees worked at an institution where a robotic system was already available. All (100 %) of participants who started a robotic program after the course had an available robotic system at their institution. A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system available.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2011epsc.conf.1775H','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2011epsc.conf.1775H"><span>Teacher Workshops in the US: Goals, Best <span class="hlt">Practices</span> and <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Hörst, S. M.</p> <p>2011-10-01</p> <p>The goal of the workshop is to educate the teachers on a few focused topics so that they can transfer the knowledge they gain to their students. We will recruit scientists who are attending the meeting to participate in the workshops and will also pair the teachers with scientists in the field who can serve as a resource for the teacher and their class throughout the school year. The scientists can answer questions the teachers may have, be available to do video lectures or interactive question and answer sessions over skype, and work with the teachers to develop hands-on classroom activities. We will partner closely with EPO professionals in NASA's Science Mission Directorate to ensure that best <span class="hlt">practices</span> for the workshops are employed, including ensuring that the workshop and workshop materials are designed within the framework of the state standards, surveying participating teachers before the workshops about their needs and goals, assessing the participants pre-workshop knowledge, and engaging participants as learners during the workshop [1]. The <span class="hlt">impact</span> of the workshop will be increased by providing the teachers and students with a scientist who will serve as a long-term resource. We will maintain contact with the teachers after the workshop to ensure that the scientists are still actively engaged in their classroom and to collect feedback. References [1] Shupla C, et al. (2011) Lessons Learned: Best <span class="hlt">Practices</span> in Educator Workshops. 42nd Lunar and Planetary Science Conference, no. 2828. EPSC Abstracts Vol. 6, EPSC-DPS2011-1775, 2011 EPSC-DPS Joint Meeting 2011 c Author(s) 2011</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25178830','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25178830"><span>Permeation studies through porcine small intestine of furosemide solutions for personalised <span class="hlt">paediatric</span> administration.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Provenza, N; Calpena, A C; Mallandrich, M; Sánchez, A; Egea, M A; Clares, B</p> <p>2014-11-20</p> <p>Personalized medicine is a challenging research area in <span class="hlt">paediatric</span> drug design since no suitable pharmaceutical forms are currently available. Furosemide is an anthranilic acid derivative used in <span class="hlt">paediatric</span> <span class="hlt">practice</span> to treat cardiac and pulmonary disorders in premature infants and neonates. However, it is not commercialized in suitable dosage forms for <span class="hlt">paediatrics</span>. Elaborating new <span class="hlt">paediatric</span> formulations when no commercial forms are available is a common <span class="hlt">practice</span> in pharmacy laboratories; amongst these, oral liquid formulations are the most common. We developed two extemporaneous <span class="hlt">paediatric</span> oral solutions of furosemide (pure powder). The characterization and stability study were also performed. Parameters such as organoleptic characteristics, rheology, pH, content of active substance, and microbial stability were evaluated at three temperatures for two months. Evaluation of all these parameters showed that both solutions were stable for 60 days at 4 and 25 °C. Moreover, ex vivo studies were performed to evaluate the permeation behaviour of developed solutions through porcine small intestine to evaluate the potential <span class="hlt">paediatric</span> biological parameters influencing the bioavailability and efficacy. A validated spectrofluorometric method was also used for this purpose. Our results guarantee a correct dosification, administration and potential efficacy of furosemide when is formulated in liquid oral forms for the treatment of cardiac and pulmonary disorders in children.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28936698','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28936698"><span>Recommendations for mechanical ventilation of critically ill children from the <span class="hlt">Paediatric</span> Mechanical Ventilation Consensus Conference (PEMVECC).</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C</p> <p>2017-09-22</p> <p>Much of the common <span class="hlt">practice</span> in <span class="hlt">paediatric</span> mechanical ventilation is based on personal experiences and what <span class="hlt">paediatric</span> critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for <span class="hlt">Paediatric</span> and Neonatal Intensive Care initiated a consensus conference of international European experts in <span class="hlt">paediatric</span> mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The <span class="hlt">Paediatric</span> Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to <span class="hlt">paediatric</span> mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical <span class="hlt">practice</span> and clinical research.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25552272','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25552272"><span>Does health intervention research have real world policy and <span class="hlt">practice</span> <span class="hlt">impacts</span>: testing a new <span class="hlt">impact</span> assessment tool.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cohen, Gillian; Schroeder, Jacqueline; Newson, Robyn; King, Lesley; Rychetnik, Lucie; Milat, Andrew J; Bauman, Adrian E; Redman, Sally; Chapman, Simon</p> <p>2015-01-01</p> <p>There is a growing emphasis on the importance of research having demonstrable public benefit. Measurements of the <span class="hlt">impacts</span> of research are therefore needed. We applied a modified <span class="hlt">impact</span> assessment process that builds on best <span class="hlt">practice</span> to 5 years (2003-2007) of intervention research funded by Australia's National Health and Medical Research Council to determine if these studies had post-research real-world policy and <span class="hlt">practice</span> <span class="hlt">impacts</span>. We used a mixed method sequential methodology whereby chief investigators of eligible intervention studies who completed two surveys and an interview were included in our final sample (n = 50), on which we conducted post-research <span class="hlt">impact</span> assessments. Data from the surveys and interviews were triangulated with additional information obtained from documentary analysis to develop comprehensive case studies. These case studies were then summarized and the reported <span class="hlt">impacts</span> were scored by an expert panel using criteria for four <span class="hlt">impact</span> dimensions: corroboration; attribution, reach, and importance. Nineteen (38%) of the cases in our final sample were found to have had policy and <span class="hlt">practice</span> <span class="hlt">impacts</span>, with an even distribution of high, medium, and low <span class="hlt">impact</span> scores. While the tool facilitated a rigorous and explicit criterion-based assessment of post-research <span class="hlt">impacts</span>, it was not always possible to obtain evidence using documentary analysis to corroborate the <span class="hlt">impacts</span> reported in chief investigator interviews. While policy and <span class="hlt">practice</span> is ideally informed by reviews of evidence, some intervention research can and does have real world <span class="hlt">impacts</span> that can be attributed to single studies. We recommend <span class="hlt">impact</span> assessments apply explicit criteria to consider the corroboration, attribution, reach, and importance of reported <span class="hlt">impacts</span> on policy and <span class="hlt">practice</span>. <span class="hlt">Impact</span> assessments should also allow sufficient time between <span class="hlt">impact</span> data collection and completion of the original research and include mechanisms to obtain end-user input to corroborate claims and reduce biases</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2008PMB....53.3365V','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2008PMB....53.3365V"><span><span class="hlt">Paediatric</span> entrance doses from exposure index in computed radiography</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Vano, E.; Martinez, D.; Fernandez, J. M.; Ordiales, J. M.; Prieto, C.; Floriano, A.; Ten, J. I.</p> <p>2008-06-01</p> <p>Over the last two years we have evaluated <span class="hlt">paediatric</span> patient doses in projection radiography derived from exposure level (EL) in computed radiography (CR) in a large university hospital. Entrance surface air kerma (ESAK) for 3501 <span class="hlt">paediatric</span> examinations was calculated from the EL, which is a dose index parameter related to the light emitted by the phosphor-stimulable plate, archived in the Digital Imaging and Communications in Medicine (DICOM) header of the images and automatically transferred to a database using custom-built dedicated software. Typical mean thicknesses for several age bands of <span class="hlt">paediatric</span> patients was estimated to calculate ESAK from the EL values, using results of experimental measurements with phantoms for the typical x-ray beam qualities used in <span class="hlt">paediatric</span> examinations. Mean/median ESAK values (in µGy) for the age bands of <1 year, 1-5 years, 6-10 years and 11-15 years have been obtained for chest without a bucky: 51/41, 57/34, 91/54 and 122/109; chest with a bucky (for only the last three age bands): 114/87, 129/105 and 219/170; abdomen: 119/91, 291/225, 756/600 and 1960/1508 and pelvis: 65/48, 455/314, 943/707 and 2261/1595. Sample sizes of clinical images used for the (indirect) measurements were 1724 for chest without a bucky, 799 for chest with a bucky, 337 for abdomen and 641 for pelvis. The methodology we describe could be applicable to other centres using CR as an imaging modality for <span class="hlt">paediatrics</span>. Presently, this method is the only <span class="hlt">practical</span> approach to automatically extract parameters contained in the DICOM header, for the calculation of patient dose values for the CR modality.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24015733','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24015733"><span>A model for peer-assisted learning in <span class="hlt">paediatrics</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gandhi, Ajay; Primalani, Nishal; Raza, Sadaf; Marlais, Matko</p> <p>2013-10-01</p> <p>Previous studies have shown peer-assisted learning (PAL) to be an effective method of teaching, with benefits to students and tutors; however, the effect of PAL in <span class="hlt">paediatrics</span> has not been evaluated in the literature. This study aimed to evaluate a student-led <span class="hlt">paediatrics</span> revision course for students preparing for examinations in medical specialties. Students in their specialties year were invited to undergo a 1-day revision course consisting of a lecture and small group teaching, with a supplemental revision booklet. Tutors were recruited from the final-year cohort to facilitate the teaching. Questionnaires containing Likert-scale questions (1, strongly disagree; 5, strongly agree) were distributed before and after the course to assess its effectiveness. In all, 62 per cent (87/140) of students who attended the course responded to the study. Students felt significantly more prepared for their exam after the course (mean 3.47 post-course versus 2.16 pre-course), and significantly more prepared to manage children in clinical <span class="hlt">practice</span> (mean 3.49 post-course versus 2.53 pre-course). Students rated the course as good (4.35/5), with the small group sessions deemed to be the most useful aspect. Tutors agreed that participating had improved their teaching in general (4.0/5), their confidence (4.1/5), their clinical knowledge (3.6/5) and their oral presentation skills (3.8/5). The results demonstrate an effective model for students and tutors in building vital skills in <span class="hlt">paediatrics</span> and exam preparation. This reinforces the holistic positive attributes attainable from peer-assisted learning, and such schemes should be incorporated into undergraduate medical curricula for <span class="hlt">paediatrics</span> to increase student confidence and potentially increase recruitment to <span class="hlt">paediatrics</span>. © 2013 John Wiley & Sons Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/8461171','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/8461171"><span>Priorities and <span class="hlt">practice</span> in tropical <span class="hlt">paediatrics</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Biddulph, J</p> <p>1993-02-01</p> <p>More than 14 million children under 5 years of age die annually in the Third World, mainly due to diarrhoea, pneumonia, malaria and immunizable diseases. The problems of poverty, malnutrition, poor sanitation, illiteracy and high fertility that traditionally are associated with underdevelopment are now being compounded by social disruption due to rapid changes in lifestyle, new diseases such as AIDS and Third World debt. A vital part of the solution is provision of basic medical and education services to all, with emphasis on female literacy and improving the status of women. Key elements in providing basic medical services are delegation and empowerment. Doctors must delegate the delivery of essential child health services to appropriately trained and adequately supported auxiliaries. Parents, especially mothers, need to be empowered with the knowledge and resources to recognize and manage, or assist in the management of, their children's health problems.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1647651','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1647651"><span>Medium Chain Triglycerides in <span class="hlt">Paediatric</span> <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Gracey, Michael; Burke, Valerie; Anderson, Charlotte M.</p> <p>1970-01-01</p> <p>Medium chain triglycerides (MCT) bypass the steps necessary for the absorption of long chain fats (LCT), and so have theoretical grounds for their use in various disease states, particularly malabsorptive disorders. In childhood, MCT have particular advantages since they allow restriction of dietary long chain fats without limiting the intake of protein necessary for growth while providing adequate calories. In malabsorptive states, MCT have been used mostly in cystic fibrosis, where they may reduce steatorrhoea. However, the long-term growth patterns of these children are dependent on the extent and severity of their chest disease. MCT may be a useful source of calories for those with anorexia due to infection or liver disease and in babies recovering from meconium ileus. The decrease in offensive stools, flatus, and abdominal discomfort improves well-being and social acceptability which is important for many schoolchildren and adolescents. Rectal prolapse may be helped. Where there is loss of the small intestinal absorptive surface, particularly after massive small bowel resection, MCT can help to maintain weight and nutrition. They may also be a useful supplementary nutritional measure in patients severely affected with coeliac disease while awaiting response to a gluten-free diet, and in patients with regional enteritis. In children with liver disease, MCT provide a ready source of calories while avoiding the loss of fat in their stools. Infants with neonatal hepatitis or biliary atresia remain well nourished, and some older children with liver disease grow more rapidly and have fewer and less offensive stools and less abdominal discomfort. Where an abnormal number of faecal organisms colonize the small intestine (`contaminated small bowel syndrome' or `blind loop syndrome') intraluminal bile salts become deconjugated and cause steatorrhoea. A combination of antibiotic and surgical treatment is usually indicated, but MCT can be used to improve nutrition before operation and may be indicated for associated conditions, such as massive intestinal resection. MCT have also been helpful in patients with defective chylomicron formation due to a-β-lipoproteinaemia. In the congenital and less commonly encountered acquired lymphatic disorders in childhood, MCT have given encouraging results. This group includes patients with gross protein and fat loss due to intestinal lymphangiectasia and others with lymphatic anomalies at other sites. Hyperchylomicronaemia (familial fat-induced hypertriglyceridaemia) responds well to dietary treatment with MCT. PMID:4918706</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26017183','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26017183"><span>Family functioning in <span class="hlt">paediatric</span> obsessive compulsive and related disorders.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Murphy, Yolanda E; Flessner, Christopher A</p> <p>2015-11-01</p> <p>Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among <span class="hlt">paediatric</span> OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research. A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', '<span class="hlt">paediatric</span> OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting <span class="hlt">practices</span>, family dynamics, family involvement with symptoms, and family emotional climate. The literature reviewed demonstrated a strong relationship between <span class="hlt">paediatric</span> OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in <span class="hlt">paediatric</span> HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs. This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed. The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in <span class="hlt">paediatric</span> OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28516822','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28516822"><span>Key drivers of patient experience in ambulatory <span class="hlt">paediatric</span> cardiology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Allam, Shalini D; Mehta, Mary; Ben Khallouq, Bertha; Burrows, James F; Rosen, Paul</p> <p>2017-10-01</p> <p>Patient experience is becoming a central focus of healthcare. A broad range of studies on how to increase patient satisfaction ratings exists; however, they lack the specificity to adequately guide physicians and hospitals on how to improve patient experience. The objective of this study was to define the aspects of patient experience within <span class="hlt">paediatric</span> cardiologist <span class="hlt">practices</span> that can serve as predictors of excellent patient satisfaction. From 1 January, 2013 to 28 February, 2015 (26 months), outpatients who visited <span class="hlt">paediatric</span> cardiologists were asked to complete a 39-question patient satisfaction survey regarding their experience. Surveys were collected over a 26-month period by Press Ganey, an independent provider of patient satisfaction surveys. Participants were asked to rate their experience on a 1-5 Likert-scale: a score of 1 demonstrated a "poor" experience, whereas a score of 5 demonstrated a "very good" experience. This retrospective study of 2468 responses determined that cheerfulness of the <span class="hlt">practice</span> (r=0.85, p<0.001), a cohesive staff (r=0.83, p<0.001), and a care provider explaining problems and conditions (r=0.81, p<0.001) were key aspects of a <span class="hlt">paediatric</span> cardiologist's <span class="hlt">practice</span> that can be used as predictors of overall patient satisfaction. Awareness of how doctors can personalise a patient's experience is vital to achieve greater patient satisfaction and, ultimately, better patient outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23001574','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23001574"><span>ESPR Uroradiology Task Force and ESUR <span class="hlt">Paediatric</span> Working Group--Imaging recommendations in <span class="hlt">paediatric</span> uroradiology, part V: childhood cystic kidney disease, childhood renal transplantation and contrast-enhanced ultrasonography in children.