Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists.

PubMed

Williams, D G; Howard, R F

2003-11-01

Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed. Questionnaires were sent to the members of the Association of Paediatric Anaesthetists (APA) working within the UK and to lead clinicians and clinical nurse specialists for acute pain in the 26 designated major paediatric centres. The response rate was 72%. There was little consensus regarding drugs and drug combinations used for epidural analgesia. A total of 36% of paediatric centres did not audit their epidural practice, and of those that did the reported incidences of side-effects showed wide variation. Important differences in practice were also identified in the areas of patient selection, informed consent, the use of epidural test doses, drug delivery systems, monitoring and the management of side-effects. Twelve per cent of specialist paediatric hospitals did not have an acute pain team and elsewhere the provision was often limited to staff with few or no specialist skills. There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.

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).

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.

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.

Choosing a career in paediatrics: do trainees' views change over the first year of specialty training?

PubMed

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

2014-09-01

To look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one. A 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes. West Midlands Deanery, UK. Twenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training. Reasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year. Key influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work-life balance and a growing feeling that family came first. Senior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment.

The EU paediatric regulation: still a large discrepancy between therapeutic needs and approved paediatric investigation plans.

PubMed

Wimmer, Stefan; Rascher, Wolfgang; McCarthy, Suzanne; Neubert, Antje

2014-10-01

Prior to the implementation of the EU Paediatric Regulation, the European Medicines Agency (EMA) defined unmet paediatric needs for active substances already available on the market. Seven years after the Paediatric Regulation came into force, we investigated the extent to which previously identified needs have led to programmes for generating evidence necessary for the regulatory approval of medicines for managing childhood conditions. The websites of the EMA and the European Commission Community Research and Development Information Service (CORDIS) were systematically screened to identify active substances from the assessment of paediatric needs, off-patent priority list, agreed Paediatric Investigation Plans (PIP) and 7th Framework Programme (FP7) projects related to paediatric medicines. A total of 357 active substances with paediatric needs were identified by June 2013. 511 PIPs were agreed by the Paediatric Committee at the EMA (PDCO), including 51 (14.3 %) PIPs for a previously identified need. Amongst those, 21 were off-patent at the time of the PIP approval, 15 of which received funding from the European Commission's FP7. According to the assessment of paediatric needs, evidence is particularly needed for active substances treating cardiovascular diseases (n = 61), cancer (n = 40) and in the field of anaesthesiology (n = 38). Whereas oncology drugs (n = 66) were frequently represented in PIPs, drugs for cardiovascular diseases (n = 39) and anaesthesiology (n = 3) rarely were. Most PIPs are attributable to marketing authorisations of new active substances, whereas off-patent drugs which are commonly used off-label remain unstudied to a large extent. More effort including ongoing research funding is essential to further regularise and standardise paediatric pharmacotherapy.

Paediatric manpower: towards the 21st century.

PubMed Central

Appleyard, W J; Jackson, A D

1988-01-01

The British Paediatric Association (BPA) has carried out a national survey of paediatric 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 paediatric care paediatric manpower requirements over the next 10 years are estimated. PMID:3178274

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 motivated for their own teaching tasks if they are assisted by student peer teachers. More research is needed to investigate the influence of peer teaching on the motivation of paediatric doctors to teach medical students und the academic performance of the student peers.

Implementation of mechanism of action biology-driven early drug development for children with cancer.

PubMed

Pearson, Andrew D J; Herold, Ralf; Rousseau, Raphaël; Copland, Chris; Bradley-Garelik, Brigid; Binner, Debbie; Capdeville, Renaud; Caron, Hubert; Carleer, Jacqueline; Chesler, Louis; Geoerger, Birgit; Kearns, Pamela; Marshall, Lynley V; Pfister, Stefan M; Schleiermacher, Gudrun; Skolnik, Jeffrey; Spadoni, Cesare; Sterba, Jaroslav; van den Berg, Hendrick; Uttenreuther-Fischer, Martina; Witt, Olaf; Norga, Koen; Vassal, Gilles

2016-07-01

An urgent need remains for new paediatric oncology drugs to cure children who die from cancer and to reduce drug-related sequelae in survivors. In 2007, the European Paediatric Regulation came into law requiring industry to create paediatric drug (all types of medicinal products) development programmes alongside those for adults. Unfortunately, paediatric drug development is still largely centred on adult conditions and not a mechanism of action (MoA)-based model, even though this would be more logical for childhood tumours as these have much fewer non-synonymous coding mutations than adult malignancies. Recent large-scale sequencing by International Genome Consortium and Paediatric Cancer Genome Project has further shown that the genetic and epigenetic repertoire of driver mutations in specific childhood malignancies differs from more common adult-type malignancies. To bring about much needed change, a Paediatric Platform, ACCELERATE, was proposed in 2013 by the Cancer Drug Development Forum, Innovative Therapies for Children with Cancer, the European Network for Cancer Research in Children and Adolescents and the European Society for Paediatric Oncology. The Platform, comprising multiple stakeholders in paediatric oncology, has three working groups, one with responsibility for promoting and developing high-quality MoA-informed paediatric drug development programmes, including specific measures for adolescents. Key is the establishment of a freely accessible aggregated database of paediatric biological tumour drug targets to be aligned with an aggregated pipeline of drugs. This will enable prioritisation and conduct of early phase clinical paediatric trials to evaluate these drugs against promising therapeutic targets and to generate clinical paediatric efficacy and safety data in an accelerated time frame. Through this work, the Platform seeks to ensure that potentially effective drugs, where the MoA is known and thought to be relevant to paediatric malignancies, are evaluated in early phase clinical trials, and that this approach to generate pre-clinical and clinical data is systematically pursued by academia, sponsors, industry, and regulatory bodies to bring new paediatric oncology drugs to front-line therapy more rapidly. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain].

PubMed

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Admission, discharge and triage guidelines for paediatric intensive care units in Spain.

PubMed

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

The European Paediatric Mycology Network (EPMyN): Towards a Better Understanding and Management of Fungal Infections in Children.

PubMed

Warris, Adilia

The European Paediatric Mycology Network (EPMyN) was launched in 2014 to create a European platform for research and education in the field of paediatric mycology. The EPMyN aims to address the lack of paediatric specific evidence and knowledge needed to (1) improve the management and outcome of invasive fungal infections in children and neonates and to (2) enhance and develop paediatric antifungal stewardship programmes.

Impact of the new european paediatric regulatory framework on ethics committees: overview and perspectives.

PubMed

Altavilla, A; Manfredi, C; Baiardi, P; Dehlinger-Kremer, M; Galletti, P; Pozuelo, A Alemany; Chaplin, J; Ceci, A

2012-01-01

To evaluate the impact of the new European paediatric regulatory framework on the activities of Ethics Committees operating in Europe and to assess their involvement and interest in paediatric research. Task-force in Europe for Drug Development for the Young Network of Excellence and Relating Expectations and Needs to the Participation and Empowerment of Children in Clinical Trials project set up an inventory of Ethics Committees existing in Europe and conducted a survey on their approach to paediatric trials. Ethics Committees operating in 22 European Countries participated in this survey. Results showed a high lack of knowledge, understanding and awareness of the current European paediatric regulatory framework and a lack of involvement of Ethics Committees in paediatric research, especially in terms of training and education, demonstrated also by the decreasing number of Ethics Committees answering exhaustively to the whole questionnaire. The majority of participating Ethics Committees expressed interest in future initiatives related to paediatric research. Despite a limited knowledge and understanding of the current paediatric regulatory framework, a significant number of Ethics Committees operating in Europe show interest in initiatives related to paediatric research. Networking may be an essential tool to be used to enhance Ethics Committees role in supporting paediatric research. Any initiative should be undertaken at European level in collaboration with European Union Institutions. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

The Internet and the paediatric surgeon.

PubMed

Srinivas, M; Inumpudi, A; Mitra, D K

1998-12-01

The Internet, which has truly united the world, is an extensive network of inter-linked computers storing immense bytes of information that can be accessed by anyone, transcending all barriers. The paediatric surgery Internet consists of exponentially growing material that deals with information specifically for paediatric surgeons and patients of the paediatric age group. We reviewed the methods available to take advantage of this network to enable busy paediatric surgeons to accrue the benefits easily and efficiently rather than be lost in the information ocean by surfing individually. By getting connected to the Internet, the paediatric surgeon gains enormous information that can be useful for patient care. The Internet has revolutionised scientific publications by virtue of its fast and accurate transmission of manuscripts. Paediatric surgeons can send manuscripts by this channel and also access journals, obviating the inherent lag period of communication by post.

Stressors of newly graduated nurses in Shanghai paediatric hospital: a qualitative study.

PubMed

Hu, Yun; Zhang, Yaqing; Shen, Nanping; Wu, Juemin; Wu, Jia; Malmedal, Wenche K

2017-04-01

To identify stressors of newly graduated paediatric nurses at a children's hospital in Shanghai, China. Stress is an international phenomenon in nursing generally, but little is known about its effect on new paediatric nurses at the Shanghai paediatric hospital. Participants in this research were 25 newly graduated paediatric nurses. Their behaviours and perceptions were explored by field observations and interviews. Findings indicated that participants experienced numerous stressors: low work status, insufficient professional competence, heavy workload, inadequate supportive systems and uncertainty of career development. The results of the present study provide useful information for administrators to develop and improve postgraduate programmes to support novice paediatric nurses. Our research highlights the importance of identifying the stressors of new paediatric nurses in the light of a serious nurse shortage and an increasing birth rate. © 2016 John Wiley & Sons Ltd.

Balancing research interests and patient interests: a qualitative study into the intertwinement of care and research in paediatric oncology.

PubMed

Dekking, Sara A S; van der Graaf, Rieke; Kars, Marijke C; Beishuizen, Auke; de Vries, Martine C; van Delden, Johannes J M

2015-05-01

Traditionally, in ethical guidelines and in research ethics literature, care and research are clearly separated based on their different objectives. In contrast, in paediatric oncology, research and care are closely combined. Currently, it is unknown how relevant actors in paediatric oncology perceive this combination of research and care. We conducted a qualitative study into the experiences of those involved in Dutch paediatric oncology with the intertwinement of research and care and the dual role of paediatric oncologists as researchers and treating physicians. A qualitative study approach, using two focus groups and 19 semi-structured, in-depth interviews with paediatric oncologists, research coordinators, parents of children with cancer, and adolescents with cancer. Four themes characterize how actors experience the intertwinement of research and care in paediatric oncology. First, research is considered of major importance, and paediatric oncology professionals convey this message to patients and their parents. Second, there is ambiguity about categorization of studies into cancer therapy as either research or treatment. Third, role conflicts appear within the work of the paediatric oncologists. Finally, the various benefits of combining treatment with research are emphasized. Research is regarded as a fundamental and indispensable characteristic of paediatric oncology practice. Paediatric oncology professionals, parents, and patients have a very positive outlook on combining research and care, but they may not be sufficiently critical with respect to potential conflicts. Increased reflection on how to optimally combine research and care could serve as an important protection of the interests of children with cancer and their parents. © 2015 Wiley Periodicals, Inc.

Choosing a career in paediatrics: do trainees’ views change over the first year of specialty training?

PubMed Central

Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna

2014-01-01

Summary Objectives To look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one. Design A 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes. Setting West Midlands Deanery, UK Participants Twenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training. Main outcome measures Reasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year. Results Key influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work–life balance and a growing feeling that family came first. Conclusions Senior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment. PMID:25352989

Successful private-public funding of paediatric medicines research: lessons from the EU programme to fund research into off-patent medicines.

PubMed

Ruggieri, L; Giannuzzi, V; Baiardi, P; Bonifazi, F; Davies, E H; Giaquinto, C; Bonifazi, D; Felisi, M; Chiron, C; Pressler, R; Rabe, H; Whitaker, M J; Neubert, A; Jacqz-Aigrain, E; Eichler, I; Turner, M A; Ceci, A

2015-04-01

The European Paediatric Regulation mandated the European Commission to fund research on off-patent medicines with demonstrated therapeutic interest for children. Responding to this mandate, five FP7 project calls were launched and 20 projects were granted. This paper aims to detail the funded projects and their preliminary results. Publicly available sources have been consulted and a descriptive analysis has been performed. Twenty Research Consortia including 246 partners in 29 European and non-European countries were created (involving 129 universities or public-funded research organisations, 51 private companies with 40 SMEs, 7 patient associations). The funded projects investigate 24 medicines, covering 10 therapeutic areas in all paediatric age groups. In response to the Paediatric Regulation and to apply for a Paediatric Use Marketing Authorisation, 15 Paediatric Investigation Plans have been granted by the EMA-Paediatric Committee, including 71 studies of whom 29 paediatric clinical trials, leading to a total of 7,300 children to be recruited in more than 380 investigational centres. Notwithstanding the EU contribution for each study is lower than similar publicly funded projects, and also considering the complexity of paediatric research, these projects are performing high-quality research and are progressing towards the increase of new paediatric medicines on the market. Private-public partnerships have been effectively implemented, providing a good example for future collaborative actions. Since these projects cover a limited number of off-patent drugs and many unmet therapeutic needs in paediatrics remain, it is crucial foreseeing new similar initiatives in forthcoming European funding programmes.

Application of in vitro biopharmaceutical methods in development of immediate release oral dosage forms intended for paediatric patients.

PubMed

Batchelor, Hannah K; Kendall, Richard; Desset-Brethes, Sabine; Alex, Rainer; Ernest, Terry B

2013-11-01

Biopharmaceutics is routinely used in the design and development of medicines to generate science based evidence to predict in vivo performance; the application of this knowledge specifically to paediatric medicines development is yet to be explored. The aim of this review is to present the current status of available biopharmaceutical tools and tests including solubility, permeability and dissolution that may be appropriate for use in the development of immediate release oral paediatric medicines. The existing tools used in adults are discussed together with any limitations for their use within paediatric populations. The results of this review highlight several knowledge gaps in current methodologies in paediatric biopharmaceutics. The authors provide recommendations based on existing knowledge to adapt tests to better represent paediatric patient populations and also provide suggestions for future research that may lead to better tools to evaluate paediatric medicines. Copyright © 2013 Elsevier B.V. All rights reserved.

Paediatric expert witness.

PubMed

Johnson, Sandra L J

2013-08-01

Paediatricians may be asked to provide expert opinion in paediatric cases that come under legal consideration. This article provides suggestions to assist paediatricians in this role and emphasises their duty to the court when giving expert opinion. © 2013 The Author. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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

PubMed

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

2011-09-01

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

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

PubMed

Ó Mír, M; O'Sullivan, C

2018-02-01

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.

A paediatric cardiopulmonary resuscitation training project in Honduras.

PubMed

Urbano, Javier; Matamoros, Martha M; López-Herce, Jesús; Carrillo, Angel P; Ordóñez, Flora; Moral, Ramón; Mencía, Santiago

2010-04-01

It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Inequality of Paediatric Workforce Distribution in China.

PubMed

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

2016-07-12

Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.

Inequality of Paediatric Workforce Distribution in China

PubMed Central

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

2016-01-01

Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation. PMID:27420083

[Current situation of the organisation, resources and activity in paediatric cardiology in Spain].

PubMed

Sánchez Ferrer, Francisco; Castro García, Francisco José; Pérez-Lescure Picarzo, Javier; Roses Noguer, Ferrán; Centeno Malfaz, Fernándo; Grima Murcia, María Dolores; Brotons, Dimpna Albert

2018-04-26

The results are presented on the «current situation of the organisation, resources and activity in paediatric cardiology in Spain». It was promoted by the Spanish Society of Paediatric Cardiology and Congenital Heart disease. An analysis was carried out on the results obtained from a specifically designed questionnaire, prepared by the Spanish Society of Paediatric Cardiology and Congenital Heart disease, that was sent to all hospitals around the country that offer the speciality of paediatric cardiology. A total of 86 questionnaires were obtained, including 14 hospitals that perform cardiac surgery on children. A total of 190 paediatric cardiology consultants, 40 cardiac surgeons, and 27 middle grade doctors performing their paediatric residency (MIR program) were identified. All hospitals had adequate equipment to perform an optimal initial evaluation of any child with a possible cardiac abnormality, but only tertiary centres could perform complex diagnostic procedures, interventional cardiology, and cardiac surgery. In almost all units around the country, paediatric cardiology consultants were responsible for outpatient clinics and hospital admissions, whereas foetal cardiology units were still mainly managed by obstetricians. The number of diagnostic and therapeutic procedures was similar to those reported in the first survey, except for a slight decrease in the total number of closed cardiac surgery procedures, and a proportional increase in the number of therapeutic catheterisations. Paediatric Cardiology in Spain is performed by paediatric cardiology consultants that were trained initially as general paediatricians, and then completed a paediatric cardiology training period. Almost all units have adequate means for diagnosis and treatment. Efforts should be directed to create a national registry that would not only allow a prospective quantification of diagnostic and therapeutic procedures, but also focus on their clinical outcomes. Copyright © 2018. Publicado por Elsevier España, S.L.U.

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

PubMed Central

2014-01-01

Background Drug development for rare diseases is challenging, especially when these orphan drugs (OD) are intended for children. In 2007 the EU Paediatric Drug Regulation was enacted to improve the development of high quality and ethically researched medicines for children through the establishment of Paediatric Investigation Plans (PIPs). The effect of the EU Paediatric Drug Regulation on the marketing authorisation (MA) of drugs for children with rare diseases was studied. Methods Data on all designated orphan drugs, their indication, MA, PIPs and indication group (adult or child) were obtained from the European Medicines Agency (EMA). The outcome and duration of the process from orphan drug designation (ODD) to MA, was compared, per indication, by age group. The effect of the Paediatric Drug Regulation, implemented in 2007, on the application process was assessed with survival analysis. Results Eighty-one orphan drugs obtained MA since 2000 and half are authorised for (a subgroup of) children; another 34 are currently undergoing further investigations in children through agreed PIPs. The Paediatric Drug Regulation did not significantly increase the number of ODDs with potential paediatric indications (58% before vs 64% after 2007 of ODDs, p = 0.1) and did not lead to more MAs for ODs with paediatric indications (60% vs 43%, p = 0.22). ODs authorised after 2007 had a longer time to MA than those authorised before 2007 (Hazard ratio (95% CI) 2.80 (1.84-4.28), p < 0.001); potential paediatric use did not influence the time to MA (Hazard ratio (95% CI) 1.14 (0.77-1.70), p = 0.52). Conclusions The EU Paediatric Drug Regulation had a minor impact on development and availability of ODs for children, was associated with a longer time to MA, but ensured the further paediatric development of drugs still off-label to children. The impact of the Paediatric Drug Regulation on research quantity and quality in children through PIPs is not yet clear. PMID:25091201

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.

Clinical Profile of Children and Adolescents Attending the Behavioural Paediatrics Unit OPD in a Tertiary Care Set up

ERIC Educational Resources Information Center

Jayaprakash, R.

2012-01-01

Background: There are limited studies on the clinical profile of children attending child guidance clinic under Paediatric background. Aims: To study clinical profile of Children & adolescents attending the Behavioural Paediatrics Unit (BPU) OPD under department of Paediatrics in a tertiary care set up. Methods: Monthly average turnover in the…

Differences in clinical reasoning among nurses working in highly specialised paediatric care.

PubMed

Andersson, Nina; Klang, Birgitta; Petersson, Gunilla

2012-03-01

The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses. Highly specialised paediatric care requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations. The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning. Several themes were uncovered: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task-oriented approach (novices and experienced), an action-oriented approach (novices and experienced) and hypothesis-oriented approach (specialists) while discussing the case. When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care. Nurses' reasoning in clinical paediatric care is related to experience and training. © 2012 Blackwell Publishing Ltd.

Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

PubMed

McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

2016-04-01

The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

Paediatric clinical research from the perspective of hospital pharmacists from France and Canada.

PubMed

Guérin, Aurélie; Tanguay, Cynthia; Lebel, Denis; Prot-Labarthe, Sonia; Bourdon, Olivier; Bussières, Jean-François

2014-12-01

To compare pharmacy support for paediatric research services in France and Canada and to describe the perception of pharmacists and rank the paediatric clinical research issues. This was a cross-sectional descriptive study. All paediatric hospitals from Canada and the main hospitals from France were contacted. A survey was conducted from May-September 2012. Descriptive statistics were performed. Results from 11 paediatric hospitals in Canada (11/12, 92%) and 11 (11/18, 61%) in France were obtained. There was a similar number of ongoing paediatric clinical trials per hospital in France versus Canada (38 (10-81) versus 20 (4-178)). A lower number of pharmacists per hospital was observed in France (17 (11.5-35) versus 45 (18.9-76.8)), but a similar number of pharmacists were assigned to clinical trials (1.5 (1-3) versus 1.9 (0.2-17.4)). Institutional protocols represented the majority of paediatric clinical trials in France (61% (14-100) versus 25% (0-100)). Similar pharmacy support services were offered, but the majority of French respondents also offered help for institutional protocol development (91 versus 50% P = 0.063). The main issues associated with paediatric clinical research were absence of financial interest from the pharmaceutical industry, prohibitive cost versus profit ratio, small patient cohorts and the non-availability of the appropriate drug formulations. Difficulties related to pharmaceutical compounding were identified as the main hindrance to paediatric clinical research; particular attention should be paid to these details when setting up a paediatric trial. © 2014 Royal Pharmaceutical Society.

Advance care planning for adolescent patients with life-threatening neurological conditions: a survey of Japanese paediatric neurologists.

PubMed

Yotani, Nobuyuki; Kizawa, Yoshiyuki; Shintaku, Haruo

2017-01-01

To evaluate current attitudes and barriers to advance care planning for adolescent patients with life-threatening conditions among paediatric neurologists. Cross-sectional study. A self-reported questionnaire was administered to assess the practice of advance care planning, advance directives and barriers to advance care planning for adolescent patients with life-threatening conditions. All board-certified paediatric neurologists in Japan were surveyed and those who had experience in taking care of adolescent patients with decision-making capacity were analysed. We compared the results with those of paediatric haematologists reported previously. In total, 186 paediatric neurologists were analysed. If the patient's prognosis was <3 months, only about 30% of paediatric neurologists reported having discussions with patients, such as 'do not attempt resuscitation' orders (28%) and ventilator use (32%), whereas more than 70% did discuss these topics with patients' families. About half of the paediatric neurologists did not discuss advance directives at the end of life with their patients, whereas over 75% did discuss advance directives with patients' families. Compared with paediatric haematologists, paediatric neurologists had more end-of-life discussions with patients, such as where treatment and care will take place, do not attempt resuscitation orders, and the use of a ventilator, if the patient's prognosis was >1 year. About half or less of the paediatric neurologists discussed advance care planning and advance directives with their adolescent patients who had life-threatening conditions, even if the patient's prognosis was <3 months. They tended to discuss advance care planning and advance directives more with families than with patients themselves.

The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou

PubMed Central

Mammas, Ioannis N.; Spandidos, Demetrios A.

2017-01-01

Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the ‘Aghia Sophia’ Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy. PMID:29042916

The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou.

PubMed

Mammas, Ioannis N; Spandidos, Demetrios A

2017-10-01

Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the 'Aghia Sophia' Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy.

Future career intentions of higher specialist trainees in general Paediatrics.

PubMed

Butler, Grainne; Breatnach, Colm; Harty, Sinead; Gavin, Patrick; O'Donnell, Colm; O'Grady, Michael J

2018-03-27

A survey of paediatric higher specialist trainees was carried out in 2002 assessing career intentions and perception of training. Fourteen years later, with increased numbers of trainees and a national model of care and a tertiary paediatric hospital on the horizon, we re-evaluated the career intentions of the current trainee workforce. To assess the career intentions of the current paediatric higher specialist trainees. A 28-item questionnaire was developed based on a previously validated instrument and distributed online using the Royal College of Physicians of Ireland trainee database. We distributed the questionnaire to 118 eligible trainees and received responses from 92 (78%). Seventy-nine (86%) respondents desire a consultant post in Ireland. Seventy-five (82%) indicated that their preferred consultant post location was in a tertiary paediatric centre. Sixty-two trainees (67%) intend to become subspecialists with 25 (27%) planning a career in general paediatrics. This contrasts with the 2002 survey when 76% wished to work in urban centres and 61% of trainees planned a career in general paediatrics. There appears to be a mismatch between the career goals of the future paediatric consultant workforce and the requirements for staffing paediatric units nationally. This has the potential to complicate the proposed expansion of general paediatricians in regional centres and result in a significant proportion of current trainees failing to secure a post in their desired location.

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

PubMed Central

2018-01-01

ABSTRACT Background: Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective: To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method: Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t-tests and multiple regression. Results: Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions: There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries. PMID:29760867

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries.

PubMed

Hoysted, Claire; Babl, Franz E; Kassam-Adams, Nancy; Landolt, Markus A; Jobson, Laura; Van Der Westhuizen, Claire; Curtis, Sarah; Kharbanda, Anupam B; Lyttle, Mark D; Parri, Niccolò; Stanley, Rachel; Alisic, Eva

2018-01-01

Background : Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective : To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method : Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t -tests and multiple regression. Results : Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions : There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.

Validation of the Australian diagnostic reference levels for paediatric multi detector computed tomography: a comparison of RANZCR QUDI data and subsequent NDRLS data from 2012 to 2015.

PubMed

Anna, Hayton; Wallace, Anthony; Thomas, Peter

2017-03-01

The national diagnostic reference level service (NDRLS), was launched in 2011, however no paediatric data were submitted during the first calendar year of operation. As such, Australian national diagnostic reference levels (DRLs), for paediatric multi detector computed tomography (MDCT), were established using data obtained from a Royal Australian and New Zealand College of Radiologists (RANZCR), Quality Use of Diagnostic Imaging (QUDI), study. Paediatric data were submitted to the NDRLS in 2012 through 2015. An analysis has been made of the NDRLS paediatric data using the same method as was used to analyse the QUDI data to establish the Australian national paediatric DRLs for MDCT. An analysis of the paediatric NDRLS data has also been made using the method used to calculate the Australian national adult DRLs for MDCT. A comparison between the QUDI data and subsequent NDRLS data shows the NDRLS data to be lower on average for the Head and AbdoPelvis protocol and similar for the chest protocol. Using an average of NDRLS data submitted between 2012 and 2015 implications for updated paediatric DRLS are considered.

Paediatrics: the etymology of a name.

PubMed

Pearn, John

2011-08-01

Within the history of paediatrics is the history of the name used to describe it. The etymology of the word 'paediatrics' dates from its first written use, recorded as 'pädiatrik' in the German literature and as 'paediatric', later 'pediatric' in the USA, both first in 1850. Professor Robley Dunglison (1788-1869), the British and American medical lexicographer, first defined 'paediatria' as 'the treatment of the diseases of children' in 1855. 'Pediatric medicine' was promoted as a specialty in the USA in 1880. The oldest monumental inscription defining the specialty of 'paediatrics' in the UK is to be found on a plaque added (in 1950) to the memorial to Dr George Armstrong (1719-1789), a founder of the specialty of paediatrics, in Castleton Cemetery, Scottish Borders, Roxburghshire. 'Paediatrics' and 'child health', with subtle semantic distinctions, had become well established in the English-speaking world by the middle of the 20th century. This paper presents an interpretative chronology of the etymology of the descriptors of the specialty that enjoins all who care for children.

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

PubMed Central

Ganpule, Arvind P.; Sripathi, Venkat

2015-01-01

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

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.

Overview of paediatric obesity for the paediatric mental health provider.

PubMed

Scheimann, Ann O

2012-06-01

Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesity rates increase, obese children and adolescents are at significant risk for the development of a myriad of medical and surgical problems as well as mental health problems. Moreover, children with mental health problems are increasingly presenting to their psychiatrists with obesity. Treatment of paediatric obesity requires a multidisciplinary approach with incorporation of the family into the treatment plan although still typically only offering suboptimal results. Paediatric providers from all disciplines should focus efforts primarily on obesity prevention and encouragement of healthy lifestyles, while incorporating treatment for obesity when such efforts fail. The goals of this article are to provide an overview of the epidemiology, pathophysiology, genetics, clinical features and treatment strategies for paediatric obesity.

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.

Prevention of central venous catheter infections: a survey of paediatric ICU nurses' knowledge and practice.

PubMed

Ullman, Amanda J; Long, Debbie A; Rickard, Claire M

2014-02-01

Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment. To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge. Cross-sectional surveys using convenience sampling. Tertiary level paediatric intensive care units in Australia and New Zealand. Paediatric intensive care nursing staff and nurse managers. Between 2010 and 2011, the 'Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire' was distributed to paediatric intensive care nursing staff and the 'Catheter-Related Bloodstream Infection Prevention Practices Survey' was distributed to nurse managers to measure knowledge, practices and culture. The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p=0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n=8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site. This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management.

PubMed

Rickard, Annette C; Vassallo, James; Nutbeam, Tim; Lyttle, Mark D; Maconochie, Ian K; Enki, Doyo G; Smith, Jason E

2018-04-28

Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of paediatric radiology services in hospitals in the UK.

PubMed

Halliday, K; Drinkwater, K; Howlett, D C

2016-12-01

To compare paediatric radiology provision across the UK with national standards published by the Department of Health and the Royal College of Radiologists (RCR). Audit standards and indicators for paediatric imaging were derived from "Delivering quality imaging services for children", 1 "Standards for imaging in cases of suspected non-accidental injury" 2 and "Improving paediatric interventional radiology services" 3 and agreed jointly by the Clinical Radiology Audit Committee and the British Society of Paediatric Radiology. A questionnaire was sent to all hospitals and NHS trusts imaging children aged 16 or younger in the UK in October 2013. The target for all indicators was 100%. Eighty-seven of 196 (44%) eligible institutions submitted data, the size distribution of the institutions was representative when compared to data from "Facing the future: a review of paediatric services" 4 published by the Royal College of Paediatrics and Child health. Only 65% of paediatric images were obtained by staff who had had specific training and only 60% were reported by radiographers or radiologists with appropriate training. Sixty-two percent of centres did not have access to a paediatric opinion 24 hours a day, 7 days a week all year; only 34% of radiographers who regularly imaged children had had any access to continuing professional development (CPD) in the 12 months of the audit. Although all hospitals had facilities for image transfer, only 57% had any formal funding arrangements in place for external reporting of images. The standards set for a network approach to paediatric radiology provision in "Delivering quality imaging services for children" are largely unmet. This failure to make the most of the workforce and resources puts vulnerable children at risk. The authors urge NHS England to work with the RCR to organise and administer a national network for paediatric imaging. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Confidence and authority through new knowledge: An evaluation of the national educational programme in paediatric oncology nursing in Sweden.

PubMed

Pergert, Pernilla; Af Sandeberg, Margareta; Andersson, Nina; Márky, Ildikó; Enskär, Karin

2016-03-01

There is a lack of nurse specialists in many paediatric 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 practice and also to retain them. The aim of this study was to evaluate a Swedish national educational programme in paediatric oncology nursing. The nurses who participated came from all of the six paediatric oncology centres as well as from general paediatric 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 paediatric 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 paediatric oncology care which included: knowledge generating new knowledge; confidence and authority; national networks and resources. They felt increased confidence in their roles as paediatric 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 paediatric oncology. The programme was of importance to the career of the individual nurse and also to the quality of care given to families in paediatric oncology. The national educational programme for nurses in Paediatric Oncology Care meets the needs of the highly specialised care. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

PubMed Central

2013-01-01

Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families. PMID:24093461

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

PubMed

Adeyinka, Daniel A; Evans, Meirion R; Ozigbu, Chamberline E; van Woerden, Hugo; Adeyinka, Esther F; Oladimeji, Olanrewaju; Aimakhu, Chris; Odoh, Deborah; Chamla, Dick

2017-03-01

Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals. Copyright© by the National Institute of Public Health, Prague 2017

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

PubMed

Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

2018-05-04

To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ethical dimensions of paediatric nursing: A rapid evidence assessment.

PubMed

Bagnasco, Annamaria; Cadorin, Lucia; Barisone, Michela; Bressan, Valentina; Iemmi, Marina; Prandi, Marzia; Timmins, Fiona; Watson, Roger; Sasso, Loredana

2018-02-01

Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, 'What are the most common ethical dimensions and competences related to paediatric nursing?' A rapid evidence assessment. According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses' perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

Tertiary paediatric emergency department use in children and young people with cerebral palsy.

PubMed

Meehan, Elaine; Reid, Susan M; Williams, Katrina; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Rawicki, Barry; Reddihough, Dinah S

2015-10-01

The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

[Materials for the paediatric resuscitation trolley or backpack: Expert recommendations].

PubMed

López-Herce Cid, Jesús; Rodríguez Núñez, Antonio; Carrillo Álvarez, Ángel; Zeballos Sarrato, Gonzalo; Martínez Fernández-Llamazares, Cecilia; Calvo Macías, Custodio

2018-03-01

Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

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

PubMed Central

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

2016-01-01

Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified. PMID:27429578

How well are general practice trainees prepared for paediatric prescribing?

PubMed

Isa, N M; Taylor, Michael W; Helms, Peter J; McLay, James S

2009-03-01

We invited 232 General Practice Trainees to complete an on-line questionnaire to assess how they rated their training for the task of paediatric prescribing and therapeutics in the community. Of the 166 (71%) respondents who completed the questionnaire, 26.5% recalled specific teaching about paediatric prescribing and 59.6% covering one or more relevant topic during their undergraduate years. Undertaking a paediatric post during vocational training was associated with greater prescribing confidence (P < 0.001); however, 35% of respondents were not intending to undertake such a post. This study suggests that many GP trainees perceive their paediatric prescribing training as inadequate.