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Riccabona, Michael; Avni, Fred Efraim; Damasio, Maria Beatrice; Ording-Müller, Lil-Sofie; Blickman, Johan G; Darge, Kassa; Lobo, Maria Luisa; Papadopoulou, Frederica; Vivier, Pierre-Hugues; Willi, Ullrich</p> <p>2012-10-01</p> <p>The ESPR Uroradiology Task Force and the ESUR <span class="hlt">Paediatric</span> Working Group present two new recommendations on imaging in childhood cystic kidney disease and in childhood renal transplantation, and address the presently restricted availability of contrast-enhanced (ce) US in children. New insights into the genetics require an updated classification of <span class="hlt">paediatric</span> cystic kidney disease along with a new concept of diagnostic imaging. Characteristic imaging features are key to the new classification. Available recommendations for imaging renal transplantation in children are not satisfactory. The following consensus-based algorithm proposes a more effective and more uniform imaging concept, reducing invasiveness, enhancing diagnostic accuracy, and facilitating future multicentre studies and meta-analysis. At present, ce-US in children can only be performed off-license, since the only approved US contrast agent (CA) for children has been taken off the market. Nevertheless, <span class="hlt">paediatric</span> ce-US is <span class="hlt">practiced</span> at multiple places using Sonovue (Bracco, Milan, Italy), a generally available agent in Europe. From a medical and scientific perspective, <span class="hlt">paediatric</span> ce-US should be promoted, and efforts are undertaken to collect data on <span class="hlt">paediatric</span> US-CA applications. Routine <span class="hlt">paediatric</span> imaging depends on local expertise and availability of equipment. The imaging recommendations and supportive data are intended to ease the physicians' difficult task of dealing with the specific diagnostic demands of <span class="hlt">paediatric</span> <span class="hlt">paediatric</span> cystic kidney disease and transplantation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21539697','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21539697"><span>The <span class="hlt">impact</span> of 'best-<span class="hlt">practice</span>' patient care in fibromyalgia on <span class="hlt">practice</span> economics.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Brown, T Michelle; Garg, Suchita; Chandran, Arthi B; McNett, Michael; Silverman, Stuart L; Hadker, Nandini</p> <p>2012-08-01</p> <p>The office time required for primary care physicians (PCPs) to diagnose, treat and manage fibromyalgia (FM) patients can be extensive. The study objective was to determine if PCPs can positively <span class="hlt">impact</span> <span class="hlt">practice</span> economics by requiring fewer patient visits and less office time, while still achieving an acceptable quality of life, as reported by the physician. Survey of PCPs who diagnose, manage and treat FM patients. Surveys were administered to US private <span class="hlt">practice</span> PCPs, obtaining information on the number of office visits, and time spent with FM patients. PCPs were allotted into two groups: FM-efficient (FME; n = 40) and FM usual care (FMUC; n = 54), based on their reported ability to achieve an acceptable quality of life for ≥50% of their FM patients in less than four office visits post FM diagnosis. An economic model estimated the monetary value of each PCP cohorts' time spent with a newly diagnosed FM patient over a 2-year timeframe. Significant office time cost differences across 2 years exist between FME PCPs and FMUC PCPs ($840 vs. $1117, P < 0.05). FME PCPs had a significantly lower cost of scheduled time to confirm diagnosis ($243 vs. $339, P < 0.05) and time to find right treatment ($264 vs. $365, P < 0.05) than FMUC PCPs. Both groups incurred costs related to excess visit time, but it was less for FME PCPs ($119, 29 minutes) than FMUC PCPs ($182, 44 minutes, P < 0.01), driven by quicker diagnosis confirmation (P < 0.01) and treatment initiation (P < 0.01). Research suggests that efficient FM care delivery during diagnosis and treatment can be associated with improved <span class="hlt">practice</span> economics. © 2011 Blackwell Publishing Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15556822','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15556822"><span>The <span class="hlt">impact</span> of transesophageal echocardiography on daily clinical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kühl, H P; Hanrath, P</p> <p>2004-12-01</p> <p>The development of transesophageal echocardiography (TEE) almost 20 years ago has tremendously widened the diagnostic potential of cardiac ultrasound and has, without doubt, strongly improved our pathophysiological understanding of many cardiovascular diseases such as aortic dissection, mitral valve disease or ischemic stroke. Especially the introduction of multiplane transducers that allow imaging of the cardiac structures from various scan plane orientations has yielded a level of diagnostic accuracy that is seldom attained by other imaging modalities. The outstanding image quality as well as the high temporal and spatial resolution provided by TEE renders the method especially suited to visualize small and rapidly moving structures, such as left atrial thrombus formation and valvular vegetations. In addition, TEE is exceptional in its capability to scan the heart from perspectives that cannot be easily attained by any other modality, thus enhancing its diagnostic yield. In the last few years the clinical application of TEE has been extended from a pure diagnostic tool to an indispensable monitoring adjunct for percutaneous interventional procedures as well as for the intra- and peri-operative monitoring in the operating theatre and on the intensive care unit. In the surroundings of emerging sophisticated technologies to image the heart and the great vessels within the thorax such as multi-slice computed tomography and cardiovascular magnetic resonance imaging TEE asserts a firm place in the diagnostic armamentarium for the cardiologist. This review will focus the <span class="hlt">impact</span> of TEE in daily clinical <span class="hlt">practice</span> and on possible future applications of the technique.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25586844','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25586844"><span>In the beginning, there was general <span class="hlt">paediatrics</span> ….</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gunasekera, Hasantha; Kilham, Henry</p> <p>2015-01-01</p> <p>In this article, we address how general <span class="hlt">paediatrics</span> has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general <span class="hlt">paediatrics</span> with that of general adult medicine. We argue that general <span class="hlt">paediatrics</span> must continue to have a strong role both in <span class="hlt">paediatric</span> teaching hospitals and the community. © 2015 The Authors. Journal of <span class="hlt">Paediatrics</span> and Child Health © 2015 <span class="hlt">Paediatrics</span> and Child Health Division (Royal Australasian College of Physicians).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24103240','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24103240"><span>[Knowledge of health care ethics in <span class="hlt">paediatric</span> residents].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hernández González, A; Rodríguez Núñez, A; Cambra Lasaosa, F J; Quintero Otero, S; Ramil Fraga, C; García Palacios, M V; Hernández Rastrollo, R; Ruiz Extremera, M A</p> <p>2014-02-01</p> <p>Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical <span class="hlt">practice</span> is not well structured. To evaluate the knowledge of bioethics in Spanish <span class="hlt">paediatric</span> residents, and to analyse how this relates to the medical education during graduate and post-graduate training. A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical <span class="hlt">practice</span>. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. A total of 210 completed questionnaires were received from medical residents in <span class="hlt">paediatrics</span> from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical <span class="hlt">practice</span> by Spanish residents in <span class="hlt">paediatrics</span>. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in <span class="hlt">paediatrics</span>. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24534116','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24534116"><span>Hypnosis in <span class="hlt">paediatric</span> respiratory medicine.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D</p> <p>2014-03-01</p> <p>Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of <span class="hlt">paediatric</span> 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 <span class="hlt">paediatric</span> 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.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25407568','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25407568"><span>Trismus in the <span class="hlt">paediatric</span> population.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Shires, Peter M; Chow, Gabriel</p> <p>2015-04-01</p> <p>Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the <span class="hlt">paediatric</span> patient are discussed in this review article; they are divided into intra- and extra-articular types. The extra-articular group consists of congenital and acquired disorders. The acquired group includes infective causes such as tetanus, iatrogenic causes related to drugs, cancer or dental treatment, and trauma causing articulation difficulty or triggering a rare type of bone growth in myositis ossificans. Changes in the mouth resulting from oral submucous fibrosis can undergo malignant transformation. This review aims to raise awareness of potential causes of trismus in <span class="hlt">paediatric</span> populations, helping clinicians identify the underlying pathology so appropriate strategies for treatment be applied, with the ultimate aim of improving long-term outlook and quality of life for affected children. © 2014 Mac Keith Press.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23463409','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23463409"><span>[Current aspects of <span class="hlt">paediatric</span> cholesteatomas].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Thomas, J P; Volkenstein, S; Minovi, A; Dazert, S</p> <p>2013-05-01</p> <p>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, <span class="hlt">paediatric</span> 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 <span class="hlt">paediatric</span> 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.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25316255','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25316255"><span><span class="hlt">Paediatric</span> bacteraemias in tropical Australia.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Er, Jeremy; Wallis, Peter; Maloney, Samuel; Norton, Robert</p> <p>2015-04-01</p> <p>Bacteraemias in children are an important cause of morbidity and mortality. Knowledge of local epidemiology and trends is important to inform practitioners of likely pathogens in the sick child. This study aimed to determine trends over time in pathogenic organisms causing <span class="hlt">paediatric</span> bacteraemia in North Queensland and to audit a hospital's blood culture results with respect to contamination rate. This was a retrospective review of 8385 blood cultures collected from children attending a tertiary centre in North Queensland over a 10-year period (2001-2010). There were 696 positive blood cultures (8.3%) with 70 different bacterial species detected. Gram-positive and Gram-negative bacteria accounted for 48.6% and 51.4% of isolates, respectively. Overall, bacteraemia accounted for 4.7 per 1000 admissions. The rate of contamination was 60.6% among positive blood cultures and 5.0% for all blood cultures sampled. These results were compared with previous published reports. Notable differences were seen in the frequencies of Salmonella and group A Streptococcus bacteraemias in North Queensland when compared with other reports. There was also a decline in vaccine-preventable infections such as S. pneumoniae and an increasing trend of community-acquired MRSA bacteraemia. This study has demonstrated the unique profile of causative pathogens of <span class="hlt">paediatric</span> bacteraemias in tropical Australia. In light of the increasing prevalence of MRSA, empiric treatment for sepsis for children in this region needs to be reconsidered. © 2014 The Authors. Journal of <span class="hlt">Paediatrics</span> and Child Health © 2014 <span class="hlt">Paediatrics</span> and Child Health Division (Royal Australasian College of Physicians).</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li class="active"><span>19</span></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_19 --> <div id="page_20" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li class="active"><span>20</span></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="381"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4962244','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4962244"><span>Inequality of <span class="hlt">Paediatric</span> Workforce Distribution in China</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Song, Peige; Ren, Zhenghong; Chang, Xinlei; Liu, Xuebei; An, Lin</p> <p>2016-01-01</p> <p>Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of <span class="hlt">paediatric</span> workforce distribution. This study aimed to analyse the inequality of the distributions of the <span class="hlt">paediatric</span> workforce (including paediatricians and <span class="hlt">paediatric</span> nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the <span class="hlt">paediatric</span> workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the <span class="hlt">paediatric</span> workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of <span class="hlt">paediatric</span> nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the <span class="hlt">paediatric</span> workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the <span class="hlt">paediatric</span> workforce in China for the first time, substantial inequality of <span class="hlt">paediatric</span> workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation. PMID:27420083</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2014ECSS..136...53G','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2014ECSS..136...53G"><span><span class="hlt">Impacts</span> of docks on seagrass and effects of management <span class="hlt">practices</span> to ameliorate these <span class="hlt">impacts</span></span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Gladstone, William; Courtenay, Glenn</p> <p>2014-01-01</p> <p>Seagrasses have high conservation and human-use values, but around the world they are being damaged by human activities. Compared to the larger spatial scale at which some human activities affect estuaries and their seagrasses (e.g. catchment disturbance, dredging, pollution, trawling), recreational boating and infrastructure of moorings and docks act at smaller scales. However, the cumulative effects contribute to stresses acting on seagrass beds. This study assessed the effects of docks on the native seagrass Zostera muelleri subsp. capricorni in an estuary in south-east Australia and of current management <span class="hlt">practices</span> designed to reduce dock <span class="hlt">impacts</span> on this seagrass. A field survey found that seagrass biomass was significantly reduced below docks, and the effects were not influenced by dock orientation. Management <span class="hlt">practices</span> requiring the use of a mesh decking to provide greater light penetration reduced, but did not eliminate, the reduction in seagrass biomass caused by docks. A modified beyond BACI experiment provided evidence for a causal link between the installation of wooden or mesh docks and reductions in biomass of seagrass. The reduction in biomass was apparent 6 mo after dock installation, and by 26 mo seagrass biomass had declined by at least 90%. Faced with increasing coastal populations, increases in recreational use, and continued pressures from other human activities, alternative management <span class="hlt">practices</span> that further minimize the effects of docks are needed.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28501462','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28501462"><span>Ray resection in <span class="hlt">paediatric</span> population.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Martínez-Álvarez, S; Maldonado-Morillo, A; Vara-Patudo, I; Martínez-González, C; Miranda-Gorozarri, C</p> <p></p> <p>Evaluation of clinical and functional outcome of ray resection in <span class="hlt">paediatric</span> population and description of key aspects of surgical technique. We performed a retrospective review of all patients undergoing surgery between 2010-2015. one or more ray resections of the hand and a minimum of one year follow-up. Evaluation of clinical characteristics, functional and cosmetic results, complications, need for psychological support and patient or family satisfaction. Four patients met the inclusion criteria. The mean age at surgery was 5 years (range, 1-14 years). Aetiology was: fibrolipomatous hamartoma, traumatic amputation, radial deficiency and complex syndactyly. Second ray was resected in three patients and third and fourth ray in one. No finger transfer was performed. No immediate post-operative complications were found at the final evaluation. None of them needed psychological support. All the patients showed excellent clinical and functional results with a high grade of satisfaction. Ray resection of the hand has been used as salvage procedure in patients with vascular lesions, tumours, trauma, infections or congenital malformations. There are only a few published studies including small samples in adults or case reports, with no references in the <span class="hlt">paediatric</span> population. Ray resection of the hand is a useful and safe technique in <span class="hlt">paediatric</span> population, obtaining excellent cosmetic and functional results in those cases in which it is impossible to preserve one or more fingers. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4237943','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4237943"><span>The influence of the European <span class="hlt">paediatric</span> regulation on marketing authorisation of orphan drugs for children</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2014-01-01</p> <p>Background Drug development for rare diseases is challenging, especially when these orphan drugs (OD) are intended for children. In 2007 the EU <span class="hlt">Paediatric</span> Drug Regulation was enacted to improve the development of high quality and ethically researched medicines for children through the establishment of <span class="hlt">Paediatric</span> Investigation Plans (PIPs). The effect of the EU <span class="hlt">Paediatric</span> Drug Regulation on the marketing authorisation (MA) of drugs for children with rare diseases was studied. Methods Data on all designated orphan drugs, their indication, MA, PIPs and indication group (adult or child) were obtained from the European Medicines Agency (EMA). The outcome and duration of the process from orphan drug designation (ODD) to MA, was compared, per indication, by age group. The effect of the <span class="hlt">Paediatric</span> Drug Regulation, implemented in 2007, on the application process was assessed with survival analysis. Results Eighty-one orphan drugs obtained MA since 2000 and half are authorised for (a subgroup of) children; another 34 are currently undergoing further investigations in children through agreed PIPs. The <span class="hlt">Paediatric</span> Drug Regulation did not significantly increase the number of ODDs with potential <span class="hlt">paediatric</span> indications (58% before vs 64% after 2007 of ODDs, p = 0.1) and did not lead to more MAs for ODs with <span class="hlt">paediatric</span> indications (60% vs 43%, p = 0.22). ODs authorised after 2007 had a longer time to MA than those authorised before 2007 (Hazard ratio (95% CI) 2.80 (1.84-4.28), p < 0.001); potential <span class="hlt">paediatric</span> use did not influence the time to MA (Hazard ratio (95% CI) 1.14 (0.77-1.70), p = 0.52). Conclusions The EU <span class="hlt">Paediatric</span> Drug Regulation had a minor <span class="hlt">impact</span> on development and availability of ODs for children, was associated with a longer time to MA, but ensured the further <span class="hlt">paediatric</span> development of drugs still off-label to children. The <span class="hlt">impact</span> of the <span class="hlt">Paediatric</span> Drug Regulation on research quantity and quality in children through PIPs is not yet clear. PMID</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/10168441','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/10168441"><span><span class="hlt">Impact</span> of tax sanctions on physician <span class="hlt">practice</span> acquisitions and employment.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hardy, C T; Lyden, S M; Kasmarcak, S J</p> <p>1997-07-01</p> <p>The intermediate tax sanctions create significant concerns for tax-exempt healthcare organizations that seek to integrate <span class="hlt">practicing</span> physicians through <span class="hlt">practice</span> acquisition or employment. The sanctions will force not-for-profit healthcare organizations to examine both the strategic and business implications of the dollars they have committed to <span class="hlt">practice</span> acquisition and physician employment. The sanctions also should motivate organizations to reexamine their existing physician compensation arrangements, which may be creating negative incentives for <span class="hlt">practice</span> productivity.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=art+AND+evaluation&pg=5&id=EJ1033982','ERIC'); return false;" href="http://eric.ed.gov/?q=art+AND+evaluation&pg=5&id=EJ1033982"><span>The Conditional Nature of High <span class="hlt">Impact</span>/Good <span class="hlt">Practices</span> on Student Learning Outcomes</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Seifert, Tricia A.; Gillig, Benjamin; Hanson, Jana M.; Pascarella, Ernest T.; Blaich, Charles F.</p> <p>2014-01-01</p> <p>Using a multi-institutional sample of undergraduate students, this study found that the relationships between engaging in high <span class="hlt">impact</span>/good <span class="hlt">practices</span> and liberal arts outcomes differ based on students' precollege and background characteristics. Findings suggest that high <span class="hlt">impact</span>/good <span class="hlt">practices</span> are not a panacea and require a greater degree of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=elementary+AND+school&pg=6&id=ED571977','ERIC'); return false;" href="http://eric.ed.gov/?q=elementary+AND+school&pg=6&id=ED571977"><span>The <span class="hlt">Impact</span> of Servant Leadership <span class="hlt">Practices</span> in an Urban Focus Elementary School</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Davis-Elenis, Sharon V.</p> <p>2016-01-01</p> <p>This study examined the <span class="hlt">impact</span> of servant leadership <span class="hlt">practices</span> as perceived by faculty and staff in an urban Focus elementary school. A mixed-methods design was used to explore the <span class="hlt">impact</span> of the school leader's servant leadership <span class="hlt">practices</span> on the behavior and perceptions of the faculty and staff, and the challenges a school leader faces as a…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28458122','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28458122"><span><span class="hlt">Impact</span> of social prescribing on general <span class="hlt">practice</span> workload and polypharmacy.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Loftus, A M; McCauley, F; McCarron, M O</p> <p>2017-07-01</p> <p>Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the <span class="hlt">impact</span> of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Quality-improvement design with social prescribing activity interventions from an urban general <span class="hlt">practice</span> in Northern Ireland. Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25261099','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25261099"><span><span class="hlt">Impact</span> of intervention on healthcare waste management <span class="hlt">practices</span> in a tertiary care governmental hospital of Nepal.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sapkota, Binaya; Gupta, Gopal Kumar; Mainali, Dhiraj</p> <p>2014-09-26</p> <p>Healthcare waste is produced from various therapeutic procedures performed in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, injections, etc. These result in the production of non-hazardous waste (75-95%) and hazardous waste (10-25%), such as sharps, infectious, chemical, pharmaceutical, radioactive waste, and pressurized containers (e.g., inhaler cans). Improper healthcare waste management may lead to the transmission of hepatitis B, Staphylococcus aureus and Pseudomonas aeruginosa. This evaluation of waste management <span class="hlt">practices</span> was carried out at gynaecology, obstetrics, <span class="hlt">paediatrics</span>, medicine and orthopaedics wards at Government of Nepal Civil Service Hospital, Kathmandu from February 12 to October 15, 2013, with the permission from healthcare waste management committee at the hospital. The Individualized Rapid Assessment tool (IRAT), developed by the United Nations Development Program Global Environment Facility project, was used to collect pre-interventional and post-interventional performance scores concerning waste management. The healthcare waste management committee was formed of representing various departments. The study included responses from focal nurses and physicians from the gynaecology, obstetrics, <span class="hlt">paediatrics</span>, medicine and orthopaedics wards, and waste handlers during the study period. Data included average scores from 40 responders. Scores were based on compliance with the IRAT. The waste management policy and standard operating procedure were developed after interventions, and they were consistent with the national and international laws and regulations. The committee developed a plan for recycling or waste minimization. Health professionals, such as doctors, nurses and waste handlers, were trained on waste management <span class="hlt">practices</span>. The programs included segregation, collection, handling, transportation, treatment and disposal of waste, as well as occupational health and safety issues</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18808544','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18808544"><span>UK National Clinical Guidelines in <span class="hlt">Paediatric</span> Dentistry: stainless steel preformed crowns for primary molars.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kindelan, S A; Day, P; Nichol, R; Willmott, N; Fayle, S A</p> <p>2008-11-01</p> <p>This revised Clinical Guideline in <span class="hlt">Paediatric</span> Dentistry replaces the previously published sixth guideline (Fayle SA. Int J <span class="hlt">Paediatr</span> 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 <span class="hlt">paediatric</span> dentistry, council members of the British Society of <span class="hlt">Paediatric</span> 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 <span class="hlt">practice</span> 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 <span class="hlt">paediatric</span> dentistry guideline production in the UK is described in the Int J <span class="hlt">Paediatr</span> Dent 1997; 7: 267-268.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23519851','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23519851"><span>Evaluation of clinical research reporting in African Journal of <span class="hlt">Paediatric</span> Surgery.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nasir, Abdulrasheed A; Lakhoo, Kokila</p> <p>2013-01-01</p> <p>Clinical research forms the cornerstone of efforts to improve the lives of patients. African Journal of <span class="hlt">Paediatric</span> Surgery has been a major vehicle for dissemination of information to <span class="hlt">paediatric</span> surgeons in Africa since 2004. Most studies in the <span class="hlt">paediatric</span> surgical literature are observational studies. This study aims to assess the adequacy of clinical research reporting in African Journal <span class="hlt">paediatric</span> surgery. The authors analyzed all observational studies published in African Journal of <span class="hlt">Paediatric</span> Surgery from 2006 to 2010 (n = 73). Studies were assessed using a validated tool for 16 baseline criteria essential for the non-biased reporting of clinical data (details regarding surgeons, cases, interventions, and statistical methods). Seven additional criteria pertaining to comparison methods were assessed in studies using controls. Sixty-seven percent of all studies were retrospective, and only 5.5% utilized a control group. There were 72 (98.6%) case series. Most studies met less than half of the essential reporting criteria (mean, 7.3 of 16 baseline criteria). Reporting deficiencies were found in all major aspects of study design and statistical analysis. There is no statistical difference between prospective and retrospective studies. This study has identified deficiencies in the fundamental elements essential to non-biased reporting of clinical research in African Journal of <span class="hlt">Paediatric</span> Surgery. We recommend that the Journal adopt the validated standard reporting criteria for these studies to improve the ability of its readers to interpret the relevance of clinical research findings to their own <span class="hlt">practice</span>.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26121885','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26121885"><span>[SYSTEMATIZATION, ORDER AND SECURITY AS A RESULT OF THE NURSE ASSESSMENT IN <span class="hlt">PAEDIATRIC</span> EMERGENCY: A METAMORPHOSIS PROCESS].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>García-Hernández, M-Noelia; Fraga-Hernández, Ma Elena; Mahtani-Chugani, Vinita</p> <p>2014-12-01</p> <p>To determine from the health care professionals perspective the <span class="hlt">impact</span> on clinical <span class="hlt">practice</span> of incorporating an assessment tool for primary care <span class="hlt">paediatric</span> emergency. Qualitative study based on the collection of written documents. Twenty-four wide and detailed documents were collected. Thematic analysis was used. Participants were 9 nurses and 7 paediatricians, all with experience in the <span class="hlt">Paediatric</span> Emergency Department. The results are grouped into three areas: perception of previous situation; benefits perceived; difficulties of the change process related to the triage instrument. The benefits perceived include the achievement of the objectives related to triage as well as collateral benefits for the organization and distribution of structural resources, adequacy of human resources, self-assessment and professional recognition, improvement of team communication and users service perception. The difficulties identified are related to the feasibility of using this instrument when patient flow is high and to the need of specialized training. All participants perceived more benefits than disadvantages, and both nurses and paediatricians experienced the process as a positive experience. The introduction of the assessment tool had a broader <span class="hlt">impact</span> than expected.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12447104','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12447104"><span>Recent advances in <span class="hlt">paediatric</span> neuro-oncology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Saran, Frank</p> <p>2002-12-01</p> <p>Primary central nervous system malignancies incorporate a variety of tumours with diverse biology and clinical behaviour and represent the most common solid tumour entity of childhood, accounting for approximate 20-25% of all primary <span class="hlt">paediatric</span> malignancies. Recent findings regarding the underlying tumour biology may open up new avenues of clinical trial design, particularly identifying possible targets for biological modifiers. Over the last 12-18 months a significant number of institutional and national studies have been reported which are likely to <span class="hlt">impact</span> on the design of future clinical trials. In low-grade gliomas, stereotactically guided conformal radiotherapy should lead to a significant reduction in radiation-associated late toxicity, while in selected groups of high-grade gliomas the use of adjuvant or neo-adjuvant chemotherapy may improve survival. Completeness of resection and use of adjuvant focal radiotherapy remains the most important prognostic factor for outcome in patients with ependymomas, although in infants the use of post-surgical chemotherapy alone may allow the postponing of radiotherapy in selected cases. In primitive neuroectodermal tumours prognostic biological markers have been identified that are undergoing prospective evaluation. For patients with localized medulloblastomas a new standard treatment is emerging that uses reduced-dose craniospinal radiotherapy followed by platinum-based chemotherapy, while in supratentorial primitive neuroectodermal tumours future treatment will be aimed at improving local control. Given the rarity of <span class="hlt">paediatric</span> primary central nervous system malignancies, further progress can only be achieved in the context of national or multinational prospective clinical trials incorporating biological studies, and participation in these should be strongly encouraged. Copyright 2002 Lippincott Williams & Wilkins</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2014PMB....59.1165X','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2014PMB....59.1165X"><span>Evaluation of radiation dose to anthropomorphic <span class="hlt">paediatric</span> models from positron-emitting labelled tracers</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Xie, Tianwu; Zaidi, Habib</p> <p>2014-03-01</p> <p>PET uses specific molecules labelled with positron-emitting radionuclides to provide valuable biochemical and physiological information. However, the administration of radiotracers to patients exposes them to low-dose ionizing radiation, which is a concern in the <span class="hlt">paediatric</span> population since children are at a higher cancer risk from radiation exposure than adults. Therefore, radiation dosimety calculations for commonly used positron-emitting radiotracers in the <span class="hlt">paediatric</span> population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic <span class="hlt">paediatric</span> models including the newborn, 1-, 5-, 10- and 15-year-old male and female. This is achieved using pre-calculated S-values of positron-emitting radionuclides of UF-NCI <span class="hlt">paediatric</span> phantoms and published biokinetic data for various radiotracers. The influence of the type of anthropomorphic model, tissue weight factors and direct human- versus mouse-derived biokinetic data on the effective dose for <span class="hlt">paediatric</span> phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference <span class="hlt">paediatric</span> patients from various dose regimens were also calculated. Among the considered radiotracers, 18F-FBPA and 15O-water resulted in the highest and lowest effective dose in the <span class="hlt">paediatric</span> phantoms, respectively. The ICRP 103 updated tissue-weighting factors decrease the effective dose in most cases. Substantial differences of radiation dose were observed between direct human- versus mouse-derived biokinetic data. Moreover, the effect of using voxel- versus MIRD-type models on the calculation of the effective dose was also studied. The generated database of absorbed organ dose and effective dose for various positron-emitting labelled radiotracers using new generation computational models and the new ICRP tissue-weighting factors can be used for the assessment of radiation risks to <span class="hlt">paediatric</span> patients in clinical <span class="hlt">practice</span>. This work also contributes</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3500799','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3500799"><span>Sedation/anaesthesia in <span class="hlt">paediatric</span> radiology</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Arlachov, Y; Ganatra, R H</p> <p>2012-01-01</p> <p>Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in <span class="hlt">practice</span> and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, <span class="hlt">paediatric</span> radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological <span class="hlt">practice</span> is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and <span class="hlt">practice</span> safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment. PMID:22898157</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29021237','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29021237"><span>Recommendations for collaborative <span class="hlt">paediatric</span> research including biobanking in Europe: a Single Hub and Access point for <span class="hlt">paediatric</span> Rheumatology in Europe (SHARE) initiative.