The educational challenge of Paediatric Virology: An interview with Professor of Neonatology Anne Greenough.

PubMed

Mammas, Ioannis N; Spandidos, Demetrios A

2017-10-01

According to Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology at the King's College London (London, UK), Paediatric Virology is indeed a rapidly increasing educational challenge. Professor Greenough, who in 1992 wrote her book on congenital, perinatal and neonatal infections, believes that during the past 3 decades, paediatric health professionals are becoming increasingly involved in specialised care and follow-up of paediatric patients with viral diseases, who require advanced medical care and innovative technological services. Moreover, she highlights the expected role of new vaccines and antiviral agents that are currently under investigation, as well as the impact of emerging viral diseases that require novel prevention strategies and therapeutic protocols. However, she notes that the number of Paediatric Virologists in any one country is likely to be small; hence, a separate paediatric subspecialty needs to be considered carefully. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor Greenough will give her plenary lecture on the impact of viral infections on the long term outcomes of prematurely born infants.

Enabling Development of Paediatric Medicines in Europe: 10 Years of the EU Paediatric Regulation.

PubMed

Tomasi, Paolo A; Egger, Gunter F; Pallidis, Chrissi; Saint-Raymond, Agnes

2017-12-01

The year 2017 marks the tenth anniversary of entry into force of the Paediatric Regulation in the European Union (EU). This law aimed to stimulate the development of paediatric medicines and provide more information on their use, as a response to the lack of evidence and approval of medicines for children. The European Medicines Agency (EMA) has had a central role in the implementation of the Regulation. Pharmaceutical companies need to submit a paediatric investigation plan (PIP) to the EMA's Paediatric Committee (PDCO) for every new medicine, unless an exemption (waiver) is granted. The plans, which describe the development of drugs for children, must be agreed well in advance of the request for marketing authorization of the medicine. Deferrals of studies can be granted to allow approval in adults before the completion of paediatric studies. Between January 2007 and December 2016, a total of 273 new medicines and 43 additional pharmaceutical forms appropriate for use in children were authorized in the EU, and 950 PIPs were agreed by the EMA. In addition, 486 waivers of the development of a medicine in one or more medical conditions were agreed. The Paediatric Regulation has had a very positive impact on paediatric drug development, as exemplified by a comparison of two periods of 3 years before and after entry into force of the Regulation. We conclude that the Regulation has resulted in more medicines for children and more information on the pediatric use of medicines in the EU being available to clinicians.

Ocular medicines in children: the regulatory situation related to clinical research

PubMed Central

2012-01-01

Background Many ocular medications are prescribed for paediatric patients, but the evidence for their rational use is very scant. This study was planned to compare the availability and the licensing status of ocular medications marketed in Italy, the United Kingdom (UK), and the United States of America (USA) related to the amount of published and un-published RCTs testing these drugs in the paediatric population. Methods A quantitative analysis was performed to evaluate the number of ocular medications with a paediatric license in Italy, the UK, and the USA. A literature search was also performed in MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) on ophthalmic pharmacological therapy in children aged < 18 years, published up to December 2010. A search in the international clinical trial registries, the list of paediatric investigation plans (PIPs) approved by European Medicines Agency (EMA), and the table of medicines with new paediatric information approved by Food and Drug Administration (FDA) was also performed. Results In all, of 197 drugs identified, 68 (35%) single drugs are licensed for paediatric use at least in one considered country, while 23 (12%) were marketed in all three countries. More specifically, in Italy 43 single drugs (48% of those marketed) had a paediatric license, while 39 (64%) did in the UK and 22 (54%) did in the USA. Only 13 drugs were marketed with a paediatric license in all countries. The percentage of drugs licensed for paediatric use and for which at least one RCT had been performed ranged between 51% in Italy and 55% in the USA. No published RCTs were found for 11 (48%) drugs licensed for paediatric use in all three countries. In all, 74 (35%) of the retrieved RCTs involved mydriatic/cycloplegic medications. A total of 62 RCTs (56% completed) on 46 drugs were found in the international clinical trial registries. Cyclosporin and bevacizumab were being studied in many ongoing trials. Twenty-six drugs had new paediatric information approved by FDA based on new paediatric clinical trials, while only 4 PIPs were approved by EMA. Conclusions There is a pressing need for further research and clinical development in the pediatric ophthalmic area, where effective up-to-date treatments, and additional research and education on use in children, remain priorities. PMID:22264311

Job satisfaction and burnout among paediatric nurses.

PubMed

Akman, Ozlem; Ozturk, Candan; Bektas, Murat; Ayar, Dijle; Armstrong, Merry A

2016-10-01

This study aims to determine factors of job satisfaction and burnout levels of paediatric nurses. A total of 165 nurses working in paediatric clinics completed the Minnesota job satisfaction scale and the Maslach burnout scale. Average scores of the emotional exhaustion and depersonalisation score were low, while personal accomplishment scores were high. A high level of job satisfaction, being married, increased age and a decreased number of assigned patients were significantly associated with a low level of burnout. Paediatric nurses experience burnout at significant levels. The most important variable that affected job satisfaction was income. The results of the study could guide development of strategies that might prevent or alleviate burnout of paediatric nurses. © 2016 John Wiley & Sons Ltd.

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

PubMed

O'Keeffe, Mick

2014-01-01

For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental-behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency-based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace-based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended. © 2013 The Author. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Prospective Incidence of Paediatric Inflammatory Bowel Disease in New Zealand in 2015: Results From the Paediatric Inflammatory Bowel Disease in New Zealand (PINZ) Study.

PubMed

Lopez, Robert N; Evans, Helen M; Appleton, Laura; Bishop, Jonathan; Chin, Simon; Mouat, Stephen; Gearry, Richard B; Day, Andrew S

2018-05-01

The global incidence of paediatric inflammatory bowel disease (IBD) is increasing. Much of the evidence attesting to this has arisen from North America and Europe. There is a relative paucity of information on the epidemiology of paediatric IBD in the Southern Hemisphere. The present study aimed to document the prospectively collected incidence of paediatric IBD in New Zealand in 2015. All patients younger than 16 years of age and diagnosed with IBD in New Zealand between 1 January 2015 and 31 December 2015 were identified. Demographic and disease phenotypic details were collected and entered into a secure database. Age-specific population data for New Zealand were obtained and national incidence rates for IBD and its subtypes were calculated. The prospectively calculated incidence of paediatric IBD, Crohn disease, ulcerative colitis (UC), and IBD unclassified in New Zealand in 2015 were 5.2 (95% confidence interval 3.9-6.8), 3.5 (2.4-4.8), 1.0 (0.5-1.8), and 0.7 (0.3-1.4) per 100,000 children, respectively. Incidence rates of paediatric IBD in New Zealand are comparable to the highest rates published in the literature from Western Europe and North America. Ongoing prospective ascertainment of the incidence of paediatric IBD is required to better understand the environmental factors, which are accounting for this increase in disease burden.

Paediatric emergency department utilisation: is it necessary an educational intervention?

PubMed

De Tina, Annalisa; Quattrin, Rosanna; Montina, Laura; Brusaferro, Silvio

2014-01-01

Over the past ten years there has been a progressive increase in accesses to services for paediatric emergency room, documented in Italy and abroad. The aim of the study is describe the sociodemographic, cultural, subjective and objective factors for non-urgent access to paediatric emergency service in an Italian region. It was adopted a descriptive survey of a sample of non-urgent accesses to two paediatric emergency room services in an Italian region during the period from February-March 2009, through the administration of questionnaires and the consultation of facilities databases. Half of the accesses to the paediatric emergency room are not urgent and are to be referred to the paediatric primary care. 80% of the users do not call for advice before coming to the emergency room. The convenience of the service, which accounts for more than 50% of the case, and the proximity from home are reasons to go to the emergency room. Approximately half of the accesses to the paediatric emergency department could be managed by primary care services. The convenience of the service, the self-referred and the proximity to home are emerging as the only influential factors reported by literature. In the future it should become crucial providing strategies for education/health information focused on non-urgent paediatric problems and offering people a call center phone service in order to filter and prevent the inappropriate accesses.

Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units.

PubMed

Tiboni, S; Bhangu, A; Hall, N J

2014-05-01

Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0.37, 95 per cent confidence interval 0.23 to 0.59; P < 0.001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0.34, 0.21 to 0.57; P < 0.001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1.90, 1.18 to 3.06; P = 0.011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1.59, 0.93 to 2.73; P = 0.091). The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Paediatric case mix in a rural clinical school is relevant to future practice.

PubMed

Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

2017-11-29

Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences in clinical settings. Logged cases met the curriculum learning outcomes of graduates. Minor variations were readily addressed via recommendations about logging. This paper provides evidence of the legitimacy of student logs as useful tools in affirming appropriate paediatric case mix. It validates the rural clinical school context as appropriate for medical students to prepare for future clinical paediatric practice.

A systematic review of clinical pharmacist interventions in paediatric hospital patients.

PubMed

Drovandi, Aaron; Robertson, Kelvin; Tucker, Matthew; Robinson, Niechole; Perks, Stephen; Kairuz, Therése

2018-06-19

Clinical pharmacists provide beneficial services to adult patients, though their benefits for paediatric hospital patients are less defined. Five databases were searched using the MeSH terms 'clinical pharmacist', 'paediatric/paediatric', 'hospital', and 'intervention' for studies with paediatric patients conducted in hospital settings, and described pharmacist-initiated interventions, published between January 2000 and October 2017. The search strategy after full-text review identified 12 articles matching the eligibility criteria. Quality appraisal checklists from the Joanna Briggs Institute were used to appraise the eligible articles. Clinical pharmacist services had a positive impact on paediatric patient care. Medication errors intercepted by pharmacists included over- and under-dosing, missed doses, medication history gaps, allergies, and near-misses. Interventions to address these errors were positively received, and implemented by physicians, with an average acceptance rate of over 95%. Clinical pharmacist-initiated education resulted in improved medication understanding and adherence, improved patient satisfaction, and control of chronic medical conditions. This review found that clinical pharmacists in paediatric wards may reduce drug-related problems and improve patient outcomes. The benefits of pharmacist involvement appear greatest when directly involved in ward rounds, due to being able to more rapidly identify medication errors during the prescribing phase, and provide real-time advice and recommendations to prescribers. What is Known: • Complex paediatric conditions can require multiple pharmaceutical treatments, utilised in a safe manner to ensure good patient outcomes • The benefits of pharmacist interventions when using these treatments are well-documented in adult patients, though less so in paediatric patients What is New: • Pharmacists are adept at identifying and managing medication errors for paediatric patients, including incorrect doses, missed doses, and gaps in medication history • Interventions recommended by pharmacists are generally well-accepted by prescribing physicians, especially when recommendations can be made during the prescribing phase of treatment.

The educational challenge of Paediatric Virology: An interview with Professor of Neonatology Anne Greenough

PubMed Central

Mammas, Ioannis N.; Spandidos, Demetrios A.

2017-01-01

According to Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology at the King's College London (London, UK), Paediatric Virology is indeed a rapidly increasing educational challenge. Professor Greenough, who in 1992 wrote her book on congenital, perinatal and neonatal infections, believes that during the past 3 decades, paediatric health professionals are becoming increasingly involved in specialised care and follow-up of paediatric patients with viral diseases, who require advanced medical care and innovative technological services. Moreover, she highlights the expected role of new vaccines and antiviral agents that are currently under investigation, as well as the impact of emerging viral diseases that require novel prevention strategies and therapeutic protocols. However, she notes that the number of Paediatric Virologists in any one country is likely to be small; hence, a separate paediatric subspecialty needs to be considered carefully. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor Greenough will give her plenary lecture on the impact of viral infections on the long term outcomes of prematurely born infants. PMID:29042914

Towards evidence-based medicine in specific grass pollen immunotherapy.

PubMed

Calderon, M; Mösges, R; Hellmich, M; Demoly, P

2010-04-01

When initiating grass pollen immunotherapy for seasonal allergic rhinoconjunctivitis, specialist physicians in many European countries must choose between modalities of differing pharmaceutical and regulatory status. We applied an evidence-based medicine (EBM) approach to commercially available subcutaneous and sublingual Gramineae grass pollen immunotherapies (SCIT and SLIT) by evaluating study design, populations, pollen seasons, treatment doses and durations, efficacy, quality of life, safety and compliance. After searching MEDLINE, Embase and the Cochrane Library up until January 2009, we identified 33 randomized, double-blind, placebo-controlled trials (including seven paediatric trials) with a total of 440 specific immunotherapy (SIT)-treated subjects in seven trials (0 paediatric) for SCIT with natural pollen extracts, 168 in three trials (0 paediatric) for SCIT with allergoids, 906 in 16 trials (five paediatric) for natural extract SLIT drops, 41 in two trials (one paediatric) for allergoid SLIT tablets and 1605 in five trials (two paediatric) for natural extract SLIT tablets. Trial design and quality varied significantly within and between SIT modalities. The multinational, rigorous trials of natural extract SLIT tablets correspond to a high level of evidence in adult and paediatric populations. The limited amount of published data on allergoids prevented us from judging the level of evidence for this modality.

Neck pain in children: a retrospective case series.

PubMed

Cox, Jocelyn; Davidian, Christine; Mior, Silvano

2016-09-01

Spinal pain in the paediatric population is a significant health issue, with an increasing prevalence as they age. Paediatric patients attend for chiropractor care for spinal pain, yet, there is a paucity of quality evidence to guide the practitioner with respect to appropriate care planning. A retrospective chart review was used to describe chiropractic management of paediatric neck pain. Two researchers abstracted data from 50 clinical files that met inclusion criteria from a general practice chiropractic office in the Greater Toronto Area, Canada. Data were entered into SPSS 15 and descriptively analyzed. Fifty paediatric neck pain patient files were analysed. Patients' age ranged between 6 and 18 years (mean 13 years). Most (98%) were diagnosed with Grade I-II mechanical neck pain. Treatment frequency averaged 5 visits over 19 days; with spinal manipulative therapy used in 96% of patients. Significant improvement was recorded in 96% of the files. No adverse events were documented. Paediatric mechanical neck pain appears to be successfully managed by chiropractic care. Spinal manipulative therapy appears to benefit paediatric mechanical neck pain resulting from day-today activities with no reported serious adverse events. Results can be used to inform clinical trials assessing effectiveness of manual therapy in managing paediatric mechanical neck pain.

Music therapy as a non-pharmacological anxiolytic for paediatric radiotherapy patients.

PubMed

O'Callaghan, C; Sexton, M; Wheeler, G

2007-04-01

Outpatient radiotherapy treatment in the paediatric cancer patient can be a traumatic and an anxiety-provoking experience for both the patient and the family. Music therapy has been widely reported to have psychosocial, educational and physical benefits for the paediatric cancer patient. Using individual case reports, this paper shows the successful use of music therapy as a non-pharmacological anxiolytic in the paediatric radiotherapy, outpatient waiting room setting, by providing the patient and the family with a means of communication, self-expression and creativity.

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

PubMed Central

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

2010-01-01

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

Seroprevalence of occult hepatitis B among Egyptian paediatric hepatitis C cancer patients.

PubMed

Raouf, H E; Yassin, A S; Megahed, S A; Ashour, M S; Mansour, T M

2015-02-01

Occult hepatitis B infection is characterized by the presence of hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). Prevalence of hepatitis C virus (HCV) infections in Egypt is among the highest in the world. In this study, we aim at analysing the rates of occult HBV infections among HCV paediatric cancer patients in Egypt. The prevalence of occult HBV was assessed in two groups of paediatric cancer patients (HCV positive and HCV negative), in addition to a third group of paediatric noncancer patients, which was used as a general control. All groups were negative for HBsAg and positive for HCV antibody. HBV DNA was detected by nested PCR and real-time PCR. HCV was detected by real-time PCR. Sequencing was carried out in order to determine HBV genotypes to all HBV patients as well as to detect any mutation that might be responsible for the occult phenotype. Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV. Occult HBV infection seems to be relatively frequent in HCV-positive paediatric cancer patients, indicating that HBsAg negativity is not sufficient to completely exclude HBV infection. These findings emphasize the importance of considering occult HBV infection in HCV-positive paediatric cancer patients especially in endemic areas as Egypt. © 2014 John Wiley & Sons Ltd.

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

PubMed

Allin, Benjamin; Aveyard, Nicholas; Campion-Smith, Timothy; Floyd, Eleanor; Kimpton, James; Swarbrick, Kate; Williams, Emma; Knight, Marian

2016-01-01

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. 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. 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. One managed by general paediatric surgeons. Used for treatment of a condition managed by general paediatric surgeons. 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. 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). 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.

The status of paediatric medicines initiatives around the world--What has happened and what has not?

PubMed

Hoppu, Kalle; Anabwani, Gabriel; Garcia-Bournissen, Facundo; Gazarian, Madlen; Kearns, Gregory L; Nakamura, Hidefumi; Peterson, Robert G; Sri Ranganathan, Shalini; de Wildt, Saskia N

2012-01-01

This review was conducted to examine the current status of paediatric medicines initiatives across the globe. The authors made a non-systematic descriptive review of current world situation. Two regions, the United States (US) and the European Union (EU), and the World Health Organization (WHO) have introduced strong paediatric initiatives to improve children's health through improving access to better paediatric medicines. The experience from the US initiative indicates that it is possible to stimulate development and study of paediatric medicines and provide important new information for improvement of paediatric therapy. The early results from the EU initiative are similarly encouraging. In Canada, Japan, Australia and other developed countries, specific paediatric medicines initiatives have been less extensive and weaker, with modest results. Disappointingly, current evidence suggests that results from clinical trials outside the US often do not benefit children in the country in which the trials were largely conducted. Pharmaceutical companies that have derived a financial benefit commensurate with the cost of doing the paediatric trials in one country do not seem to be making the results of these trials available to all countries if there is no financial incentive to the company. The WHO campaign 'make medicines child size' has produced substantive accomplishments in building improved foundations to improve mechanisms that will enhance children's access to critical medicines in resource-limited settings. However, practically all of this work has been performed using an amalgamation of short-term funding from a variety of sources as opposed to a sustained, programmatic commitment. Although much still needs to be done, it's clear that with concerted efforts and appropriate resources, change is possible but slow. Retaining and fostering public and political interest in paediatric medicines is challenging, but pivotal for success.

Sustainable Benefits of a Community Hospital-Based Paediatric Asthma Clinic.

PubMed

Kuzik, Brian A; Chen, Chee P; Hansen, Miriam J; Montgomery, Paula L

2017-01-01

In 2011, we reported that our paediatric asthma clinic (PAC) appeared to significantly reduce the burden of paediatric asthma in our community. Supported by these results, the PAC underwent a gradual threefold expansion while maintaining the same model of care. We now report on the outcome of that expansion and demonstrate that our PAC continues to significantly reduce the burden of paediatric asthma in our community. As previously, newly enrolled PAC patients continue to show a 12-month reduction in asthma-related emergency department (ED) visits and admissions exceeding 60% and 80%, respectively. This consistent short-term benefit, coupled with clinic expansion, has contributed to a significant improvement in our rate of paediatric asthma-related ED visits or hospitalizations when compared to other Ontario hospitals.

A Clinical Study of Phenomenology and Comorbidity of Paediatric Bipolar Disorder

ERIC Educational Resources Information Center

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

2012-01-01

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

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria

PubMed Central

Ekure, Ekanem N; Sadoh, Wilson E; Bode-Thomas, Fidelia; Yilgwan, Christopher S; Orogade, Adeola A; Animasahun, Adeola B; Ogunkunle, Oluwatoyin O; Omokhodion, Samuel I; Babaniyi, Iretiola; Anah, Maxwell U; Otaigbe, Barbara E; Olowu, Adebiyi; Okpokowuruk, Frances; Maduka, Ogechi C; Onakpoya, Uvie U; Adiele, Daberechi K; Sani, Usman. M; Asani, Mustapha; Daniels, Queennette; Uzodimma, Chinyere C; Duru, Chika O; Abdulkadir, Mohammad B; Afolabi, Joseph K; Okeniyi, John A

2017-01-01

Summary Background Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. Objective: To evaluate and document the currently available paediatric cardiac services in Nigeria. Methods In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. Results Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). Conclusions Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel. PMID:27701490

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria.

PubMed

Ekure, Ekanem N; Sadoh, Wilson E; Bode-Thomas, Fidelia; Orogade, Adeola A; Animasahun, Adeola B; Ogunkunle, Oluwatoyin O; Babaniyi, Iretiola; Anah, Maxwell U; Otaigbe, Barbara E; Olowu, Adebiyi; Okpokowuruk, Frances; Omokhodion, Samuel I; Maduka, Ogechi C; Onakpoya, Uvie U; Adiele, Daberechi K; Sani, Usman M; Asani, Mustapha; Yilgwan, Christopher S; Daniels, Queennette; Uzodimma, Chinyere C; Duru, Chika O; Abdulkadir, Mohammad B; Afolabi, Joseph K; Okeniyi, John A

Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. To evaluate and document the currently available paediatric cardiac services in Nigeria. In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

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

PubMed

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

2011-12-01

Vaccination in immunocompromised infants, children and adolescents is a major aspect in the follow-up of this complex pathology in specific Paediatric Units. Vaccination is also an important prevention tool, as this can, to a certain extent, determine the morbidity and mortality in these patients. This consensus document was jointly prepared by Working Groups of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Paediatric Association, who are usually involved in updating the management of vaccinations in immunocompromised children, and reflects their opinions. The consensus specifically summarises indications for vaccination in the following special paediatric populations: Solid organ and haematopoietic transplant-recipients; primary immunodeficiency; asplenic children; non-previously transplanted immunocompromised patients; chronically ill patients; HIV-infected children and also the vaccines recommended for immunodeficient children who travel. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Paediatric Virology: A rapidly increasing educational challenge

PubMed Central

Mammas, Ioannis N.; Theodoridou, Maria; Kramvis, Anna; Thiagarajan, Prakash; Gardner, Sharryn; Papaioannou, Georgia; Melidou, Angeliki; Koutsaki, Maria; Kostagianni, Georgia; Achtsidis, Vassilis; Koutsaftiki, Chryssie; Calachanis, Marcos; Zaravinos, Apostolos; Greenough, Anne; Spandidos, Demetrios A.

2017-01-01

The ‘2nd Workshop on Paediatric Virology’, which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop. PMID:28352303

The 2017 Seventh World Congress of Paediatric Cardiology and Cardiac Surgery: "The Olympics of our Profession".

PubMed

Cohen, Mitchell I; Jacobs, Jeffrey P; Cicek, Sertac

2017-12-01

The 1st World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children would really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada, 2001, organised by Bill Williams and Lee Benson; Buenos Aires, Argentina, 2005, organised by Horatio Capelli and Guillermo Kreutzer; Cairns, Australia, 2009, organised by Jim Wilkinson; Cape Town, South Africa, 2013, organised by Christopher Hugo-Hamman; and Barcelona, Spain, 2017, organised by Sertac Cicek. With stops in Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), Australia (2009), Africa (2013), and Europe again (2017), in 2021, The World Congress of Paediatric Cardiology and Cardiac Surgery will be held for the first time in the continental United States. 1 The 8th World Congress of Paediatric Cardiology and Cardiac Surgery will be held in Washington DC, United States of America, 19-24 September, 2021, and will be organised by Jeffrey P. Jacobs and Gil Wernovsky. Mitchell I. Cohen served as the Scientific Program Co-Chair for the 2017 World Congress of Paediatric Cardiology and Cardiac Surgery, and he will again serve as the Scientific Program Co-Chair for the 2021 World Congress of Paediatric Cardiology and Cardiac Surgery along with Kathyrn Dodds RN, MSN, CRNP. Information about the upcoming 8th World Congress of Paediatric Cardiology and Cardiac Surgery can be found at www.WCPCCS2021.org.

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

PubMed Central

Verrier, Molly C.; Landry, Michel D.

2014-01-01

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

Shared decision-making in the paediatric field: a literature review and concept analysis.

PubMed

Park, Eun Sook; Cho, In Young

2017-09-13

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 paediatric 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 paediatric 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 paediatric health care. This study provides a theoretical understanding of the concept of shared decision-making in the paediatric field; furthermore, by integrating this concept into paediatric practice, it may help to reduce the gap between theory and practice. The analysis could also provide nursing researchers with insight into paediatric decision-making and establish a foundation to develop future interventions and situation-specific theory for promoting high-quality decision-making in the paediatric field. © 2017 Nordic College of Caring Science.

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

ERIC Educational Resources Information Center

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

2007-01-01

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

How many procedures do UK paediatric trainees perform in their neonatal posts?

PubMed

Ramaiah, Sridhar M; Athiraman, Naveen; Tse, Yincent

2018-05-26

The UK training programme typically takes 8 years full time equivalent to become a paediatric consultant but can be shortened to as little as five years if deemed competent. At minimum trainees complete two six months posts in neonatology, one at level 1 Specialty training (ST 1-3) and another at level 2 training (ST 4-5) during their paediatric training programme. According to the Royal College of Paediatrics and Child Health curriculum (1), by end of ST 5 training year the competent paediatric registrar will 'be able to provide and lead basic and advanced neonatal resuscitation' and 'be able to intubate sick newborn infants without direct supervision. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Contribution to scientific research in paediatrics in The Netherlands: evaluation according to subspeciality over a 10-year period.

PubMed

Verberkmoes, J A; Monnens, L A; Vossen, J M; Weening, R S

1993-11-01

The board of the Dutch Paediatric Association requested a survey of the scientific research performed in all academic and non-academic paediatric hospitals, authorized to train medical doctors in paediatrics in the Netherlands. Contributions to the international and the Dutch scientific literature, in the form of regular publications, chapters in books, contributions to proceedings and Ph.D. theses were counted over two 5-year periods, i.e. 1981-1985 and 1986-1990. The quality of publications in the international journals was assessed using the average impact factor of the journals over the 10-year period. The number of publications in the international literature doubled during the observation period 1986-1990 compared to the period 1981-1985. Nevertheless, the quality of the publications remained the same. Metabolism, oncology/haematology, immunology/infectious diseases and cardiology are the subspecializations in which scientific research takes place in four or more academic paediatric hospitals. In total, 84 Ph.D. theses were produced in which a paediatrician was either the project leader (mostly a professor in paediatrics) or the investigator-in-charge. Insight into structure and major research efforts of paediatric hospitals in other countries of Europe may lead to exchange of views and, maybe, profitable co-operation.

Permeation studies through porcine small intestine of furosemide solutions for personalised paediatric administration.

PubMed

Provenza, N; Calpena, A C; Mallandrich, M; Sánchez, A; Egea, M A; Clares, B

2014-11-20

Personalized medicine is a challenging research area in paediatric drug design since no suitable pharmaceutical forms are currently available. Furosemide is an anthranilic acid derivative used in paediatric practice to treat cardiac and pulmonary disorders in premature infants and neonates. However, it is not commercialized in suitable dosage forms for paediatrics. Elaborating new paediatric formulations when no commercial forms are available is a common practice in pharmacy laboratories; amongst these, oral liquid formulations are the most common. We developed two extemporaneous paediatric 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 paediatric 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. Copyright © 2014 Elsevier B.V. All rights reserved.

Are TB control programmes in South Asia ignoring children with disease? A situational analysis.

PubMed

Shakoor, Sadia; Qamar, Farah Naz; Mir, Fatima; Zaidi, Anita; Hasan, Rumina

2015-02-01

Paediatric tuberculosis (TB) has long been an evasive entity for public health practitioners striving to control the disease. Owing to difficulty in diagnosis of paediatric TB, incidence estimates based on current case detection fall short of actual rates. The four high-burden countries in South Asia (SA-HBC)-Afghanistan, Pakistan, India and Bangladesh-alone account for >75% of missed TB cases worldwide. It follows that these countries are also responsible for a large although unmeasured proportion of missed paediatric cases. In view of current Millennium Development Goals recommending a scale-up of paediatric TB detection and management globally, there is a dire need to improve paediatric TB programmes in these high-burden countries. Inherent problems with diagnosis of paediatric TB are compounded by programmatic and social barriers in SA-HBC. We have reviewed the current situation of TB control programmes in SA-HBC countries based on published statistics and performed a strengths, weaknesses, opportunities and threats situational analysis with a view towards identifying critical issues operant in the region posing barriers to improving paediatric TB control. 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.

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry.

PubMed

Woolley, S M; Hingston, E J; Shah, J; Chadwick, B L

2009-09-26

The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

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

PubMed

Holland, Andrew J A; McBride, Craig A

2015-01-01

Paediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long-term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non-operative management of solid organ injury following blunt abdominal trauma. Nano-crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case-only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The european paediatric legislation: benefits and perspectives

PubMed Central

2010-01-01

Background The lack of availability of appropriate medicines for children is an extensive and well known problem. Paediatricians and Physicians who take care of the paediatric population are primarily exposed to cope with this negative situation very often as more than half of the children are prescribed off-label or unlicensed medicines. Discussion Medicinal products used to treat this population should be subjected to ethical research of high quality and be explicitly authorised for use in children as it happens in adults. For that reason, and following the US experience, the European Paediatric Regulation has been amended in January 2007 by the European Commission. The objective of the Paediatric Regulation is to improve the development of high quality and ethically researched medicines for children aged 0 to 17 years, to facilitate the availability of information on the use of medicines for children, without subjecting children to unnecessary trials, or delaying the authorisation of medicines for use in adults. Summary The Paediatric Regulation is dramatically changing the regulatory environment for paediatric medicines in Europe and is fuelling an increased number of clinical trials in the paediatric population. Nevertheless, there are some risks and pitfalls that need to be anticipated and controlled in order to ensure that children will ultimately benefit from this European initiative. PMID:20716337

Potential Usefulness of the Kampo Medicine Yokukansan, Containing Uncaria Hook, for Paediatric Emotional and Behavioural Disorders: A Case Series

PubMed Central

2013-01-01

Background. Paediatric emotional and behavioural disorders (EBD) are relatively common diseases. Although nonpharmacologic and pharmacologic treatments are utilized in these cases, it is sometimes difficult to manage the symptoms of EBD. Historically, Uncaria hook has been used for treating nighttime crying and convulsions in children. Recent clinical studies have demonstrated that the Kampo medicine Yokukansan (YKS), which contains Uncaria hook, is efficacious for behaviour disorders in Alzheimer's disease patients. Herein, we investigated the clinical efficacy and safety of YKS in a series of cases with paediatric EBD. Patients and Methods. We retrospectively reviewed all paediatric patients who sought Japanese Kampo therapy at our outpatient clinics between April 1, 2012, and April 30, 2013; we selected patients who were diagnosed with paediatric EBD and were treated with YKS. Results. After screening all candidates, 3 patients were eligible for this analysis. Their average age was 11.6 years (range 10–13 years). All 3 patients responded very well to YKS within 1 month. No drug-related adverse events were observed during the course of YKS treatment. Conclusion. Yokukansan may be efficacious for paediatric EBD. We believe these results warrant further evaluation of the clinical efficacy and safety of Yokukansan for paediatric EBD in a carefully designed, double-blind, randomized clinical study. PMID:24204394

Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study.

PubMed

Hussen, Sophia A; Chakraborty, Rana; Knezevic, Andrea; Camacho-Gonzalez, Andres; Huang, Eugene; Stephenson, Rob; Del Rio, Carlos

2017-09-01

The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p  = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p  = 0.002). Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting.

Derivation of new diagnostic reference levels for neuro-paediatric computed tomography examinations in Switzerland.

PubMed

Wagner, Franca; Bize, Julie; Racine, Damien; Le Coultre, Regis; Francis, Verdun; Trueb, Philipp; Treier, Reto

2018-05-22

Definition of new national diagnostic reference levels (DRLs) for volume computed tomography dose index (CTDIvol) and dose length product (DLP) for neuro-paediatric CT examinations depending on the medical indication. Methods: Paediatric cranial CT data sets acquired between January 2013 and December 2016 were retrospectively collected between July 2016 and March 2017 from the eight largest university and cantonal hospitals that perform most of the neuro-paediatric CTs in Switzerland. A consensus review of CTDIvol and DLP was undertaken for the three defined anatomical regions: brain, facial bone and petrous bone; each with and without contrast medium application. All indications for cranial CT imaging in paediatrics were assigned to one of these three regions. Descriptive statistical analysis of the distribution of the median values for CTDIvol and DLP yielded minimum, maximum, 25th percentile (1st quartile), median (2nd quartile) and 75th percentile (3rd quartile). New DRLs for neuro-paediatric CT examinations in Switzerland were based on the 75th percentiles of the distributions of the median values of all eight centres. Where appropriate, values were rounded such that the DRLs increase or at least remain constant as the age of the patient increases. Results: Our results revealed DRLs for CTDIvol and DLP up to 20% lower than the DRLs used so far in Switzerland and elsewhere in Europe. Conclusions: This study provides Swiss neuro-paediatric CT DRL values to establish optimum conditions for paediatric cranial CT examinations. Periodic national updates of DRLs, following international comparisons, are essential. . Creative Commons Attribution license.

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Introduction to "Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations".

PubMed

Ehrich, Jochen; Namazova-Baranova, Leyla; Pettoello-Mantovani, Massimo

2016-10-01

The field of pediatrics in Europe is characterized by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within a typical environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since its foundation in 1976, the European Paediatric Association-Union of National European Paediatric Societies and Associations has worked to improve both medical care of all children and cooperation of their caretakers in Europe. Such a report has been conceived in the strong belief that broadening of the intellectual basis of the European Paediatric Association-Union of National European Paediatric Societies and Associations and creating a multidisciplinary society will be necessary to reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child health care in Europe. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Causes, mechanisms and management of paediatric osteoporosis.

PubMed

Mäkitie, Outi

2013-08-01

Osteoporosis, a skeletal disorder characterized by compromised bone strength and an increased risk of fractures, is an important paediatric disorder that involves almost all paediatric subspecialties. Osteogenesis imperfecta is the most common form of childhood-onset primary osteoporosis, but several other forms are also known. Secondary osteoporosis is caused by an underlying chronic illness or its treatment. The most common causes of secondary osteoporosis include chronic systemic inflammation, glucocorticoid use and neuromuscular disabilities. The skeletal sequelae can present in childhood as low-energy peripheral and vertebral fractures, or become evident in adulthood as low bone mass and an increased propensity to develop osteoporosis. Management should aim at prevention, as interventions to treat symptomatic osteoporosis in the paediatric age group are scarce. Bisphosphonates are the principal pharmacological agents that can be used in this setting, but data on their efficacy and safety in paediatric populations remain inadequate, especially in patients with secondary osteoporosis. Consequently, it is important to understand the potential skeletal effects of paediatric illnesses and their therapies in order to institute effective and timely prevention of skeletal complications.

EAP viewpoint on unpublished data from paediatric clinical trials.

PubMed

Schrier, L; Illy, K; Valiulis, A; Wyder, C; Stiris, T

2018-02-01

European children and paediatricians rely heavily on the fair, complete and timely publication of data obtained from paediatric randomised controlled trials (RCTs). Selective publication and reporting of paediatric RCTs is common practice. Industry-sponsored trials are more likely to remain unpublished, and take longer to get published compared with trials sponsored by others. However, also academic sponsors contribute to inefficiencies in publishing clinical data. Publication bias violates the ethical obligation that investigators have towards study participants, leads to considerable inefficiencies in research and a waste of financial and human resources, and has the potential to distort evidence for treatment approaches. The European Academy of Paediatrics (EAP) therefore actively supports initiatives that increase the public dissemination of paediatric clinical trial data. The EAP will raise awareness about the guidelines for Good Publication Practice among European paediatricians and subspecialty societies.

Evaluation of radiation dose to anthropomorphic paediatric models from positron-emitting labelled tracers

NASA Astrophysics Data System (ADS)

Xie, Tianwu; Zaidi, Habib

2014-03-01

PET uses specific molecules labelled with positron-emitting radionuclides to provide valuable biochemical and physiological information. However, the administration of radiotracers to patients exposes them to low-dose ionizing radiation, which is a concern in the paediatric population since children are at a higher cancer risk from radiation exposure than adults. Therefore, radiation dosimety calculations for commonly used positron-emitting radiotracers in the paediatric population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic paediatric models including the newborn, 1-, 5-, 10- and 15-year-old male and female. This is achieved using pre-calculated S-values of positron-emitting radionuclides of UF-NCI paediatric phantoms and published biokinetic data for various radiotracers. The influence of the type of anthropomorphic model, tissue weight factors and direct human- versus mouse-derived biokinetic data on the effective dose for paediatric phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference paediatric patients from various dose regimens were also calculated. Among the considered radiotracers, 18F-FBPA and 15O-water resulted in the highest and lowest effective dose in the paediatric phantoms, respectively. The ICRP 103 updated tissue-weighting factors decrease the effective dose in most cases. Substantial differences of radiation dose were observed between direct human- versus mouse-derived biokinetic data. Moreover, the effect of using voxel- versus MIRD-type models on the calculation of the effective dose was also studied. The generated database of absorbed organ dose and effective dose for various positron-emitting labelled radiotracers using new generation computational models and the new ICRP tissue-weighting factors can be used for the assessment of radiation risks to paediatric patients in clinical practice. This work also contributes to a better understanding of the factors influencing patient-specific radiation dose calculation.

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 professions to collect information in a standardised format based on best evidence assessment methods whilst aiding consistency in communication between health professionals.

Pattern of paediatric trauma in Sokoto, North West Nigeria.

PubMed

Oboirien, Muhammad

2013-01-01

Paediatric trauma has become a major cause of mortality, disability and socioeconomic burden in developing countries and the World Health Organization (WHO) projects that by 2020 it will be the leading disease globally. This study described the pattern of paediatric injuries seen at a regional trauma center in North West, Nigeria. Trauma centre of a tertiary hospital in North-Western Nigeria. A retrospective look at the trauma register for records of paediatric trauma from January to December 2010 was performed. Information obtained include age and sex, causes and pattern of injury. The limit of 16 years was set for paediatric in our centre. The numbers of paediatric trauma seen over the 12-month period were 567 out of a total of 3984 trauma cases representing 14.2%. The number of males was 407(71.8%) and females were 160(28.2%) with M: F ratio of 2.5:1. The mean age was 7.77 and standard deviation of 0.19. Road Traffic Accidents (RTA) and Domestic injuries representing 44.8 and 42.0%, respectively, were the commonest causes of injuries. Laceration and bruises, head injuries including extremities were the commonest types of injuries seen. Road traffic accidents and domestic injuries as common causes of paediatric trauma need to be 'addressed by the authorities' so as to reduce the burden of trauma on the vulnerable children in our society.

Single institution experience of paediatric melanoma in Victoria, Australia.

PubMed

Le, Quynh; Norris, Diana; McClean, Catriona A; Mcguiness, Myra; Meani, Rowena; Kelly, John W; Pan, Yan

2017-05-01

Paediatric melanoma is an uncommon presentation of melanoma that accounts for 3% of all paediatric cancers. The objective was to describe a series of paediatric melanoma cases presenting to a state-wide tertiary referral service over the past 19 years. A search of the Victorian Melanoma Service database was performed to identify all patients under the age of 20 years diagnosed with melanoma from 1994 to 2013. Histological, demographic and phenotypical information for each patient was collected. Patients were matched against the Victorian Death Registry to identify those who had died. Fisher's exact test was used to examine associations. Melanoma-specific survival was estimated using the Kaplan-Meier method. A total of 65 paediatric melanoma patients were included for analysis, in whom 72.3% of melanomas were diagnosed when they were 16-19 years of age with a mean age at diagnosis of 16 years. The mean Breslow thickness was 1.4 mm. It was greatest (3.4 mm) in the youngest age group (< 12 years of age). Ten patients developed nodal metastatic disease, eight of which progressed to visceral metastatic disease. The 5-year melanoma-specific survival rate was 96.8%. This is the first descriptive epidemiological study of paediatric melanoma in Victoria. Further large, population-based, multi-institutional studies of paediatric melanoma are warranted to provide a clearer understanding of this group of melanoma patients. © 2016 The Australasian College of Dermatologists.

Career choices for paediatrics: national surveys of graduates of 1974-2002 from UK medical schools.

PubMed

Turner, G; Lambert, T W; Goldacre, M J; Turner, Steve

2007-05-01

Knowledge of UK doctors' career intentions and pathways is essential for understanding future workforce requirements. The aim of this study was to report career choices for and career progression in paediatrics in the UK. Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. In total, 74% (24 621/33 412) and 73% (20 720/28 459) of doctors responded at 1 and 3 years after graduation. Choices for paediatrics 1 year after qualifying fell from 7.8% of 1974 graduates to 5.0% of 1983 graduates, increased to 7.2% of 1993 graduates, and since the level has remained fairly constant. Approximately twice the percentage of women graduates than men graduates indicated a long-term career choice for paediatrics. A total of 44% of those who chose paediatrics 1 year after graduation were working in it 10 years after qualifying. Experience of the subject as a student, and enthusiasm/commitment: what I really want to do, affected long-term career choices more for paediatrics than for other medical careers. The proportion of junior doctors wishing to become paediatricians has not changed much during the last 30 years. The planned increase in the number of medical school graduates is necessary to increase the number of UK-trained consultant paediatricians. Medical students who experience enthusiastic and stimulating training in paediatrics may be more likely to become paediatricians.

Survey on sedation in paediatric dentistry: a global perspective.

PubMed

Wilson, Stephen; Alcaino, Eduardo A

2011-09-01

Paediatric dentists receive training in sedation during their advanced education training, but evidence suggests that this training varies widely. The purpose of this study was to survey members of the International Association of Paediatric Dentistry (IAPD) and the European Academy of Paediatric Dentistry (EAPD) on their opinion on pharmacological and other behavioural management techniques and their training related to provision of oral health care of paediatric patients in the dental setting. A request was made for access to the IAPD and EAPD membership email addresses. The responses were recorded anonymously and data uploaded into spss (version 9) and analysed using descriptive analysis and chi-square with and without tabulation processes. A total of 311 respondents of 1973 targeted individuals answered the survey. The response rate was 16%. The majority of the respondents came from the continent of Europe, Asia, and the Americas. The most frequent type of sedation was general anaesthesia (52% of the respondents), followed by nitrous oxide (46%) and then oral sedation (44%). At least 91% of the respondents indicated that they were interested in the development of continuing education on the topic of sedation. Paediatric dentists around the world use relatively few behaviour management techniques, including pharmacological management. There is a definite interest in continuing education in the area of sedation. The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

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

PubMed Central

MAMMAS, IOANNIS N.; GREENOUGH, ANNE; THEODORIDOU, MARIA; KRAMVIS, ANNA; CHRISTAKI, ILIANA; KOUTSAFTIKI, CHRYSSIE; KOUTSAKI, MARIA; PORTALIOU, DIMITRA M.; KOSTAGIANNI, GEORGIA; PANAGOPOULOU, PARASKEVI; SOURVINOS, GEORGE; SPANDIDOS, DEMETRIOS A.

2016-01-01

Paediatric Virology is a bold new scientific field, which combines Paediatrics with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on Paediatric Virology, which took place on Saturday October 10, 2015 in Athens, Greece, provided an overview of recent views and advances on viral infections occurring in neonates and children. It was included in the official programme of the 20th World Congress on Advances in Oncology and the 18th International Symposium on Molecular Medicine, which attracted over 500 delegates from the five continents. During the Workshop, the topics covered included the challenges of vaccine implementation against human papillomaviruses in countries under financial crisis, strategies for eradicating poliomyelitis and its 60th vaccine anniversary, as well as the debate on the association between autism and vaccination against measles, mumps and rubella. Among the non-vaccine related topics, emphasis was given to viral infections in prematurely born infants and their long-term outcomes, new paediatric intensive care management options for bronchiolitis related to respiratory syncytial virus, the clinical implications of hepatitis B virus and cytomegalovirus genotyping, the Ebola virus threat and preparedness in Paediatric Emergency Departments, oral, oropharynx, laryngeal, nasal and ocular viral infections and Merkel cell polyomavirus as a novel emerging virus of infancy and childhood. In this review, we provide selected presentations and reports discussed at the Workshop. PMID:26889211

[Antonino Longo: the school of Concetti and the birth of paediatrics in Catania].

PubMed

Farnetani, I; Farnetani, F

2007-12-01

The biography of Antonino Longo gives us the opportunity to gain knowledge in, even in everyday life, Luigi Concetti's school of paediatrics in Rome, the state of the art in some infectious diseases,and the reality of paediatrics in Catania where Longo founded University teachings and organised health care for children.

Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland - Appraisals by parents of children requiring medical attention.

PubMed

Kołłątaj, Barbara; Kołłątaj, Witold; Wrzołek, Katarzyna; Karwat, Irena Dorota; Klatka, Maria

2017-03-31

 Introduction. The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as 'the European Health Consumer Index', Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. The materials for this study consisted of 540 parents of children aged 6-16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved.

Family-centred care in the paediatric intensive care unit: an integrative review of the literature.

PubMed

Butler, Ashleigh; Copnell, Beverley; Willetts, Georgina

2014-08-01

To review extant research on family-centred care in a paediatric intensive care environment and identify gaps in the literature. Family-centred care is currently a core concept in paediatric nursing, focusing on the premise that families are central to a child's well-being, and as such, should be included as equal members of the child's healthcare team. Due to the nature of critical care, family-centred care may be challenging to implement and maintain. An integrative literature review. The review was conducted using the Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar databases, from 1990 to present. The search focused on the following terms: 'p(a)ediatric critical care', 'paediatric intensive care unit', 'family cent(e)red care', 'parental needs', 'family presence' and 'family/nurse roles'. Additionally, the search was limited to studies conducted in a developed country and published in English. Eighteen studies were included in the review. The results demonstrated that implementing family-centred care into a paediatric intensive care environment posed several challenges. The discrepancy between nurses' and parents' perception of their roles, the reluctance of medical staff to share potentially negative or rapidly changing information, restrictive family presence and poor understanding of family needs emerged as the key difficulties. No studies evaluated strategies to improve family-centred care practice. Family-centred care presents many challenges in a paediatric intensive care environment; however, nurses are uniquely positioned to foster relationships with families, encourage accurate and honest information sharing and advocate for families to be present when they choose. This review outlines the extant research to enhance awareness of the unique state of family-centred care in paediatric intensive care and makes recommendations for future research. © 2013 John Wiley & Sons Ltd.

"Not such a kid thing anymore": Young adults' perspectives on transfer from paediatric to adult cardiology care.

PubMed

Catena, G; Rempel, G R; Kovacs, A H; Rankin, K N; Muhll, I V; Mackie, A S

2018-03-25

Transfer of adolescents with congenital heart disease from paediatric cardiology providers to specialized adult congenital heart disease (ACHD) care providers is becoming a standard practice. However, some paediatric cardiologists continue to provide care for their patients into adult life. Little is known about the perspectives of young adult patients who have been transferred to ACHD clinics versus those who continue to receive their cardiology care in paediatric settings. Content and thematic analysis of structured telephone interviews with 21 young adults age 18-25 (13 transferred to ACHD clinic and 8 who had not transferred) was conducted to identify similarities and differences in patient characteristics of those in ACHD versus paediatric settings. There were no appreciable differences in gender, age, heart disease type, and independence between those transferred to ACHD care versus those not transferred. Participants in both groups were aware of differences between the paediatric and ACHD care settings and providers, with some favouring the familiarity offered by the paediatric setting and providers. Participants had varying views on parental involvement in their care; most of them had attended clinic appointments on their own. Those who had transferred to ACHD care acknowledged that it would take time to adjust to new relationships. Positive perspectives on actual or anticipated transfer to ACHD care included a growing sense of autonomy and responsibility, as well as access to reproductive information relevant to ACHD patients. The absence of patient characteristics distinguishing those in ACHD care versus those still followed in paediatric care suggests that system, provider, and parent factors, rather than patient factors, may account for patients' perspectives on transfer to ACHD care. © 2018 John Wiley & Sons Ltd.

A survey of specialist paediatric dental services in Sweden: results from 2003, and trends since 1983.

PubMed

Klingberg, G; Dahllöf, G; Erlandsson, A-L; Grindefjord, M; Hallström-Stalin, U; Koch, G; Lundin, S-A

2006-03-01

The child population in Sweden has changed dramatically during the last 20 years. Changes have also occurred within the Public Dental Service (PDS), regarding the provision of dental care to children and adolescents. All these changes may affect the referral pattern and provision of specialist dental care for children and adolescents. The primary aim of this study was to survey the services provided by specialists in paediatric dentistry in Sweden during 2003. A secondary aim was to compare the results with previous surveys. A Web-based survey was sent to all 34 specialist paediatric dentistry clinics and was answered by all clinics. Data were compared with results from the surveys performed in 1983, 1989, and 1996. The number of paediatric dentists had been relatively constant over the last 20 years, whereas the number of children referred to paediatric dentists had increased by 28% since 1983. It was estimated that 1.3% of all children in Sweden are treated at a specialist paediatric dental clinic in 2003. Dental treatment need in combination with behaviour management problems (BMP) was the main reason for referral and occurred in 37% of all referrals. The proportion of medically compromised children/children with disabilities had increased from 6% in 1983 to 22% in 2003. The number of patients treated using sedation and general anaesthesia had increased since 1983, and particularly since 1996. Despite improvements in dental health among children and adolescents in Sweden during the last 20 years, an increasing number of children are referred for specialist paediatric dental treatment. There is an urgent need to increase the number of specialist paediatric dentists in Sweden in order to ensure the continuation of high quality of dental care for children and adolescents.

Development of a subspecialty cardiology curriculum for paediatric registrars in Malawi: Implementation of a long-distance hybrid model.

PubMed

Newberry, Laura; Kennedy, Neil; Greene, Elizabeth A

2016-06-01

Malawi has a high burden of paediatric cardiac disease but a limited number of health providers familiar with these chronic diseases. Given the rising number of Malawian postgraduate paediatric trainees at the University of Malawi College of Medicine, we sought to remedy this lack of basic cardiology training with a long-distance, module-based curriculum that could be utilised independently, as needed, with on-site teaching. We also wished to evaluate the initial modules for utility and improvement in knowledge and confidence in each topic. After an initial site visit to determine curriculum needs, online modules with interactive evaluations and quizzes were developed by a paediatric cardiologist in the United States, in collaboration with paediatric registrar training directors in Malawi. This online interactive curriculum was followed by several site visits to Malawi, by the United States-based paediatric cardiologist, to provide bedside teaching, case-based discussions and hands-on skill training in cardiac ultrasound and electrocardiogram interpretation. Evaluation of the curriculum model included post-module quizzes on cardiac topics as well as registrar self-assessments regarding confidence in content areas. The average post-module quiz score was 93.6%. Repeat testing with the same questions four months later yielded an average score of 78%, with a range from 60 to 100%. Pre- and post-module registrar self-assessment regarding confidence in content areas showed a substantial gain in knowledge and confidence mean. In their qualitative feedback, registrars noted that the modules were helpful in studying for their certifying examinations, and all four of the registrars sitting Part I of their Malawian and South African paediatric certifying examinations passed. Our innovative hybrid approach, combining online educational modules with in-person teaching visits, is a useful approach in expanding paediatric cardiology subspecialty education in Malawi.

A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests.

PubMed

Walsh, Órla; Lydon, Sinéad; O'Connor, Paul

2017-12-01

Paediatric cardiopulmonary arrest (CPA) survival rates are strongly linked to the training of the doctors responding to the event. This study sought to characterise the level of experience in managing CPAs among paediatric trainees and to investigate the nontechnical (NTS) required to effectively lead a paediatric CPA team. A mixed-methods research design was used. For the quantitative phase, a questionnaire was developed to assess training, confidence, and experiences related to CPA management. During the qualitative phase, 17 paediatric trainees participated in a series of critical incident technique (CIT) interviews to explore the NTS used during the management of paediatric CPAs. A total of 56 of 131 (37.1% response rate) trainees responded to the preparedness questionnaire. A total of 48.2% of respondents expressed low confidence in their skill as a team leader during the management of a CPA. The CIT interviews highlighted deficiencies in specific NTS (identifying options, prioritising, and identifying and utilising resources). Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS. What is Known • Levels of preparedness to be a paediatric cardiopulmonary arrests team member/leader are generally lower than desirable. • The importance of nontechnical skills to the effective performance of adult cardiopulmonary arrests teams has been identified. What is New • Levels of preparedness to be a cardiopulmonary arrests team member were higher than reported in US studies. • There is a need for greater training in cardiopulmonary arrest management which includes a focus on key nontechnical skills to include identifying options, prioritising, identifying and utilising resources.

Sources of funding for adult and paediatric CT procedures at a metropolitan tertiary hospital: How much do Medicare statistics really cover?

PubMed

Hayton, Anna; Wallace, Anthony; Johnston, Peter

2015-12-01

The radiation dose to the Australian paediatric population as a result of medical imaging is of growing concern, in particular the dose from CT. Estimates of the Australian population dose have largely relied on Medicare Australia statistics, which capture only a fraction of those imaging procedures actually performed. The fraction not captured has been estimated using a value obtained for a survey of the adult population in the mid-1990s. To better quantify the fraction of procedures that are not captured by Medicare Australia, procedure frequency and funding data for adult and paediatric patients were obtained from a metropolitan tertiary teaching and research hospital. Five calendar years of data were obtained with a financial class specified for each individual procedure. The financial classes were grouped to give the percentage of Medicare Australia billable procedures for both adult and paediatric patients. The data were also grouped to align with the Medicare Australia age cohorts. The percentage of CT procedures billable to Medicare Australia increased from 16% to 28% between 2008 and 2012. In 2012, the percentage billable for adult and paediatric patients was 28% and 33%, respectively; however, many adult CT procedures are performed at stand-alone clinics, which bulk bill. Using Medicare Australia statistics alone, the frequency of paediatric CT procedures performed on the Australian paediatric population will be grossly under estimated. A correction factor of 4.5 is suggested for paediatric procedures and 1.5 for adult procedures. The fraction of actual procedures performed that are captured by Medicare Australia will vary with time. © 2015 The Royal Australian and New Zealand College of Radiologists.

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.

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. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Who are the PDCO?

PubMed

Dempsey, E M; Connolly, K

2014-02-01

In January 2007, the Paediatric Regulation entered into force and established the Paediatric Committee (PDCO) within the European Medicines Agency. The goal of the PDCO is to improve the health of the children of Europe by increasing high-quality research for medicinal products and promoting the development and authorization of such medicines at the EU level. A major function of the PDCO is to formulate and authorize Paediatric Investigation Plans and Paediatric Use Marketing Authorisations. The EU's Seventh Framework Programme for Research has facilitated the establishment of consortia whose ultimate goal is to answer important clinical questions involving medicines commonly used "off-label", in children. The benefits of these consortia include enhanced collaboration amongst paediatricians, scientists and small to medium enterprises whose ultimate goal is to obtain an authorization for a new indication or formulation for use in the paediatric population. It will be interesting in a number of years time to measure the success of this very important European initiative.

Recent developments in neonatal and paediatric emergencies.

PubMed

Turner, Nigel M

2011-07-01

The present article is intended as an update for anaesthesiologists on recent developments in life-threatening paediatric emergencies and paediatric resuscitation. It is assumed that the reader has at least a basic knowledge of the general principles of emergency medicine, such as the ABCDE-approach and the principle of 'treat first what kills first'; and also that the reader is familiar with the anatomical, physiological and psychological differences between adults and children. The article begins with a description of the background to paediatric emergencies followed by a description of a widely used systematic approach to the assessment of the seriously ill child. In the second half of the article, the principles of the initial treatment for acute, life-threatening problems in children and paediatric resuscitation are discussed with reference to the recent literature. The article ends with a discussion of the changes in latest guidelines for resuscitation of babies at birth.

Negotiating identity at the intersection of paediatric and genetic medicine: the parent as facilitator, narrator and patient.

PubMed

Dimond, Rebecca

2014-01-01

This article identifies a significant transformation in the role and identity of parents accompanying their child to clinic. This shift is a product of the intersection between paediatric and genetic medicine, where parents play a critical role in providing information about their child, family and ultimately, about themselves. To provide a context for this matrix, two broad areas of sociological inquiry are highlighted. The first is explanations of the role a parent plays in paediatric medicine and the second is the diagnostic process in paediatric genetics and the implications for parent and child identities. Drawing from an ethnographic study of clinical consultations, attention is paid to the changing role of parenthood and the extended role of patienthood in paediatric genetic medicine. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Information Seeking Behaviour of Parents of Paediatric Patients for Clinical Decision Making: The Central Role of Information Literacy in a Participatory Setting

ERIC Educational Resources Information Center

Kostagiolas, Petros; Martzoukou, Konstantina; Georgantzi, Georgia; Niakas, Dimitris

2013-01-01

Introduction: This study investigated the information seeking behaviour and needs of parents of paediatric patients and their motives for seeking Internet-based information. Method: A questionnaire survey of 121 parents was conducted in a paediatric clinic of a Greek university hospital. Analysis: The data were analysed using SPSS; descriptive…

Framework conditions facilitating paediatric clinical research

PubMed Central

2011-01-01

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 paediatric population which represents approximately 25% of the whole European population. On 26 January 2007, entered into force the European Regulation of Paediatric Medicines. It aims at the quality of research into medicines for children but without subjecting the paediatric 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

Prebiotics as a modulator of gut microbiota in paediatric obesity.

PubMed

Nicolucci, A C; Reimer, R A

2017-08-01

This review highlights our current understanding of the role of gut microbiota in paediatric obesity and the potential role for dietary manipulation of the gut microbiota with prebiotics in managing paediatric obesity. The aetiology of obesity is multifactorial and is now known to include microbial dysbiosis in the gut. Prebiotics are non-digestible carbohydrates which selectively modulate the number and/or composition of gut microbes. The goal of prebiotic consumption is to restore symbiosis and thereby confer health benefits to the host. There is convincing evidence that prebiotics can reduce adiposity and improve metabolic health in preclinical rodent models. Furthermore, there are several clinical trials in adult humans highlighting metabolic and appetite-regulating benefits of prebiotics. In paediatric obesity, however, there are very limited data regarding the potential role of prebiotics as a dietary intervention for obesity management. As the prevalence of paediatric obesity and obesity-associated comorbidities increases globally, interventions that target the progression of obesity from an early age are essential in slowing the obesity epidemic. This review emphasizes the need for further research assessing the role of prebiotics, particularly as an intervention in effectively managing paediatric obesity. © 2016 World Obesity Federation.

Per capita increase in hospital presentations and admissions among children since the 1990s.

PubMed

Hardy, Andrew; Fuller, David G; Forrester, Mike; Anderson, Kym P; Cooper, Chris; Jenner, Bernard; Marshall, Isaac; Mccloskey, Kate; Sanderson, Christine; Standish, Jane; Vuillermin, Peter

2016-10-01

Data regarding temporal trends in per capita paediatric hospital presentations and admissions are required to inform health system and workforce planning. Emergency Department (ED) presentations and admissions to the University Hospital Geelong among patients aged 0 to 16 years over a 12-month period (2012-2013) were determined by review of hospital records and then compared with similar data collected during 1996/1997. 1 During each period, the Geelong region was serviced by a single ED, enabling us to estimate per capita presentation and admission rates. Since 1996/1997, per capita paediatric presentations to the ED increased from 643 to 1837 per 10 000 (186%; 95% confidence interval 181% to 191%). Moreover, the proportion of paediatric ED presentations resulting in hospital admission increased from 12.3% to 18.3% (49%; 95% confidence interval 39% to 59%). There has been a substantial absolute and per capita increase in paediatric ED presentations and hospital admissions since the 1990s. These trends place an increasing burden on the public hospital system, and strategies are required to promote paediatric acute care in the ambulatory setting. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Paediatric investigation plans for pain: painfully slow!

PubMed

Davies, Elin H; Ollivier, Cecile M; Saint Raymond, Agnes

2010-11-01

To examine the early impact of the Paediatric Regulation, which entered into force in Europe on 27 January 2007, on the development of pharmaceutical drugs in the therapeutic field of pain submitted to the Paediatric Committee (PDCO) and to the European Medicines Agency (EMA). Paediatric Investigations Plans (PIPs) submitted with a Decision (outcome) reached between September 2007 and March 2010 were included in the analysis. Of the 17 Paediatric Investigation Plans submitted, 14 have resulted in an EMA Decision, 3 were withdrawn by the applicants, 8 were granted a full waiver from development, and 1 resulted in a negative opinion. Decisions as issued included 15 clinical trials, with at least 1,282 children to be recruited into studies across five different products. Neonates were included in four of the products. The small number of submissions indicates a lack of new drugs being developed for the management of pain. Ethical concerns that too many vulnerable children will be recruited into clinical trials must be balanced against limiting the number of off-label prescribing and obtaining age-appropriate information on paediatric use. Now is an opportune time for clinicians, academics, learned societies and industry to collaborate for the benefit of children in pain.

Is optimal paddle force applied during paediatric external defibrillation?

PubMed

Bennetts, Sarah H; Deakin, Charles D; Petley, Graham W; Clewlow, Frank

2004-01-01

Optimal paddle force minimises transthoracic impedance; a factor associated with increased defibrillation success. Optimal force for the defibrillation of children < or =10 kg using paediatric paddles has previously been shown to be 2.9 kgf, and for children >10 kg using adult paddles is 5.1 kgf. We compared defibrillation paddle force applied during simulated paediatric defibrillation with these optimal values. 72 medical and nursing staff who would be expected to perform paediatric defibrillation were recruited from a University teaching hospital. Participants, blinded to the nature of the study, were asked to simulate defibrillation of an infant manikin (9 months of age) and a child manikin (6 years of age) using paediatric or adult paddles, respectively, according to guidelines. Paddle force (kgf) was measured at the time of simulated shock and compared with known optimal values. Median paddle force applied to the infant manikin was 2.8 kgf (max 9.6, min 0.6), with only 47% operators attaining optimal force. Median paddle force applied to the child manikin was 3.8 kgf (max 10.2, min 1.0), with only 24% of operators attaining optimal force. Defibrillation paddle force applied during paediatric defibrillation often falls below optimal values.

Community engagement for paediatric MDR-TB clinical trials: principles to support ethical trial implementation.

PubMed

Hoddinott, G; Staples, S; Brown, R; Simwinga, M; Mubekapi-Musadaidzwa, C; Hesseling, A C; Hendricks, G; De Koker, P; McKenna, L

2018-05-01

The paediatric tuberculosis (TB) prevention and treatment landscape is moving into a new and exciting era, with knowledge from clinical trials offering real benefit to children. Community engagement is key to optimising the success of these trials. However, the clinical profile, epidemiology and social perceptions for paediatric multidrug-resistant TB (MDR-TB) complicate the operationalisation of this community engagement. We reflect on a diversity of recent experiences attempting to implement this type of research and the community engagement around it. We describe four recommendations and argue that these should guide the implementation of the community engagement agenda in the new landscape of paediatric MDR-TB clinical trials. Specifically, we argue for 1) dynamic, long-term continuity in community engagement platforms; 2) tiers of TB and research literacy; 3) multiple separate and joint platforms for holding 'stakes'; and 4) addressing the social/structural implications of family participation. We conclude that community-level stakeholders, such as health workers, parents and children, are willing to collaborate in paediatric MDR-TB clinical trials. Using these recommendations, there is considerable opportunity for effective community engagement in this new era of paediatric MDR-TB research.

Shortening the decade-long gap between adult and paediatric drug formulations: a new framework based on the HIV experience in low- and middle-income countries.

PubMed

Penazzato, Martina; Lewis, Linda; Watkins, Melynda; Prabhu, Vineet; Pascual, Fernando; Auton, Martin; Kreft, Wesley; Morin, Sébastien; Vicari, Marissa; Lee, Janice; Jamieson, David; Siberry, George K

2018-02-01

Despite the coordinated efforts by several stakeholders to speed up access to HIV treatment for children, development of optimal paediatric formulations still lags 8 to 10 years behind that of adults, due mainly to lack of market incentives and technical complexities in manufacturing. The small and fragmented paediatric market also hinders launch and uptake of new formulations. Moreover, the problems affecting HIV similarly affect other disease areas where development and introduction of optimal paediatric formulations is even slower. Therefore, accelerating processes for developing and commercializing optimal paediatric drug formulations for HIV and other disease areas is urgently needed. The Global Accelerator for Paediatric Formulations (GAP-f) is an innovative collaborative model that will accelerate availability of optimized treatment options for infectious diseases, such as HIV, tuberculosis and viral hepatitis, affecting children in low- and middle-income countries (LMICs). It builds on the HIV experience and existing efforts in paediatric drug development, formalizing collaboration between normative bodies, research networks, regulatory agencies, industry, supply and procurement organizations and funding bodies. Upstream, the GAP-f will coordinate technical support to companies to design and study optimal paediatric formulations, harmonize efforts with regulators and incentivize manufacturers to conduct formulation development. Downstream, the GAP-f will reinforce coordinated procurement and communication with suppliers. The GAP-f will be implemented in a three-stage process: (1) development of a strategic framework and promotion of key regulatory efficiencies; (2) testing of feasibility and results, building on the work of existing platforms such as the Paediatric HIV Treatment Initiative (PHTI) including innovative approaches to incentivize generic development and (3) launch as a fully functioning structure. GAP-f is a key partnership example enhancing North-South and international cooperation on and access to science and technology and capacity building, responding to Sustainable Development Goal (SDG) 17.6 (technology) and 17.9. (capacity-building). By promoting access to the most needed paediatric formulations for HIV and high-burden infectious diseases in low-and middle-income countries, GAP-f will support achievement of SDG 3.2 (infant mortality), 3.3 (end of AIDS and combat other communicable diseases) and 3.8 (access to essential medicines), and be an essential component of meeting the global Start Free, Stay Free, AIDS Free super-fast-track targets. © 2018 World Health Organization; licensee IAS.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

PubMed

Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

2017-08-01

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Trends and patterns of computed tomography scan use among children in The Netherlands: 1990-2012.

PubMed

Meulepas, Johanna M; Smets, Anne M J B; Nievelstein, Rutger A J; Gradowska, Patrycja; Verbeke, Jonathan; Holscher, Herma C; Rutten, Matthieu J C M; Kieft, Mariëtte; Ronckers, Cécile M; Hauptmann, Michael

2017-06-01

To evaluate trends and patterns in CT usage among children (aged 0-17 years) in The Netherlands during the period 1990-2012. Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds). Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older. The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades. • Paediatric CT in The Netherlands has tripled during the last two decades. • The number of paediatric CTs increased through 2012 in general hospitals. • Paediatric CTs continued to increase among children aged 10 years or older.