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kuemmerle-Deschner, Jasmin B; Hansmann, Sandra; Wulffraat, Nico M; Vastert, Sebastiaan J; Hens, Kristien; Anton, Jordi; Avcin, Tadej; Martini, Alberto; Koné-Paut, Isabelle; Uziel, Yosef; Ravelli, Angelo; Wouters, Carine; Shaw, David; Özen, Seza; Eikelberg, Andreas; Prakken, Berent J; Ruperto, Nicolino; Horneff, Gerd; Constantin, Tamas; Beresford, Michael W; Sikken, Marijn; Foster, Helen E; Haug, Iris; Schuller, Sabrina; Jägle, Christine; Benseler, Susanne M</p> <p>2017-10-11</p> <p>Innovative research in childhood rheumatic diseases mandates international collaborations. However, researchers struggle with significant regulatory heterogeneity; an enabling European Union (EU)-wide framework is missing. The aims of the study were to systematically review the evidence for best <span class="hlt">practice</span> and to establish recommendations for collaborative research. The <span class="hlt">Paediatric</span> Rheumatology European Single Hub and Access point for <span class="hlt">paediatric</span> Rheumatology in Europe (SHARE) project enabled a scoping review and expert discussion, which then informed the systematic literature review. Published evidence was synthesised; recommendations were drafted. An iterative review process and consultations with Ethics Committees and European experts for ethical and legal aspects of <span class="hlt">paediatric</span> research refined the recommendations. SHARE experts and patient representatives vetted the proposed recommendations at a consensus meeting using Nominal Group Technique. Agreement of 80% was mandatory for inclusion. The systematic literature review returned 1319 records. A total of 223 full-text publications plus 22 international normative documents were reviewed; 85 publications and 16 normative documents were included. A total of 21 recommendations were established including general principles (1-3), ethics (4-7), <span class="hlt">paediatric</span> principles (8 and 9), consent to <span class="hlt">paediatric</span> research (10-14), <span class="hlt">paediatric</span> databank and biobank (15 and 16), sharing of data and samples (17-19), and commercialisation and third parties (20 and 21). The refined recommendations resulted in an agreement of >80% for all recommendations. The SHARE initiative established the first recommendations for <span class="hlt">Paediatric</span> Rheumatology collaborative research across borders in Europe. These provide strong support for an urgently needed European framework and evidence-based guidance for its implementation. Such changes will promote research in children with rheumatic diseases. © Article author(s) (or their employer(s) unless otherwise</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21983004','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21983004"><span>From pharmacovigilance to therapy amelioration in <span class="hlt">paediatric</span> patients: the role of the clinical pharmacologists and family paediatricians. Part of a series on <span class="hlt">Paediatric</span> Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Napoleone, Ettore; Radice, Sonia</p> <p>2012-02-01</p> <p>An active pharmacovigilance approach is advisable in <span class="hlt">paediatric</span> pharmacotherapy as it contributes to generate knowledge promptly and to enhance the estimation of true risk in clinical <span class="hlt">practice</span>. Reports and studies from the scientific community and regulatory agencies have shown that effective methods for early detection of adverse drug reaction and pharmacoepidemiological studies are a primary need since they increase drug safety in the <span class="hlt">paediatric</span> population. In this perspective article we describe how pharmacologists and paediatricians may actively synergise to optimise drug therapies and their management in <span class="hlt">paediatric</span> patients.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26746592','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26746592"><span>Confidence and authority through new knowledge: An evaluation of the national educational programme in <span class="hlt">paediatric</span> oncology nursing in Sweden.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pergert, Pernilla; Af Sandeberg, Margareta; Andersson, Nina; Márky, Ildikó; Enskär, Karin</p> <p>2016-03-01</p> <p>There is a lack of nurse specialists in many <span class="hlt">paediatric</span> hospitals in Sweden. This lack of competence is devastating for childhood cancer care because it is a highly specialised area that demands specialist knowledge. Continuing education of nurses is important to develop nursing <span class="hlt">practice</span> and also to retain them. The aim of this study was to evaluate a Swedish national educational programme in <span class="hlt">paediatric</span> oncology nursing. The nurses who participated came from all of the six <span class="hlt">paediatric</span> oncology centres as well as from general <span class="hlt">paediatric</span> wards. At the time of the evaluation, three groups of registered nurses (n=66) had completed this 2year, part-time educational programme. A study specific questionnaire, including closed and open-ended questions was sent to the 66 nurses and 54 questionnaires were returned. Answers were analysed using descriptive statistics and qualitative content analysis. The results show that almost all the nurses (93%) stayed in <span class="hlt">paediatric</span> care after the programme. Furthermore, 31% had a position in management or as a consultant nurse after the programme. The vast majority of the nurses (98%) stated that the programme had made them more secure in their work. The nurses were equipped, through education, for <span class="hlt">paediatric</span> oncology care which included: knowledge generating new knowledge; confidence and authority; national networks and resources. They felt increased confidence in their roles as <span class="hlt">paediatric</span> oncology nurses as well as authority in their encounters with families and in discussions with co-workers. New networks and resources were appreciated and used in their daily work in <span class="hlt">paediatric</span> oncology. The programme was of importance to the career of the individual nurse and also to the quality of care given to families in <span class="hlt">paediatric</span> oncology. The national educational programme for nurses in <span class="hlt">Paediatric</span> Oncology Care meets the needs of the highly specialised care. Copyright © 2015 Elsevier Ltd. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23864083','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23864083"><span>Measuring <span class="hlt">impact</span> of JAMA Dermatology <span class="hlt">Practice</span> Gaps section on training in US dermatology residency programs.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Britton, Kristina M; Stratman, Erik J</p> <p>2013-07-01</p> <p>JAMA Dermatology <span class="hlt">Practice</span> Gaps commentaries are intended to aid in the interpretation of the literature to make it more <span class="hlt">practical</span> and applicable to daily patient care. <span class="hlt">Practice</span> Gaps commentaries have had an <span class="hlt">impact</span> on physician clinical <span class="hlt">practice</span> and dermatology residency curricula. To assess the <span class="hlt">impact</span> of JAMA Dermatology <span class="hlt">Practice</span> Gaps commentaries on dermatology residency training programs in the United States, including journal club discussions and local quality improvement activities. A web-based questionnaire of 17 questions was sent via e-mail to US dermatology residency program directors (PDs) in February 2012. Program director report of incorporating <span class="hlt">Practice</span> Gaps themes and discussions into resident journal club activities, clinical <span class="hlt">practice</span>, quality improvement activities, or research projects in the residency programs, as a result of a <span class="hlt">Practice</span> Gaps commentary. Of the 114 surveys distributed to US dermatology residency PDs, 48 were completed (42% response rate). Sixty percent of PDs reported familiarity with the <span class="hlt">Practice</span> Gaps section of JAMA Dermatology, and 56% discuss these commentaries during resident journal club activities. Quality improvement and research projects have been initiated as a result of <span class="hlt">Practice</span> Gaps commentaries. <span class="hlt">Practice</span> Gaps commentaries are discussed during most dermatology residency journal club activities. <span class="hlt">Practice</span> Gaps have had an <span class="hlt">impact</span> on physician <span class="hlt">practice</span> and dermatology residency curricula and can serve as a tool for enhanced continuing medical education and quality improvement initiatives.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18487985','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18487985"><span>[Naples: the historic capital of Italian <span class="hlt">paediatrics</span>].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Farnetani, I; Farnetani, F</p> <p>2008-06-01</p> <p>No other Italian city has contributed to the birth and development of <span class="hlt">paediatrics</span> more than Naples. This is why it can be considered the historic capital of Italian <span class="hlt">paediatrics</span>. Here are the main reasons: Luigi Somma was the first professor of Italian <span class="hlt">paediatrics</span> whereas Francesco Fede was the first president of the Italian <span class="hlt">Paediatrics</span> Association. Neapolitan paediatricians have been the most numerous amongst the founder members. The first three Italian journals of <span class="hlt">paediatrics</span> 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 <span class="hlt">Paediatrics</span> Association, while Rocco Jemma was the one who remained the longest in charge. ''Rocco Jemma's school'' taught not only to most professors in <span class="hlt">paediatrics</span> 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 <span class="hlt">Paediatrics</span> Association was founded in Naples as well as the Association of Nipiology.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li class="active"><span>20</span></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_20 --> <div id="page_21" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li class="active"><span>21</span></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="401"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26946709','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26946709"><span>[News in <span class="hlt">paediatrics</span>].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Depallens, Sarah; Lutz, Nicolas; Carlomagno, Raffaella; Meyrat, Blaise; Barazzoni, Mirjam Schuler; Tchameni, Yves Yamgoue; Pascual, Andres; Scerba, François; Superti-Furga, Andrea</p> <p>2016-01-13</p> <p>Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A <span class="hlt">practical</span> algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24001576','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24001576"><span>Estimation of head <span class="hlt">impact</span> exposure in high school football: implications for regulating contact <span class="hlt">practices</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Broglio, Steven P; Martini, Douglas; Kasper, Luke; Eckner, James T; Kutcher, Jeffery S</p> <p>2013-12-01</p> <p>Increased attention is being placed on the role of subconcussive <span class="hlt">impacts</span> to the head during football participation and long-term cognitive health. Some have suggested that mitigating <span class="hlt">impacts</span> to the head can be achieved by reducing or eliminating contact football <span class="hlt">practices</span>. The effect that this might have on the number and magnitude of <span class="hlt">impacts</span> is unknown. To estimate the effect of limiting contact <span class="hlt">practices</span> on the frequency and magnitude of head <span class="hlt">impacts</span> through the retrospective assessment of in vivo head <span class="hlt">impact</span> data. Cross-sectional study; Level of evidence, 3. Data on <span class="hlt">impact</span> magnitude and frequency were collected with the Head <span class="hlt">Impact</span> Telemetry System during the 2009 football season among 42 varsity high school football athletes (mean age, 16.2 ± 0.6 years; mean height, 180.9 ± 7.2 cm; mean weight, 89.8 ± 20.1 kg). Head <span class="hlt">impacts</span> were compared between player positions and session types (noncontact <span class="hlt">practice</span>, contact <span class="hlt">practice</span>, and game). These results were used to estimate the frequency and magnitude of head <span class="hlt">impacts</span> when contact sessions were restricted. The participants collectively sustained 32,510 <span class="hlt">impacts</span> over the 15-week season. The typical athlete sustained a mean of 774 ± 502 <span class="hlt">impacts</span> during the season, with linemen (center, guard, and offensive or defensive tackle positions) sustaining the highest number of <span class="hlt">impacts</span> per athlete (1076 ± 541), followed by tight ends, running backs, and linebackers (779 ± 286); wide receivers, cornerbacks, and safeties (417 ± 266); and quarterbacks (356 ± 433). When viewed by session type, noncontact <span class="hlt">practices</span> (n = 21) accounted for 1998 total <span class="hlt">impacts</span> (2.4 ± 1.4 per athlete per session), contact <span class="hlt">practices</span> (n = 36) accounted for 16,346 <span class="hlt">impacts</span> (10.5 ± 7.7 per athlete per session), and games (n = 14) accounted for 14,166 <span class="hlt">impacts</span> (24.1 ± 19.1 per athlete per session). Significantly more <span class="hlt">impacts</span> occurred during games when compared with contact (P = .02) and noncontact <span class="hlt">practices</span> (P < .001), and contact <span class="hlt">practices</span> yielded</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351256','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351256"><span>Estimation of head <span class="hlt">impact</span> exposure in high school football: Implications for regulating contact <span class="hlt">practices</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Broglio, Steven P.; Martini, Douglas; Kasper, Luke; Eckner, James T.; Kutcher, Jeffrey S.</p> <p>2015-01-01</p> <p>Background Increased attention is being placed on the role of subconcussive <span class="hlt">impacts</span> to the head during football participation and long-term cognitive health. Some have suggested that mitigating <span class="hlt">impacts</span> to the head can be achieved by reducing or eliminating contact football <span class="hlt">practices</span>. The effect that this might have on the number and magnitude of <span class="hlt">impacts</span> is unknown. Purpose To estimate the effect of limiting contact <span class="hlt">practices</span> on the frequency and magnitude of head <span class="hlt">impacts</span> through the retrospective assessment of in vivo head <span class="hlt">impact</span> data. Study Design Cross-sectional study; Level of evidence, 3. Methods Data on <span class="hlt">impact</span> magnitude and frequency were collected with the Head <span class="hlt">Impact</span> Telemetry System during the 2009 football season among 42 varsity high school football athletes (mean age, 16.2 ± 0.6 years; mean height, 180.9 ± 7.2 cm; mean weight, 89.8 ± 20.1 kg). Head <span class="hlt">impacts</span> were compared between player positions and session types (noncontact <span class="hlt">practice</span>, contact <span class="hlt">practice</span>, and game). These results were used to estimate the frequency and magnitude of head <span class="hlt">impacts</span> when contact sessions were restricted. Results The participants collectively sustained 32,510 <span class="hlt">impacts</span> over the 15-week season. The typical athlete sustained a mean of 774 ± 502 <span class="hlt">impacts</span> during the season with linemen (center, guard, and offensive or defensive tackle positions) sustaining the highest number of <span class="hlt">impacts</span> per athlete (1076 ± 541), followed by the tight ends, running backs, and linebackers (779 ± 286);wide receivers, cornerbacks, and safeties (417 ± 266); and quarterbacks (356 ± 433). When viewed by session type, noncontact <span class="hlt">practices</span> (n = 21) accounted for 1998 total <span class="hlt">impacts</span> (2.4 ± 1.4 per athlete per session), contact <span class="hlt">practices</span> (n = 36) accounted for 16,346 <span class="hlt">impacts</span> (10.5 ± 7.7 per athlete per session), and games (n = 14) accounted for 14,166 <span class="hlt">impacts</span> (24.1 ± 19.1 per athlete per session). Significantly more <span class="hlt">impacts</span> occurred during games when compared with contact (P = .02) and noncontact <span class="hlt">practices</span></p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=soler&pg=5&id=EJ638986','ERIC'); return false;" href="http://eric.ed.gov/?q=soler&pg=5&id=EJ638986"><span><span class="hlt">Impact</span> of Authentic Adult Literacy Instruction on Adult Literacy <span class="hlt">Practices</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Purcell-Gates, Victoria; Degener, Sophie C.; Jacobson, Erik; Soler, Marta</p> <p>2002-01-01</p> <p>Investigates relationships between two dimensions of adult literacy instruction and change in the literacy <span class="hlt">practices</span> of adult literacy students. Finds that authenticity of class literacy activities and texts had a statistically significant effect on change in student literacy <span class="hlt">practices</span>; and increases in types of texts involved reading and writing…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=%22monitoring+and+evaluation%22&pg=6&id=EJ833060','ERIC'); return false;" href="http://eric.ed.gov/?q=%22monitoring+and+evaluation%22&pg=6&id=EJ833060"><span>Evidence-Based <span class="hlt">Practice</span> and Evaluation: From Insight to <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Dunsmuir, Sandra; Brown, Emma; Iyadurai, Suzi; Monsen, Jeremy</p> <p>2009-01-01</p> <p>With the growing emphasis on accountability and evidence-based <span class="hlt">practice</span>, evaluation has become increasingly important in the contexts in which educational psychologists (EPs) <span class="hlt">practice</span>. This paper describes a Target Monitoring and Evaluation (TME) system, derived from Goal Attainment Scaling (GAS) which was developed to evaluate outcomes of a wide…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=self+AND+perception+AND+competencies+AND+higher+AND+education&pg=4&id=EJ1011563','ERIC'); return false;" href="http://eric.ed.gov/?q=self+AND+perception+AND+competencies+AND+higher+AND+education&pg=4&id=EJ1011563"><span>National Board Certification and Developmentally Appropriate <span class="hlt">Practices</span>: Perceptions of <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>McKenzie, Ellen Nancy</p> <p>2013-01-01</p> <p>The study investigated a relationship between National Board certification and perceived use of developmentally appropriate <span class="hlt">practices</span> (DAP). A self-developed survey, the Early-childhood Teacher Inventory of <span class="hlt">Practices</span>, was e-mailed to participants. Participants included 246 non-National Board-certified (non-NBCT) and 135 National Board-certified…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28803588','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28803588"><span>The history of <span class="hlt">paediatric</span> cardiology on stamps.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gursu, Hazım A; Cetin, Ibrahim I</p> <p>2017-08-14</p> <p><span class="hlt">Paediatric</span> cardiology is arguably the sub-specialty in which the greatest advances have been made in both disease diagnosis and treatment over the past half a century. <span class="hlt">Paediatric</span> cardiology emerged as a discipline in the 1930s. Since then, advances in imaging techniques such as echocardiography, angiography, CT, or magnetic resonance and extracorporeal circulation have provided excellent diagnosis and treatment of CHD. The pioneers of <span class="hlt">paediatric</span> cardiology are more than eponyms, for each used in new and original ways the tools and concepts available in his or her era. This brief overview of the history of <span class="hlt">paediatric</span> cardiology on stamps begins from William Harvey up to our own time, and includes the milestones in <span class="hlt">paediatric</span> cardiology.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28284593','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28284593"><span>Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in <span class="hlt">paediatric</span> patients following cardiac surgery.