Efficacy, safety and feasibility of antifungal prophylaxis with posaconazole tablet in paediatric patients after haematopoietic stem cell transplantation.

PubMed

Döring, Michaela; Cabanillas Stanchi, Karin Melanie; Queudeville, Manon; Feucht, Judith; Blaeschke, Franziska; Schlegel, Patrick; Feuchtinger, Tobias; Lang, Peter; Müller, Ingo; Handgretinger, Rupert; Heinz, Werner J

2017-07-01

Paediatric recipients of haematopoietic stem cell transplantation (HSCT) have a high risk for invasive fungal infections. Posaconazole oral suspension has proven to be effective in antifungal prophylaxis in adult and paediatric patients. A new posaconazole tablet formulation with absorption independent of the gastric conditions was approved by the FDA in 2013. This is the first report on the use of posaconazole tablets in paediatric patients. This single-centre study included 63 paediatric patients with haemato-oncological malignancies who received posaconazole for antifungal prophylaxis after HSCT. They were analysed for efficacy, feasibility and the safety of posaconazole. Out of 63 patients, 31 received posaconazole oral suspension and 32 received posaconazole tablets up to 200 days after transplantation. Analyses of the posaconazole trough levels were determined. No possible, probable or proven invasive fungal infection was observed in either group. Posaconazole trough levels were significantly higher in the tablet group than in the suspension group at all analysed time points. Drug-related adverse events were similarly low in both groups. Posaconazole tablets are effective in preventing invasive fungal infections in paediatric patients. As early as day 3 after starting posaconazole tablets, over 50% of the posaconazole trough levels were >500 ng/mL, while this was observed on day 14 after start with posaconazole suspension. The administration of posaconazole tablets was safe, effective and feasible as antifungal prophylaxis in paediatric patients after HSCT.

Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana.

PubMed

Sampson, Wireko-Gyebi; Sandra, Ashiagbor Emelia

2018-01-01

Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse's knowledge of autism spectrum disorder in Ghana. The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses' gender, age, marital status, working experience and their knowledge. In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder.

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

PubMed

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

2017-12-01

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric 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 Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric 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 Paediatric 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 paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

Catalysing the development and introduction of paediatric drug formulations for children living with HIV: a new global collaborative framework for action.

PubMed

Penazzato, Martina; Watkins, Melynda; Morin, Sébastien; Lewis, Linda; Pascual, Fernando; Vicari, Marissa; Lee, Janice; Hargreaves, Sally; Doherty, Meg; Siberry, George K

2018-05-01

Progress in the development and introduction of paediatric formulations for key infectious diseases is poor in low-income and middle-income countries (LMICs). Although major steps have been made in the scale-up of antiretroviral medicines in LMICs, the development and deployment of formulations for infants and children is suboptimal. Of the children living with HIV globally (most in Africa), only 43% are receiving antiretroviral therapy (ART), many with suboptimal formulations. These shortfalls pose a series of challenges to meeting global treatment targets of 1·6 million children (aged 0-14 years) on ART by the end of 2018 (95% coverage) and to ensuring that 95% of those on ART are virologically suppressed. The Global Accelerator for Paediatric Formulations (GAP-f) has been developed to accelerate research, development, regulatory filing, introduction, and uptake of prioritised paediatric antiretrovirals in age-appropriate formulations by 2020, with innovative, strategic, and sustainable financing. The GAP-f will build on existing efforts to maximise coordination and alignment of policy makers, research networks, regulatory agencies, funding organisations, and manufacturers in paediatric HIV and other paediatric diseases, including tuberculosis, viral hepatitis, and other infectious diseases. Paediatric drug development and scale-up will require special efforts to bring greater visibility and new solutions to ensure that children in LMICs have access to effective and appropriate treatment options. Copyright © 2018 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

The effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.

PubMed

Armfield, Nigel R; Coulthard, Mark G; Slater, Anthony; McEniery, Julie; Elcock, Mark; Ware, Robert S; Scuffham, Paul A; Bensink, Mark E; Smith, Anthony C

2014-11-11

In many health systems, specialist services for critically ill children are typically regionalised or centralised. Studies have shown that high-risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality. In acute cases where distance and time impede access to specialist care, clinical advice may be provided remotely by telephone. Emergency retrieval services, attended by medical and nursing staff may be used to transport patients to specialist centres. Even with the best quality retrieval services, stabilisation of the patient and transport logistics may delay evacuation to definitive care. Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children. However, no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval. The study is a pragmatic, multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit. We aim to recruit 160 children for whom a specialist retrieval consultation is required. The primary outcome measure is stabilisation time (time spent on site at the referring hospital by the retrieval team) adjusted for initial risk. Secondary outcome measures are change in patient's physiological status (repeated measure, two time points) scored using the Children's Emergency Warning Tool; change in diagnosis (repeated measure taken at three time points); change in destination of retrieved patients at the tertiary hospital (general ward or paediatric intensive care unit); retrieval decision, and length of stay in the Paediatric Intensive Care Unit for retrieved patients. The trial has been approved by the Human Research Ethics Committees of Children's Health Services Queensland and The University of Queensland, Australia. Health services are adopting telemedicine, however formal evidence to support its use in paediatric acute care is limited. Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval. Australian and New Zealand Clinical Trials Registry ACTRN12612000156886 .

[Contribution of Anales de Pediatría to the international visibility of Spanish paediatric research in the Web of Science (2010-2014)].

PubMed

Abad-García, María Francisca; González-Teruel, Aurora; Solís Sánchez, Gonzalo

2016-12-01

To describe the role of Anales de Pediatría in highlighting Spanish paediatric research, and to identify the journals with which it competes internationally. Spanish paediatric articles, including those from Anales de Pediatría were identified using the Paediatrics category of the Science Citation Index (2010-2014), and their volume and document type was analysed. For original articles and review articles, the year, the citation and journal of publication was studied. The journals were classified as general and specialised. The productivity of general journals was analysed according to their language, JCR quartile, and article access. A total of 2,701 Spanish paediatric papers were identified, accounting for 2.8% of the paediatrics world output. More than two-thirds (68%) of papers were articles that received an average number of 4.97 citations per article. The 965 papers published in Anales de Pediatría accounted for 38.7% of the Spanish paediatric output, and for 1% of the paediatric world publications. A mean of 1.03 citations per article were received for 439 (45.4%) articles and reviews. Of the 106 journals identified, 82 were classified as specialised (1,196 articles) and 24 as general (741 articles). Anales de Pediatría published 60% of the articles in general journals. The rest of articles (309) were published in general journals published in English (82.8%), with a best position in the JCR ranking (83.4%) and mainly by subscription (73.8%). Anales de Pediatría plays an important role in providing international visibility to a large volume of Spanish scientific production in paediatrics. The results presented are a still only a snapshot of this role that could be used in the near future for assessing its evolution and the changes that could be made in order to improve its quality, positioning and competitiveness. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R).

PubMed

Af Sandeberg, Margareta; Wenemark, Marika; Bartholdson, Cecilia; Lützén, Kim; Pergert, Pernilla

2017-02-20

Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised (MDS-R) is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction. The procedure included linguistic translation and cultural adaptation of MDS-R's paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care. To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens. Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients.

[Spanish Society of Pediatric Infectious Diseases, Spanish Society of Paediatric Clinical Immunology and Allergy, Spanish Association of Paediatric Primary Care, and the Spanish Society of Extra-hospital Paediatrics and Primary Health Care consensus document on antibiotic treatment in penicillin or amoxicillin allergy].

PubMed

Baquero-Artigao, Fernando; Michavila, Antonio; Suárez-Rodriguez, Ángeles; Hernandez, Anselmo; Martínez-Campos, Leticia; Calvo, Cristina

2017-02-01

The suspected allergy to beta-lactam antibiotics, especially penicillin and amoxicillin, is the most frequent reason for consultation in Child Allergy Units. In this consensus document, the clinical and diagnostic criteria of allergic reactions are described, as well as alternative antibiotic treatment for the most common infections diagnosed in paediatrics for patients with known or suspected allergy. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Paediatric Pain Management: Using Complementary and Alternative Medicine.

PubMed

Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K

2008-09-01

Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.

A dose comparison survey in CT departments of dedicated paediatric hospitals in Australia and Saudi Arabia

PubMed Central

Mohiy, Hussain Al; Sim, Jenny; Seeram, Euclid; Annabell, Nathan; Geso, Moshi; Mandarano, Giovanni; Davidson, Rob

2012-01-01

AIM: To measure and compare computed tomography (CT) radiation doses delivered to patients in public paediatric hospitals in Australia and Saudi Arabia. METHODS: Doses were measured for routine CT scans of the head, chest and abdomen/pelvis for children aged 3-6 years in all dedicated public paediatric hospitals in Australia and Saudi Arabia using a CT phantom measurement cylinder. RESULTS: CT doses, using the departments’ protocols for 3-6 year old, varied considerably between hospitals. Measured head doses varied from 137.6 to 528.0 mGy·cm, chest doses from 21.9 to 92.5 mGy·cm, and abdomen/pelvis doses from 24.9 to 118.0 mGy·cm. Mean head and abdomen/pelvis doses delivered in Saudi Arabian paediatric CT departments were significantly higher than those in their Australian equivalents. CONCLUSION: CT dose varies substantially across Australian and Saudi Arabian paediatric hospitals. Therefore, diagnostic reference levels should be established for major anatomical regions to standardise dose. PMID:23150767

Cone beam computed tomography in paediatric dentistry: overview of recent literature.

PubMed

Aps, J K M

2013-06-01

The use of cone beam computed tomography (CBCT) in paediatric dentistry has been mentioned in numerous publications and case reports. The indications for the use of CBCT in paediatric dentistry, however, have not yet been properly addressed. On the other hand, the three basic principles of radiation protection (justification, limitation and optimisation) should suffice. A review of the current literature was used to assess the indications and contra-indications for the use of CBCT in paediatric dentistry. Paramount is the fact that CBCT generates a higher effective dose to the tissues than traditional dental radiographic exposures do. The effective radiation dose should not be underestimated, especially not in children, who are much more susceptible to stochastic biological effects. The thyroid gland in particular should be kept out of the primary beam as much as possible. As with any other radiographical technique, routine use of CBCT is not acceptable clinical practice. CBCT certainly has a place in paediatric dentistry, but its use must be justified on a patient case individual basis.

A comparison of paediatrics occupational therapy university program curricula in New Zealand, Australia, and Canada.

PubMed

Rodger, Sylvia; Brown, G Ted; Brown, Anita; Roever, Carsten

2006-01-01

Comparisons were made of the paediatric content of professional entry-level occupational therapy university program curricula in Australia, New Zealand, and Canada using an ex post facto survey methodology. The findings indicated that in Australia/New Zealand, paediatrics made up 20% of the total curriculum, but only 13% in Canada. Canadian reference materials were utilized less often in Canadian universities than in Australia/New Zealand. Theories taught most often in Australia/New Zealand were: Sensory Integration, Neurodevelopmental Therapy, Client-Centered Practice, Playfulness, and the Model of Human Occupation. In Canada, the most frequent theories were: Piaget's Stages of Cognitive/Intellectual Development, Neurodevelopmental Therapy, Erikson's Eight Stages of Psychosocial Development and Sensory Integration. The most frequently taught paediatric assessment tools in both regions were the Bruininks-Oseretsky Test of Motor Proficiency and Miller Assessment for Preschoolers. Paediatric intervention methods taught to students in all three countries focused on activities of daily living/self-care, motor skills, perceptual and visual motor integration, and infant and child development.

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

PubMed

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

2016-09-25

A Paediatric Investigation Plan (PIP) is a development plan that aims to ensure that sufficient data are obtained through studies in paediatrics to support the generation of marketing authorisation of medicines for children. This paper highlights some practical considerations and challenges with respect to PIP submissions and paediatric clinical trials during the pharmaceutical development phase, using the FP7-funded Clonidine for Sedation of Paediatric Patients in the Intensive Care Unit (CloSed) project as a case study. Examples discussed include challenges and considerations regarding formulation development, blinding and randomisation, product labelling and shipment and clinical trial requirements versus requirements for marketing authorisation. A significant quantity of information is required for PIP submissions and it is hoped that future applicants may benefit from an insight into some critical considerations and challenges faced in the CloSed project. Copyright © 2016 Elsevier B.V. All rights reserved.

Examining the Needs of Paediatric Nurses Caring for Children and Young People Presenting with Self-Harm/Suicidal Behaviour on General Paediatric Wards: Findings from a Small-Scale Study

ERIC Educational Resources Information Center

Fisher, Gemma; Foster, Celeste

2016-01-01

This article reports on the process and findings from a small-scale qualitative research study. The study intended to develop an evidence-based care plan/pathway for children and young people in paediatric inpatient settings presenting with self-harm/suicidal behaviour. The article includes a critical review of unanticipated challenges of…

Use of the Delphi process in paediatric cataract management.

PubMed

Serafino, Massimiliano; Trivedi, Rupal H; Levin, Alex V; Wilson, M Edward; Nucci, Paolo; Lambert, Scott R; Nischal, Ken K; Plager, David A; Bremond-Gignac, Dominique; Kekunnaya, Ramesh; Nishina, Sachiko; Tehrani, Nasrin N; Ventura, Marcelo C

2016-05-01

To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. A modified Delphi method. International paediatric cataract experts with a publishing record in paediatric cataract management. The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions. 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/

Evaluation of words in child-paediatric dentist communication.

PubMed

Caglar, K; Sandalli, N; Kirant, B; Kuscu, O O

2015-09-01

Aim of the present study is to demonstrate which words are widely used by children and a paediatric dentist during different dental procedures in conjunction with behaviour shaping in paediatric dentistry. Twenty children aged between 3.5 and 10.5 (10 F, 10 M) visiting the clinic of Yeditepe University were enrolled for the study. An audio recorder was hidden in the operatory room, the paediatric dentist was blind. The procedure was randomised as for each child only one appointment was recorded (one patient-one appointment-one procedure). Age, gender, appointment type, details of procedure performed were recorded. At the end of every session, records were investigated regarding verbal communication. The paediatric dentist used a total of 5,005 words during the trial with minimum of 13 and max of 518 words in a session (mean 211.8 ± 153.1). There were no significant differences in the words used by the child and the practitioner regarding gender, session, and duration of being acquainted with (p>0.05). Regarding age groups, preschoolers (3.5-6 yrs old) significantly used more words than the schoolers (7- 10.5 yrs old) (p<0.05). Paediatric dentists should be careful and selective in communication with children as well as using an age-appropriate language.

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development.

PubMed

Vileito, A; Siebelink, M J; Verhagen, Aae

2018-05-01

Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population. PubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full-text screening of relevant data. We included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised. Scientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols. ©2018 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Factors influencing transitional care from adolescents to young adults with cancer in Taiwan: A population-based study.

PubMed

Jin, Yo-Ting; Chen, Chin-Mi; Chien, Wu-Chien

2016-08-02

To investigate the progress of transition from paediatric to adult health care for patients with cancer in Taiwan's medical system. The data were retrieved from the Longitudinal Health Insurance Database (LHID), which contains the original inpatient and outpatient medical claims data for 1,000,000 enrollees randomly sampled from the NHIRD between 1997 and 2010. Among the 1,411 cancer patients selected for this study, 98.09 % received adult-oriented therapy before the age of 18. In addition, only 1.91 % of the patients received paediatric-oriented therapy during adolescence. The primary factors that determine whether these patients would receive paediatric-oriented therapy or adult-oriented therapy at an early age were as follows: the age of the patient at the first visit and the performance-level of the hospital (p < 0.001). Previous studies conducted in developed countries have demonstrated that the unwillingness of patients to switch from paediatric-oriented therapy to adult-oriented therapy being the major obstacle that hinders the transition process. However, this study revealed a different result: the implementation of the National Health Insurance system in Taiwan makes healthcare affordable for the adolescent patients who may not possess adequate knowledge about paediatric health care and may not appreciate paediatric-oriented therapy, thereby hindering the transition process.

[Transition - how adolescents with cystic fibrosis their parents experience the change from paediatric to adult care].

PubMed

Becher, Christine; Regamey, Nicolas; Spichiger, Elisabeth

2014-12-01

Cystic Fibrosis is the most common autosomal-recessive hereditary disease among white Europeans. The average survival of CF patients has increased to above 40 years and transition from paediatric to adult care has therefore become a significant issue. With this study, experiences of adolescents with CF and their parents with the transition from the paediatric to the adult care were explored. At a Swiss university CF centre, six adolescents and their mothers were recruited. Twelve narrative interviews were conducted on how the phase of transition was experienced. The transcribed interviews were analysed according to the method of hermeneutic phenomenology. Positive and negative experiences with long term routine care in the paediatric service, general themes of adolescence and the quality of the relationship with paediatric doctors influenced the families' experience during transition significantly. For mothers, insensitive information on the CF diagnosis might have influenced the transition experience. The adolescents welcomed an individualized and age appropriate care. Continuity in care, the announcement of, and involvement in the planning of the transfer were of great importance. The families particularly appreciated the timed adaptations of the transfer to individual needs. Flexibility and a strong collaboration between paediatric and adult CF teams are most relevant in the care of families.

Training in paediatric trauma: the problem of safer societies.

PubMed

Hamill, James; Beasley, Spencer W

2006-07-01

Trauma remains the most common cause of child death worldwide but the incidence of major trauma is declining in many developed countries: this has implications for training. A survey of paediatric surgeons and paediatric surgical trainees was undertaken to evaluate perceptions of the relative importance of various forms of trauma training. A questionnaire was e-mailed to Australasian paediatric surgeons and trainees to determine trauma courses they had undertaken, operative and non-operative paediatric trauma experience and attitudes towards trauma training. The overall response rate was 49% (40 of 83 consultants and 11 of 22 trainees). The Early Management of Severe Trauma course had been undertaken by 82% of consultants and all trainees. The Definitive Surgical Trauma Care course had been undertaken by 22% of consultants and one trainee. The number of trauma laparotomies carried out in the previous year was in the one to five range for 71% of responders. Greater emphasis was placed on the value of adult trauma experience by consultants who had a general surgical fellowship. In societies where major trauma in children is relatively rare (fortunately) and the opportunities for training are limited, it is important to ensure that advanced trainees in paediatric surgery gain sufficient skills from a variety of sources to enable them to treat competently the severely injured child with multiple injuries.

Safety climate, emotional exhaustion and job satisfaction among Brazilian paediatric professional nurses.

PubMed

Alves, D F S; Guirardello, E B

2016-09-01

International studies indicate that job satisfaction and burnout interfere with the safety climate and quality of care. However, no evidence of such relationships is available for Brazilian paediatric hospitals. To assess the correlation and predictive effect of emotional exhaustion and job satisfaction on the perception of professional nurses at paediatric hospitals regarding safety climate and quality of care. Cross-sectional correlational design. The study was conducted with registered nurses, technician and assistant nurses from two Brazilian paediatric hospitals over 3 months in 2013-2014 using instruments to assess safety climate, quality of care, job satisfaction and emotional exhaustion. Data related to 267 professional nurses from 15 inpatient wards and 3 intensive care units were analysed. Overall, the respondents exhibited moderate emotional exhaustion, were satisfied with their jobs and considered the quality of care as good. However, the respondents exhibited low concordance as to the positive perception of the safety climate. The variables, emotional exhaustion and job satisfaction, exhibited significant correlations with safety climate and were considered predictive of the latter. Emotional exhaustion and job satisfaction among professional nurses influence the safety climate at paediatric hospitals. Investments to reduce emotional exhaustion and to improve job satisfaction among professional nurses allocated to paediatric hospitals might contribute to the patients' safety. © 2016 International Council of Nurses.

Paediatric musculoskeletal interventional radiology.

PubMed

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

2016-01-01

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

Understanding the responsibilities and obligations of the modern paediatric surgeon.

PubMed

Beasley, Spencer W

2015-02-01

The modern paediatric surgeon needs to be competent in multiple domains that extend well beyond their clinical and technical expertise. This article, based on the Journal of Pediatric Surgery Lecture at the BAPS Congress (2014), explores some of these less well understood responsibilities and obligations, including professionalism, leadership, effective clinical teaching, and research. The consequence of falling short in these areas includes risks to our profession as a whole as well as compromising our ability to provide our patients with the best clinical care. Paediatric surgeons have a responsibility to influence the configuration of services to improve the quality of care and equity of access to specialist services for all children in their region. Evidence presented shows how a well-organised and funded regional paediatric surgical service allows children to receive quality treatment closer to home and is reflected in better clinical outcomes, less unnecessary surgery, and fewer complications. A paradigm for support to emerging countries as they increase the capacity and infrastructure of their paediatric surgical services is proposed. The way we judge ourselves and others should relate to our performance across the full scope of roles that a responsible and committed paediatric surgeon is expected to display. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana

PubMed Central

Sampson, Wireko-Gyebi; Sandra, Ashiagbor Emelia

2018-01-01

Background: Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse’s knowledge of autism spectrum disorder in Ghana. Objective: The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. Method: In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. Results: It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses’ gender, age, marital status, working experience and their knowledge. Conclusion: In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder. PMID:29785200

Understanding Market Size and Reporting Gaps for Paediatric TB in Indonesia, Nigeria and Pakistan: Supporting Improved Treatment of Childhood TB in the Advent of New Medicines.

PubMed

Coghlan, Renia; Gardiner, Elizabeth; Amanullah, Farhana; Ihekweazu, Chikwe; Triasih, Rina; Grzemska, Malgorzata; Sismanidis, Charalambos

2015-01-01

We sought to understand gaps in reporting childhood TB cases among public and private sector health facilities (dubbed "non-NTP" facilities) outside the network of national TB control programmes, and the resulting impact of under-reporting on estimates of paediatric disease burden and market demand for new medicines. Exploratory assessments were carried out in Indonesia, Nigeria and Pakistan, reaching a range of facility types in two selected areas of each country. Record reviews and interviews of healthcare providers were carried out to assess numbers of unreported paediatric TB cases, diagnostic pathways followed and treatment regimens prescribed. A total of 985 unreported diagnosed paediatric TB cases were identified over a three month period in 2013 in Indonesia from 64 facilities, 463 in Pakistan from 35 facilities and 24 in Nigeria from 20 facilities. These represent an absolute additional annualised yield to 2013 notifications reported to WHO of 15% for Indonesia, 2% for Nigeria and 7% for Pakistan. Only 12% of all facilities provided age and sex-disaggregated data. Findings highlight the challenges of confirming childhood TB. Diagnosis patterns in Nigeria highlight a very low suspicion for childhood TB. Providers note the need for paediatric medicines aligned to WHO recommendations. This study emphasises the impact of incomplete reporting on the estimation of disease burden and potential market size of paediatric TB medicines. Further studies on "hubs" (facilities treating large numbers of childhood TB cases) will improve our understanding of the epidemic, support introduction efforts for new treatments and better measure markets for new paediatric medicines.

Fluid bolus therapy in critically ill children: a survey of practice among paediatric intensive care doctors in Australia and New Zealand.

PubMed

Gelbart, Ben; Schlapbach, Luregn; Ganeshalingham, Anusha; Ganu, Subodh; Erickson, Simon; Oberender, Felix; Hoq, Monsurul; Williams, Gary; George, Shane; Festa, Marino

2018-06-01

Fluid bolus therapy (FBT) is a widely used intervention in paediatric critical illness. The aim of this study was to describe the attitudes and practices towards FBT of paediatric intensive care doctors in Australia and New Zealand. An internet-based survey of paediatric intensive care doctors in Australia and New Zealand between 7 and 30 November 2016. Paediatric intensive care units with greater than 400 admissions annually. Paediatric intensive care specialists and junior medical staff. Preferences for FBT and markers of fluid responsiveness. There were 106/175 respondents (61%); 0.9% saline and 4% albumin are used frequently or almost always by 86% and 57% of respondents respectively. The preferred volume and duration were 10 mL/kg in less than 10 minutes. The highest rated markers of fluid responsiveness were heart rate and blood pressure - rated as "good" or "very good" by 75% and 58% of respondents respectively. Central venous saturations and serum lactate were the highest rated biochemical markers. The most frequently expected magnitude of change for heart rate and blood pressure was 6-15% by 89% and 76% of respondents respectively. The preferred fluid composition for sepsis, trauma, traumatic brain injury and acute lung injury was 0.9% saline, and 4% albumin for post-operative cardiac surgery. Paediatric intensive care doctors prefer 0.9% saline and 4% albumin for FBT. Heart rate and blood pressure are the most preferred markers to assess fluid responsiveness. Preferences for FBT in specific conditions exist.

Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study.

PubMed

Khoo, Teik Beng; Tan, Jing Wen; Ng, Hoong Phak; Choo, Chong Ming; Bt Abdul Shukor, Intan Nor Chahaya; Teh, Siao Hean

2017-06-01

Background There is a lack of large comprehensive studies in developing countries on paediatric in-patient prescribing errors in different settings. Objectives To determine the characteristics of in-patient prescribing errors among paediatric patients. Setting General paediatric wards, neonatal intensive care units and paediatric intensive care units in government hospitals in Malaysia. Methods This is a cross-sectional multicentre study involving 17 participating hospitals. Drug charts were reviewed in each ward to identify the prescribing errors. All prescribing errors identified were further assessed for their potential clinical consequences, likely causes and contributing factors. Main outcome measures Incidence, types, potential clinical consequences, causes and contributing factors of the prescribing errors. Results The overall prescribing error rate was 9.2% out of 17,889 prescribed medications. There was no significant difference in the prescribing error rates between different types of hospitals or wards. The use of electronic prescribing had a higher prescribing error rate than manual prescribing (16.9 vs 8.2%, p < 0.05). Twenty eight (1.7%) prescribing errors were deemed to have serious potential clinical consequences and 2 (0.1%) were judged to be potentially fatal. Most of the errors were attributed to human factors, i.e. performance or knowledge deficit. The most common contributing factors were due to lack of supervision or of knowledge. Conclusions Although electronic prescribing may potentially improve safety, it may conversely cause prescribing errors due to suboptimal interfaces and cumbersome work processes. Junior doctors need specific training in paediatric prescribing and close supervision to reduce prescribing errors in paediatric in-patients.

Challenges of intra-institutional transfer of care from paediatric to adult congenital cardiology: the need for retention as well as transition.

PubMed

Bohun, Claudine M; Woods, Patricia; Winter, Christiane; Mitchell, Julie; McLarry, Joel; Weiss, Joseph; Broberg, Craig S

2016-02-01

Transferring patients with CHD from paediatric to adult care has been challenging, especially across institutions. Within a single institution, some issues such as provider interaction, information exchange, or administrative directives should not play a significant role, and should favour successful transfer. We studied patients who were eligible for transfer to the adult congenital heart disease service within our institution in order to identify factors associated with successful transfer to adult care providers versus failure to transfer. Patients above18 years of age with CHD who were seen by paediatric cardiologists before January, 2008 were identified through a patient-care database. Records were reviewed to determine follow-up between 2008 and 2011 and to determine whether the patient was seen in the adult congenital cardiology clinic, paediatric cardiology clinic, or had no follow-up, and statistical comparisons were made between groups. After reviewing 916 records, 229 patients were considered eligible for transition to adult congenital cardiology. Of these, 77 (34%) were transferred successfully to adult congenital cardiology, 47 (21%) continued to be seen by paediatric cardiologists, and 105 (46%) were lost to follow-up. Those who transferred successfully differed with regard to complexity of diagnosis, insurance, and whether a formal referral was made by a paediatric care provider. Only a small fraction of the patients who were lost to follow-up could be contacted. Within a single institution, with shared information systems, administrations, and care providers, successful transfer from paediatric to adult congenital cardiology was still poor. Efforts for successful retention are just as vital as those for transfer.

Paediatric musculoskeletal matters (pmm)--collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine.

PubMed

Smith, Nicola; Rapley, Tim; Jandial, Sharmila; English, Christine; Davies, Barbara; Wyllie, Ruth; Foster, Helen E

2016-01-05

We describe the collaborative development of an evidence based, free online resource namely 'paediatric musculoskeletal matters' (pmm). This resource was developed with the aim of reaching a wide range of health professionals to increase awareness, knowledge and skills within paediatric musculoskeletal medicine, thereby facilitating early diagnosis and referral to specialist care. Engagement with stakeholder groups (primary care, paediatrics, musculoskeletal specialties and medical students) informed the essential 'core' learning outcomes to derive content of pmm. Representatives from stakeholder groups, social science and web development experts transformed the learning outcomes into a suitable framework. Target audience representatives reviewed the framework and their opinion was gathered using an online survey (n = 74) and focus groups (n = 2). Experts in paediatric musculoskeletal medicine peer reviewed the content and design. User preferences informed design with mobile, tablet and web compatible versions to facilitate access, various media and formats to engage users and the content presented in module format (i.e. Clinical assessment, Investigations and management, Limping child, Joint pain by site, Swollen joint(s) and Resources). We propose that our collaborative and evidence-based approach has ensured that pmm is user-friendly, with readily accessible, suitable content, and will help to improve access to paediatric musculoskeletal medicine education. The content is evidence-based with the design and functionality of pmm to facilitate optimal and 'real life' access to information. pmm is targeted at medical students and the primary care environment although messages are transferable to all health care professionals involved in the care of children and young people.

Participation in paediatric perioperative care: 'what it means for parents'.

PubMed

Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

2017-12-01

To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

Attitudes of Slovene paediatricians to end-of-life care.

PubMed

Grosek, Stefan; Orazem, Miha; Kanic, Maja; Vidmar, Gaj; Groselj, Urh

2016-03-01

The aims of this study were to assess the attitudes of Slovene paediatricians to aspects of end-of-life (EOL) care and compare these attitudes between paediatric intensivists, paediatric specialists and paediatric residents. We performed a cross-sectional survey, using a specifically designed 43-item anonymous questionnaire. We included 323 out of 586 Slovene paediatricians and residents, while 46.7% (151 of 323) of them responded to our questionnaire. More than half of intensivists (54.2%) had sought counsel from the Committee for Medical Ethics in the past as compared with 12.0% and 12.1% of specialists and residents, respectively (P < 0.001). The decision to limit life-sustaining treatment (LST) was found to be ethically acceptable in all groups of respondents. The highest level of agreement was found in residents (90.2%), followed by 83.3% among intensivists and 73.8% among specialists (P = not statistically significant (NS)). Disagreement with termination of hydration was highest among residents (85%) and intensivists (79.2%) while it was lower among specialists (66.7%) (P = NS). Patient's best interest, good clinical practice and patient's autonomous decision were graded as the top three aspects of the EOL care, while cost effectiveness and availability of patient's bed in intensive care were the least important. The decision to limit LST measures was found to be ethically acceptable for Slovene paediatricians. No major differences were found among paediatric intensivists, specialist paediatricians and paediatric residents in the attitudes towards the EOL care. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The effect of enzyme replacement therapy on clinical outcomes in paediatric patients with Fabry disease - A systematic literature review by a European panel of experts.

PubMed

Spada, Marco; Baron, Ralf; Elliott, Perry M; Falissard, Bruno; Hilz, Max J; Monserrat, Lorenzo; Tøndel, Camilla; Tylki-Szymańska, Anna; Wanner, Christoph; Germain, Dominique P

2018-04-26

Fabry disease is caused by a deficiency of the lysosomal enzyme α-galactosidase, resulting in progressive accumulation of globotriaosylceramide (GL-3). The disease can manifest early during childhood and adolescence. Enzyme replacement therapy (ERT) with recombinant human α-galactosidase is the first specific treatment for Fabry disease and has been available in Europe since 2001. This paper presents the findings of a systematic literature review of clinical outcomes with ERT in paediatric patients with Fabry disease. A comprehensive systematic review of published literature on ERT in Fabry disease was conducted in January 2017. The literature analysis included all original articles reporting outcomes of ERT in paediatric patients. Treatment-related outcomes in the paediatric population were reported in six publications derived from open-label clinical trials and in 10 publications derived from observational or registry-based studies. ERT was shown to significantly reduce plasma and urine GL-3 levels in paediatric patients with Fabry disease. The effect of ERT on GL-3 clearance from renal podocytes appeared to be agalsidase dose-dependent. ERT relieved pain and improved gastrointestinal symptoms and quality of life. Based on the published literature, the use of ERT in paediatric patients can significantly clear GL-3 accumulation, ameliorate the early symptoms of Fabry disease, and improve quality of life. Treatment with ERT in paediatric patients with Fabry disease may be important to prevent further disease progression and overt organ damage. Copyright © 2018. Published by Elsevier Inc.

Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan.

PubMed

Hijjawi, Nawal; Zahedi, Alireza; Kazaleh, Mahmoud; Ryan, Una

2017-11-01

Cryptosporidiosis is a protozoan parasitic disease which affects human and animals worldwide. In adult immunocompetent individuals, cryptosporidiosis usually results in acute and self-limited diarrhoea; however, it can cause life threatening diarrhoea in children and immunocompromised individuals. In the present study, we compared the prevalence of Cryptosporidium species and gp60 subtypes amongst paediatric oncology patients with diarrhoea (n=160) from King Hussein Medical Centre for Cancer in Jordan, and non-oncology paediatric patients with diarrhoea (n=137) from Al-Mafraq paediatric hospital. Microscopy results using modified acid fast staining identified a significantly (p≤0.05) higher prevalence of Cryptosporidium in paediatric oncology patients with diarrhoea (14.4% - 23/160), compared to non-oncology paediatric patients with diarrhoea only (5.1% - 7/137). With the exception of one sample, all microscopy-positive samples (n=29) and an additional 3/30 microscopy-negative controls were typed to species and subtype level at the 18S and gp60 loci, respectively. All Cryptosporidium positives were typed as C. parvum. Of the 22 typed Cryptosporidium positives from the paediatric oncology patients, 21 were subtyped as IIaA17G2R1 and one as IIaA16G2R1 C. parvum subtypes. The 7 typed positives from the paediatric patients from Al-Mafraq hospital were subtyped as IIaA17G2R1 (n=5) and IIaA16G2R1 (n=2). The 3 additional positives from the 30 microscopy negative control samples were subtyped as IIaA17G2R1. The high prevalence of the IIaA17G2R1 subtype, particularly amongst oncology patients, suggests that an outbreak of cryptosporidiosis may have been occurring in oncology patients during the collection period (April to December, 2016). New therapies for cryptosporidiosis in immunocompromised patients are urgently required. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed Central

2014-01-01

Background Students’ motives for studying Dentistry have been a subject of interest for years because of the potential for understanding the psychological makeup and subsequent job satisfaction for the dentist. It is also useful in identifying expectations of the profession. This study therefore tried to identify study motives and career preferences of dental students especially with respect to the practice of paediatric dentistry. Methods This was a cross-sectional study using a self-administered questionnaire. The final year students in six dental schools in Nigeria were required to fill the questionnaire. Students were asked to rank their motives and career preferences on a Likert like scale with points ranging from 0–5 where 0 represented a factor that had no influence on their decision and 5 represented a very influential factor. The underlying dimensions for study motives, career preference, impression about and motive for interest in the practice of paediatric dentistry were identified using factor analysis. Results One hundred and seventy nine of 223 students (80.3%) participated in this study. Motives for the practice of dentistry included characteristics of the profession, altruism and intellectual challenges, existence of artistic theme in dentistry and parent’s recommendation. Overall, 67.1% of respondents indicated interest in postgraduate studies and 50.8% were interested in paediatric dentistry practice. The main motives for showing interest in the practice of paediatric dentistry were ‘personal interest, professional interest and interest of significant others in children’, and ‘family influence’. Significantly more males than females were interested in the practice of paediatric dentistry though the motives for interest in the practice of paediatric dentistry did not differ significantly by sex or age. Conclusion The non-significant sex difference in the motives for interest in the practice of paediatric dentistry is a possible reflection of changes in strong cultural themes in the motives for career choices in Nigeria. PMID:24989055

The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity.

PubMed

Lambden, Simon; DeMunter, Claudine; Dowson, Anne; Cooper, Mehrengise; Gautama, Sanjay; Sevdalis, Nick

2013-06-01

To develop and test the feasibility, reliability, and validity of a practical toolkit for the assessment and feedback of skills required to manage paediatric emergencies in critical care settings. The Imperial Paediatric Emergency Training Toolkit (IPETT) was developed based on current evidence-base and expert input. IPETT assesses both technical and non-technical skills. The technical component covers skills in the areas of clinical assessment, airway and breathing, cardiovascular, and drugs. The non-technical component is based on the validated NOTECHS tool and covers communication and interaction, cooperation and team skills, leadership and managerial skills, and decision-making. The reliability (internal consistency), content validity (inter-correlations between different skills) and concurrent validity (correlations between global technical and non-technical scores) of IPETT were prospectively evaluated in 45 simulated paediatric crises carried out in a PICU with anaesthetic and paediatric trainees (N=52). Non-parametric analyses were carried out. Significance was set at P<0.05. Cronbach alpha reliability coefficients were overall acceptable for the technical (alpha range=0.638-0.810) and good for the non-technical (alpha range=0.701-0.899) component of IPETT. The median inter-skill correlation was rho=0.564 and rho=0.549 for the technical and non-technical components, respectively. These indicate good content validity, as the skills were inter-related but not redundant. We also demonstrate a correlation between the global technical and non-technical scores (rho=0.471) - all Ps<0.05 during the assessments. IPETT offers a psychometrically viable and feasible to use tool in the context of paediatric emergencies training. This study shows that assessment of technical and non-technical skills in combination may offer a more clinically relevant model for training in paediatric emergencies. Further validation should aim to demonstrate skill retention over time and skill transfer from simulation-based training to real emergencies. Copyright © 2013. Published by Elsevier Ireland Ltd.

Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

PubMed Central

Adam, Murtaza K.; Krespan, Kelly; Moster, Mark L.; Sergott, Robert C.

2014-01-01

Abstract An 11-year-old female developed bilateral oculomotor nerve palsies without pupillary involvement and bilateral optic neuropathy as the presenting signs of paediatric multiple sclerosis (MS). Although ocular mono-neuropathies have been reported, this is the first bilateral mono-neuropathy reported in a paediatric patient due to MS. The differential diagnosis and evaluation for bilateral ophthalmoplegia are discussed in detail. PMID:27928305

Patient centric formulations for paediatrics and geriatrics: Similarities and differences.

PubMed

Hanning, Sara M; Lopez, Felipe L; Wong, Ian C K; Ernest, Terry B; Tuleu, Catherine; Orlu Gul, Mine

2016-10-30

Paediatrics and geriatrics both represent highly heterogenous populations and require special consideration when developing appropriate dosage forms. This paper discusses similarities, differences and considerations with respect to the development of appropriate medicine formulations for paediatrics and geriatrics. Arguably the most significant compliance challenge in older people is polypharmacy, whereas for children the largest barrier is taste. Pharmaceutical technology has progressed rapidly and technologies including FDCs, multi-particulates and orodispersible dosage forms provide unprecedented opportunities to develop novel and appropriate formulations for both old and new drugs. However, it is important for the formulation scientists to work closely with patients, carers and clinicians to develop such formulations for both the paediatric and geriatric population. Copyright © 2016 Elsevier B.V. All rights reserved.

Modified endotracheal tube: emergency alternative to paediatric tracheostomy tube.

PubMed

Kurien, M; Raviraj, R; Mathew, J; Kaliaperumal, I; Ninan, S

2011-07-01

In an emergency, the non-availability of a conventional paediatric tracheostomy tube is a therapeutic challenge for the attending surgeon. To describe a simple alternative to a paediatric tracheostomy tube for use in an emergency situation. Case report of a 14-year-old boy who developed tracheomalacia following partial cricotracheal resection for subglottic stenosis. As a suitably sized tracheostomy tube (with a long narrow segment) was not available, an endotracheal tube was modified and used successfully. Details of the modification, and a relevant literature review, are also discussed. In the paediatric age group, when an appropriately sized tracheostomy tube is not available, a modified endotracheal tube is a simple temporary alternative; this may be especially useful in an emergency.

Development of a paediatric population-based model of the pharmacokinetics of rivaroxaban.

PubMed

Willmann, Stefan; Becker, Corina; Burghaus, Rolf; Coboeken, Katrin; Edginton, Andrea; Lippert, Jörg; Siegmund, Hans-Ulrich; Thelen, Kirstin; Mück, Wolfgang

2014-01-01

Venous thromboembolism has been increasingly recognised as a clinical problem in the paediatric population. Guideline recommendations for antithrombotic therapy in paediatric patients are based mainly on extrapolation from adult clinical trial data, owing to the limited number of clinical trials in paediatric populations. The oral, direct Factor Xa inhibitor rivaroxaban has been approved in adult patients for several thromboembolic disorders, and its well-defined pharmacokinetic and pharmacodynamic characteristics and efficacy and safety profiles in adults warrant further investigation of this agent in the paediatric population. The objective of this study was to develop and qualify a physiologically based pharmacokinetic (PBPK) model for rivaroxaban doses of 10 and 20 mg in adults and to scale this model to the paediatric population (0-18 years) to inform the dosing regimen for a clinical study of rivaroxaban in paediatric patients. Experimental data sets from phase I studies supported the development and qualification of an adult PBPK model. This adult PBPK model was then scaled to the paediatric population by including anthropometric and physiological information, age-dependent clearance and age-dependent protein binding. The pharmacokinetic properties of rivaroxaban in virtual populations of children were simulated for two body weight-related dosing regimens equivalent to 10 and 20 mg once daily in adults. The quality of the model was judged by means of a visual predictive check. Subsequently, paediatric simulations of the area under the plasma concentration-time curve (AUC), maximum (peak) plasma drug concentration (C max) and concentration in plasma after 24 h (C 24h) were compared with the adult reference simulations. Simulations for AUC, C max and C 24h throughout the investigated age range largely overlapped with values obtained for the corresponding dose in the adult reference simulation for both body weight-related dosing regimens. However, pharmacokinetic values in infants and preschool children (body weight <40 kg) were lower than the 90 % confidence interval threshold of the adult reference model and, therefore, indicated that doses in these groups may need to be increased to achieve the same plasma levels as in adults. For children with body weight between 40 and 70 kg, simulated plasma pharmacokinetic parameters (C max, C 24h and AUC) overlapped with the values obtained in the corresponding adult reference simulation, indicating that body weight-related exposure was similar between these children and adults. In adolescents of >70 kg body weight, the simulated 90 % prediction interval values of AUC and C 24h were much higher than the 90 % confidence interval of the adult reference population, owing to the weight-based simulation approach, but for these patients rivaroxaban would be administered at adult fixed doses of 10 and 20 mg. The paediatric PBPK model developed here allowed an exploratory analysis of the pharmacokinetics of rivaroxaban in children to inform the dosing regimen for a clinical study in paediatric patients.

An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population--A retrospective cohort study.

PubMed

Fleming, C A; Kearney, D E; Moriarty, P; Redmond, H P; Andrews, E J

2015-06-01

Enterobius vermicularis is an often unexpected finding in appendectomy specimen, most commonly seen in paediatric cases. Predicting the presence of E. vermicularis in the setting of appendectomy is important to avoid unnecessary appendectomy and associated morbidity. We sought to identify the incidence of E. vermicularis in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify predictive factors for E. vermicularis. This study was performed in an 800-bed University Teaching Hospital, in the Republic of Ireland. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. In total 182 paediatric appendectomies were performed during the year 2012 for clinically suspected acute appendicitis. Demographics included: Mean age 11.14 years (3-16), gender 1M: 1F. 58.8% of procedures were completed laparoscopically, 39% open and 2.2% were converted. The negative appendectomy rate was 22.5%. The annual incidence of E. vermicularis in acute appendicitis specimen from a paediatric cohort at our institute was 7% (1 in 14). In specimen containing E. vermicularis, 69% had no evidence of appendicitis and of those that had, no gangrene or perforation was seen. The presence of E. vermicularis in paediatric patients with RIF pain may be predicted by Eosinophilia (p = 0.016), normal WCC (p = 0.034) and normal Neutrophil count (p = 0.014). E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity. Copyright © 2015. Published by Elsevier Ltd.

[Early clinical trials in paediatric oncology in Spain: a nationwide perspective].

PubMed

Bautista, Francisco; Gallego, Soledad; Cañete, Adela; Mora, Jaume; Díaz de Heredia, Cristina; Cruz, Ofelia; Fernández, José María; Rives, Susana; Berlanga, Pablo; Hladun, Raquel; Juan Ribelles, Antonio; Madero, Luis; Ramírez, Manuel; Fernández Delgado, Rafael; Pérez-Martínez, Antonio; Mata, Cristina; Llort, Anna; Martín Broto, Javier; Cela, María Elena; Ramírez, Gema; Sábado, Constantino; Acha, Tomás; Astigarraga, Itziar; Sastre, Ana; Muñoz, Ascensión; Guibelalde, Mercedes; Moreno, Lucas

2017-09-01

Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I-II) in Spain. All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Family presence during resuscitation in a paediatric hospital: health professionals' confidence and perceptions.

PubMed

McLean, Julie; Gill, Fenella J; Shields, Linda

2016-04-01

To investigate medical and nursing staff's perceptions of and self-confidence in facilitating family presence during resuscitation in a paediatric hospital setting. Family presence during resuscitation is the attendance of family members in a location that affords visual or physical contact with the patient during resuscitation. Providing the opportunity for families to be present during resuscitation embraces the family-centred care philosophy which underpins paediatric care. Having families present continues to spark much debate amongst health care professionals. A descriptive cross-sectional randomised survey using the 'Family Presence Risk/Benefit Scale' and the 'Family Presence Self-Confidence Scale 'to assess health care professionals' (doctors and nurses) perceptions and self-confidence in facilitating family presence during resuscitation of a child in a paediatric hospital. Surveys were distributed to 300 randomly selected medical and nursing staff. Descriptive and inferential statistics were used to compare medical and nursing, and critical and noncritical care perceptions and self-confidence. Critical care staff had statistically significant higher risk/benefit scores and higher self-confidence scores than those working in noncritical care areas. Having experience in paediatric resuscitation, having invited families to be present previously and a greater number of years working in paediatrics significantly affected participants' perceptions and self-confidence. There was no difference between medical and nursing mean scores for either scale. Both medical and nursing staff working in the paediatric setting understood the needs of families and the philosophy of family-centred care is a model of care practised across disciplines. This has implications both for implementing guidelines to support family presence during resuscitation and for education strategies to shift the attitudes of staff who have limited or no experience. © 2016 John Wiley & Sons Ltd.

Emergency medical services responders’ perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study

PubMed Central

Hansen, Matthew; O'Brien, Kerth; Dickinson, Caitlin; Meckler, Garth; Engle, Phil; Lambert, William; Jui, Jonathan

2017-01-01

Objective Prehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety. Setting This was a nationwide study of EMS providers from 44 of 50 (88%) US states. Participants A total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports. Primary and secondary outcome measures Outcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events. Results EMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies. Conclusions Caring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions. PMID:28246139

Diagnostic reference levels of paediatric computed tomography examinations performed at a dedicated Australian paediatric hospital.

PubMed

Bibbo, Giovanni; Brown, Scott; Linke, Rebecca

2016-08-01

Diagnostic Reference Levels (DRL) of procedures involving ionizing radiation are important tools to optimizing radiation doses delivered to patients and in identifying cases where the levels of doses are unusually high. This is particularly important for paediatric patients undergoing computed tomography (CT) examinations as these examinations are associated with relatively high-dose. Paediatric CT studies, performed at our institution from January 2010 to March 2014, have been retrospectively analysed to determine the 75th and 95th percentiles of both the volume computed tomography dose index (CTDIvol ) and dose-length product (DLP) for the most commonly performed studies to: establish local diagnostic reference levels for paediatric computed tomography examinations performed at our institution, benchmark our DRL with national and international published paediatric values, and determine the compliance of CT radiographer with established protocols. The derived local 75th percentile DRL have been found to be acceptable when compared with those published by the Australian National Radiation Dose Register and two national children's hospitals, and at the international level with the National Reference Doses for the UK. The 95th percentiles of CTDIvol for the various CT examinations have been found to be acceptable values for the CT scanner Dose-Check Notification. Benchmarking CT radiographers shows that they follow the set protocols for the various examinations without significant variations in the machine setting factors. The derivation of DRL has given us the tool to evaluate and improve the performance of our CT service by improved compliance and a reduction in radiation dose to our paediatric patients. We have also been able to benchmark our performance with similar national and international institutions. © 2016 The Royal Australian and New Zealand College of Radiologists.

Current opinions and recommendations of paediatric healthcare professionals – The importance of tablets: Emerging orally disintegrating versus traditional tablets

PubMed Central

Alyami, Hamad; Koner, Jasdip; Terry, David; Mohammed, Afzal R.

2018-01-01

The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT’s is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional’s opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties. PMID:29489871

Do Paediatric Investigation Plans (PIPs) Advance Paediatric Healthcare?

PubMed

Rose, Klaus; Walson, Philip D

2017-12-01

Since 2007, new drugs need a paediatric investigation plan (PIP) for EU registration. The PIPs' justifications can be traced back to concerns expressed by Shirkey that label warnings against paediatric use made children "therapeutic orphans", and the American Academy of Pediatrics' claim that all children differ considerably from adults. US legislation first encouraged, then also required, separate, adult-style safety and efficacy studies in all paediatric subpopulations. This triggered paediatric regulatory studies by the pharmaceutical industry. There were also negative outcomes, as a result of using the legal definition of childhood as a medical/physiological term. The "therapeutic orphans" concept became dogma that supported/expanded adult-style regulatory testing into all age groups even when poorly justified in adolescents or where other methods are available to generate needed data. PIPs are especially problematic because they lack the limitations imposed on the Food and Drug Administration's (FDA's) regulatory actions and more practical approaches used in the USA. Many PIP studies are medically senseless or even questionable and/or unfeasible with poor risk/benefit ratios. For example, physiologically mature adolescents have been exposed to treatments and doses known to be suboptimal in adults. Unfeasible PIP studies in rare diseases may harm patients by preventing their participation in more beneficence-driven studies. PIP-required studies can prevent effective treatment of allergic rhinitis during years of placebo treatment, exposing minors to the risk of disease progression to asthma. The PIP system should be revised; more should be done by key players, including institutional review boards/ethics committees, to ensure that all paediatric clinical studies are medically justified, rather than legislation driven, and can produce scientifically valid results.

Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.

PubMed

Buckland, Aaron J; Bressan, Silvia; Jowett, Helen; Johnson, Michael B; Teague, Warwick J

2016-10-01

Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Understanding Market Size and Reporting Gaps for Paediatric TB in Indonesia, Nigeria and Pakistan: Supporting Improved Treatment of Childhood TB in the Advent of New Medicines

PubMed Central

2015-01-01

Objective of the Study We sought to understand gaps in reporting childhood TB cases among public and private sector health facilities (dubbed “non-NTP” facilities) outside the network of national TB control programmes, and the resulting impact of under-reporting on estimates of paediatric disease burden and market demand for new medicines. Methodology Exploratory assessments were carried out in Indonesia, Nigeria and Pakistan, reaching a range of facility types in two selected areas of each country. Record reviews and interviews of healthcare providers were carried out to assess numbers of unreported paediatric TB cases, diagnostic pathways followed and treatment regimens prescribed. Main Findings A total of 985 unreported diagnosed paediatric TB cases were identified over a three month period in 2013 in Indonesia from 64 facilities, 463 in Pakistan from 35 facilities and 24 in Nigeria from 20 facilities. These represent an absolute additional annualised yield to 2013 notifications reported to WHO of 15% for Indonesia, 2% for Nigeria and 7% for Pakistan. Only 12% of all facilities provided age and sex-disaggregated data. Findings highlight the challenges of confirming childhood TB. Diagnosis patterns in Nigeria highlight a very low suspicion for childhood TB. Providers note the need for paediatric medicines aligned to WHO recommendations. Conclusion: How Market Data Can Support Better Public Health Interventions This study emphasises the impact of incomplete reporting on the estimation of disease burden and potential market size of paediatric TB medicines. Further studies on “hubs” (facilities treating large numbers of childhood TB cases) will improve our understanding of the epidemic, support introduction efforts for new treatments and better measure markets for new paediatric medicines. PMID:26460607

Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

PubMed Central

Boyd, Nicholas; Walker, Isabeau; Zadutsa, Beatiwel; Baqui, Abdullah H; Ahmed, Salahuddin; Islam, Mazharul; Kainja, Esther; Nambiar, Bejoy; Wilson, Iain; McCollum, Eric D

2018-01-01

Objective To gain an understanding of what challenges pulse oximetry for paediatric pneumonia management poses, how it has changed service provision and what would improve this device for use across paediatric clinical settings in low-income countries. Design Focus group discussions (FGDs), with purposive sampling and thematic analysis using a framework approach. Setting Community, front-line outpatient, and hospital outpatient and inpatient settings in Malawi and Bangladesh, which provide paediatric pneumonia care. Participants Healthcare providers (HCPs) from Malawi and Bangladesh who had received training in pulse oximetry and had been using oximeters in routine paediatric care, including community healthcare workers, non-physician clinicians or medical assistants, and hospital-based nurses and doctors. Results We conducted six FGDs, with 23 participants from Bangladesh and 26 from Malawi. We identified five emergent themes: trust, value, user-related experience, sustainability and design. HCPs discussed the confidence gained through the use of oximeters, resulting in improved trust from caregivers and valuing the device, although there were conflicts between the weight given to clinical judgement versus oximeter results. HCPs reported the ease of using oximeters, but identified movement and physically smaller children as measurement challenges. Challenges in sustainability related to battery durability and replacement parts, however many HCPs had used the same device longer than 4 years, demonstrating robustness within these settings. Desirable features included back-up power banks and integrated respiratory rate and thermometer capability. Conclusions Pulse oximetry was generally deemed valuable by HCPs for use as a spot-check device in a range of paediatric low-income clinical settings. Areas highlighted as challenges by HCPs, and therefore opportunities for redesign, included battery charging and durability, probe fit and sensitivity in paediatric populations. Trial registration number NCT02941237. PMID:29382679

Use of antibiotics in paediatric long-term care facilities.

PubMed

Murray, M T; Johnson, C L; Cohen, B; Jackson, O; Jones, L K; Saiman, L; Larson, E L; Neu, N

2018-06-01

Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P < 0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAIs. Eighty-six percent of antibiotic courses for identified bacterial pathogens (201/233) provided appropriate coverage. Access to susceptibility testing was not associated with appropriate antibiotic choice (P = 0.26). Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Characteristics of Faecal Microbiota in Paediatric Crohn's Disease and Their Dynamic Changes During Infliximab Therapy.

PubMed

Wang, Yizhong; Gao, Xuefeng; Ghozlane, Amine; Hu, Hui; Li, Xiaolu; Xiao, Yongmei; Li, Dan; Yu, Guangjun; Zhang, Ting

2018-02-28

Crohn's disease [CD] is known to be associated with gut microbial dysbiosis. Infliximab [IFX] is increasingly used to treat paediatric CD; however, it is not clear how the gut microbiota is modified during IFX treatment. The aim of this study was to characterise the faecal microbiota community composition in paediatric CD patients and to assess its dynamic changes during IFX therapy. A 16S rRNA sequencing approach was applied to determine the compositions of microbial communities in faecal samples. The composition and function of the faecal microbiota were compared between CD patients and healthy controls. Characteristics of faecal microbiome composition in paediatric CD patients before IFX treatment were represented by a lower biodiversity, a gain in Enterococcus, and a significant loss in multiple short-chain fatty acid [SCFA]-producing bacteria, including Anaerostipes, Blautia, Coprococcus, Faecalibacterium, Lachnospira, Odoribacter, Roseburia, Ruminococcus, and Sutterella. Additionally, alterations were observed in metabolic functions of the gut microbial community in CD. IFX treatment increased the biodiversity of gut microbiota and shifted its composition as well as its functional capabilities in the paediatric CD patients toward a healthy status. However, multiple SCFA-producing taxa were not significantly expanded. The sustained response of paediatric CD patients to IFX was associated with abundance of SCFA-producing bacteria. A lower biodiversity with alterations in the composition and function of faecal microbial community, characterising gut microbial dysbiosis, was observed in Chinese paediatric CD patients. IFX diminished the CD-associated gut microbial dysbiosis but was deficient in increasing certain SCFA-producing taxa. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Optimising research to speed up availability of paediatric antiretroviral drugs and formulations

PubMed Central

Penazzato, M; Gnanashanmugam, D; Rojo, P; Lallemant, M; Lewis, L; Rocchi, F; Saint Raymond, A; Ford, N; Hazra, R; Giaquinto, C; Gibb, D; Abrams, Elaine J

2018-01-01

Globally 1.8 million children are estimated to be living with HIV, yet only 51% of those eligible actually start treatment. The completion of research and development (R&D) for paediatric antiretrovirals (ARVs) is a lengthy process and licensing of new paediatric ARVs continues to lag considerably behind adults. Providing safe, effective, and well-tolerated drugs for children remains critical to ensuring scale-up of paediatric treatment globally. In this manuscript we review current approaches to R&D for paediatric ARVs and suggest innovations to enable simplified, faster, and more comprehensive strategies to develop optimal formulations. Several approaches could be adopted, including enrolment of multiple age-cohorts concurrently and the early introduction of dosing approaches for both single and fixed-dose combination (FDC) drug formulations (preferably scored and dispersible) that match WHO weight-bands. Efforts to speed up development of optimal drugs and formulations for children should focus on a limited number of prioritised formulations. This work should build upon existing partnerships and collaborations to ensure that paediatric investigation plans are developed early in the drug development process but can be modified in a streamlined manner as more information becomes available. In addition, simplified and more efficient mechanisms to undertake R&D need to be put in place, and financing mechanisms must be made more efficient and sustainable. Registration, implementation, and strategic use of drugs should not be seen as a sequential process, with research designed to address multiple questions simultaneously to respond to the needs of HIV-infected children where they live. It is imperative that lessons learned from HIV should be shared to support progress in developing paediatric formulations for other diseases with similar treatment challenges, including tuberculosis and viral hepatitis. PMID:29190337

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

PubMed

Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

2018-06-01

Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital.

PubMed

McDougall, Rosalind J; Notini, Lauren

2016-09-01

Clinical ethics has been developing in paediatric healthcare for several decades. However, information about how paediatricians use clinical ethics case consultation services is extremely limited. In this project, we analysed a large set of case records from the clinical ethics service of one paediatric hospital in Australia. We applied a paediatric-specific typology to the case referrals, based on the triadic doctor-patient-parent relationship. We reviewed the 184 cases referred to the service in the period 2005-2014, noting features including the type of case, the referring department(s) and the patient's age at referral. The two most common types of referral involved clinician uncertainty about the appropriate care pathway for the child (26% of total referrals) and situations where the child's parents disagreed with the doctors' recommendations for the child's care (22% of total referrals). Referrals came from 28 different departments. Cancer, cardiology/cardiac surgery and general medicine referred the highest numbers of cases. The most common patient age groups were children under 1, and 14-15 years old. For three controversial areas of paediatric healthcare, clinicians had initiated processes of routine review of cases by the clinical ethics service. These insights into the way in which one very active paediatric clinical ethics service is used further our understanding of the work of paediatric clinical ethics, particularly the kinds of ethically challenging cases that paediatricians view as appropriate to refer for clinical ethics support. 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/

Site of childhood cancer care in the Netherlands.

PubMed

Reedijk, A M J; van der Heiden-van der Loo, M; Visser, O; Karim-Kos, H E; Lieverst, J A; de Ridder-Sluiter, J G; Coebergh, J W W; Kremer, L C; Pieters, R

2017-12-01

Due to the complexity of diagnosis and treatment, care for children and young adolescents with cancer preferably occurs in specialised paediatric oncology centres with potentially better cure rates and minimal late effects. This study assessed where children with cancer in the Netherlands were treated since 2004. All patients aged under 18 diagnosed with cancer between 2004 and 2013 were selected from the Netherlands Cancer Registry (NCR) and linked with the Dutch Childhood Oncology Group (DCOG) database. Associations between patient and tumour characteristics and site of care were tested statistically with logistic regression analyses. This population-based study of 6021 children diagnosed with cancer showed that 82% of them were treated in a paediatric oncology centre. Ninety-four percent of the patients under 10 years of age, 85% of the patients aged 10-14 and 48% of the patients aged 15-17 were treated in a paediatric oncology centre. All International Classification of Childhood Cancers (ICCC), 3rd edition, ICCC-3 categories, except embryonal tumours, were associated with a higher risk of treatment outside a paediatric oncology centre compared to leukaemia. Multivariable analyses by ICCC-3 category revealed that specific tumour types such as chronic myelogenous leukaemia (CML), embryonal carcinomas, bone tumours other type than osteosarcoma, non-rhabdomyosarcomas, thyroid carcinomas, melanomas and skin carcinomas as well as lower-staged tumours were associated with treatment outside a paediatric oncology centre. The site of childhood cancer care in the Netherlands depends on the age of the cancer patient, type of tumour and stage at diagnosis. Collaboration between paediatric oncology centre(s), other academic units is needed to ensure most up-to-date paediatric cancer care for childhood cancer patients at the short and long term. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Kid-Short Marfan Score (Kid-SMS) - an easy executable risk score for suspected paediatric patients with Marfan syndrome.

PubMed

Mueller, Goetz C; Stark, Veronika; Steiner, Kristoffer; Weil, Jochen; von Kodolitsch, Yskert; Mir, Thomas S

2013-02-01

Due to age-dependent manifestations, diagnosis of Marfan syndrome (MFS) in children and adolescents is sophisticated. Although revised Ghent criteria is a major step forward, its utility in children is still restricted due to expensive and technically advanced diagnostics. As early diagnosis submits long-term benefits concerning prognosis, the need of an appropriate diagnostic tool for risk stratification of suspected paediatric patients with Marfan is justified. Sixty paediatric patients with Marfan were subject to a standardized diagnostic programme. All clinical symptoms of the revised Ghent nosology were analysed concerning age at first clinical manifestation, prevalence and likelihood ratio for MFS. Symptoms with early onset, high prevalence and high positive likelihood ratio were identified and combined for a risk score called Kid-Short Marfan Score (Kid-SMS). Three risk categories for suspicion of Marfan syndrome were developed. Finally, the Kid-SMS was operated in 130 paediatric patients with suspected MFS. Kid-SMS identified significantly more suspected patients with Marfan compared with Ghent nosology, revised Ghent and genetics alone without oversensitivity. Whereas diagnosis of MFS in childhood is sophisticated, Kid-SMS is a useful tool for risk stratification of suspected paediatric patients with Marfan by easy executable diagnostics, especially for paediatricians and paediatric cardiologists. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis

PubMed Central

Veeratterapillay, R; Shaw, MBK; Williams, R; Haslam, P; Lall, A; De la Hunt, M; Hasan, ST; Thomas, DJ

2012-01-01

INTRODUCTION Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. METHODS All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. RESULTS PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5–40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. CONCLUSIONS Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance. PMID:23131231

Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis.

PubMed

Veeratterapillay, R; Shaw, M B K; Williams, R; Haslam, P; Lall, A; De la Hunt, M; Hasan, S T; Thomas, D J

2012-11-01

Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5-40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.

ESPR uroradiology task force and ESUR Paediatric Work Group--Imaging recommendations in paediatric uroradiology, part VI: childhood renal biopsy and imaging of neonatal and infant genital tract. Minutes from the task force session at the annual ESPR Meeting 2012 in Athens on childhood renal biopsy and imaging neonatal genitalia.

PubMed

Riccabona, Michael; Lobo, Maria Luisa; Willi, Ulrich; Avni, Fred; Damasio, Beatrice; Ording-Mueller, Lil-Sofie; Blickman, Johan; Darge, Kassa; Papadopoulou, Frederika; Vivier, Pierre-Hugues

2014-04-01

The European Society of Paediatric Radiology Uroradiology Task Force and the ESUR Paediatric Work Group jointly publish guidelines for paediatric urogenital imaging. Two yet unaddressed topics involving patient safety and imaging load are addressed in this paper: renal biopsy in childhood and imaging of the neonatal genital tract, particularly in girls. Based on our thorough review of literature and variable practice in multiple centers, procedural recommendations are proposed on how to perform renal biopsy in children and how to approach the genital tract in (female) neonates. These are statements by consensus due to lack of sufficient evidence-based data. The procedural recommendation on renal biopsy in childhood aims at improving patient safety and reducing the number of unsuccessful passes and/or biopsy-related complications. The recommendation for an imaging algorithm in the assessment of the neonatal genital tract focuses on the potential of ultrasonography to reduce the need for more invasive or radiating imaging, however, with additional fluoroscopy or MRI to be used in selected cases. Adherence to these recommendations will allow comparable data and evidence to be generated for future adaptation of imaging strategies in paediatric uroradiology.

Clinician's gaze behaviour in simulated paediatric emergencies.

PubMed

McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

2018-03-07

Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases.

PubMed

Sykora, T; Horakova, J; Buzzasyova, D; Sladekova, M; Poczova, M; Sufliarska, S

2014-11-01

The case presented here illustrates a protothecal infection caused by Prototheca wickerhamii in a paediatric haematopoietic stem cell recipient followed by a review of the literature of all 13 paediatric cases published since 1980. Protothecosis is a rare disease caused by algae, not described in this setting before. Infection was proven additionally post-mortem from peritoneal dialysis fluid. Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents. Prototheca spp. show various susceptibility profiles, and there is no direct correlation between in vitro activity and clinical response. There are different treatment regimens described but there are no clear published guidelines of specific therapy of protothecosis. Paediatric cases were successfully treated mostly with amphotericin B and azoles. As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

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

PubMed

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

2016-01-01

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

pGALS – paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system

PubMed Central

2013-01-01

We describe pGALS (paediatric Gait, Arms, Legs and Spine) – a simple quick musculoskeletal assessment to distinguish abnormal from normal joints in children and young people. The use of pGALS is aimed at the non-specialist in paediatric musculoskeletal medicine as a basic clinical skill to be used in conjunction with essential knowledge about red flags, normal development and awareness of patterns of musculoskeletal pathologies. pGALS has been validated in school-aged children and also in the context of acute general paediatrics to detect abnormal joints. We propose that pGALS is an important part of basic clinical skills to be acquired by all doctors who may be involved in the care of children. The learning of pGALS along with basic knowledge is a useful way to increase awareness of joint disease, facilitate early recognition of joint problems and prompt referral to specialist teams to optimise clinical outcomes. We have compiled this article as a resource that can be used by the paediatric rheumatology community to facilitate teaching. PMID:24219838

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

PubMed Central

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

2016-01-01

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

[The electrocardiogram in the paediatric age group].