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Larson, Grace E; McKeever, Stephen</p> <p>2017-03-08</p> <p>Pain and sedation protocols are suggested to improve the outcomes of patients within <span class="hlt">paediatric</span> intensive care. However, it is not clear how protocols will influence <span class="hlt">practice</span> within individual units. Evaluate a nurse led pain and sedation protocols <span class="hlt">impact</span> on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a <span class="hlt">paediatric</span> intensive care unit. A retrospective chart review was performed on 100 patients admitted to a tertiary <span class="hlt">paediatric</span> intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi 2 or student t tests to compare data between the groups. Post protocol introduction documentation of pain assessments increased (pre protocol 3/24h vs post protocol 5/24h, p=0.006). Along with a reduction in administration of midazolam (57.6mcg/kg/min pre protocol vs 24.5mcg/kg/min post protocol, p=0.0001). Children's pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p=0.06). Introducing a pain and sedation protocol changed bedside nurse <span class="hlt">practice</span> in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of <span class="hlt">practice</span> change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in <span class="hlt">practice</span>. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ1083261.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ1083261.pdf"><span>The <span class="hlt">Impact</span> of OER on Teaching and Learning <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Weller, Martin; de los Arcos, Bea; Farrow, Rob; Pitt, Beck; McAndrew, Patrick</p> <p>2015-01-01</p> <p>The OER Research Hub has been investigating the <span class="hlt">impact</span> of OER, using eleven hypotheses, and a mixed methods approach to establish an evidence base. This paper explores the findings relating to teaching and learning. The findings reveal a set of direct <span class="hlt">impacts</span>, including an increase in factors relating to student performance, increased reflection…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18047166','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18047166"><span>Introduction of an isolation policy in <span class="hlt">paediatric</span> wards.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hall, Joanna; Roopnarine, Sharmela; McLean, Jane</p> <p>2007-11-01</p> <p>Where and how to care for children with infections, or those requiring protection, is a daily debate in many <span class="hlt">paediatric</span> settings. The <span class="hlt">practice</span> of placing patients into single rooms for infection control purposes is well documented but there is little guidance on when to remove patients from isolation rooms. Unless the appropriateness of isolation for each patient is evaluated daily, the availability of cubicles falls, resulting in potentially unnecessary transfers to other hospitals where such facilities are available. A new isolation policy was introduced to improve the availability of isolation rooms on <span class="hlt">paediatric</span> wards in a large inner city teaching hospital with over 100 <span class="hlt">paediatric</span> inpatient beds. A change management framework was used that included empowering organisational action and consolidating improvements. A number of strategies were introduced to prompt daily review of children in isolation, including clear criteria for isolation and nursing staff in the emergency department challenging the decision to admit a child into an isolation room. Introduction of the policy and subsequent audits have resulted in improved staff awareness, more effective use of isolation rooms and reduced transfers to other hospitals.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21134155','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21134155"><span>Undergraduate interprofessional education using high-fidelity <span class="hlt">paediatric</span> simulation.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Stewart, Moira; Kennedy, Neil; Cuene-Grandidier, Hazel</p> <p>2010-06-01</p> <p>High-fidelity simulation is becoming increasingly important in the delivery of teaching and learning to health care professionals within a safe environment. Its use in an interprofessional context and at undergraduate level has the potential to facilitate the learning of good communication and teamworking, in addition to clinical knowledge and skills. Interprofessional teaching and learning workshops using high-fidelity <span class="hlt">paediatric</span> simulation were developed and delivered to undergraduate medical and nursing students at Queen's University Belfast. Learning outcomes common to both professions, and essential in the clinical management of sick children, included basic competencies, communication and teamworking skills. Quantitative and qualitative evaluation was undertaken using published questionnaires. Quantitative results - the 32-item questionnaire was analysed for reliability using spss. Responses were positive for both groups of students across four domains - acquisition of knowledge and skills, communication and teamworking, professional identity and role awareness, and attitudes to shared learning. Qualitative results - thematic content analysis was used to analyse open-ended responses. Students from both groups commented that an interprofessional education (IPE) approach to <span class="hlt">paediatric</span> simulation improved clinical and <span class="hlt">practice</span>-based skills, and provided a safe learning environment. Students commented that there should be more interprofessional and simulation learning opportunities. High-fidelity <span class="hlt">paediatric</span> simulation, used in an interprofessional context, has the potential to meet the requirements of undergraduate medical and nursing curricula. Further research is needed into the long-term benefits for patient care, and its generalisability to other areas within health care teaching and learning. © Blackwell Publishing Ltd 2010.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25940425','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25940425"><span>Conflict escalation in <span class="hlt">paediatric</span> services: findings from a qualitative study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Forbat, Liz; Teuten, Bea; Barclay, Sarah</p> <p>2015-08-01</p> <p>To explore clinician and family experiences of conflict in <span class="hlt">paediatric</span> services, in order to map the trajectory of conflict escalation. 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. 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. Two teaching hospitals, one district general hospital and two <span class="hlt">paediatric</span> hospices in England, in 2011. 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. Understanding how conflicts escalate provides clinicians with a <span class="hlt">practical</span>, evidence-based framework to identify the warning signs of conflict in <span class="hlt">paediatrics</span>. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4449274','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4449274"><span>Improving transition from <span class="hlt">paediatric</span> to adult cystic fibrosis care: programme implementation and evaluation</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Okumura, Megumi J; Ong, Thida; Dawson, Diana; Nielson, Dennis; Lewis, Nancy; Richards, Martha; Brindis, Claire D; Kleinhenz, Mary Ellen</p> <p>2015-01-01</p> <p>Background The paradigm of cystic fibrosis (CF) care has changed as effective therapies extend the lives of patients well into adulthood. Preparing for and maintaining high quality CF care into the adult healthcare setting is critical for prolonged survival. Unfortunately, this transfer process from the <span class="hlt">paediatric</span> to the adult CF centre is met with a variety of challenges. Objective and methods The objective of this quality improvement (QI) project was to develop, implement and evaluate a theory-based programme for transition from <span class="hlt">paediatric</span> to adult CF care. In a multi-phase process, the <span class="hlt">paediatric</span> and adult programmes developed a transition curriculum, addressed care standards and standardised patient transfer protocols. We evaluated the <span class="hlt">impact</span> of this process through staff surveys, review of field notes from QI meetings, tracking transfers and responses of patients to the Transition Readiness Assessment Questionnaire (TRAQ) at the start of the programme and 18 months after initiation. Results The collaboration between the <span class="hlt">paediatric</span> and adult teams continued through quarterly meetings over the past 4 years. This has provided a forum that sustained our transition programme, harmonised care across CF centres and addressed other needs of our CF centre. Discussion of transition with families in the <span class="hlt">paediatric</span> centre increased twofold (35% to 73% p<0.001), and resulted in a trend towards improved patient TRAQ self-advocacy scores and decreased in-hospital transfer. Conclusions We successfully created a curriculum and process for transition from <span class="hlt">paediatric</span> to adult CF care at our centres. This collaboration shapes the communication between our <span class="hlt">paediatric</span> and adult CF care teams and enables ongoing feedback among patients, families and providers. The <span class="hlt">impact</span> of our transition programme on long-term patient morbidity will require future evaluation. PMID:24415776</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17425127','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17425127"><span>Nasojejunal tube placement in <span class="hlt">paediatric</span> intensive care.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>McDermott, Ann; Tomkins, Natalie; Lazonby, Gill</p> <p>2007-03-01</p> <p>Nasojejunal delivery of enteral feeds is a safe and effective alternative to parenteral nutrition in critically ill children in whom intra-gastric feeding is usually poorly tolerated. A guideline for bedside placement of nasojejunal tubes (NJTs) was developed by a mulit-disciplinary group. An audit of <span class="hlt">practice</span> was carried out following implementation of the guideline. During the audit period 27 NJTs were successfully passed in 21 patients. The result of this innovation has been early initiation of nasojejunal feeding and an increase in bedside placement of NJTs within the PICU. <span class="hlt">Paediatric</span> radiologists have reported a reduction in requests for NJT placement under X-ray screening and there has been a reduction in the use of medication and X-ray to place NJTs. Based on the audit data, 58 per cent of the children would have definitely or probably commenced parenteral nutrition had NJT placement and feeding been unsuccessful. The audit also demonstrated that 26 out of 27 nurses and doctors reported they found the guidelines easy or very easy to follow. Reducing variations in <span class="hlt">practice</span> through the use of guidelines increases the frequency of jejunal feeding. This benefits critically ill patients by improving tolerance of enteral feeding for better nutritional outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=hyperbolic&pg=7&id=EJ410764','ERIC'); return false;" href="http://eric.ed.gov/?q=hyperbolic&pg=7&id=EJ410764"><span><span class="hlt">Impact</span> of <span class="hlt">Practice</span> on Speed of Mental Rotation.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Kail, Robert; Park, Young-Shin</p> <p>1990-01-01</p> <p>Massive <span class="hlt">practice</span> on mental rotation of letters resulted in substantial change in speed of mental rotation of 11 and 20 year olds. Change in rate of mental rotation was characterized by hyperbolic and power functions. (RH)</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20828075','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20828075"><span>The <span class="hlt">impact</span> of pastors' spiritual <span class="hlt">practices</span> on burnout.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Chandler, Diane J</p> <p>2010-01-01</p> <p>This qualitative study addressed two research questions (a) what spiritual <span class="hlt">practices</span> contribute to pastors' emotional and spiritual well-being?, and (b) what factors contribute to pastoral burnout? Based on an inductive analysis of eight pastoral interviews, the study revealed that these spiritual leaders engage in specific spiritual disciplines that contribute to their sense of well-being. The implications of this study prompt further research into the relationship between leaders' spiritual <span class="hlt">practices</span> and burnout.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22855590','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22855590"><span>Economic <span class="hlt">impact</span> of dental hygienists on solo dental <span class="hlt">practices</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lazar, Vickie F; Guay, Albert H; Beazoglou, Tryfon J</p> <p>2012-08-01</p> <p>The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental <span class="hlt">practices</span> that utilize a dental hygienist structurally and operationally different from <span class="hlt">practices</span> that do not? This article explores differences among dental <span class="hlt">practices</span> that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental <span class="hlt">Practice</span>, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in <span class="hlt">practice</span> characteristics--such as hours spent in the <span class="hlt">practice</span> and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15850142','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15850142"><span>Acute pancreatitis in the <span class="hlt">paediatric</span> age group: a personal experience.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cosentini, A; Stranieri, G; Capillo, S; Notarangelo, L; Madonna, L; Iannini, S; Ferro, V; Defilippo, V; Defilippo, R G; Rubino, R</p> <p>2005-01-01</p> <p>Although relatively rare, acute pancreatitis is the most common disease complex involving the pancreas in the <span class="hlt">paediatric</span> age group. The etiology of the disease is often unknown, and Italian epidemiological data on the <span class="hlt">paediatric</span> population and, in particular, on the etiology of the disease are not available (except for studies of prevalence). Within the field of the most frequently encountered pancreatitis in the age range of our interest (i.e. 0-18 years), not only the commonly observed forms whose etiopathogenesis is ascribable to cholelithiasis must be mentioned but also those forms due to proteic-caloric malnutrition that are becoming increasingly common. The presenting clinical symptoms and signs may not be typical and the laboratory tests may not always be sensitive enough. In such age range chronic recurrent pancreatitis plays a very important epidemiologic role. Approximately 40% of children and teenagers admitted to the hospital with a diagnosis of pancreatitis report a previous episode of the disease. Irreversible changes in pancreatic parenchyma develop in those patients in whom the disease progresses, leading to pancreatic insufficiency. Such a morbid condition (chronic pancreatitis) is more often observed in adolescents, in whom the disease manifests itself with a vague repetitive dyspeptic symptomatology, after alternating remissions and recrudescences, not always clinically evident. In children, the clinical picture most commonly encountered is represented by recurrent abdominal pains, in view of the fact that the patients are frequently affected by thalassaemia. The pseudocystic evolution of the disease is the most common organic damage resulting from the chronic progression of the pancreatic impairment. A few differences have been found with respect to severity, etiology, and mortality of pancreatitis in the <span class="hlt">paediatric</span> age group as compared with older age groups. Both the general practitioner with a <span class="hlt">paediatric</span> <span class="hlt">practice</span> and the paediatrician</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24282901','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24282901"><span>Economics and ethics of <span class="hlt">paediatric</span> respiratory extra corporeal life support.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Callaghan, M; Doyle, Y; O'Hare, B; Healy, M; Nölke, L</p> <p>2013-09-01</p> <p>Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A <span class="hlt">paediatric</span> cardiac ECMO programme was established in 2005 at Our Lady's Children's Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal <span class="hlt">paediatric</span> respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000 Euros/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social <span class="hlt">impact</span> on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000 Euros. There is now a strong argument for a fully funded single national cardiac and respiratory <span class="hlt">paediatric</span> ECMO centre, similar to that for adult patients.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=reviews&pg=2&id=EJ1098870','ERIC'); return false;" href="https://eric.ed.gov/?q=reviews&pg=2&id=EJ1098870"><span>Beyond Synthesis: Augmenting Systematic Review Procedures with <span class="hlt">Practical</span> Principles to Optimise <span class="hlt">Impact</span> and Uptake in Educational Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Green, Chris; Taylor, Celia; Buckley, Sharon; Hean, Sarah</p> <p>2016-01-01</p> <p>Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited <span class="hlt">impact</span> on educational policy and <span class="hlt">practice</span> has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li class="active"><span>21</span></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_21 --> <div id="page_22" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li class="active"><span>22</span></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="421"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=systematic+AND+review&id=EJ1098870','ERIC'); return false;" href="http://eric.ed.gov/?q=systematic+AND+review&id=EJ1098870"><span>Beyond Synthesis: Augmenting Systematic Review Procedures with <span class="hlt">Practical</span> Principles to Optimise <span class="hlt">Impact</span> and Uptake in Educational Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Green, Chris; Taylor, Celia; Buckley, Sharon; Hean, Sarah</p> <p>2016-01-01</p> <p>Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited <span class="hlt">impact</span> on educational policy and <span class="hlt">practice</span> has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.dtic.mil/docs/citations/ADA566741','DTIC-ST'); return false;" href="http://www.dtic.mil/docs/citations/ADA566741"><span>Small Scale Drop Tower Test for <span class="hlt">Practice</span> Torpedo <span class="hlt">Impact</span> Modelling</span></a></p> <p><a target="_blank" href="http://www.dtic.mil/">DTIC Science & Technology</a></p> <p></p> <p>2012-06-01</p> <p>stiffener materials tested in accordance with AS1391-2005, Metallic materials – Tensile testing at ambient temperature. Available on request is a...Height [m] Drop Carriage Mass [kg] <span class="hlt">Impact</span> Velocity [ms-1] Rebound Velocity [ms-1] Rebound / <span class="hlt">Impact</span> Velocity Ratio1 Impac t...Ratio1 Impac t Energ y [kJ] Nose Dent Shape Nose Dent Depth [m] Plate Dent Depth [m] Velocity Data Smoothing Length [samples</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4717424','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4717424"><span>Varicella <span class="hlt">paediatric</span> hospitalisations in Belgium: a 1-year national survey</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Blumental, Sophie; Sabbe, Martine; Lepage, Philippe</p> <p>2016-01-01</p> <p>Background Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results Participation of 101 hospitals was obtained, covering 97.7% of the total <span class="hlt">paediatric</span> beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of <span class="hlt">paediatric</span> varicella hospitalisations reached 29.5/105 person-years, with the highest <span class="hlt">impact</span> among those 0–4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. <span class="hlt">Paediatric</span> intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian <span class="hlt">paediatric</span> population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium. PMID:26130380</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26130380','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26130380"><span>Varicella <span class="hlt">paediatric</span> hospitalisations in Belgium: a 1-year national survey.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Blumental, Sophie; Sabbe, Martine; Lepage, Philippe</p> <p>2016-01-01</p> <p>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. 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. Participation of 101 hospitals was obtained, covering 97.7% of the total <span class="hlt">paediatric</span> beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of <span class="hlt">paediatric</span> varicella hospitalisations reached 29.5/10(5) person-years, with the highest <span class="hlt">impact</span> among those 0-4 years old (global incidence and odds of hospitalisation: 79/10(5) 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 19/10(5) person-years. <span class="hlt">Paediatric</span> intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian <span class="hlt">paediatric</span> population was 0.5/10(6) and fatality ratio 0.2% among our cohort. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27762188','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27762188"><span>Information technology in <span class="hlt">paediatric</span> rheumatology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Consolaro, Alessandro; Morgan, Esi M; Giancane, Gabriella; Rosina, Silvia; Lanni, Stefano; Ravelli, Angelo</p> <p>2016-01-01</p> <p>Information technology in <span class="hlt">paediatric</span> rheumatology has seen several exciting developments in recent years. The new multidimensional questionnaires for juvenile idiopathic arthritis, juvenile dermatomyositis, and juvenile autoinflammatory diseases integrate all major parent- and child-reported outcomes (PCROs) used in these diseases into a single tool, and provide an effective guide to manage, document change in health, assess effectiveness of therapeutic interventions, and verify the parent and child satisfaction with illness outcome. The Pharmachild registry is aimed to gain information concerning the long-term effectiveness and safety of the medications currently used in juvenile idiopathic arthritis, particularly biologic agents, through collection of prospective data in a large, multinational sample of patients. Children and their parents are directly involved in the data collection by means of the regular completion of a digital version of a multidimensional questionnaire. The Patient-Reported Outcomes Measurement Information System (PROMIS) employs modern measurement science to advance assessment of PCROs, particularly HRQL, and offers multidimensional profile measures. The conceptual link of <span class="hlt">paediatric</span> PROMIS with adult instruments facilitates harmonisation of assessments made in children and adolescents with those carried out in young adults in the process of transition of medical care. Development of electronic versions of questionnaires that permit their completion through smartphones or touch-screen devices will revolutionise information collection from parents and children, foster the regular collection of PCROs in routine care, and ultimately improve the quality of self-reported health data, and patient outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25486164','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25486164"><span>Community psychology <span class="hlt">practice</span>: expanding the <span class="hlt">impact</span> of psychology's work.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wolff, Tom</p> <p>2014-11-01</p> <p>This article introduces the reader to community psychology <span class="hlt">practice</span> by defining the field and its key principles and then illustrating through brief case stories what community psychology <span class="hlt">practice</span> looks like in various employment settings. An exploration of the development of the field includes a review of the competencies of community psychology <span class="hlt">practice</span>. Finally, the emerging opportunities for community psychology <span class="hlt">practice</span> for psychologists are outlined. Well-publicized issues such as health disparities give psychologists an opportunity to bring social problems such as racism, sexism, homophobia, and income inequality to the forefront and to create community-wide efforts to improve the ways in which people live. Community psychology <span class="hlt">practice</span> offers psychologists a format and a set of competencies for moving forward on this work by focusing on approaches that are ecological, community centered, population based, preventive, focused on systems change and empowerment, and multidisciplinary and that bring those most affected by the issues to the heart of the decision making. PsycINFO Database Record (c) 2014 APA, all rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25407852','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25407852"><span>The importance of mental health monitoring during transfer to adult care settings as examined among <span class="hlt">paediatric</span> transplant recipients.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Annunziato, Rachel A; Arrato, Nicole; Rubes, Melissa; Arnon, Ronen</p> <p>2015-02-01</p> <p>Although the transfer out of <span class="hlt">paediatrics</span> is established as a dangerous time for transplant recipients, the reasons for this are not well understood. One possible explanation is that in general, young adulthood is a period of vulnerability to psychological distress, which could <span class="hlt">impact</span> self-management. The purpose of the present study was to investigate whether psychological distress is associated with medication non-adherence after transfer. Twenty <span class="hlt">paediatric</span> liver transplant recipients (mean age = 22.42, standard deviation (SD) = 1.64) have been followed prospectively at our site for a year after they transferred from <span class="hlt">paediatrics</span>. At their last visit in <span class="hlt">paediatrics</span>, they completed the Symptom Checklist-90, a measure of psychological distress. Additionally, patients' medication adherence was tracked 1 year after transfer, using a validated measure, SDs of tacrolimus blood levels. Psychological distress and medication non-adherence after transfer were significantly correlated, r = 0.50, P = 0.04. Furthermore, there was a significant interaction between adherence status and changes in mental health after transfer. Psychological distress may be one factor behind deteriorating medical outcomes when transplant recipients transfer out of <span class="hlt">paediatric</span> settings. It is important to consider mental health screening as a part of the transition process. Further research is needed to determine if identified patients may require services in addition to transitional interventions. © 2014 The Authors. Journal of <span class="hlt">Paediatrics</span> and Child Health © 2014 <span class="hlt">Paediatrics</span> and Child Health Division (Royal Australasian College of Physicians).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=risk+AND+return&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50','EPA-EIMS'); return false;" href="http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=risk+AND+return&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50"><span>Novel Use of Time Domain Reflectometry in Infiltration-based Low <span class="hlt">Impact</span> Development <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://oaspub.epa.gov/eims/query.page">EPA Science Inventory</a></p> <p></p> <p></p> <p>Low <span class="hlt">impact</span> development (LID) <span class="hlt">practices</span> are structures that intercept stormwater runoff and infiltrate it through a range of media types, including aggregate, rain garden media, and underlying soils. Hydrologic performance is typically evaluated by comparing inlet and underdrain o...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.epa.gov/research-grants/presentation-human-and-ecological-health-impacts-associated-water-reuse-and','PESTICIDES'); return false;" href="https://www.epa.gov/research-grants/presentation-human-and-ecological-health-impacts-associated-water-reuse-and"><span>Presentation: Human and Ecological Health <span class="hlt">Impacts</span> Associated with Water Reuse and Conservation <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.epa.gov/pesticides/search.htm">EPA Pesticide Factsheets</a></p> <p></p> <p></p> <p>This presentation was given by Dr. James Johnson at the STAR Human and Ecological Health <span class="hlt">Impacts</span> Associated with Water Reuse and Conservation <span class="hlt">Practices</span> Kick-off Meeting and Webinar held on Oct. 26-27, 2016.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=civil+AND+engineering&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=79986326&CFTOKEN=50040645','EPA-EIMS'); return false;" href="http://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=226386&keyword=civil+AND+engineering&actType=&TIMSType=+&TIMSSubTypeID=&DEID=&epaNumber=&ntisID=&archiveStatus=Both&ombCat=Any&dateBeginCreated=&dateEndCreated=&dateBeginPublishedPresented=&dateEndPublishedPresented=&dateBeginUpdated=&dateEndUpdated=&dateBeginCompleted=&dateEndCompleted=&personID=&role=Any&journalID=&publisherID=&sortBy=revisionDate&count=50&CFID=79986326&CFTOKEN=50040645"><span>Novel Use of Time Domain Reflectometry in Infiltration-based Low <span class="hlt">Impact</span> Development <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://oaspub.epa.gov/eims/query.page">EPA Science Inventory</a></p> <p></p> <p></p> <p>Low <span class="hlt">impact</span> development (LID) <span class="hlt">practices</span> are structures that intercept stormwater runoff and infiltrate it through a range of media types, including aggregate, rain garden media, and underlying soils. Hydrologic performance is typically evaluated by comparing inlet and underdrain o...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25439093','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25439093"><span><span class="hlt">Practical</span> management of cumulative anthropogenic <span class="hlt">impacts</span> with working marine examples.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wright, Andrew J; Kyhn, Line A</p> <p>2015-04-01</p> <p>Human pressure on the environment is expanding and intensifying, especially in coastal and offshore areas. Major contributors to this are the current push for offshore renewable energy sources, which are thought of as environmentally friendly sources of power, as well as the continued demand for petroleum. Human disturbances, including the noise almost ubiquitously associated with human activity, are likely to increase the incidence, magnitude, and duration of adverse effects on marine life, including stress responses. Stress responses have the potential to induce fitness consequences for individuals, which add to more obvious directed takes (e.g., hunting or fishing) to increase the overall population-level <span class="hlt">impact</span>. To meet the requirements of marine spatial planning and ecosystem-based management, many efforts are ongoing to quantify the cumulative <span class="hlt">impacts</span> of all human actions on marine species or populations. Meanwhile, regulators face the challenge of managing these accumulating and interacting <span class="hlt">impacts</span> with limited scientific guidance. We believe there is scientific support for capping the level of <span class="hlt">impact</span> for (at a minimum) populations in decline or with unknown statuses. This cap on <span class="hlt">impact</span> can be facilitated through implementation of regular application cycles for project authorization or improved programmatic and aggregated <span class="hlt">impact</span> assessments that simultaneously consider multiple projects. Cross-company collaborations and a better incorporation of uncertainty into decision making could also help limit, if not reduce, cumulative <span class="hlt">impacts</span> of multiple human activities. These simple management steps may also form the basis of a rudimentary form of marine spatial planning and could be used in support of future ecosystem-based management efforts.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27117211','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27117211"><span>[<span class="hlt">Impact</span> of digital technology on clinical <span class="hlt">practices</span>: perspectives from surgery].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Zhang, Y; Liu, X J</p> <p>2016-04-09</p> <p>Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical <span class="hlt">practices</span>. Being integrated into clinical <span class="hlt">practice</span>, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical <span class="hlt">practices</span>. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2017OGeo....9...20S','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2017OGeo....9...20S"><span>Retrofitting the Low <span class="hlt">Impact</span> Development <span class="hlt">Practices</span> into Developed Urban areas Including Barriers and Potential Solution</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Shafique, Muhammad; Kim, Reeho</p> <p>2017-06-01</p> <p>Low <span class="hlt">impact</span> development (LID)/green infrastructure (GI) <span class="hlt">practices</span> have been identified as the sustainable <span class="hlt">practices</span> of managing the stormwater in urban areas. Due to the increasing population, most of the cities are more developing which results in the change of natural area into impervious areas (roads, buildings etc.). Moreover, urbanization and climate change are causing many water-related problems and making over cities unsafe and insecure. Under these circumstances, there is a need to introduce new stormwater management <span class="hlt">practices</span> into developed cities to reduce the adverse <span class="hlt">impacts</span> of urbanization. For this purpose, retrofitting low <span class="hlt">impact</span> development <span class="hlt">practices</span> demands more attention to reduce these water-related problems and trying to make our cities sustainable. In developed areas, there is a little space is available for the retrofitting of LID <span class="hlt">practices</span> for the stormwater management. Therefore, the selection of an appropriate place to retrofitting LID <span class="hlt">practices</span> needs more concern. This paper describes the successfully applied retrofitting LID <span class="hlt">practices</span> around the globe. It also includes the process of applying retrofitting LID <span class="hlt">practices</span> at the suitable place with the suitable combination. Optimal places for the retrofitting of different LID <span class="hlt">practices</span> are also mentioned. This paper also highlights the barriers and potential solutions of retrofitting LID <span class="hlt">practices</span> in urban areas.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27702711','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27702711"><span>Optimal nutrition therapy in <span class="hlt">paediatric</span> critical care in the Asia-Pacific and Middle East: a consensus.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lee, Jan Hau; Rogers, Elizabeth; Chor, Yek Kee; Samransamruajkit, Rujipat; Koh, Pei Lin; Miqdady, Mohamad; Al-Mehaidib, Ali Ibrahim; Pudjiadi, Antonius; Singhi, Sunit; Mehta, Nilesh M</p> <p>2016-12-01</p> <p>Current <span class="hlt">practices</span> and available resources for nutrition therapy in <span class="hlt">paediatric</span> intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the <span class="hlt">Paediatric</span> Critical Care Environment. Challenges and recommendations unique to the region are described. Following a systematic literature search from 2004-2014, consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams. Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional assessment must be implemented to document prevalence and <span class="hlt">impact</span> of malnutrition. Nutritional support must be given greater priority in PICUs, with particular emphasis in optimizing EN delivery.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24351606','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24351606"><span><span class="hlt">Paediatric</span> exercise training in prevention and treatment.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pieles, Guido E; Horn, Richard; Williams, Craig A; Stuart, A Graham</p> <p>2014-04-01</p> <p>Exercise training is an underused intervention in <span class="hlt">paediatric</span> healthcare. This is surprising, since initial evidence demonstrates its effectiveness and safety; furthermore it confers socioeconomic benefits for healthcare systems. Pilot studies have assessed and confirmed the feasibility of exercise training in many <span class="hlt">paediatric</span> disease settings. However, more research is needed to understand the pathophysiology, quantify treatment effects and monitor outcomes. A concerted effort from researchers, health professionals and police makers will be necessary to make exercise training an evidence-based and cost-effective intervention in <span class="hlt">paediatric</span> care.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24907888','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24907888"><span>[The electrocardiogram in the <span class="hlt">paediatric</span> age group].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sanches, M; Coelho, A; Oliveira, E; Lopes, A</p> <p>2014-09-01</p> <p>A properly interpreted electrocardiogram (ECG) provides important information and is an inexpensive and easy test to perform. It continues to be the method of choice for the diagnosis of arrhythmias. Although the principles of cardiac electrophysiology are the same, there are anatomical and physiological age-dependent changes which produce specific alterations in the <span class="hlt">paediatric</span> ECG, and which may be misinterpreted as pathological. The intention of this article is to address in a systematic way the most relevant aspects of the <span class="hlt">paediatric</span> ECG, to propose a possible reading scheme of the ECG and to review the electrocardiograph tracings most frequently found in the <span class="hlt">paediatric</span> age group.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3055809','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3055809"><span>Framework conditions facilitating <span class="hlt">paediatric</span> clinical research</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2011-01-01</p> <p>The use of unlicensed and "off-label" medicines in children is widespread. Between 50-80% of the medicines currently administered to children have neither been tested nor authorized for their use in the <span class="hlt">paediatric</span> population which represents approximately 25% of the whole European population. On 26 January 2007, entered into force the European Regulation of <span class="hlt">Paediatric</span> Medicines. It aims at the quality of research into medicines for children but without subjecting the <span class="hlt">paediatric</span> population to unnecessary clinical trial. This article addresses ethical and legal issues arising from the regulation and makes recommendations for the framework conditions facilitating the development of clinical research with children. PMID:21345195</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23513431','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23513431"><span><span class="hlt">Impact</span> of unit <span class="hlt">practice</span> councils on culture and outcomes.