PubMed

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

2014-09-01

A properly interpreted electrocardiogram (ECG) provides important information and is an inexpensive and easy test to perform. It continues to be the method of choice for the diagnosis of arrhythmias. Although the principles of cardiac electrophysiology are the same, there are anatomical and physiological age-dependent changes which produce specific alterations in the paediatric ECG, and which may be misinterpreted as pathological. The intention of this article is to address in a systematic way the most relevant aspects of the paediatric ECG, to propose a possible reading scheme of the ECG and to review the electrocardiograph tracings most frequently found in the paediatric age group. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Formulations for children: problems and solutions

PubMed Central

Batchelor, Hannah K; Marriott, John F

2015-01-01

Paediatric formulation design is complex as there is a need to understand the developmental physiological changes that occur during childhood and their impact on the absorption of drugs. Paediatric dose adjustments are usually based on achieving pharmacokinetic or pharmacodynamic profiles equivalent to those achieved in adult populations. However, differences in the way in which children handle adult products or the use of bespoke paediatric formulations can result in unexpected pharmacokinetic drug profiles with altered clinical efficacy. Differences in drug formulations need to be understood by healthcare professionals involved in the prescribing, administration or dispensing of drugs to children such that appropriate advice is given to ensure that therapeutic outcomes are achieved. This issue is not confined to oral medicines but is applicable for all routes of administration encountered in paediatric therapy. PMID:25855822

Nomenclature for congenital and paediatric cardiac disease: historical perspectives and The International Pediatric and Congenital Cardiac Code.

PubMed

Franklin, Rodney C G; Jacobs, Jeffrey Phillip; Krogmann, Otto N; Béland, Marie J; Aiello, Vera D; Colan, Steven D; Elliott, Martin J; William Gaynor, J; Kurosawa, Hiromi; Maruszewski, Bohdan; Stellin, Giovanni; Tchervenkov, Christo I; Walters Iii, Henry L; Weinberg, Paul; Anderson, Robert H

2008-12-01

Clinicians working in the field of congenital and paediatric cardiology have long felt the need for a common diagnostic and therapeutic nomenclature and coding system with which to classify patients of all ages with congenital and acquired cardiac disease. A cohesive and comprehensive system of nomenclature, suitable for setting a global standard for multicentric analysis of outcomes and stratification of risk, has only recently emerged, namely, The International Paediatric and Congenital Cardiac Code. This review, will give an historical perspective on the development of systems of nomenclature in general, and specifically with respect to the diagnosis and treatment of patients with paediatric and congenital cardiac disease. Finally, current and future efforts to merge such systems into the paperless environment of the electronic health or patient record on a global scale are briefly explored. On October 6, 2000, The International Nomenclature Committee for Pediatric and Congenital Heart Disease was established. In January, 2005, the International Nomenclature Committee was constituted in Canada as The International Society for Nomenclature of Paediatric and Congenital Heart Disease. This International Society now has three working groups. The Nomenclature Working Group developed The International Paediatric and Congenital Cardiac Code and will continue to maintain, expand, update, and preserve this International Code. It will also provide ready access to the International Code for the global paediatric and congenital cardiology and cardiac surgery communities, related disciplines, the healthcare industry, and governmental agencies, both electronically and in published form. The Definitions Working Group will write definitions for the terms in the International Paediatric and Congenital Cardiac Code, building on the previously published definitions from the Nomenclature Working Group. The Archiving Working Group, also known as The Congenital Heart Archiving Research Team, will link images and videos to the International Paediatric and Congenital Cardiac Code. The images and videos will be acquired from cardiac morphologic specimens and imaging modalities such as echocardiography, angiography, computerized axial tomography and magnetic resonance imaging, as well as intraoperative images and videos. Efforts are ongoing to expand the usage of The International Paediatric and Congenital Cardiac Code to other areas of global healthcare. Collaborative efforts are underway involving the leadership of The International Nomenclature Committee for Pediatric and Congenital Heart Disease and the representatives of the steering group responsible for the creation of the 11th revision of the International Classification of Diseases, administered by the World Health Organisation. Similar collaborative efforts are underway involving the leadership of The International Nomenclature Committee for Pediatric and Congenital Heart Disease and the International Health Terminology Standards Development Organisation, who are the owners of the Systematized Nomenclature of Medicine or "SNOMED". The International Paediatric and Congenital Cardiac Code was created by specialists in the field to name and classify paediatric and congenital cardiac disease and its treatment. It is a comprehensive code that can be freely downloaded from the internet (http://www.IPCCC.net) and is already in use worldwide, particularly for international comparisons of outcomes. The goal of this effort is to create strategies for stratification of risk and to improve healthcare for the individual patient. The collaboration with the World Heath Organization, the International Health Terminology Standards Development Organisation, and the healthcare industry, will lead to further enhancement of the International Code, and to its more universal use.

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

2017-10-01

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. Limitations included a non-externally validated questionnaire. There may also have been bias in larger journals that generate and maintain social media platforms such as Twitter, which may then in turn have an influence on impact factor. Social media use within paediatric urology was associated with a higher impact factor, which remained significant after 4 years of analysis. Parents were more likely to use a wide variety of social media to search for conditions and physicians/healthcare providers; therefore, journals and institutions need to embrace and endorse SoMe as a potential source of important clinical information. Copyright © 2017. Published by Elsevier Ltd.

An introduction to behavioural decision-making theories for paediatricians.

PubMed

Haward, Marlyse F; Janvier, Annie

2015-04-01

Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Singapore Paediatric Resuscitation Guidelines 2016.

PubMed

Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

[Paediatric Rehabilitation by the German Pension Insurance - Status Quo and Future Developments].

PubMed

Widera, T; Baumgarten, E; Druckenmüller, A; Niehues, C

2017-04-01

In Germany inpatient rehabilitation plays a major role for the treatment of children and adolescents with chronic health conditions. The German Pension Insurance carries out the rehabilitation of children and adolescents with high commitment. Paediatric rehabilitation enables children to go to kindergarten and school without interruption and participate in later professional life. The article specifies the basics of paediatric rehabilitation, describes the disease structure, defines the therapeutic care and explicates survey results. © Georg Thieme Verlag KG Stuttgart · New York.

Australian Paediatric Rheumatology Group standards of care for the management of juvenile idiopathic arthritis.

PubMed

Munro, Jane; Murray, Kevin; Boros, Christina; Chaitow, Jeffrey; Allen, Roger C; Akikusa, Jonathan; Adib, Navid; Piper, Susan E; Singh-Grewal, Davinder

2014-09-01

This standards document outlines accepted standards of management for children, adolescents and young adults with juvenile idiopathic arthritis (JIA) in Australia. This document acknowledges that the chronic inflammatory arthritis conditions (JIA) in childhood are different diseases from inflammatory arthritis in adults and that specific expertise is required in the care of children with arthritis. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A review of epidemiology of paediatric elbow injuries in sports.

PubMed

Magra, Merzesh; Caine, Dennis; Maffulli, Nicola

2007-01-01

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

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

PubMed

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results of this project to better target and enhance their ethics education efforts directed at residents in the out-patient setting. Future research could further examine and test these findings in other clinical settings (e.g. adult general medicine).

Career intentions and choices of paediatricians entering training in the UK.

PubMed

Shortland, David; Roland, Damian; Lumsden, Daniel Edward; Ewing, Carol; L'Esperance, Veline; McColgan, Martin; Winch, Rachel; Mahmood, Shazia

2015-06-01

The paediatric workforce has grown substantially in recent years. Roles have changed considerably with the introduction of working time legislation and a move towards a trained doctor solution. By gaining a better understanding of paediatric trainees' career intentions, this study aims to assess whether the right workforce is being trained to meet the future demand for paediatric services in the UK. A survey was sent to paediatric specialist trainees, when they were expected to have completed their 1st year of Specialty Training or Fixed Term Specialty Training Appointments, in 2009 (part 1). A second survey was sent to the same cohort when they were expected to have completed their 3rd year in 2011 (part 2). In part 1 of the survey, the response rate was 79.1%. In part 2 the response rate was 80.5%. Of those who had responded to part 1, 87.4% also responded to part 2. The attrition rate of trainees leaving the paediatric training scheme between the 1st year and 3rd year of training was 15%. Of those still training in paediatrics after the 3rd year, 38.7% intended to be subspecialty paediatricians, 25.7% general paediatricians, 5.4% community paediatricians and 3.5% academic paediatricians. 26% were undecided and 0.6% did not intend to follow a career in paediatrics at all. The proportion of trainees who were undecided about their career intentions had risen substantially from 7.7% after the 1st year. There was a decrease in trainees' confidence in obtaining a consultant post between the 1st year and the 3rd year. Workforce planning is a complex task and this study shows that trainees will change their career plans while progressing through their run-through programmes. A better understanding of these factors will enable the Royal College of Paediatrics and Chld Health to deliver the right workforce for the UK. 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.

Evaluation and optimisation of current milrinone prescribing for the treatment and prevention of low cardiac output syndrome in paediatric patients after open heart surgery using a physiology-based pharmacokinetic drug-disease model.

PubMed

Vogt, Winnie

2014-01-01

Milrinone is the drug of choice for the treatment and prevention of low cardiac output syndrome (LCOS) in paediatric patients after open heart surgery across Europe. Discrepancies, however, among prescribing guidance, clinical studies and practice pattern require clarification to ensure safe and effective prescribing. However, the clearance prediction equations derived from classical pharmacokinetic modelling provide limited support as they have recently failed a clinical practice evaluation. Therefore, the objective of this study was to evaluate current milrinone dosing using physiology-based pharmacokinetic (PBPK) modelling and simulation to complement the existing pharmacokinetic knowledge and propose optimised dosing regimens as a basis for improving the standard of care for paediatric patients. A PBPK drug-disease model using a population approach was developed in three steps from healthy young adults to adult patients and paediatric patients with and without LCOS after open heart surgery. Pre- and postoperative organ function values from adult and paediatric patients were collected from literature and integrated into a disease model as factorial changes from the reference values in healthy adults aged 20-40 years. The disease model was combined with the PBPK drug model and evaluated against existing pharmacokinetic data. Model robustness was assessed by parametric sensitivity analysis. In the next step, virtual patient populations were created, each with 1,000 subjects reflecting the average adult and paediatric patient characteristics with regard to age, sex, bodyweight and height. They were integrated into the PBPK drug-disease model to evaluate the effectiveness of current milrinone dosing in achieving the therapeutic target range of 100-300 ng/mL milrinone in plasma. Optimised dosing regimens were subsequently developed. The pharmacokinetics of milrinone in healthy young adults as well as adult and paediatric patients were accurately described with an average fold error of 1.1 ± 0.1 (mean ± standard deviation) and mean relative deviation of 1.5 ± 0.3 as measures of bias and precision, respectively. Normalised maximum sensitivity coefficients for model input parameters ranged from -0.84 to 0.71, which indicated model robustness. The evaluation of milrinone dosing across different paediatric age groups showed a non-linear age dependence of total plasma clearance and exposure differences of a factor 1.4 between patients with and without LCOS for a fixed dosing regimen. None of the currently used dosing regimens for milrinone achieved the therapeutic target range across all paediatric age groups and adult patients, so optimised dosing regimens were developed that considered the age-dependent and pathophysiological differences. The PBPK drug-disease model for milrinone in paediatric patients with and without LCOS after open heart surgery highlights that age, disease and surgery differently impact the pharmacokinetics of milrinone, and that current milrinone dosing for LCOS is suboptimal to maintain the therapeutic target range across the entire paediatric age range. Thus, optimised dosing strategies are proposed to ensure safe and effective prescribing.

The Committee to Advise on Tropical Medicine and Travel (CATMAT) - a reference for Canadian paediatricians.

PubMed

Hui, Charles Ps

2015-01-01

The Committee to Advise on Tropical Medicine and Travel (CATMAT) is a federal government committee with wide representation in the fields of travel medicine and infectious diseases. They produce evidence-based statements on tropical and travel medicine for Canadian clinicians, including paediatric content ensured by the involvement of paediatric experts and a liaison member from the Canadian Paediatric Society. Links to all of the active statements are provided in the present practice point, with the aim of making Canadian health care providers more aware of this excellent resource. CATMAT statements of special interest to clinicians who deal with children address paediatric travellers, international adoption, personal protective measures to prevent arthropod bites, fever in the returning traveller, malaria, injury risk and travel, and guidelines for the practice of travel medicine.

Is autologous chondrocyte implantation (ACI) an adequate treatment option for repair of cartilage defects in paediatric patients?

PubMed

Kaszkin-Bettag, Marietta

2013-08-01

Cartilage lesions in the knee of juvenile patients require an effective repair to regain life-long functional activity of the joint. Autologous chondrocyte implantation (ACI) is discussed to be advantageous over other methods for cartilage repair regarding long-term outcome. ACI has successfully been applied in juvenile patients, although currently recommended for patients ≥18 years of age. Only few controlled clinical trials present evidence of efficacy and safety of ACI in adolescent patients. ACI products have to undergo the process of a marketing authorisation application, including the submission of a paediatric investigation plan (PIP). Data from prospective clinical studies or retrospective collection of long-term data in paediatric patients should be submitted for risk-benefit evaluation by the Paediatric Committee (PDCO). Copyright © 2013 Elsevier Ltd. All rights reserved.

Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium

PubMed Central

Wilson, M E; Pandey, S K; Thakur, J

2003-01-01

Paediatric cataract blindness presents an enormous problem to developing countries in terms of human morbidity, economic loss, and social burden. Managing cataracts in children remains a challenge: treatment is often difficult, tedious, and requires a dedicated team effort. To assure the best long term outcome for cataract blind children, appropriate paediatric surgical techniques need to be defined and adopted by ophthalmic surgeons of developing countries. The high cost of operative equipment and the uneven world distribution of ophthalmologists, paediatricians, and anaesthetists create unique challenges. This review focuses on issues related to paediatric cataract management that are appropriate and suitable for ophthalmic surgeons in the developing world. Practical guidelines and recommendations have also been provided for ophthalmic surgeons and health planners dealing with childhood cataract management in the developing world. PMID:12488254

Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.

PubMed

Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen

2016-04-01

This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.

Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison.

PubMed

Tork, Hanan; Dassen, Theo; Lohrmann, Christa

2009-02-01

This paper is a report of a study to examine the psychometric properties of the Care Dependency Scale for Paediatrics in Germany and Egypt and to compare the care dependency of school-age children in both countries. Cross-cultural differences in care dependency of older adults have been documented in the literature, but little is known about the differences and similarities with regard to children's care dependency in different cultures. A convenience sample of 258 school-aged children from Germany and Egypt participated in the study in 2005. The reliability of the Care Dependency Scale for Paediatrics was assessed in terms of internal consistency and interrater reliability. Factor analysis (principal component analysis) was employed to verify the construct validity. A Visual Analogue Scale was used to investigate the criterion-related validity. Good internal consistency was detected both for the Arabic and German versions. Factor analysis revealed one factor for both versions. A Pearson's correlation between the Care Dependency Scale for Paediatrics and Visual Analogue Scale was statistically significant for both versions indicating criterion-related validity. Statistically significant differences between the participants were detected regarding the mean sum score on the Care Dependency Scale for Paediatrics. The Care Dependency Scale for Paediatrics is a reliable and valid tool for assessing the care dependency of children and is recommended for assessing the care dependency of children from different ethnic origins. Differences in care dependency between German and Egyptian children were detected, which might be due to cultural differences.

Overuse of CT and MRI in paediatric emergency departments.

PubMed

Ohana, Orly; Soffer, Shelly; Zimlichman, Eyal; Klang, Eyal

2018-05-01

The aim of this review is to survey CT and MRI overuse in the paediatric emergency department (ED) population. CT is one of the most important modalities employed in the ED. Not surprisingly, its high accuracy, rapid acquisition and availability have resulted in overuse. An obvious limitation of CT is ionizing radiation; in addition there are economic implications to overuse. Studies from the last two decades have shown increase in paediatric ED CT utilization in the first decade, reaching a plateau forming around 2008, followed by a decrease in the last decade. This decrease occurred in conjunction with campaigns raising awareness to the risks of radiation exposure. Although a trend of decrease in overuse have been observed, great variability has been shown across different facilities, as well as among physicians, with more pronounced overuse in non-teaching and non-children dedicated EDs. The leading types of paediatric ED CTs are head and abdominal scans. Decision rules, such as PECARN for head injury and the Alvarado score for abdominal pain, as well as using alternative imaging modalities, have been shown to reduce CT overuse in these two categories. MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher costs, less availability and less tolerability in younger children. Although anecdotally paediatric ED MRI usage has increased in recent years, only scarce reports have been published. In our opinion, there is need to conduct up-to-date studies covering paediatric CT and MRI overuse trends, usage variability and adherence to clinical protocols.

Paediatric patient navigation models of care in Canada: An environmental scan.

PubMed

Luke, Alison; Doucet, Shelley; Azar, Rima

2018-05-01

(1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.

Finally in Italy the School of Specialisation in Paediatric Dentistry!

PubMed

Marzo, G

2017-06-01

After over two decades of discussions, promises and indecisions, the year 2016 marked the birth of the School of Specialisation in Paediatric Dentistry, which is now a reality. The importance of dental post-graduate specialisation schools has been debated since the Degree Course in Dentistry was established. Previously, in Italy only two dental branches - Oral Surgery and Orthodontics - had obtained the recognition that a School of Specialisation entails. Today, with specific training and the newly- established hyper-specialisation in Paediatric Dentistry, the future of the profession is brighter than ever. This will allow dental professionals to provide the best cure to our young patients but it especially marks and recognises the importance of prevention in general. Having established a Specialty School in Paediatric Dentistry is also important to keep the pace with the other European countries where this postgraduate course has been already offered for many years. In my opinion, training professionals with a solid specialisation based both on cultural insights and hands-on clinical activities translates into the possibility of making true prevention. The ultimate goal of paediatric dentists, as well as paediatricians, is certainly to treat young patients but also and above all to accompany them toward an adulthood possibly free of pathologies. With an eye to a future where Paediatric Dentistry will be at the core of dental and orthodontic prevention, I wish great success to all the many specialisation schools established within the Italian Universities.

Economic evaluation of genomic sequencing in the paediatric population: a critical review.

PubMed

Alam, Khurshid; Schofield, Deborah

2018-05-24

Systematic evidence is critical to the formulation of national health policy to provide public funding for the integration of genomic sequencing into routine clinical care. The purpose of this review is to present systematic evidence on the economic evaluation of genomic sequencing conducted for paediatric patients in clinical care, and to identify any gaps in the methodology of economic evaluations. We undertook a critical review of the empirical evidence from economic evaluations of genomic sequencing among paediatric patients searching five electronic databases. Our inclusion criteria were limited to literature published in the English language between 2010 and 2017 in OECD countries. Articles that met our inclusion criteria were assessed using a recognised checklist for a well-designed economic evaluation. We found 11 full-text articles that met our inclusion criteria. Our analysis found that genomic sequencing markedly increased the diagnostic rate to 16-79%, but lowered the cost by 11-64% compared to the standard diagnostic pathway. Only five recent studies in paediatric clinical cohorts met most of the criteria for a well-designed economic evaluation and demonstrated cost-effectiveness of genomic sequencing in paediatric clinical cohorts of patients. Our review identified the need for improvement in the rigour of the methodologies used to provide robust evidence for the formulation of health policy on public funding to integrate genomic sequencing into routine clinical care. Nonetheless, there is emerging evidence of the cost-effectiveness of genomic sequencing over usual care for paediatric patients.

Antenatal diagnosis of congenital heart disease and Down's syndrome: the potential effect on the practice of paediatric cardiology.

PubMed Central

Abu-Harb, M.; Wyllie, J.; Hey, E.; Richmond, S.; Wren, C.

1995-01-01

OBJECTIVE--To predict the effect of antenatal ultrasound screening for congenital heart disease and maternal serum screening of Down's syndrome on the practice of paediatric cardiology and paediatric cardiac surgery. DESIGN--A retrospective and prospective ascertainment of all congenital heart disease diagnosed in infancy in 1985-1991. SETTING--One English health region. PATIENTS--All congenital heart disease diagnosed in infancy by echocardiography, cardiac catheterisation, surgery, or necropsy was classified as "complex", "significant", or "minor" and as "detectable" or "not detectable" on a routine antenatal ultrasound scan. RESULTS--1347 infants had congenital heart disease which was "complex" in 13%, "significant" in 55%, and "minor" in 32%. 15% of cases were "detectable" on routine antenatal ultrasound. Assuming 20% detection and termination of 67% of affected pregnancies, liveborn congenital heart disease would be reduced by 2%, infant mortality from congenital heart disease by 5%, and paediatric cardiac surgical activity by 3%. Maternal screening for Down's syndrome, assuming 75% uptake, 60% detection, and termination of all affected pregnancies, would reduce liveborn cases of Down's syndrome by 45%, liveborn cases of congenital heart disease by 3.5%, and cardiac surgery by 2.6%. CONCLUSIONS--Screening for congenital heart disease using the four chamber view in routine obstetric examinations and maternal serum screening for Down's syndrome is likely to have only a small effect on the requirements for paediatric cardiology services and paediatric cardiac surgery. PMID:7547001

Peer mentoring: evaluation of a novel programme in paediatrics.

PubMed

Eisen, Sarah; Sukhani, Seema; Brightwell, Alex; Stoneham, Sara; Long, Andrew

2014-02-01

Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors. Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires. 90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor-mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor. Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees.

Peer mentoring: evaluation of a novel programme in paediatrics

PubMed Central

Eisen, Sarah; Sukhani, Seema; Brightwell, Alex; Stoneham, Sara; Long, Andrew

2014-01-01

Background Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors. Programme design Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires. Results 90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor–mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor. Conclusions Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees. PMID:24152570

Benchmarking pediatric cranial CT protocols using a dose tracking software system: a multicenter study.

PubMed

De Bondt, Timo; Mulkens, Tom; Zanca, Federica; Pyfferoen, Lotte; Casselman, Jan W; Parizel, Paul M

2017-02-01

To benchmark regional standard practice for paediatric cranial CT-procedures in terms of radiation dose and acquisition parameters. Paediatric cranial CT-data were retrospectively collected during a 1-year period, in 3 different hospitals of the same country. A dose tracking system was used to automatically gather information. Dose (CTDI and DLP), scan length, amount of retakes and demographic data were stratified by age and clinical indication; appropriate use of child-specific protocols was assessed. In total, 296 paediatric cranial CT-procedures were collected. Although the median dose of each hospital was below national and international diagnostic reference level (DRL) for all age categories, statistically significant (p-value < 0.001) dose differences among hospitals were observed. The hospital with lowest dose levels showed smallest dose variability and used age-stratified protocols for standardizing paediatric head exams. Erroneous selection of adult protocols for children still occurred, mostly in the oldest age-group. Even though all hospitals complied with national and international DRLs, dose tracking and benchmarking showed that further dose optimization and standardization is possible by using age-stratified protocols for paediatric cranial CT. Moreover, having a dose tracking system revealed that adult protocols are still applied for paediatric CT, a practice that must be avoided. • Significant differences were observed in the delivered dose between age-groups and hospitals. • Using age-adapted scanning protocols gives a nearly linear dose increase. • Sharing dose-data can be a trigger for hospitals to reduce dose levels.

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 study compared to 18 (26 %) in the study of 1998 (P < 0.0001). The present study shows that nowadays a remarkable number of paediatric surgical procedures are supported by high level of evidence. Despite this improvement in evidence-based paediatric surgical practice, more than a third of the procedures still lack sufficient evidence-based literature support. More RCTs are warranted to support and direct paediatric surgery practice according to the principals of EBM.

How readable are Australian paediatric oral health education materials?

PubMed

Arora, Amit; Lam, Andy S F; Karami, Zahra; Do, Loc Giang; Harris, Mark Fort

2014-09-02

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

Predicting the characteristics of the aetiological agent for Kawasaki disease from other paediatric infectious diseases in Japan.

PubMed

Nagao, Y; Urabe, C; Nakamura, H; Hatano, N

2016-02-01

Although Kawasaki disease (KD), which was first reported in the 1960s, is assumed to be infectious, its aetiological agent(s) remains unknown. We compared the geographical distribution of the force of infection and the super-annual periodicity of KD and seven other paediatric infectious diseases in Japan. The geographical distribution of the force of infection, which was estimated as the inverse of the mean patient age, was similar in KD and other paediatric viral infections. This similarity was due to the fact that the force of infection was determined largely by the total fertility rate. This finding suggests that KD shares a transmission route, i.e. sibling-to-sibling infection, with other paediatric infections. The super-annual periodicity, which is positively associated with the sum of an infectious disease's incubation period and infectious period, was much longer for KD and exanthema subitum than other paediatric infectious diseases. The virus for exanthema subitum is known to persist across the host's lifespan, which suggests that the aetiological agent for KD may also be capable of persistent infection. Taken together, these findings suggest that the aetiological agent for KD is transmitted through close contact and persists asymptomatically in most hosts.

Increasing workload and changing referral patterns in paediatric cardiology outreach clinics: implications for consultant staffing

PubMed Central

Wagstaff, M; Rigby, M; Redington, A

1998-01-01

Objective—To assess the workload of, and referral patterns to, paediatric cardiology outreach clinics to provide data for future planning.
Design—Descriptive study of outpatient attendance during 1991 and 1996.
Setting—Five district general hospitals with unchanged local demographics and referral patterns during the study period.
Methods—Postal, telephone, and on site survey of clinic records and case notes.
Results—The number of outpatients increased by 61%, with a consequent increase in the number of clinics held and patients seen in each clinic. The number of patients aged between 10 and 15 years doubled.
Conclusion—These data confirm the impression that demands for paediatric cardiology services are increasing. The increased need for attendance at outreach clinics has inevitable consequences for the clinical, teaching, and research activities of specialists in tertiary centres. An increase in the number of paediatric cardiologists, or development of local expertise (general paediatricians with an interest in cardiology), will be required. Furthermore, the increasingly large cohort of older teenagers and young adults with congenital heart disease underscores the need for the development of specialist facilities.

 Keywords: paediatric clinics;  workload;  congenital heart disease PMID:9602652

Developmental milestones for productivity occupations in children and youth: An integrative review.

PubMed

d'Entremont, Lisette; Gregor, Megan; Kirou, Evangelia; Nelligan, Lindsay; Dennis, Donna

2017-01-01

Limited research exists on developmental milestones for productivity occupations throughout the paediatric lifespan, and negative connotations of work for children and youth may have contributed to a paucity of literature on the topic. To ascertain what is currently known about the timing and types of engagement in productivity occupations in children and youth aged 4-19. Literature referencing productive occupations in children and youth aged 4-19 was searched for this integrative review. Search terms were established based on paediatric age and occupational therapy descriptors, and terminology associated with productivity. Sixty-seven peer-reviewed articles were analyzed according to the constant comparative method. Six core productive occupations emerged as avenues for productive engagement: paid work, school-related activities, caring for self and others, household chores, volunteering, and agricultural chores. A timeline was constructed to display common milestones for engagement in these occupations throughout the paediatric lifespan. Paediatric engagement was found to be influenced by personal (age, gender, child and youth perceptions, and safety considerations), and environmental (familial factors, parental perceptions, societal influences, and safety considerations) factors. Approaches to paediatric practice must account for the full spectrum of productive occupations children and youth engage in beyond the school context.

An evaluation of paediatric dental general anaesthesia in Yorkshire and the Humber.

PubMed

Ní Chaollaí, A; Robertson, S; Dyer, T A; Balmer, R C; Fayle, S A

2010-12-18

Following major change in UK policy regarding dental general anaesthesia (DGA) in 2001, there appears to be little information available about paediatric DGA services, their organisation, availability and utilisation. To establish the location, organisation and monitoring systems of paediatric DGA services in Yorkshire and the Humber Strategic Health Authority and to audit these services against existing standards of best practice. A postal survey of all potential paediatric DGA providers in Yorkshire and the Humber. Thirty-one possible DGA service providers were identified, 24 of which provided paediatric DGAs. Of 84 DGA lists identified, 75 regularly treated children, and nine were run on an ad hoc basis. The lists were held in 20 centres. The number of patients treated per list varied depending on treatment provided, ranging from 3.9 to 7.5 patients per list. Maximum waiting times varied from three to 84 weeks. Outcome data recording methods varied. Just over half of respondents used the Hospital Episode Statistics system; the remainder used other systems, or none. There was much variation in how DGA lists were organised. Most lists met some of the accepted standards, but very few met all. Waiting times were largely in accordance with national targets.

An update on the assessment and management of metabolic syndrome, a growing medical emergency in paediatric populations.

PubMed

Mameli, Chiara; Zuccotti, Gian Vincenzo; Carnovale, Carla; Galli, Erica; Nannini, Pilar; Cervia, Davide; Perrotta, Cristiana

2017-05-01

In the last decades the increasing rate of obesity in children and adolescents worldwide has led to the onset in paediatric age of metabolic syndrome, a disease commonly associated to adulthood. Central obesity, dyslipidaemia, hyperglycaemia, and hypertension are typical features of metabolic syndrome that seem to hesitate often in type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, and many other clinical conditions. Thus preventing and curing metabolic syndrome in paediatric patients is becoming an urgent need for public health. While diagnostic criteria and therapy of metabolic syndrome in adults are very well defined, there is no consensus on the definition of metabolic syndrome in children and adolescents as well as on healing approaches. The aim of this review is to describe the recent advances on the pathogenesis and clinical outcomes of paediatric metabolic syndrome. We then detail the therapeutic strategies (i.e. dietary regimens, physical exercise, nutraceuticals, and medications) employed to manage the disease. Finally, we analyse the safety profile of the drugs used in children and adolescents by performing a retrospective review of paediatric adverse reactions reported in the FDA's Adverse Event Reporting System database. Copyright © 2017 Elsevier Ltd. All rights reserved.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Adalimumab for the treatment of refractory noninfectious paediatric uveitis.

PubMed

Muñoz-Gallego, Alicia; Barral, Estefanía; Enríquez, Eugenia; Tejada, Pilar; Barceló, Ana; de Inocencio, Jaime

2017-06-01

To report the experience of our center with the use of adalimumab (ADA) for the treatment of severe refractory noninfectious paediatric uveitis. The study is a retrospective case series of all paediatric patients with refractory uveitis who were treated with ADA at the Paediatric Uveitis Unit of our center from 2008 to 2015. We present 12 patients (6 Juvenile idiopathic arthritis-associated uveitis, 4 idiopathic panuveitis, 1 early-onset sarcoidosis-associated panuveitis, and 1 intermediate uveitis), with uveitis in 19/24 eyes. Once ADA therapy was started, all the patients presented improved activity according to Standardization of Uveitis Nomenclature (SUN) criteria. Nine out of the 12 patients had structural damage before ADA could be started: cataract (n = 4), glaucoma (n = 2), cystic macular edema (n = 1), exudative retinal detachment (n = 1), and optic disk edema (n = 5). Visual acuity improved or maintained stable in 17/19 affected eyes, and only 2 eyes decreased its visual acuity because of structural damage, which was already present before ADA therapy. In our experience, ADA presents a good safety profile and is efficacious in the treatment of paediatric patients with different forms of refractory noninfectious uveitis.

Variation in radiographic protocols in paediatric interventional cardiology.

PubMed

McFadden, S L; Hughes, C M; Winder, R J

2013-06-01

The aim of this work is to determine current radiographic protocols in paediatric interventional cardiology (IC) in the UK and Ireland. To do this we investigated which imaging parameters/protocols are commonly used in IC in different hospitals, to identify if a standard technique is used and illustrate any variation in practice. A questionnaire was sent to all hospitals in the UK and Ireland which perform paediatric IC to obtain information on techniques used in each clinical department and on the range of clinical examinations performed. Ethical and research governance approval was sought from the Office for Research Ethics Committees Northern Ireland and the individual trusts. A response rate of 79% was achieved, and a wide variation in technique was found between hospitals. The main differences in technique involved variations in the use of an anti-scatter grid and the use of additional filtration to the radiation beam, frame rates for digital acquisition and pre-programmed projections/paediatric specific programming in the equipment. We conclude that there is no standard protocol for carrying out paediatric IC in the UK or Ireland. Each hospital carries out the IC procedure according to its own local protocols resulting in a wide variation in radiation dose.

ASSESSMENT OF CLINICAL IMAGE QUALITY IN PAEDIATRIC ABDOMINAL CT EXAMINATIONS: DEPENDENCY ON THE LEVEL OF ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASiR) AND THE TYPE OF CONVOLUTION KERNEL.

PubMed

Larsson, Joel; Båth, Magnus; Ledenius, Kerstin; Caisander, Håkan; Thilander-Klang, Anne

2016-06-01

The purpose of this study was to investigate the effect of different combinations of convolution kernel and the level of Adaptive Statistical iterative Reconstruction (ASiR™) on diagnostic image quality as well as visualisation of anatomical structures in paediatric abdominal computed tomography (CT) examinations. Thirty-five paediatric patients with abdominal pain with non-specified pathology undergoing abdominal CT were included in the study. Transaxial stacks of 5-mm-thick images were retrospectively reconstructed at various ASiR levels, in combination with three convolution kernels. Four paediatric radiologists rated the diagnostic image quality and the delineation of six anatomical structures in a blinded randomised visual grading study. Image quality at a given ASiR level was found to be dependent on the kernel, and a more edge-enhancing kernel benefitted from a higher ASiR level. An ASiR level of 70 % together with the Soft™ or Standard™ kernel was suggested to be the optimal combination for paediatric abdominal CT examinations. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Movie making as a cognitive distraction for paediatric patients receiving radiotherapy treatment: qualitative interview study.

PubMed

Shrimpton, Bradley J M; Willis, David J; Tongs, Cáthal D; Rolfo, Aldo G

2013-01-16

To establish the outcomes achieved by using an innovative movie-making programme designed to reduce fear of radiotherapy among paediatric patients. Qualitative descriptive evaluation based on semistructured, qualitative interviews with purposeful sampling and thematic analysis. Tertiary Cancer Centre. 20 parents of paediatric patients who had produced a movie of their radiation therapy experience and were in a follow-up phase of cancer management. Participants attributed a broad range of outcomes to the movie-making program. These included that the programme had helped reduce anxiety and distress exhibited by paediatric patients and contributed to a willingness to receive treatment. Other outcomes were that the completed movies had been used in school reintegration and for maintaining social connections. Allowing children to create a video of their experience of radiotherapy provided a range of benefits to paediatric patients that varied according to their needs. For some patients, movie-making offered a valuable medium for overcoming fear of the unknown as well as increasing understanding of treatment processes. For others, the development of a personalised video offered an important cognitive/attentional distraction through engaging with an age-appropriate activity. Together these outcomes helped children maintain self-control and a positive outlook.

Can drawing be considered a projective measure for children's distress in paediatric dentistry?

PubMed

Aminabadi, Naser Asl; Ghoreishizadeh, Arezoo; Ghoreishizadeh, Mohammadali; Oskouei, Sina Ghertasi

2011-01-01

Several tools have been developed for the measurement of emotional status of the child in paediatric dental clinics including nonverbal self-report techniques. Subjective methods like drawing and Child Drawing: Hospital (CD:H) score have recently been applied in hospitalized children. Studies, however, have not attempted to analyse children's drawings as an aid to investigate the subjective feelings of children in paediatric dental settings. To assess drawing as a measure for child's distress in paediatric dental settings. Fifty-four children, aged 4-11 years, participated in this study. After finishing the first therapeutic session, the child was instructed to draw a picture of a person in a dental clinic. The pictures were scored using CD:H score sheet and the findings were compared with SEM and Frankl scores. CD:H was correlated with both Frankl (correlation coefficient = -0.550) and SEM (correlation coefficient = +0.483) scales (P < 0.001). Drawing is a useful measure of children's emotional status in dental settings in a way that is easier, familiar and more enjoyable for the child patient. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.

Paediatric head injuries in the Kwazulu-Natal Province of South Africa: a developing country perspective.

PubMed

Okyere-Dede, Ebenezer K; Nkalakata, Munyaradzi C; Nkomo, Tshepo; Hadley, G P; Madiba, Thandinkosi E

2013-01-01

We investigated the causes, management and outcome of head injuries in paediatric patients admitted to the paediatric surgery unit at King Edward VIII Hospital over a 3-year period, from 1999 to 2001. There were 506 patients (331 male; M:F ratio 2:1) and the mean age was 71.99 +36.8 months (2 weeks to 180 months). The injuries were due to: motor vehicle crashes (324); falls (121); assault (30); inadvertent injury (23); and unknown (11). Forty-nine patients (9%) were admitted with a Glasgow Coma Scale ≤8. The most common intracranial pathology on computed tomography was: intracranial haematoma/haemorrhage (44); contusion (16); and brain oedema (10). Nineteen patients (3.4%) underwent neurosurgical intervention and the rest were managed conservatively. Eighteen died in hospital (3.6%). The mean hospital stay was 5 ± 12 days. Twenty-three patients (4.5%) were discharged with neurological sequelae. Few paediatric patients are admitted with severe head injury: the majority from blunt injury caused by motor vehicle crashes. Management mainly requires simple neurological observation in a general ward with a surprisingly good prognosis. Specific protocols for paediatric head injuries have been proposed based on these findings.

Perinatal and paediatric post-mortem magnetic resonance imaging (PMMR): sequences and technique

PubMed Central

Norman, Wendy; Jawad, Noorulhuda; Jones, Rod; Taylor, Andrew M

2016-01-01

As post-mortem MRI (PMMR) becomes more widely used for investigation following perinatal and paediatric deaths, the best possible images should be acquired. In this article, we review the most widely used published PMMR sequences, together with outlining our acquisition protocol and sequence parameters for foetal, perinatal and paediatric PMMR. We give examples of both normal and abnormal appearances, so that the reader can understand the logic behind each acquisition step before interpretation, as a useful day-to-day reference guide to performing PMMR. PMID:26916282

The African Hospitalist Fellowship.

PubMed

Daniels, A D; Buys, H; Dunkley, R; Wilmshurst, J M

2017-10-31

The African Paediatric Fellowship Programme is rolling out a training course for newly qualified paediatricians to equip them with the leadership skills to function in complex general paediatric settings. The care of children in Africa carries its own unique demands, from the layering effects of multiple conditions through to establishing and sustaining services under severe resource constraints. This novel training concept aims to strengthen confidence and knowledge in areas that are not priorities during standard general paediatric training. The skills gained are considered of great relevance in assisting general paediatricians to achieve their full potential in their careers.

Implantable cardiac devices: the utility of remote monitoring in a paediatric and CHD population.

PubMed

Olen, Melissa M; Dechert-Crooks, Brynn

2017-01-01

Remote monitoring in the modern era has improved outcomes for patients with cardiac implantable electronic devices. There are many advantages to remote monitoring, including improved quality of life for patients, decreased need for in-office interrogation, and secondary reduced costs. Patient safety and enhanced survival remain the most significant benefit. With most of the published literature on this topic being focussed on adults, paediatric outcomes continue to be defined. This is a review of the benefits of remote monitoring in paediatrics and in patients with CHD.

Is encopresis always the result of constipation?

PubMed Central

Benninga, M A; Büller, H A; Heymans, H S; Tytgat, G N; Taminiau, J A

1994-01-01

Encopresis is often the result of chronic constipation in the majority of paediatric patients. In clinical practice, however, encopresis is also seen without constipation and it is unknown whether these two clinical variants are based on similar or different pathophysiological mechanisms, requiring different therapeutic approaches. We analysed clinical symptoms, colonic transit time (CTT), orocaecal transit time (OCTT), anorectal manometric profiles, and behavioural scores. Patients were divided into two groups, one consisted of 111 children with paediatric constipation, and another group of 50 children with encopresis and/or soiling without constipation. Significant clinical differences in children with encopresis/soiling existed compared with children with paediatric constipation regarding: bowel movements per week, the number of daytime soiling episodes, the presence of night time soiling, the presence and number of encopresis episodes, normal stools, pain during defecation, abdominal pain, and good appetite. Total and segmental CTT were significantly prolonged in paediatric constipation compared with encopresis/soiling, 62.4 (3.6-384) and 40.2 (10.8-104.4) hours, respectively. No significant differences were found in OCTT. Among the two groups, all manometric parameters were comparable, except for a significantly higher threshold of sensation in children with paediatric constipation. The defecation dynamics were abnormal in 59% and 46% in paediatric constipation and encopresis/soiling, respectively, and were significantly different from controls. Using the child behaviour checklist no significant differences were found when comparing children with paediatric constipation and encopresis/soiling, while both patient groups differed significantly from controls. In conclusion, our findings support the concept of the existence of encopresis as a distinct entity in children with defecation disorders. Identification of such children is based on clinical symptoms, that is, normal defecation frequency, absence of abdominal or rectal palpable mass, in combination with normal marker studies and normal anal manometric threshold of sensation, Thus, encopresis is not always the result of constipation and can be the only clinical presentation of a defecation disorder. PMID:7979489

Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study.

PubMed

Guise, Jeanne-Marie; Hansen, Matthew; O'Brien, Kerth; Dickinson, Caitlin; Meckler, Garth; Engle, Phil; Lambert, William; Jui, Jonathan

2017-02-28

Prehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety. This was a nationwide study of EMS providers from 44 of 50 (88%) US states. A total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports. Outcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events. EMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies. Caring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions. 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/.

Aetiology of congenital and paediatric cataract in an Australian population

PubMed Central

Wirth, M G; Russell-Eggitt, I M; Craig, J E; Elder, J E; Mackey, D A

2002-01-01

Background/aim: Paediatric cataract is a major cause of childhood blindness. Several genes associated with congenital and paediatric cataracts have been identified. The aim was to determine the incidence of cataract in a population, the proportion of hereditary cataracts, the mode of inheritance, and the clinical presentation. Methods: The Royal Children's Hospital and the Royal Victorian Eye and Ear Hospital have a referral base for almost all paediatric patients with cataracts in south eastern Australia. The database contains cases seen over the past 25 years. The medical histories of these patients were reviewed. Results: 421 patients with paediatric cataract were identified, which gives an estimated incidence of 2.2 per 10 000 births. Of the 342 affected individuals with a negative family history, 50% were diagnosed during the first year of life, and 56/342 (16%) were associated with a recognised systemic disease or syndrome. Unilateral cataract was identified in 178/342 (52%) of sporadic cases. 79 children (from 54 nuclear families) had a positive family history. Of these 54 families, 45 were recruited for clinical examination and DNA collection. Ten nuclear families were subsequently found to be related, resulting in four larger pedigrees. Thus, 39 families have been studied. The mode of inheritance was autosomal dominant in 30 families, X linked in four, autosomal recessive in two, and uncertain in three. In total, 178 affected family members were examined; of these 8% presented with unilateral cataracts and 43% were diagnosed within the first year of life. Conclusions: In the paediatric cataract population examined, approximately half of the patients were diagnosed in the first year of life. More than 18% had a positive family history of cataracts. Of patients with hereditary cataracts 8% presented with unilateral involvement. Identification of the genes that cause paediatric and congenital cataract should help clarify the aetiology of some sporadic and unilateral cataracts. PMID:12084750

Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

PubMed

Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

2015-11-06

Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in system performance with some paediatric drowning cases subsequently not identified for P-HEMS response being transported to adult hospitals.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

PubMed

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Comparison of two European paediatric emergency departments: does primary care organisation influence emergency attendance?

PubMed

Poropat, F; Heinz, P; Barbi, E; Ventura, A

2017-03-08

To compare paediatric Emergency Department (ED) attendances and admission outcomes in two European hospitals with different paediatric primary care set-up. This is a retrospective prevalence study comparing all paediatric ED attendances during calendar years 2013 in two EDs with similar catchment area: one in Italy (Trieste) where paediatric primary care is provided by office paediatricians, the other, in the UK (Cambridge), where paediatric primary care is provided by general practitioners. Data on reason for presentation, discharge diagnosis and admission rate were collected and sub-group analysis for specific age groups (<1 year, 1-4 years, 5-15 years) was performed. Over 12 months, 20.331 children (0-15 years old) were seen in Cambridge and 18.646 in Trieste, with a very similar age distribution in both centres, except for the youngest age group: the percentage of infants seen in comparison with the total number of children attending ED was 1/3 higher in England than in Italy (15.4% vs 11.4%). The reasons for attendance were similar: under 1 year of age, the chief complaints were fever, breathing difficulties and gastrointestinal problems while in the older age groups trauma represented the commonest reason. Among discharge diagnoses, no differences were found between the two hospitals, except for faltering growth and "well child", more frequently diagnosed in English children under 5 years. The proportion of admissions was three times higher in Cambridge (14.1% vs 4.8%) with most children being admitted for infectious diseases. ED attendances in infants are more common in a primary care setting provided by general practicioner and, moreover, admission rates in all age groups are 1/3 reduced by primary care based paediatricians. Due to the methodological limits of this study, it isn't possible to evaluate whether these results depend only on paediatric primary care set-up or be determined by other confounding factors. New studies are needed to confirm this preliminary evidence.

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

PubMed Central

1996-01-01

OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement's preparation. PMID:8634956

Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands.

PubMed

Dobrowolski, Linn C; van Huis, Maike; van der Lee, Johanna H; Peters Sengers, Hessel; Liliën, Marc R; Cransberg, Karlien; Cornelissen, Marlies; Bouts, Antonia H; de Fijter, Johan W; Berger, Stefan P; van Zuilen, Arjan; Nurmohamed, Shaikh A; Betjes, Michiel H G; Hilbrands, Luuk; Hoitsma, Andries J; Bemelman, Frederike J; Krediet, C T Paul; Groothoff, Jaap W

2016-11-01

Hypertension in kidney transplant recipients (KTRs) is a risk factor for cardiovascular mortality and graft loss. Data on the prevalence of hypertension and uncontrolled hypertension (uHT) in paediatric and young adult KTRs are scarce. Also, it is unknown whether 'transition' (the transfer from paediatric to adult care) influences control of hypertension. We assessed the prevalence of hypertension and uHT among Dutch paediatric and young adult KTRs and analysed the effects of transition. Additionally, we made an inventory of variations in treatment policies in Dutch transplant centres. Cross-sectional and longitudinal national data from living KTRs ≤30 years of age (≥1-year post-transplant, eGFR >20 mL/min) were extracted from the 'RICH Q' database, which comprises information about all Dutch KTRs <19 years of age, and the Netherlands Organ Transplant Registry database for adult KTRs (≥18-30 years of age). We used both upper-limit blood pressure (BP) thresholds for treatment according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. uHT was defined as a BP above the threshold. A questionnaire on treatment policies was sent to paediatric and adult nephrologists at eight Dutch transplant centres. Hypertension and uHT were more prevalent in young adult KTRs (86.4 and 75.8%) than in paediatric KTRs (62.7 and 38.3%) according to the KDIGO definition. Time after transplantation was comparable between these groups. Longitudinal analysis showed no evidence of effect of transition on systolic BP or prevalence of uHT. Policies vary considerably between and within centres on the definition of hypertension, BP measurement and antihypertensive treatment. Average BP in KTRs increases continuously with age between 6 and 30 years. Young adult KTRs have significantly more uHT than paediatric KTRs according to KDIGO guidelines. Transition does not influence the prevalence of uHT. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Comparison of differentiated thyroid cancer in children and adolescents (≤20 years) with young adults.

PubMed

Alzahrani, Ali S; Alkhafaji, Dania; Tuli, Mahmoud; Al-Hindi, Hindi; Sadiq, Bakr Bin

2016-04-01

Age is a major prognostic factor in differentiated thyroid cancer (DTC). It is not clear if paediatric DTC has a different histopathological profile and outcome than DTC in adult patients <45 years of age. To assess whether DTC in children and adolescents differs from young age group by comparing paediatric DTC (age ≤ 20) with DTC in patients >20 to <45 years of age. We studied all cases of paediatric DTC seen during the period 1998-2011. We compared this group with a large sample of 213 consecutive adult patients in the age group >20 to <45 years seen during the period 1998-1999 in terms of their pathological features, extent of the disease and long-term outcome. Both groups were managed by the same team at a single institution. A total of 310 DTC were studied including 97 paediatric patients [median age 17 years (range, 8-20)] and 213 young adult patients [median age 33 years (range, 20·5-44·9)]. There was no difference in gender distribution, tumour subtypes, size and tumour multifocality, but there was a significantly higher rate of extrathyroidal extension [40/75 (53·3%) vs 81/213 (38·0%), P = 0·03], lymph node [57/73 (78%) vs 102/183 (55·7%), P < 0·0001] and distant metastases [16/97 (16·5%) vs 8/213 (3·8%), P < 0·0001] in the paediatric than the adult groups. Kaplan-Meier analysis showed a higher risk of persistent/recurrent disease in the paediatric group than adults (log-rank test 0·03). However, there was no mortality secondary to DTC in both groups. Paediatric DTC is distinct from DTC in the young adults (age >20 to <45 years). It is characterized by a higher rate of extrathyroidal extension, lymph node and distant metastases and a higher risk of persistent/recurrent DTC. © 2015 John Wiley & Sons Ltd.

Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.

PubMed

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

2015-10-01

Paediatric 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). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations. Retrospective analysis of PSP and SSP management at nine paediatric 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. Paediatric prospective studies are urgently required to determine optimal paediatric 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.

Oral Medicines for Children in the European Paediatric Investigation Plans

PubMed Central

van Riet – Nales, Diana A.; Römkens, Erwin G. A. W.; Saint-Raymond, Agnes; Kozarewicz, Piotr; Schobben, Alfred F. A. M.; Egberts, Toine C. G.; Rademaker, Carin M. A.

2014-01-01

Introduction Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs) are subject to agreement by the European Medicines Agency (EMA) and its Paediatric Committee (PDCO). The aim of this study was to evaluate the key characteristics of oral paediatric medicines in the PIPs and the changes implemented as a result of the EMA/PDCO review. Methods All PIPs agreed by 31 December 2011 were identified through a proprietary EMA-database. PIPs were included if they contained an agreed proposal to develop an oral medicine for children 0 to 11 years. Information on the therapeutic area (EMA classification system); target age range (as defined by industry) and pharmaceutical characteristics (active substance, dosage form(s) as listed in the PIP, strength of each dosage form, excipients in each strength of each dosage form) was extracted from the EMA website or the EMA/PDCO assessment reports. Results A hundred and fifty PIPs were included corresponding to 16 therapeutic areas and 220 oral dosage forms in 431 strengths/compositions. Eighty-two PIPs (37%) included tablets, 44 (20%) liquids and 35 (16%) dosage forms with a specific composition/strength that were stored as a solid but swallowed as a liquid e.g. dispersible tablets. The EMA/PDCO review resulted in an increase of 13 (207 to 220) oral paediatric dosage forms and 44 (387 to 431) dosage forms with a specific composition/strength. For many PIPs, the target age range was widened and the excipient composition and usability aspects modified. Conclusion The EMA/PDCO review realized an increase in the number of requirements for the development of oral dosage forms and a larger increase in the number of dosage forms with a specific composition/strength, both targeting younger children. Changes to their pharmaceutical design were less profound. PMID:24897509

Oral medicines for children in the European paediatric investigation plans.

PubMed

van Riet-Nales, Diana A; Römkens, Erwin G A W; Saint-Raymond, Agnes; Kozarewicz, Piotr; Schobben, Alfred F A M; Egberts, Toine C G; Rademaker, Carin M A

2014-01-01

Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs) are subject to agreement by the European Medicines Agency (EMA) and its Paediatric Committee (PDCO). The aim of this study was to evaluate the key characteristics of oral paediatric medicines in the PIPs and the changes implemented as a result of the EMA/PDCO review. All PIPs agreed by 31 December 2011 were identified through a proprietary EMA-database. PIPs were included if they contained an agreed proposal to develop an oral medicine for children 0 to 11 years. Information on the therapeutic area (EMA classification system); target age range (as defined by industry) and pharmaceutical characteristics (active substance, dosage form(s) as listed in the PIP, strength of each dosage form, excipients in each strength of each dosage form) was extracted from the EMA website or the EMA/PDCO assessment reports. A hundred and fifty PIPs were included corresponding to 16 therapeutic areas and 220 oral dosage forms in 431 strengths/compositions. Eighty-two PIPs (37%) included tablets, 44 (20%) liquids and 35 (16%) dosage forms with a specific composition/strength that were stored as a solid but swallowed as a liquid e.g. dispersible tablets. The EMA/PDCO review resulted in an increase of 13 (207 to 220) oral paediatric dosage forms and 44 (387 to 431) dosage forms with a specific composition/strength. For many PIPs, the target age range was widened and the excipient composition and usability aspects modified. The EMA/PDCO review realized an increase in the number of requirements for the development of oral dosage forms and a larger increase in the number of dosage forms with a specific composition/strength, both targeting younger children. Changes to their pharmaceutical design were less profound.

Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.

PubMed

Cheong, Ryan Chin Taw; Bowles, Philippe; Moore, Andrew; Watts, Simon

2017-05-01

Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA). An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres. The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery. In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency. Copyright © 2017 Elsevier B.V. All rights reserved.

Birth weight and risk of paediatric Hodgkin lymphoma: Findings from a population-based record linkage study in California.

PubMed

Triebwasser, Corey; Wang, Rong; DeWan, Andrew T; Metayer, Catherine; Morimoto, Libby; Wiemels, Joseph L; Kadan-Lottick, Nina; Ma, Xiaomei

2016-12-01

To evaluate the relationship between birth weight (along with a variety of pre and perinatal characteristics) and the risk of paediatric Hodgkin lymphoma (HL) diagnosed at age <20 years. We linked California statewide birth records from 1978-2009 and cancer diagnosis data from 1988-2011 to conduct a population-based case-control study with 1216 cases and 4485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of paediatric HL overall and by age of diagnosis, controlling for other perinatal factors. Compared to children with a normal birth weight (2500-3999 g), those who had a high birth weight (≥4000 g) had an increased risk of paediatric HL overall (OR = 1.23, 95% CI: 1.02-1.48) after adjusting for birth order, maternal age at the time of delivery, and paternal age at the time of delivery. The magnitude of association appeared larger for subgroups of children whose age of diagnosis was 0-10 years (OR = 1.56, 95% CI: 1.04-2.24) or 15-19 years (OR = 1.43, 95% CI: 1.11-1.83), while no association was observed in 11-14 year olds. Compared with firstborn children, those who were third or higher in birth order had a reduced risk of paediatric HL overall (OR = 0.80, 95% CI: 0.67-0.95), and this association also varied by age of diagnosis. In this study with the largest number of paediatric HL cases, high birth weight was associated with an increased disease risk for most but not all ages of diagnosis. The different findings by age of diagnosis regarding both birth weight and birth order underscore the importance to stratify paediatric HL by age at diagnosis in future etiological investigations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Balancing paediatric anaesthesia: preclinical insights into analgesia, hypnosis, neuroprotection, and neurotoxicity.

PubMed

Sanders, R D; Ma, D; Brooks, P; Maze, M

2008-11-01

Logistical and ethical reasons make conducting clinical research in paediatric practice difficult, and therefore safe and efficacious advances are dependent on good preclinical research. For example, notable advances have been made in preclinical studies of pain processing that correlate well with patient data. Other areas of paediatric anaesthetic research remain in their infancy including mechanisms of anaesthesia and anaesthetic neuroprotection and neurotoxicity. Animal data have identified the potential 'double-edged' sword of administering anaesthetic agents in the young; although these agents can be neuroprotective in certain circumstances, they can be neurotoxic in others. The potential for this toxicity must be balanced against the importance of providing adequate anaesthesia for which there can be no compromise. We review the current state of preclinical research in paediatric anaesthesia and identify areas which require further exploration in order to provide the foundations for well-conducted clinical trials.

Accelerated oral nanomedicine discovery from miniaturized screening to clinical production exemplified by paediatric HIV nanotherapies

NASA Astrophysics Data System (ADS)

Giardiello, Marco; Liptrott, Neill J.; McDonald, Tom O.; Moss, Darren; Siccardi, Marco; Martin, Phil; Smith, Darren; Gurjar, Rohan; Rannard, Steve P.; Owen, Andrew

2016-10-01

Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes.

Smoke inhalation increases intensive care requirements and morbidity in paediatric burns.

PubMed

Tan, Alethea; Smailes, Sarah; Friebel, Thessa; Magdum, Ashish; Frew, Quentin; El-Muttardi, Naguib; Dziewulski, Peter

2016-08-01

Burn survival has improved with advancements in fluid resuscitation, surgical wound management, wound dressings, access to antibiotics and nutritional support for burn patients. Despite these advancements, the presence of smoke inhalation injury in addition to a cutaneous burn still significantly increases morbidity and mortality. The pathophysiology of smoke inhalation has been well studied in animal models. Translation of this knowledge into effectiveness of clinical management and correlation with patient outcomes including the paediatric population, is still limited. We retrospectively reviewed our experience of 13 years of paediatric burns admitted to a regional burn's intensive care unit. We compared critical care requirements and patient outcomes between those with cutaneous burns only and those with concurrent smoke inhalation injury. Smoke inhalation increases critical care requirements and mortality in the paediatric burn population. Therefore, early critical care input in the management of these patients is advised. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Paediatric home care in the UK.

PubMed Central

Tatman, M A; Woodroffe, C

1993-01-01

Paediatric home care services in the UK were ascertained in 1991 and 1992. Respondents from 209 (97%) UK health districts and boards identified 62 general and 124 specialist paediatric home care services by January 1993, 15% having opened in the previous year. Of all UK children, 30% lived in a district with a general home care service. Five health regions had only specialist services. Districts differed widely in the availability of home care for different disorders. The home care services were small, general services employing a mean (SD) of 2.5 (1.6) whole time equivalent (WTE) nurses, and specialist services 1.3 (0.8) WTE nurses. Few services were available 24 hours a day. Funding arrangements were diverse and some services had difficulties in obtaining consumables and equipment for home use. Despite rapid growth there remains considerable scope for the development of paediatric home care throughout the UK. PMID:8285782

Experiences of using an interactive audience response system in lectures

PubMed Central

Uhari, Matti; Renko, Marjo; Soini, Hannu

2003-01-01

Background Lectures are good for presenting information and providing explanations, but because they lack active participation they have been neglected. Methods Students' experiences were evaluated after exposing them to the use of voting during lectures in their paediatrics course. Questions were delivered to the students taking paediatrics course. Thirty-six students out of the total of 40 (90%) attended the opening lecture, at which the first survey concerning previous experiences of lectures was performed. Thirty-nine students (98%) answered the second series of questions at the end of the paediatrics course. Results Most of the students felt that voting improved their activity during lectures, enhanced their learning, and that it was easier to make questions during lectures than earlier. Conclusions The students gained new, exciting insights much more often during the paediatrics course than before. We as teachers found that voting during lectures could easily overcome some of the obstacles of good lecturing. PMID:14678571

Safe paediatric intensive care. Part 1: Does more medical care lead to improved outcome?

PubMed

Frey, Bernhard; Argent, Andrew

2004-06-01

Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care.

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).

Job-sharing in paediatric training in Australia: availability and trainee perceptions.

PubMed

Whitelaw, C M; Nash, M C

2001-04-16

To examine the current availability of job-sharing in paediatric training hospitals in Australia and to evaluate job-sharing from the trainees' perspective. National survey with structured telephone interviews and postal questionnai res. The eight major paediatric training hospitals in Australia. Directors of Paediatric Physician Training (DPPTs) at each hospital (or a staff member nominated by them) provided information by phone interview regarding job-sharing. All paediatric trainees who job-shared in 1998 (n=34) were sent written questionnaires, of which 25 were returned. Hospitals differed in terms of whether a trainee was required to give a reason for wishing to job-share, and what reasons were acceptable. One hospital stated that two specialty units (Intensive Care and Neonatal Intensive Care) were excluded from job-sharing, and another stated that certain units were unlikely to be allocated job-sharers. The remaining six hospitals said that all units were available for job-sharing, but the majority of their trainees disagreed. Only one hospital had a cap on the number of job-share positions available yearly. Trainees perceived benefits of job-sharing to include decreased tiredness, increased enthusiasm for work, and the ability to strike a balance between training and other aspects of life. Trainees believed job-sharing did not adversely affect the quality of service provided to patients, and that part-time training was not of lower quality than full-time training. Job-sharing in Australian paediatric training hospitals varies in terms of the number of positions available, eligibility criteria, and which units are available for job-sharing. In our survey, trainees' experience of job-sharing was overwhelmingly positive.

Licensing and labelling of drugs in a paediatric oncology ward

PubMed Central

van den Berg, Henk; Tak, Nanda

2011-01-01

AIM Paediatric drug prescriptions are known for their high percentages of off-label and unlicensed use. In paediatric oncology data available are scarce. The aim of this paper is an analysis of the licensing and labelling status of all prescribed medication over a 2 week period in a Dutch paediatric oncology centre. METHODS An analysis of the delivery of medication by the hospital pharmacy to patients admitted to the paediatric oncology centre was carried out. RESULTS In total 268 precriptions were filed for 39 patients. In 87% of children unlicensed medication was used. Fifty-nine per cent of the children received at least two unlicensed drugs. In total 72% of the drugs were used licensed and on-label was found in 57% of the prescriptions. There was a trend that in younger children percentages were lower. International and local guidelines necessitated in many cases unlicensed use, e.g. intrathecal prednisolone, low dose medication such as heparin, ethanol and vancomycin for locking intravenous devices and higher intravenous vancomycin dosages. There were no major differences with respect to type of malignancy. CONCLUSION Our figures are substantially higher than the figures reported from adult oncology. Comparison with other paediatric reports are cumbersome, due to different percentages of diseases in the reports and other rules to dispense medication in the outpatient setting. Our data are in line with reports mentioning the higher percentages of unlicensed and off-label use. Our data further underpin the need for more research on suitable formulations, dosages, safety and efficacy in these children. PMID:21453298

Genetic testing of aetiology of intellectual disability in a dedicated physical healthcare outpatient clinic for adults with intellectual disability.

PubMed

Wallace, R A

2016-02-01

No guidelines exist for assessment of aetiology of intellectual disability in adults with intellectual disability by adult physicians, although robust guidelines exist for paediatric populations. It was speculated that the paediatric guidelines would also be suitable for adults. In rural/regional setting with limited clinical genetics, to perform a quality assurance evaluation on genetics assessment of aetiology of developmental disability in adults attending a dedicated healthcare clinic for adults with intellectual disability, compared results with paediatric standards, speculates if these seem appropriate for adults and speculates on a role for clinical genetics services. Retrospective chart audit of eligible patients looking at genetic clinical assessment, tests selected (molecular karyotype, G banding, metabolics), and yields of positive results. The results were compared with the recommended paediatric guidelines. Of 117 eligible adult patients, ideal genetic history was incomplete for 40% of patients without Down syndrome because of physician cause and lack of information. The number of abnormal genetic results increased from 46% to 66%, mainly from the molecular karyotype, though not all may have been clinically relevant. The improved yield from this test was similar to that in paediatric studies. Use of G banding and metabolic testing could be refined. Improvement can be made in clinical genetic assessment, but results generally support use of molecular karyotyping as first tier testing of cause of unknown intellectual disability in adults, as in the case for paediatric populations. The study highlights a necessary complementary role for clinical geneticists to interpret abnormal results. © 2016 Royal Australasian College of Physicians.

Defining occult injuries of the distal forearm and wrist in children.

PubMed

Elvey, Michael; Patel, S; Avisar, Erez; White, W J; Sorene, E

2016-06-01

The nonspecific terms "wrist sprain" and "suspected occult bony injury" are frequently documented as diagnoses in occult paediatric wrist injuries. To date, however, no one has accurately defined their true underlying pathology. The primary objective of this study was to identify the true pathoanatomy of occult acute paediatric wrist injuries. Our secondary objective was to compare our findings with existing adult data in order to determine any population differences that might be clinically relevant. We performed a single-centre retrospective case series evaluating MRI findings in acute paediatric wrist injuries presenting to the hand injury unit between 2011 and 2014. All patients underwent standardised radiographs of the wrist and, where clinically indicated, of the scaphoid. Where no bony anomaly was identified, MRI scanning was offered. Cohen's kappa coefficient was used to calculate the agreement between clinical and MRI diagnosis. 57 patients met the final inclusion criteria. Occult fractures and bony contusions comprised the majority of the pathologies, at 36.5 and 35.0 %, respectively. There were no cases of isolated soft-tissue injury. MRI effected management change in 35.1 % of cases. Paediatric wrists demonstrated differences in injury pattern and distribution when compared to an adult population. This study defines for the first time the true pathology of occult paediatric wrist injuries. The current definition of a wrist sprain was not applicable to a single case and therefore appears to be inappropriate for use in the paediatric population. A precise knowledge of the likely pathology facilitates accurate information delivery whilst reducing parental uncertainty and treatment variation.

Telehealth in paediatric orthopaedic surgery in Queensland: a 10-year review.

PubMed

Rowell, Philip D; Pincus, Paul; White, Megan; Smith, Anthony C

2014-12-01

Telemedicine is a patient consultation method commonly available to patients in rural and remote areas throughout Australia. Its use in paediatric orthopaedics has been rarely described. The primary aim of this study was to identify the patient cohort accessing the orthopaedic paediatric telehealth service through the Royal Children's Hospital Queensland, so as to better allocate this resource. The secondary aims were to identify the orthopaedic conditions the patients utilizing this service suffered and to follow-up on treatment outcomes to potentially assess clinical benefit. A retrospective review of prospectively collected data of paediatric orthopaedic patients consulted using telehealth at the Royal Children's Hospital, Queensland over a 10-year period between January 2004 and September 2012 was conducted. One hundred and twenty-six patient records were assessed with a mean age of 6 years. Results showed that 40% of patients seen using telehealth in paediatric orthopaedics had documented cerebral palsy, an intellectual disability or congenital syndrome. Common paediatric orthopaedic conditions were seen, with lower limb malalignment being the most common presenting complaint. About 58% of patients were seen exclusively via telehealth and did not require in-person consultation or operative therapy. We found that the orthopaedic telepaedriatic consultation service at the Royal Children's Hospital reviewed a large proportion of patients with a known disability. We believe there is a role for telehealth medicine for all patients; however, we propose that even greater benefit can be obtained from telehealth consultation in patients with a disability where the cost and inconvenience of patient transport is considerably increased. © 2014 Royal Australasian College of Surgeons.

Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease.