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wessel, Susan</p> <p>2012-01-01</p> <p>This article describes positive outcomes in culture, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, employee engagement, and clinical quality as a result of using shared governance, specifically unit <span class="hlt">practice</span> councils (UPC) or staff councils, to implement Relationship-Based Care (RBC).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=definition+AND+scientific+AND+theory&pg=6&id=EJ926393','ERIC'); return false;" href="https://eric.ed.gov/?q=definition+AND+scientific+AND+theory&pg=6&id=EJ926393"><span>Evidence and <span class="hlt">Impact</span>: How Scholarship Can Improve Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Lingenfelter, Paul E.</p> <p>2011-01-01</p> <p>Researchers, policy makers, and practitioners share a sincere interest in improving the human condition. Academics may be tempted to fault irrationality, ideology, or ignorance for the failure of research to inform policy and <span class="hlt">practice</span> more powerfully, but policy makers and practitioners want academics to tell them "what works" in order to find a…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://pubs.er.usgs.gov/publication/70157273','USGSPUBS'); return false;" href="http://pubs.er.usgs.gov/publication/70157273"><span><span class="hlt">Impact</span> of fishing and stocking <span class="hlt">practices</span> on Coregonid diversity</span></a></p> <p><a target="_blank" href="http://pubs.er.usgs.gov/pubs/index.jsp?view=adv">USGS Publications Warehouse</a></p> <p>Anneville, Orlane; Lasne, Emilien; Guillard, Jean; Eckmann, Reiner; Stockwell, Jason D.; Gillet, Christian; Yule, Daniel</p> <p>2015-01-01</p> <p>Fish species diversity can be lost through interacting stressors including habitat loss, stocking and overfishing. Although a multitude of stressors have played a role in the global decline of coregonid (Coregonus spp.) diversity, a number of contemporary studies have identified habitat loss stemming from eutrophication as the primary cause. Unfortunately, reconstructing the role of fishing and stocking <span class="hlt">practices</span> can be difficult, because these records are incomplete or appear only in hard-to-access historic grey literature. Based on an illustrative set of historic and contemporary studies, we describe how fisheries management <span class="hlt">practices</span> may have contributed to coregonid diversity loss in European and North American lakes. We provide case studies examining how fishing and stocking may reduce coregonid diversity through demographic decline and introgressive hybridization. In some lakes, fisheries management <span class="hlt">practices</span> may have led to a loss of coregonid diversity well before issues with habitat degradation manifested. Our review suggests that fish conservation policies could beneficially consider the relative importance of all stressors, including management <span class="hlt">practices</span>, as potential drivers of diversity loss.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li class="active"><span>22</span></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_22 --> <div id="page_23" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li class="active"><span>23</span></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="441"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=processes+AND+cultural+AND+Mexico&pg=3&id=ED271256','ERIC'); return false;" href="https://eric.ed.gov/?q=processes+AND+cultural+AND+Mexico&pg=3&id=ED271256"><span>Administrator Preparation Models and the <span class="hlt">Impact</span> of the <span class="hlt">Practice</span> Context.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Pohland, Paul A.</p> <p></p> <p>To be responsible, educational administrator training programs must take the context of <span class="hlt">practice</span> into account in program design and execution. Adaptation in content, instructional processes, and support systems are required. The University of New Mexico's Spanish Language Master's Program, which has graduated 127 students, provides a model for…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25695118','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25695118"><span>How can radio frequency identification technology <span class="hlt">impact</span> nursing <span class="hlt">practice</span>?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Billingsley, Luanne; Wyld, David</p> <p>2014-12-01</p> <p>Radio frequency identification (RFID) technology can save nurses time, improve quality of care, en hance patient and staff safety, and decrease costs. However, without a better understanding of these systems and their benefits to patients and hospitals, nurses may be slower to recommend, implement, or adopt RFID technology into <span class="hlt">practice</span>.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=measure+AND+commitment&pg=4&id=ED564992','ERIC'); return false;" href="http://eric.ed.gov/?q=measure+AND+commitment&pg=4&id=ED564992"><span>The <span class="hlt">Impact</span> of University Religious Affiliation on Presidential Leadership <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Savior, Richard David</p> <p>2014-01-01</p> <p>Colleges and universities in the United States face a set of significant and progressive challenges requiring exemplary senior leadership. The purpose of this study was to measure and analyze the senior leadership <span class="hlt">practices</span> at private/secular and private/religious affiliated colleges and universities to identify differences in leadership practices…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=coding&pg=3&id=EJ959584','ERIC'); return false;" href="https://eric.ed.gov/?q=coding&pg=3&id=EJ959584"><span>Characterizing Mathematics Classroom <span class="hlt">Practice</span>: <span class="hlt">Impact</span> of Observation and Coding Choices</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Ing, Marsha; Webb, Noreen M.</p> <p>2012-01-01</p> <p>Large-scale observational measures of classroom <span class="hlt">practice</span> increasingly focus on opportunities for student participation as an indicator of instructional quality. Each observational measure necessitates making design and coding choices on how to best measure student participation. This study investigated variations of coding approaches that may be…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=socio-economic+AND+impact+AND+assessment&pg=3&id=ED553081','ERIC'); return false;" href="http://eric.ed.gov/?q=socio-economic+AND+impact+AND+assessment&pg=3&id=ED553081"><span>The <span class="hlt">Impact</span> of RTI <span class="hlt">Practices</span> on Student Reading Achievement</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Gleason, Tara Lynn</p> <p>2013-01-01</p> <p>The purpose of this study was to evaluate whether elementary schools that endorse implementing core components of Response to Intervention (RTI) differ in student outcomes on the Pennsylvania System of School Assessment (PSSA) Reading Assessment when compared to schools that do not endorse implementing RTI <span class="hlt">practices</span>. This study also explored…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=experimental+AND+method+AND+definition&pg=2&id=EJ926393','ERIC'); return false;" href="http://eric.ed.gov/?q=experimental+AND+method+AND+definition&pg=2&id=EJ926393"><span>Evidence and <span class="hlt">Impact</span>: How Scholarship Can Improve Policy and <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Lingenfelter, Paul E.</p> <p>2011-01-01</p> <p>Researchers, policy makers, and practitioners share a sincere interest in improving the human condition. Academics may be tempted to fault irrationality, ideology, or ignorance for the failure of research to inform policy and <span class="hlt">practice</span> more powerfully, but policy makers and practitioners want academics to tell them "what works" in order to find a…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=personal+AND+values+AND+matter&pg=2&id=ED564992','ERIC'); return false;" href="https://eric.ed.gov/?q=personal+AND+values+AND+matter&pg=2&id=ED564992"><span>The <span class="hlt">Impact</span> of University Religious Affiliation on Presidential Leadership <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Savior, Richard David</p> <p>2014-01-01</p> <p>Colleges and universities in the United States face a set of significant and progressive challenges requiring exemplary senior leadership. The purpose of this study was to measure and analyze the senior leadership <span class="hlt">practices</span> at private/secular and private/religious affiliated colleges and universities to identify differences in leadership practices…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=%22learning+communities%22&pg=4&id=ED551459','ERIC'); return false;" href="http://eric.ed.gov/?q=%22learning+communities%22&pg=4&id=ED551459"><span>Professional Learning Communities' <span class="hlt">Impact</span> on Science Teacher Classroom <span class="hlt">Practice</span> in a Midwestern Urban School District</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Carpenter, Dan</p> <p>2012-01-01</p> <p>The purpose of this reputation-based, multiple-site case study was to explore professional learning communities' <span class="hlt">impact</span> on teacher classroom <span class="hlt">practice</span>. The goal of this research was to describe the administrator and teachers' perceptions with respect to professional learning communities as it related to teacher <span class="hlt">practice</span> in their school. Educators…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED472070.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED472070.pdf"><span>Form or Flesh: Social Factors That <span class="hlt">Impact</span> Women's <span class="hlt">Practice</span> of Breast Self-Examination.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>London, Patricia A.</p> <p></p> <p>The social factors that <span class="hlt">impact</span> Caucasian middle-class women's <span class="hlt">practice</span> of breast self-examination (BSE) were examined through in-depth interviews with 15 women who were selected to represent a mix of women who <span class="hlt">practiced</span> BSE monthly, occasionally, or never. The meaning of BSE was analyzed in relation to body image and the social definition of being…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Plc&pg=4&id=EJ1104427','ERIC'); return false;" href="http://eric.ed.gov/?q=Plc&pg=4&id=EJ1104427"><span>The <span class="hlt">Impacts</span> of Professional Learning Communities on Science Teachers' Knowledge, <span class="hlt">Practice</span> and Student Learning: A Review</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Dogan, Selcuk; Pringle, Rose; Mesa, Jennifer</p> <p>2016-01-01</p> <p>The purpose of this article is to provide a review of empirical studies investigating the <span class="hlt">impact</span> of professional learning communities (PLCs) on science teachers' <span class="hlt">practices</span> and knowledge. Across 14 articles that satisfied the definition we embraced, most were devoted to the change in science teaching <span class="hlt">practices</span>, disciplinary content knowledge (DCK)…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=education+AND+leadership&pg=3&id=EJ1131936','ERIC'); return false;" href="https://eric.ed.gov/?q=education+AND+leadership&pg=3&id=EJ1131936"><span>Peer-Led Learning Communities: Exploring Integrative High-<span class="hlt">Impact</span> Educational <span class="hlt">Practices</span> for Leadership Education</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Priest, Kerry L.; de Campos Paula, Ana Luiza</p> <p>2016-01-01</p> <p>The use of high-<span class="hlt">impact</span> <span class="hlt">practices</span> is well documented in higher education literature. This brief describes the integrative <span class="hlt">practice</span> of undergraduate peer-led leadership learning communities as a model of delivery within a large introductory leadership education course for first-year students. Utilizing open-ended questions embedded within…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=PLCs&pg=4&id=EJ1104427','ERIC'); return false;" href="https://eric.ed.gov/?q=PLCs&pg=4&id=EJ1104427"><span>The <span class="hlt">Impacts</span> of Professional Learning Communities on Science Teachers' Knowledge, <span class="hlt">Practice</span> and Student Learning: A Review</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Dogan, Selcuk; Pringle, Rose; Mesa, Jennifer</p> <p>2016-01-01</p> <p>The purpose of this article is to provide a review of empirical studies investigating the <span class="hlt">impact</span> of professional learning communities (PLCs) on science teachers' <span class="hlt">practices</span> and knowledge. Across 14 articles that satisfied the definition we embraced, most were devoted to the change in science teaching <span class="hlt">practices</span>, disciplinary content knowledge (DCK)…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED446220.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED446220.pdf"><span>How Does Education and Training <span class="hlt">Impact</span> on Management <span class="hlt">Practices</span>? CRLRA Discussion Paper Series.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Kilpatrick, Sue</p> <p></p> <p>A study examined the <span class="hlt">impact</span> of agricultural education and training on farm business <span class="hlt">practice</span> and the influence of training on changes to farming <span class="hlt">practice</span> in Australia. Data were from an additional set of questions on the Australian Bureau of Statistics' 1993-94 Agricultural Financial Survey and an interview survey of 65 Tasmanian farmers. Findings…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=learning+AND+leadership+AND+experience&pg=4&id=EJ1133909','ERIC'); return false;" href="https://eric.ed.gov/?q=learning+AND+leadership+AND+experience&pg=4&id=EJ1133909"><span>The Undergraduate Leadership Teaching Assistant (ULTA): A High-<span class="hlt">Impact</span> <span class="hlt">Practice</span> for Undergraduates Studying Leadership</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Odom, Summer F.; Ho, Sarah P.; Moore, Lori L.</p> <p>2014-01-01</p> <p>To meet the demands for effective leadership, leadership educators should integrate high-<span class="hlt">impact</span> <span class="hlt">practices</span> for students to develop, <span class="hlt">practice</span>, and evaluate their leadership knowledge, skills, and abilities. The purpose of this application brief is to describe how undergraduate leadership teaching assistant (ULTA) experiences can be a high- impact…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED568367.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED568367.pdf"><span><span class="hlt">Impact</span> of Organisational Factors on the Knowledge Sharing <span class="hlt">Practice</span> of Teachers Working in Higher Education Sector</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Areekkuzhiyil, Santhosh</p> <p>2016-01-01</p> <p>The current study aims to explore the various organizational factors that influence the knowledge sharing <span class="hlt">practices</span> of teachers working in higher education sector. The study hypothesized the <span class="hlt">impact</span> of various organizational factors on the knowledge sharing <span class="hlt">practices</span> of teachers working in higher education sector. The data required for the study…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=instructional+AND+coaching&pg=3&id=ED551480','ERIC'); return false;" href="http://eric.ed.gov/?q=instructional+AND+coaching&pg=3&id=ED551480"><span>The <span class="hlt">Impact</span> of Instructional Coaching on Teaching <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Barry, Pamela K.</p> <p>2012-01-01</p> <p>The challenges facing today's schools are greater than ever. The impetus to improve educational outcomes for all students and compete with the rest of the world has become one of the country's most important endeavors. Several important factors have been identified in research as supporting improved teaching in today's schools, the <span class="hlt">impact</span> of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=rand&pg=6&id=ED508108','ERIC'); return false;" href="https://eric.ed.gov/?q=rand&pg=6&id=ED508108"><span>Capturing Research <span class="hlt">Impacts</span>: A Review of International <span class="hlt">Practice</span>. Documented Briefing</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Grant, Jonathan; Brutscher, Philipp-Bastian; Kirk, Susan Ella; Butler, Linda; Wooding, Steven</p> <p>2010-01-01</p> <p>In February 2009, the Higher Education Funding Council for England (HEFCE) commissioned RAND Europe to review approaches to evaluating the <span class="hlt">impact</span> of research as part of their wider work programme to develop new arrangements for the assessment and funding of research--referred to as the Research Excellence Framework (REF). The objectives were 1) to…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/EJ1034755.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/EJ1034755.pdf"><span>Modeling Instruction: The <span class="hlt">Impact</span> of Professional Development on Instructional <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Barlow, Angela T.; Frick, Tasha M.; Barker, Heather L.; Phelps, Amy J.</p> <p>2014-01-01</p> <p>Modeling Instruction holds the potential for transforming science instruction and improving student achievement. Key to the success of Modeling Instruction, however, is the fidelity of implementation of its curriculum. This qualitative study examined the <span class="hlt">impact</span> of Modeling Instruction professional development on participating teachers'…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Bibliographic+AND+review&pg=3&id=EJ950091','ERIC'); return false;" href="http://eric.ed.gov/?q=Bibliographic+AND+review&pg=3&id=EJ950091"><span>Safety Education <span class="hlt">Impact</span> and Good <span class="hlt">Practice</span>: A Review</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Mulvaney, Caroline A.; Watson, Michael C.; Errington, Gail</p> <p>2012-01-01</p> <p>Purpose: The aim of this literature review was to examine recent evidence of the <span class="hlt">impact</span> of safety education for children and young people on unintentional injury rates and to update an earlier review. Evidence was sought that linked safety education for children and young people in schools, centres and other settings with changes in knowledge,…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Low+AND+Impact+AND+Development%ef%bc%88&id=EJ1034755','ERIC'); return false;" href="http://eric.ed.gov/?q=Low+AND+Impact+AND+Development%ef%bc%88&id=EJ1034755"><span>Modeling Instruction: The <span class="hlt">Impact</span> of Professional Development on Instructional <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Barlow, Angela T.; Frick, Tasha M.; Barker, Heather L.; Phelps, Amy J.</p> <p>2014-01-01</p> <p>Modeling Instruction holds the potential for transforming science instruction and improving student achievement. Key to the success of Modeling Instruction, however, is the fidelity of implementation of its curriculum. This qualitative study examined the <span class="hlt">impact</span> of Modeling Instruction professional development on participating teachers'…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li class="active"><span>23</span></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_23 --> <div id="page_24" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li class="active"><span>24</span></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="461"> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Eris&pg=2&id=ED508108','ERIC'); return false;" href="http://eric.ed.gov/?q=Eris&pg=2&id=ED508108"><span>Capturing Research <span class="hlt">Impacts</span>: A Review of International <span class="hlt">Practice</span>. Documented Briefing</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Grant, Jonathan; Brutscher, Philipp-Bastian; Kirk, Susan Ella; Butler, Linda; Wooding, Steven</p> <p>2010-01-01</p> <p>In February 2009, the Higher Education Funding Council for England (HEFCE) commissioned RAND Europe to review approaches to evaluating the <span class="hlt">impact</span> of research as part of their wider work programme to develop new arrangements for the assessment and funding of research--referred to as the Research Excellence Framework (REF). The objectives were 1) to…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=vehicle+AND+safety+AND+risk&id=EJ950091','ERIC'); return false;" href="https://eric.ed.gov/?q=vehicle+AND+safety+AND+risk&id=EJ950091"><span>Safety Education <span class="hlt">Impact</span> and Good <span class="hlt">Practice</span>: A Review</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Mulvaney, Caroline A.; Watson, Michael C.; Errington, Gail</p> <p>2012-01-01</p> <p>Purpose: The aim of this literature review was to examine recent evidence of the <span class="hlt">impact</span> of safety education for children and young people on unintentional injury rates and to update an earlier review. Evidence was sought that linked safety education for children and young people in schools, centres and other settings with changes in knowledge,…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21365389','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21365389"><span>Review of <span class="hlt">paediatric</span> gastrointestinal physiology data relevant to oral drug delivery.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kaye, Jonathan L</p> <p>2011-02-01</p> <p>relatively new European Union regulations on children's medicines have emphasised the need for scientists to consider <span class="hlt">paediatric</span> populations during drug development. This requires an understanding of the physiology in the <span class="hlt">paediatric</span> population compared to that of adults. In this review, data cited in the public literature on the gastrointestinal (GI) physiology that could affect drug absorption have been summarised to draw attention to some of the differences between adults and <span class="hlt">paediatric</span> populations that can make predicting the pharmacokinetics of oral drugs in the <span class="hlt">paediatric</span> population a complex task. a search for relevant articles was conducted using EMBASE, MEDLINE (through PubMed) and The National Institute for Public Health and the Environment. Additional journals were found from the references in the initial search results. Furthermore, a selection of common textbooks was used to fill in gaps in physiology data or understanding not covered by the journal articles found. Only data obtained from healthy individuals was used. information on the pH and transit time along the GI tract, as well as other GI physiology data was collated and summarised. There was less data available in the literature on the younger population partly as a consequence of the challenging ethics of carrying out invasive tests on healthy children. it was found that considerable variability in physiology exists within the <span class="hlt">paediatric</span> population. The pH and transit time of the GI tract varies with age, with the greatest changes occurring during the neonate's first month. Other GI physiology also varies with age potentially having an <span class="hlt">impact</span> on drug absorption. This review highlights the variability of <span class="hlt">paediatric</span> physiological values within the literature, indicating the difficulty in performing measurements in the <span class="hlt">paediatric</span> population as well as the natural variability that exists in this age group.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=pharmaceutical+AND+industry&pg=3&id=EJ941445','ERIC'); return false;" href="https://eric.ed.gov/?q=pharmaceutical+AND+industry&pg=3&id=EJ941445"><span><span class="hlt">Impact</span> of Knowledge Management on Learning Organization <span class="hlt">Practices</span> in India: An Exploratory Analysis</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Chawla, Deepak; Joshi, Himanshu</p> <p>2011-01-01</p> <p>Purpose: This paper aims to report the preliminary findings of the difference in learning organization (LO) <span class="hlt">practices</span> across industries. It also reports the <span class="hlt">impact</span> of knowledge management (KM) dimensions on LO and whether this <span class="hlt">impact</span> is different across manufacturing, IT and IT-enabled services (ITES) and power generation and distribution in…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=Manufacturing+AND+papers&pg=3&id=EJ941445','ERIC'); return false;" href="http://eric.ed.gov/?q=Manufacturing+AND+papers&pg=3&id=EJ941445"><span><span class="hlt">Impact</span> of Knowledge Management on Learning Organization <span class="hlt">Practices</span> in India: An Exploratory Analysis</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Chawla, Deepak; Joshi, Himanshu</p> <p>2011-01-01</p> <p>Purpose: This paper aims to report the preliminary findings of the difference in learning organization (LO) <span class="hlt">practices</span> across industries. It also reports the <span class="hlt">impact</span> of knowledge management (KM) dimensions on LO and whether this <span class="hlt">impact</span> is different across manufacturing, IT and IT-enabled services (ITES) and power generation and distribution in…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=curriculum+AND+vitae&id=EJ1005039','ERIC'); return false;" href="http://eric.ed.gov/?q=curriculum+AND+vitae&id=EJ1005039"><span>Exploring the <span class="hlt">Impact</span> of a Professional <span class="hlt">Practice</span> Education Doctorate in Educational Environments</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Kumar, Swapna; Dawson, Kara</p> <p>2013-01-01</p> <p>This article presents one approach to assessing the <span class="hlt">impact</span> of an online professional <span class="hlt">practice</span> doctorate in education on participants' work environments. It is unique in that it explored <span class="hlt">impact</span> during the doctoral program, before participants began their dissertation research, and it focused on how participants apply learning from the program…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://eric.ed.gov/?q=impact+AND+Information+AND+Communication+AND+Technologies&pg=2&id=EJ731454','ERIC'); return false;" href="http://eric.ed.gov/?q=impact+AND+Information+AND+Communication+AND+Technologies&pg=2&id=EJ731454"><span>The <span class="hlt">Impact</span> of Information and Communication Technology (ICT) on the Management <span class="hlt">Practices</span> of Malaysian Smart Schools</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Zain, Muhammad Z. M.; Atan, Hanafi; Idrus, Rozhan M.</p> <p>2004-01-01</p> <p>The <span class="hlt">impact</span> of Information and Communication Technology (ICT) on the management <span class="hlt">practices</span> in the Malaysian Smart Schools was investigated. The analysis revealed that the <span class="hlt">impact</span> has resulted in changes that include the enrichment of the ICT culture among students and teachers, more efficient student and teacher administration, better accessibility…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=activity+AND+series&pg=4&id=EJ975185','ERIC'); return false;" href="https://eric.ed.gov/?q=activity+AND+series&pg=4&id=EJ975185"><span>Faculty Development Programs: Assessing the <span class="hlt">Impact</span> on Instructional <span class="hlt">Practices</span>, and Student Learning and Motivation</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Ambrosino, Roberta; Peel, Jennifer</p> <p>2011-01-01</p> <p>Demonstrating the <span class="hlt">impact</span> of faculty development activities is difficult and infrequently attempted beyond assessing participant satisfaction. This study examines how faculty development activities affect instructional <span class="hlt">practices</span> and the <span class="hlt">impact</span> on student learning and motivation in accordance with Kirkpatrick's levels of evaluation. Ten instructors…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1410110','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1410110"><span><span class="hlt">Impact</span> of an audiology clinic in one general <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Khunti, K; Carr, M</p> <p>1997-01-01</p> <p>There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general <span class="hlt">practice</span> based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids. PMID:9474829</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17984000','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17984000"><span><span class="hlt">Impact</span> of birthing <span class="hlt">practices</span> on the breastfeeding dyad.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Smith, Linda J</p> <p>2007-01-01</p> <p>For breastfeeding to start and continue, the newborn must be able to suck, swallow, and breathe; the mother must be able and willing to let her infant breastfeed; and surroundings must support the biological unit: the mother-baby dyad. This article reviews how birth <span class="hlt">practices</span>, including epidural anesthesia, cesarean surgery, forceps, and vacuum extraction, can affect the newborn's ability to feed, the mother's motivation and lactation capacity, and the mother-baby relationship.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://www.dtic.mil/docs/citations/ADA620780','DTIC-ST'); return false;" href="http://www.dtic.mil/docs/citations/ADA620780"><span>The <span class="hlt">Impact</span> of Train and Equip <span class="hlt">Practices</span> to Counter Insurgencies</span></a></p> <p><a target="_blank" href="http://www.dtic.mil/">DTIC Science & Technology</a></p> <p></p> <p>2014-09-01</p> <p>an act but a habit.141 — Aristotle This thesis addresses the basic question of how to train and equip forces to counter an insurgency and why train...conflicts that test the will of military forces and insurgents alike. As Aristotle points out, training is hard work in the quest to do the right thing...but the <span class="hlt">practices</span> of most militaries result in repetitive failure, regardless of good intentions. The excellence that Aristotle describes has to</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26869323','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26869323"><span>Framework for Evaluating the <span class="hlt">Impact</span> of Advanced <span class="hlt">Practice</span> Nursing Roles.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Bryant-Lukosius, Denise; Spichiger, Elisabeth; Martin, Jacqueline; Stoll, Hansruedi; Kellerhals, Sabine Degen; Fliedner, Monica; Grossmann, Florian; Henry, Morag; Herrmann, Luzia; Koller, Antje; Schwendimann, René; Ulrich, Anja; Weibel, Lukas; Callens, Betty; De Geest, Sabina</p> <p>2016-03-01</p> <p>To address the gap in evidence-based information required to support the development of advanced <span class="hlt">practice</span> nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, <span class="hlt">practice</span> setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. A <span class="hlt">practical</span>, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes. © 2016 Sigma Theta Tau International.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3627201','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3627201"><span>National Board Certification and Developmentally Appropriate <span class="hlt">Practices</span>: Perceptions of <span class="hlt">Impact</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>McKenzie, Ellen Nancy</p> <p>2013-01-01</p> <p>The study investigated a relationship between National Board certification and perceived use of developmentally appropriate <span class="hlt">practices</span> (DAP). A self-developed survey, the Early-childhood Teacher Inventory of <span class="hlt">Practices</span>, was e-mailed to participants. Participants included 246 non-National Board-certified (non-NBCT) and 135 National Board-certified (NBCT) early childhood teachers. Descriptives were reported for age, years of teaching experience, grade level currently teaching, ethnicity, degree type, certification type, and degree level. Inferential statistics were used to understand the differences between perceived use of DAP. NBCTs scored significantly higher than non-NBCTs in three of the four target areas and on the total of the scale. Pearson product-moment corelations were used to determine a relationship between years of experience or level of education and NBCTs’ perceived use of DAP. Years of experience were significantly related, but level of education was not. The findings indicate that NBCT teachers perceive they incorporate more developmentally appropriate <span class="hlt">practices</span> into their teaching than do non-NBCT teachers. PMID:23626399</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25174181','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25174181"><span>[The role of the psychologist with a death in neonatal and <span class="hlt">paediatric</span> intensive care].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Birsan, Sandrine; Rodriguez, Marie-Pierre; Brissaud, Olivier</p> <p>2014-01-01</p> <p>The psychologist within a neonatal and <span class="hlt">paediatric</span> intensive care unit intervenes in accordance with the condition of the patient and those at whom their services are aimed. The psychological <span class="hlt">practice</span> in this particular context comprises certain specificities. As the child nears the end of life the psychologist must find his place within the unit and adapt his care to the needs expressed.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26255394','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26255394"><span>Hippocratic views on <span class="hlt">Paediatric</span> Dentistry and Ancient Greek origins of Orthodontics.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tsoucalas, G; Kousoulis, A A; Karamanou, M; Marineli, F; Tsoucalas, I; Androutsos, G</p> <p>2012-12-01</p> <p>Hippocrates, the father of medicine, expressed some very interesting ideas on dentistry. His remarks on <span class="hlt">paediatric</span> dentistry and orthodontics are quite impressive and influenced its <span class="hlt">practice</span> in ancient Greece. Here we examine his writings in order to find the most important dental references.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20946480','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20946480"><span>An ethnographic study of attending rounds in general <span class="hlt">paediatrics</span>: understanding the ritual.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Balmer, Dorene F; Master, Christina L; Richards, Boyd F; Serwint, Janet R; Giardino, Angelo P</p> <p>2010-11-01</p> <p>Teaching at the bedside during attending rounds is considered to be fundamental to medical education. We conducted an ethnographic case study to investigate such teaching in general <span class="hlt">paediatrics</span> as a social phenomenon and to explore change over time in both the meaning of rounds and the context in which rounds take place. We conducted a case study from January to August 2006 on a 22-bed general <span class="hlt">paediatric</span> unit in an urban children's hospital and focused our observation on interns, senior residents and attending physicians. We observed the medical team during its normal activities on the study unit and conducted semi-structured interviews with a sample of attendings, interns and senior residents. We compiled a list of codes that emerged from patterns in the data and constructed a rich description of rounds according to the principles of inductive analysis. Four themes emerged from the data: (i) attending rounds are a pervasive and routine part of clinical education; (ii) interns, senior residents and attending physicians hold assumptions about what should happen on rounds; (iii) tension exists between interns', senior residents' and attending physicians' assumptions about bedside teaching during rounds and the reality imposed by contextual factors, and (iv) bedside teaching during rounds is <span class="hlt">impacted</span>, but not prohibited, by contextual factors. Our case study provides evidence that bedside teaching during rounds is a pedagogical ideal entrenched in medical education. Participants readily acknowledged teaching at the bedside during rounds as something they perceived should happen, although, in actuality, it was infrequently achieved. This study revealed a telling inconsistency in language and behaviour: 'bedside rounds' was embedded in the participants' ordinary language, but the activity was not necessarily part of their ordinary behaviour. We propose that the <span class="hlt">practice</span> of bedside teaching is best explained as a ritual. Considering bedside teaching as a ritual helps to</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/2151619','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/2151619"><span>[<span class="hlt">Impact</span> of HIV infection and AIDS on dental <span class="hlt">practice</span>].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kielbassa, A M</p> <p>1990-11-01</p> <p>Describing the results of a study on the <span class="hlt">impact</span> of HIV on practitional dentistry, the author finds out a considerable uncertainty of knowledge among elder practitioners. While 62% are willing to treat HIV-infected persons, a big part of the participants is looking on AIDS as an occupational risk. Regarding infection control procedures, the results show a limited compliance with the generally accepted recommendations.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3005666','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3005666"><span>Steroid Assays in <span class="hlt">Paediatric</span> Endocrinology</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2010-01-01</p> <p>Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in <span class="hlt">paediatric</span> endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation. Conflict of interest:None declared. PMID:21274330</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28028561','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28028561"><span>Management of <span class="hlt">paediatric</span> liver trauma.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>van As, A B; Millar, Alastair J W</p> <p>2017-04-01</p> <p>Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory operative to non-operative management in over 90% of cases. Penetrating liver injuries more often require operative intervention and are managed according to adult protocols. The greatest clinical challenge remains the timely identification of the severely damaged liver with immediate and aggressive resuscitation and expedition to laparotomy. The operative management can be taxing and should ideally be performed in a dedicated <span class="hlt">paediatric</span> surgical centre with experience in dealing with such trauma. Complications can occur early or late and include haemobilia, intrahepatic duct rupture with persistent biliary fistula, bilaemia, intrahepatic haematoma, post-traumatic cysts, vascular outflow obstruction, and gallstones. The prognosis is generally excellent.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21274330','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21274330"><span>Steroid assays in <span class="hlt">paediatric</span> endocrinology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.go