PubMed

Wright, E K; Williams, J; Andrews, J M; Day, A S; Gearry, R B; Bampton, P; Moore, D; Lemberg, D; Ravikumaran, R; Wilson, J; Lewindon, P; Radford-Smith, G; Rosenbaum, J; Catto-Smith, A; Desmond, P V; Connell, W R; Cameron, D; Alex, G; Bell, S J; De Cruz, P

2014-05-01

Programmes specific to inflammatory bowel disease (IBD) that facilitate transition from paediatric to adult care are currently lacking. We aimed to explore the perceived needs of adolescents with IBD among paediatric and adult gastroenterologists and to identify barriers to effective transition. A web-based survey of paediatric and adult gastroenterologists in Australia and New Zealand employed both ranked items (Likert scale; from 1 not important to 5 very important) and forced choice items regarding the importance of various factors in facilitating effective transition of adolescents from paediatric to adult care. Response rate among 178 clinicians was 41%. Only 23% of respondents felt that adolescents with IBD were adequately prepared for transition to adult care. Psychological maturity (Mean = 4.3, standard deviation (SD) = 0.70) and readiness as assessed by adult caregiver (Mean = 4, SD = 0.72) were prioritised as the most important factors in determining timing of transfer. Self-efficacy and readiness as assessed by adult caregiver were considered the two most important factors to determine timing of transition by both groups of gastroenterologists. Poor medical and surgical handover (Mean = 4.10, SD = 0.8) and patients' lack of responsibility for their own care (Mean= 4.10, SD = 0.82) were perceived as major barriers to successful transition by both paediatric and adult gastroenterologists. Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Paediatric electronic infusion calculator: An intervention to eliminate infusion errors in paediatric critical care.

PubMed

Venkataraman, Aishwarya; Siu, Emily; Sadasivam, Kalaimaran

2016-11-01

Medication errors, including infusion prescription errors are a major public health concern, especially in paediatric patients. There is some evidence that electronic or web-based calculators could minimise these errors. To evaluate the impact of an electronic infusion calculator on the frequency of infusion errors in the Paediatric Critical Care Unit of The Royal London Hospital, London, United Kingdom. We devised an electronic infusion calculator that calculates the appropriate concentration, rate and dose for the selected medication based on the recorded weight and age of the child and then prints into a valid prescription chart. Electronic infusion calculator was implemented from April 2015 in Paediatric Critical Care Unit. A prospective study, five months before and five months after implementation of electronic infusion calculator, was conducted. Data on the following variables were collected onto a proforma: medication dose, infusion rate, volume, concentration, diluent, legibility, and missing or incorrect patient details. A total of 132 handwritten prescriptions were reviewed prior to electronic infusion calculator implementation and 119 electronic infusion calculator prescriptions were reviewed after electronic infusion calculator implementation. Handwritten prescriptions had higher error rate (32.6%) as compared to electronic infusion calculator prescriptions (<1%) with a p  < 0.001. Electronic infusion calculator prescriptions had no errors on dose, volume and rate calculation as compared to handwritten prescriptions, hence warranting very few pharmacy interventions. Use of electronic infusion calculator for infusion prescription significantly reduced the total number of infusion prescribing errors in Paediatric Critical Care Unit and has enabled more efficient use of medical and pharmacy time resources.

Survey on paediatric tumour boards in Europe: current situation and results from the ExPo-r-Net project.

PubMed

Juan Ribelles, A; Berlanga, P; Schreier, G; Nitzlnader, M; Brunmair, B; Castel, V; Essiaf, S; Cañete, A; Ladenstein, R

2018-01-08

Under the ExPO-r-NeT project (European Expert Paediatric Oncology Reference Network for Diagnostics and Treatment), we aimed to identify paediatric oncology tumour boards in Europe to investigate the kind of technologies and logistics that are in place in different countries and to explore current differences between regions. A 20-question survey regarding several features of tumor boards was designed. Data collected included infrastructure, organization, and clinical decision-making information from the centres. The survey was distributed to the National Paediatric Haematology and Oncology Societies that forwarded the survey to the sites. For comparative analysis, respondents were grouped into four geographical regions. The questionnaire was distributed amongst 30 countries. Response was obtained from 23 (77%) that altogether have 212 paediatric oncology treating centres. A total of 121 institutions answered (57%). Ninety-one percent of the centres hold multidisciplinary boards; however, international second consultations are performed in 36% and only 15% participate on virtual tumor boards. Videoconferencing facilities and standard operational procedures (SOPs) are available in 49 and 43% of the centres, respectively. There were statistically significant differences between European regions concerning meeting infrastructure and organization/logistics: specific room, projecting equipment, access to medical records, videoconferencing facilities, and existence of SOPs. Paediatric tumor boards are a common feature in Europe. To reduce inequalities and have equal access to healthcare, a virtual network is needed. Important differences on the functioning and access to technology between regions in Europe have been observed and need to be addressed.

Factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation: a retrospective case study in Southeast China

PubMed Central

Guo, Wan-liang; Zhan, Yang; Fang, Fang; Deng, Yan-bing; Zhao, Jun-gang

2018-01-01

Objective The aim of this study was to evaluate factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation (CCM). Design A 3-year retrospective study was undertaken between January 2013 and December 2015 in four centres in China. Setting This involved a retrospective chart review of paediatric patients with CCM in four large hospitals in Southeast China. Participants Sixty-five paediatric patients with CCM were included in this study. We derived all available information on patient demographics, clinical characteristics, preoperative complications and surgical methods from the charts of all these patients. Interventions Univariate and multivariate logistic regression analyses were used to evaluate factors significantly affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM. Results Twenty-three of the 65 case surgeries were performed using laparoscopic technique, and 42 surgeries were performed by conventional open surgery. The median operating time was 215 min (range 120–430 min). The morphological subtype of CCM and the presence of cholecystitis or cholangitis were the only factors found to affect the operating time (p<0.05). Logistic regression analysis confirmed cholangitis as an independent risk factor. Conclusions The morphological subtype of CMM and the presence of cholecystitis or cholangitis are factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM, whereas cholangitis is an independent risk factor. PMID:29804066

Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care- an Evidence-Based Guideline from ECCO and ESPGHAN.

PubMed

Turner, Dan; Ruemmele, Frank M; Orlanski-Meyer, Esther; Griffiths, Anne M; Carpi, Javier Martin de; Bronsky, Jiri; Veres, Gabor; Aloi, Marina; Strisciuglio, Caterina; Braegger, Christian P; Assa, Amit; Romano, Claudio; Hussey, Séamus; Stanton, Michael; Pakarinen, Mikko; de Ridder, Lissy; Katsanos, Konstantinos; Croft, Nick; Navas-López, Victor; Wilson, David C; Lawrence, Sally; Russell, Richard K

2018-05-30

The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of paediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before two face-to-face meetings. All 40 included recommendations and 86 practice points, were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate. These guidelines centre on initial use of mesalamine (including topical), before using steroids, thiopurines and, for more severe disease, anti-TNF. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision making based on clinical assessment and the paediatric UC activity index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology and transition. A brief section on disease classification using the PIBD-classes criteria and IBDU is also part of these guidelines. These guidelines provide a guide to clinicians managing children with UC and IBDU to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

Recurrent mutation in the crystallin alpha A gene associated with inherited paediatric cataract.

PubMed

Javadiyan, Shari; Craig, Jamie E; Souzeau, Emmanuelle; Sharma, Shiwani; Lower, Karen M; Pater, John; Casey, Theresa; Hodson, Trevor; Burdon, Kathryn P

2016-02-11

Cataract is a major cause of childhood blindness worldwide. The purpose of this study was to determine the genetic cause of paediatric cataract in a South Australian family with a bilateral lamellar paediatric cataract displaying variable phenotypes. Fifty-one genes implicated in congenital cataract in human or mouse were sequenced in an affected individual from an Australian (Caucasian) family using a custom Ampliseq library on the Ion Torrent Personal Genome Machine. Reads were mapped against the human genome (hg19) and variants called with the Torrent Suite software. Variants were annotated to dbSNP 137 using Ion Reporter (IR 1.6.2) and were prioritised for validation if they were novel or rare and were predicted to be protein changing. We identified a previously reported oligomerization disrupting mutation, c.62G > A (p.R21Q), in the Crystallin alpha A (CRYAA) gene segregating in this three generation family. No other novel or rare coding mutations were detected in the known cataract genes sequenced. Microsatellite markers were used to compare the haplotypes between the family reported here and a previously published family with the same segregating mutation. Haplotype analysis indicated a potential common ancestry between the two South Australian families with this mutation. The work strengthens the genotype-phenotype correlations between this functional mutation in the crystallin alpha A (CRYAA) gene and paediatric cataract. The p.R21Q mutation is the most likely cause of paediatric cataract in this family. The recurrence of this mutation in paediatric cataract families is likely due to a familial relationship.

A survey on surgeons' perceived quality of the informed consent process in a Swiss paediatric surgery unit.

PubMed

Guinand, Julie; Gapany, Christophe; Simon, Jeanne-Pascale; Wasserfallen, Jean-Blaise; Joseph, Jean-Marc

2015-01-01

To evaluate the levels of satisfaction and opinions on the usefulness of the informed consent form currently in use in our Paediatric Surgery Department. Qualitative study carried out via interviews of senior paediatric surgeons, based on a questionnaire built up from reference criteria in the literature and public health law. Physicians with between 2 and 35 years experience of paediatric surgery, with a participation rate of 92 %, agreed on the definition of an informed consent form, were satisfied with the form in use and did not wish to modify its structure. The study revealed that signing the form was viewed as mandatory, but meant different things to different participants, who diverged over whom that signature protected. Finally, all respondents were in agreement over what information was necessary for parents of children requiring surgery. Paediatric surgeons seemed to be satisfied with the informed consent form in use. Most of them did not identify that the first aim of the informed consent form is to give the patient adequate information to allow him to base his consent, which is a legal obligation, the protection of physicians by the formalisation and proof of the informed consent being secondary. Few surgeons brought up the fact that the foremost stakeholder in paediatric surgery are the children themselves and that their opinions are not always sought. In the future, moving from informed consent process to shared decision-making, a more active bidirectional exchange may be strongly considered. Involving children in such vital decisions should become the norm while keeping in mind their level of maturity.

Licensing and labelling of drugs in a paediatric oncology ward.

PubMed

van den Berg, Henk; Tak, Nanda

2011-09-01

Paediatric drug prescriptions are known for their high percentages of off-label and unlicensed use. In paediatric oncology data available are scarce. The aim of this paper is an analysis of the licensing and labelling status of all prescribed medication over a 2 week period in a Dutch paediatric oncology centre. An analysis of the delivery of medication by the hospital pharmacy to patients admitted to the paediatric oncology centre was carried out. In total 268 precriptions were filed for 39 patients. In 87% of children unlicensed medication was used. Fifty-nine per cent of the children received at least two unlicensed drugs. In total 72% of the drugs were used licensed and on-label was found in 57% of the prescriptions. There was a trend that in younger children percentages were lower. International and local guidelines necessitated in many cases unlicensed use, e.g. intrathecal prednisolone, low dose medication such as heparin, ethanol and vancomycin for locking intravenous devices and higher intravenous vancomycin dosages. There were no major differences with respect to type of malignancy. Our figures are substantially higher than the figures reported from adult oncology. Comparison with other paediatric reports are cumbersome, due to different percentages of diseases in the reports and other rules to dispense medication in the outpatient setting. Our data are in line with reports mentioning the higher percentages of unlicensed and off-label use. Our data further underpin the need for more research on suitable formulations, dosages, safety and efficacy in these children. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

Global shortage of neonatal and paediatric antibiotic trials: rapid review

PubMed Central

Thompson, Georgina; Barker, Charlotte I; Folgori, Laura; Bielicki, Julia A; Bradley, John S; Lutsar, Irja; Sharland, Mike

2017-01-01

Objectives There have been few clinical trials (CTs) on antibiotics that inform neonatal and paediatric drug labelling. The rate of unlicensed and off-label prescribing in paediatrics remains high. It is unclear whether the current neonatal and paediatric antibiotic research pipeline is adequate to inform optimal drug dosing. Using the ClinicalTrials.gov registry, this review aims to establish the current global status of antibiotic CTs in children up to 18 years of age. Methods Studies were identified using key word searches of the ClinicalTrials.gov registry and were manually filtered using prespecified inclusion/exclusion criteria. Results 76 registered open CTs of antibiotics in children were identified globally; 23 (30%) were recruiting newborns (only 8 (11%) included preterm neonates), 52 (68%) infants and toddlers, 58 (76%) children and 54 (71%) adolescents. The majority of registered trials were late phase (10 (15%) phase 3 and 23 (35%) phase 4/pharmacovigilance). Two-thirds were sponsored by non-profit organisations, compared with pharmaceutical companies (50 (66%) vs 26 (34%), respectively). A greater proportion of non-profit funded trials were efficacy-based strategic trials (n=34, 68%), in comparison with industry-led trials, which were most often focused on safety or pharmacokinetic data (n=17, 65%). Only 2 of the 37 antibiotics listed on the May 2016 Pew Charitable Trusts antibiotic development pipeline, currently being studied in adults, appear to be currently recruiting in open paediatric CTs. Conclusions This review highlights that very few paediatric antibiotic CTs are being conducted globally, especially in neonates. There is a striking disparity noted between antibiotic drug development programmes in adults and children. PMID:29030411

Trends of intervention for paediatric stone disease over the last two decades (2000-2015): A systematic review of literature.

PubMed

Pietropaolo, Amelia; Proietti, Silvia; Jones, Patrick; Rangarajan, Karan; Aboumarzouk, Omar; Giusti, Guido; Somani, Bhaskar K

2017-12-01

To ascertain the publication trends of interventions for paediatric kidney stone disease (KSD) we conducted a systematic review of literature over the last 16 years. With a rise of paediatric KSD and related interventions, a systematic review using PubMed was done over the last 16 years for all published papers on 'Paediatric stone disease intervention - ureteroscopy (URS), shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), open stone surgery, and laparoscopic stone surgery'. The search was limited to English language articles with a published abstract, whilst case reports, animal and laboratory studies, were excluded. We also analysed the data in two time periods, period-1 (2000-2007) and period-2 (2008-2015). During the last 16-years, 339 papers were published on paediatric stone disease intervention on PubMed. This included papers on URS (95), PCNL (97), SWL (102), open stone surgery (34) and laparoscopic stone surgery (11). During period-1 and period-2 there were 30 and 65 papers on URS, 16 and 81 papers on PCNL, 33 and 60 papers on SWL, nine and 25 papers on open surgery, respectively. When comparing the two periods, there were 92 published papers for all interventions in period-1 and this had risen almost threefold to 247 papers in period-2. Our systematic review shows that intervention for KSD in the paediatric age group has risen over the last 8 years. Whilst URS, SWL, open surgery and laparoscopic surgery have all doubled, PCNL has risen fivefold reflecting an increase in the new minimally invasive PCNL techniques.

Use of smartphone apps by paediatric trainees.

PubMed

Jyothi, Srinivas; Halton, Fiona; Goodyear, Helen

2015-08-01

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

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

PubMed

Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

2015-10-01

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. Copyright © 2015. Published by Elsevier Ltd.

Diagnostic hearing testing of infants aged 0-36 months in 3 South African provinces - Comparison of audiology records to HPCSA guidelines.

PubMed

Moodley, Selvarani; Störbeck, Claudine

2016-12-01

Within the Early Hearing Detection and Intervention (EHDI) pathway, which includes the processes of screening, diagnosis and intervention for paediatric hearing loss, paediatric diagnostic audiology involves a battery of specific tests and procedures. International studies have highlighted a golden standard for diagnosis of paediatric hearing loss as based on the Joint Committee of Infant Hearing (2007) diagnostic guidelines, closely resembling the HPCSA diagnostic guidelines. There are limited South African studies on the processes and protocols followed in diagnostic paediatric audiology. This study aims to provide a comparison for how the tests used for diagnosis of paediatric hearing loss in South Africa (within both the public and private healthcare sectors) compare to the HPCSA recommended diagnostic guidelines. A retrospective record review of paediatric clients with hearing loss (recruited through nonprobability convenience sampling) was conducted. This study is part of a longitudinal study of 711 deaf or hard of hearing children referred to the HI HOPES early intervention programme from September 2006 to December 2011. Diagnostic data from audiology reports of 117 children between 0 and 36 months were coded and analysed. Large variation was found in the tests included in the diagnostic audiology reports. For 22 children (19%) a comprehensive test battery was used. Health Professions Council of South Africa (HPCSA) recommended guidelines for diagnostic testing were not followed in any of the records analysed. Components of the HPCSA recommended test battery most frequently omitted was bone conduction testing. For both electrophysiology and behavioural testing, there was limited frequency specificity information. This exclusion of information is evidence of deficiencies in data recording and management, as well as having an effect on accuracy of classification of degree and type of hearing loss. There are gaps in age-appropriate assessment protocols, which will have an effect on accurate differential diagnosis of paediatric hearing loss. Reasons for not including all testing components of the HPCSA recommended guidelines, as well as the possibility of developing guidelines more relevant to a developing world context, should be explored. There might be a need for. The impact of South African specific factors that have an effect on provision of accurate paediatric diagnostic audiology services should be determined. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Optimisation and establishment of diagnostic reference levels in paediatric plain radiography

NASA Astrophysics Data System (ADS)

Paulo, Graciano do Nascimento Nobre

Purpose: This study aimed to propose Diagnostic Reference Levels (DRLs) in paediatric plain radiography and to optimise the most frequent paediatric plain radiography examinations in Portugal following an analysis and evaluation of current practice. Methods and materials: Anthropometric data (weight, patient height and thickness of the irradiated anatomy) was collected from 9,935 patients referred for a radiography procedure to one of the three dedicated paediatric hospitals in Portugal. National DRLs were calculated for the three most frequent X-ray procedures at the three hospitals: chest AP/PA projection; abdomen AP projection; pelvis AP projection. Exposure factors and patient dose were collected prospectively at the clinical sites. In order to analyse the relationship between exposure factors, the use of technical features and dose, experimental tests were made using two anthropomorphic phantoms: a) CIRSTM ATOM model 705; height: 110cm, weight: 19kg and b) Kyoto kagakuTM model PBU-60; height: 165cm, weight: 50kg. After phantom data collection, an objective image analysis was performed by analysing the variation of the mean value of the standard deviation, measured with OsiriX software (Pixmeo, Switzerland). After proposing new exposure criteria, a Visual Grading Characteristic image quality evaluation was performed blindly by four paediatric radiologists, each with a minimum of 10 years of professional experience, using anatomical criteria scoring. Results: DRLs by patient weight groups have been established for the first time. ESAKP75 DRLs for both patient age and weight groups were also obtained and are described in the thesis. Significant dose reduction was achieved through the implementation of an optimisation programme: an average reduction of 41% and 18% on KAPP75 and ESAKP75, respectively for chest plain radiography; an average reduction of 58% and 53% on KAPP75 and ESAKP75, respectively for abdomen plain radiography; and an average reduction of 47% and 48% on KAPP75 and ESAKP75, respectively for pelvis plain radiography. Conclusion: Portuguese DRLs for plain radiography were obtained for paediatric plain radiography (chest AP/PA, abdomen and pelvis). Experimental phantom tests identified adequate plain radiography exposure criteria, validated by objective and subjective image quality analysis. The new exposure criteria were put into practice in one of the paediatric hospitals, by introducing an optimisation programme. The implementation of the optimisation programme allowed a significant dose reduction to paediatric patients, without compromising image quality. (Abstract shortened by ProQuest.).

A case report and literature review of autism and attention deficit hyperactivity disorder in paediatric chronic pain.

PubMed

Wiwe Lipsker, Camilla; von Heijne, Margareta; Bölte, Sven; Wicksell, Rikard K

2018-05-01

Psychiatric disorders are common in paediatric patients with chronic pain, but the overall prevalence of comorbid neurodevelopmental disorders is unclear. We report on a case of severe chronic pain in a child with undiagnosed comorbid autism spectrum disorder and attention deficit hyperactivity disorder, where significant improvements in pain and function occurred following methylphenidate medication and parental behavioural training. The inclusion of behavioural assessment and screening for neurodevelopmental comorbidity may be essential in addressing complex paediatric chronic pain. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

The Swiss regulatory framework for paediatric health research.

PubMed

Junod, Valerie

2008-07-01

Medical research on minors entails both risks and benefits. Under Swiss law, clinical trials on children, including nontherapeutic drug trials, are permissible. However, ethics committees must systematically verify that all clinical studies have a favorable risk-benefit profile. Additional safeguards are designed to ensure that children are not unnecessarily involved in research and that proper consent is always obtained. Federal Swiss law is undergoing revision to extend these protections beyond clinical trials to a broad array of health research. The Swiss drug agency also seeks to improve the incentives for pharmaceutical firms to develop new paediatric drugs and relevant paediatric drug labels.

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

Mesalamine-induced myopericarditis in a paediatric patient with Crohn's disease.

PubMed

Nair, Asha G; Cross, Russell R

2015-04-01

Mesalamine-containing products are considered first-line treatment for inflammatory bowel disease. Myocarditis is recognised as a very rare possible side effect of these medications, but has not often been described in the paediatric population. We present a case of an adolescent with Crohn's disease who presented with myopericarditis after recent initiation of Pentasa. Once identified as the causative agent, the drug was discontinued, with subsequent normalisation of troponin and improvement of function. This case identifies the importance of prompt evaluation, diagnosis, and treatment of paediatric patients receiving mesalamine-containing medications that present with significant cardiovascular symptoms.

Improving Treatment Response for Paediatric Anxiety Disorders: An Information-Processing Perspective.

PubMed

Ege, Sarah; Reinholdt-Dunne, Marie Louise

2016-12-01

Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopathology of paediatric anxiety disorders indicate possibilities for improving treatment response. Using a critical review of recent theoretical, empirical and academic literature, the paper examines the role of information-processing biases in paediatric anxiety disorders, the extent to which CBT targets information-processing biases, and possibilities for improving treatment response. The literature reviewed indicates a role for attentional and interpretational biases in anxious psychopathology. While there is theoretical grounding and limited empirical evidence to indicate that CBT ameliorates interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby in improving treatment response. The integration of novel interventions into an existing evidence-based protocol is a complex issue and faces important challenges with regard to determining the optimal treatment package. Novel interventions targeting information-processing biases may hold potential in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered.

What is the role of enhanced recovery after surgery in children? A scoping review.

PubMed

Pearson, Katherine L; Hall, Nigel J

2017-01-01

Enhanced recovery after surgery (ERAS) pathways are standard practice in adult specialties resulting in improved outcomes. It is unclear whether ERAS principles are applicable to Paediatric Surgery. We performed a scoping review to identify the extent to which ERAS has been used in Paediatric Surgery, the nature of interventions, and outcomes. Pubmed, Cochrane library, Google Scholar, and Embase were searched using the terms enhanced recovery, post-operative protocol/pathway, fast track surgery, and paediatric surgery. Studies were excluded if they did not include abdominal/thoracic/urological procedures in children. Nine studies were identified (2003-2014; total 1269 patients): three case control studies, one retrospective review and five prospective implementations, no RCTs. Interventional elements identified were post-operative feeding, mobilisation protocols, morphine-sparing analgesia, reduced use of nasogastric tubes and urinary catheters. Outcomes reported included post-operative length of stay (LOS), time to oral feeding and stooling, complications, and parent satisfaction. Fast-track programmes significantly reduced LOS in 6/7 studies, time to oral feeding in 3/3 studies, and time to stooling in 2/3 studies. The use of ERAS pathways in Paediatric surgery appears very limited but such pathways may have benefits in children. Prospective studies should evaluate interventions used in adult ERAS on appropriate outcomes in the paediatric setting.

Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature.

PubMed

Wilson, Catherine L; Johnson, David; Oakley, Ed

2016-02-01

Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Epidemiology and economic burden of rotavirus gastroenteritis in hospitals and paediatric clinics in Taiwan, 2005-2006.

PubMed

Mast, T Christopher; Chen, Po-Yen; Lu, Kun-Chia; Hsu, Chun-Ming; Lin, Hsiao Chuan; Liao, Wen-Chen; Lin, Da-Pi; Chen, Hung-Chih; Lac, Christina

2010-04-09

Baseline estimates of rotavirus disease burden and epidemiology are useful for the evaluation of newly introduced rotavirus vaccination programs. Prospective, cross-sectional surveillance for acute gastroenteritis (AGE) was conducted in hospitals and outpatient paediatric clinics in Taiwan to assess the prevalence of rotavirus gastroenteritis and associated medical costs prior to rotavirus vaccine introduction. Faecal specimens were collected from 1130 children <5 years of age from December 2004 to June 2006. The year-round rate of rotavirus detection in faecal specimens was 46% for children seen in hospitals and 14% for children seen in paediatric clinics. In the winter season, the burden was higher, reaching a peak of 60% and 21% in hospitals and paediatric clinics, respectively. The rotavirus genotype distributions were 39% (G1), 34% (G9), 12% (G2), 15% (G3), and 0.3% (G5). Total medical and nonmedical costs were US $754 for a rotavirus hospitalisation and US $60 for an outpatient clinic visit. Parental work loss averaged 4.0 days per hospital visit and 1.3 days per paediatric clinic visit. These data show that rotavirus was associated with a substantial proportion of AGE medical visits and had considerable medical costs prior to rotavirus vaccine introduction. Copyright 2010 Elsevier Ltd. All rights reserved.

Skills of primary healthcare physicians in paediatric cardiac auscultation.

PubMed

Germanakis, Ioannis; Petridou, Eleni T H; Varlamis, George; Matsoukis, Ioannis L; Papadopoulou-Legbelou, Kiriaki; Kalmanti, Maria

2013-02-01

To evaluate the performance of primary healthcare physicians in paediatric cardiac auscultation and the impact of a multimedia-based teaching intervention. A total of 106 primary healthcare physicians (77 paediatricians, 14 general practitioners and 15 medical graduates) attended four paediatric cardiac auscultation teaching courses based on virtual patients' presentation (digital phonocardiography). Their auscultatory performance was documented at the beginning of each course and at the end of two of the courses. Participants initially detected 73% of abnormal murmurs and 17% of additional sounds, while 22% of innocent murmurs were interpreted as abnormal. Overall cardiac auscultation performance, assessed by a combined auscultation score, was low and independent of training level (graduates: 39.5/trainees: 42.8/board certified: 42.6, p = 0.89) or specialty (paediatricians: 42.7/general practitioners: 43.1, p = 0.89). Multimedia-based teaching was associated with a significant improvement in abnormal murmur (92.5%) and additional sound (40%) detection (p < 0.001), while 25% of innocent murmurs were still interpreted as abnormal (p = 0.127). Clinical skills of primary healthcare physicians in paediatric cardiac auscultation, independent of training level or specialty, still leave potential for improvement. Multimedia-based teaching interventions represent an effective means of improving paediatric cardiac auscultatory skills. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

The prioritisation of paediatrics and palliative care in cancer control plans in Africa.

PubMed

Weaver, M S; Yao, A J J; Renner, L A; Harif, M; Lam, C G

2015-06-09

Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0-14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0-14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.

Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis; An Evidence-based Consensus Guideline from ECCO and ESPGHAN.

PubMed

Turner, Dan; Ruemmele, Frank M; Orlanski-Meyer, Esther; Griffiths, Anne M; Carpi, Javier Martin de; Bronsky, Jiri; Veres, Gabor; Aloi, Marina; Strisciuglio, Caterina; Braegger, Christian P; Assa, Amit; Romano, Claudio; Hussey, Séamus; Stanton, Michael; Pakarinen, Mikko; de Ridder, Lissy; Katsanos, Konstantinos H; Croft, Nick; Navas-López, Víctor Manuel; Wilson, David C; Lawrence, Sally; Russell, Richard K

2018-05-30

Acute severe colitis (ASC) is one of the few emergencies in paediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including two face-to-face meetings, was followed by voting by the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index (PUCAI). Several topics have been altered since the previous 2011 guidelines and from those published in adults. These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.

Immune activation and paediatric HIV-1 disease outcome.

PubMed

Roider, Julia M; Muenchhoff, Maximilian; Goulder, Philip J R

2016-03-01

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

Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

PubMed Central

Peters, Mark J.

2016-01-01

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

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. Copyright 2010 John Wiley & Sons, Ltd.

Oral versus intravenous antibiotics in treatment of paediatric febrile neutropenia.

PubMed

Vedi, Aditi; Cohn, Richard

2013-03-01

The purpose of this study is to determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode. A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics with intravenous antibiotics in the treatment of febrile neutropenic episodes in low-risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RRs) for dichotomous data and mean difference with standard deviation for continuous data. Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% confidence interval 0.78-1.32, P= 0.91). In carefully selected low-risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics as they lower the cost of treatment as well as psychosocial burden on these children and their families. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Prediction of outcome in internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: A machine learning approach.

PubMed

Lenhard, Fabian; Sauer, Sebastian; Andersson, Erik; Månsson, Kristoffer Nt; Mataix-Cols, David; Rück, Christian; Serlachius, Eva

2018-03-01

There are no consistent predictors of treatment outcome in paediatric obsessive-compulsive disorder (OCD). One reason for this might be the use of suboptimal statistical methodology. Machine learning is an approach to efficiently analyse complex data. Machine learning has been widely used within other fields, but has rarely been tested in the prediction of paediatric mental health treatment outcomes. To test four different machine learning methods in the prediction of treatment response in a sample of paediatric OCD patients who had received Internet-delivered cognitive behaviour therapy (ICBT). Participants were 61 adolescents (12-17 years) who enrolled in a randomized controlled trial and received ICBT. All clinical baseline variables were used to predict strictly defined treatment response status three months after ICBT. Four machine learning algorithms were implemented. For comparison, we also employed a traditional logistic regression approach. Multivariate logistic regression could not detect any significant predictors. In contrast, all four machine learning algorithms performed well in the prediction of treatment response, with 75 to 83% accuracy. The results suggest that machine learning algorithms can successfully be applied to predict paediatric OCD treatment outcome. Validation studies and studies in other disorders are warranted. Copyright © 2017 John Wiley & Sons, Ltd.

Jugular vein phlebectasia in paediatric patients with vocal fold nodules.

PubMed

Liu, Xiang; Sun, Chang-zhi; Zou, Hua; Luo, Ren-zhong

2013-08-01

Jugular vein phlebectasia (JVP) may often be overlooked in clinical practice and the management for JVP include surgery and a conservative approach. We have studied the relationship between JVP and vocal fold nodules in paediatric patients as well as the effects of treatment. Twenty-three cases of paediatric vocal fold nodules with JVP were studied. All patients received voice therapy. After 6 months of treatment, hoarseness, neck appearance (subjective evaluation) and the degree of dilation of the jugular vein detected by Doppler ultrasonography were analysed. The follow-up period was 6 to 84 months. The hoarseness disappeared or lessened noticeably after treatment for 1-4 months. The neck masses also lessened (pre vs. post: 2.58 ± 0.40 vs. 1.60 ± 0.19) after treatment for 1-4 months. The visual analogue score of the post-treatment symptoms decreased significantly compared with pre-treatment (p <0.05). The degree of dilation of the post-treatment jugular vein also decreased significantly (p <0.05). Paediatric vocal fold nodules may be related to JVP. Voice changes may also be observed in cases of paediatric JVP. Voice therapy may offer another conservative treatment option for JVP accompanied by vocal fold nodules, and it may offer better results than simple observation of JVP.

Attitudes and experiences of community pharmacists towards paediatric off-label prescribing: a prospective survey

PubMed Central

Stewart, Derek; Rouf, Abdul; Snaith, Ailsa; Elliott, Kathleen; Helms, Peter J; McLay, James S

2007-01-01

What is already known about this subject There are increasing concerns about the safety and efficacy of paediatric off-label medicines. In the UK, each year 26% of children receive an off-label prescription from their general practitioner. The community pharmacist is the final and key professional in the chain, with the responsibility to ensure that medicines are both prescribed and dispensed appropriately. What this study adds The majority of community pharmacists are aware of off-label prescribing, but through work experience rather than undergraduate or postgraduate training or professional development. Community pharmacists, like UK general practitioners, underestimate the levels of paediatric off-label prescribing, and appear unclear as to the most common reasons for a prescription being off label. Most community pharmacists stated that they should inform the prescriber that a medicine was off label; however, when given specific practical examples, less than half would actually appear to do so. The majority of community pharmacists have been asked by the public to sell over-the-counter medicines for paediatric off-label use. Aim To identify community pharmacist experiences of, and attitudes towards paediatric off-label prescribing. Methods A prospective questionnaire-based study, with a 21-item questionnaire issued to 1500 randomly selected community pharmacies throughout the UK during 2005 on three separate occasions. Results Four hundred and eighty-two (32.1%) completed questionnaires were returned. Over 70% of respondents were familiar with the concept of off-label prescribing, primarily through dispensing experience rather than education, although only 40% were aware of having dispensed a paediatric off-label prescription within the previous month. The reasons given for a prescription being off label were younger age than recommended (84.6%, 297/351), primarily for antihistamines, analgesics and β2-agonists, and higher (73.9%, 229/310) or lower than (41%, 103/258) recommended dose, primarily antibiotics and analgesics. Over 60% of respondents had been asked by the public to sell paediatric over-the-counter medicines, such as antihistamines, analgesics and steroid preparations for off-label use. The majority of respondents used the British National Formulary or the Pack Insert rather than specialist formularies or guidelines as a source of specialist paediatric information. Although 78% of respondents believed they had a responsibility to inform the prescriber that a medicine was off label, only 66% believed that they had a similar responsibility to inform parents. Conclusion The community pharmacists who responded to this questionnaire appear to be aware of and concerned by the issues which surround paediatric off-label prescribing. Despite this, most gained relevant knowledge through work experience rather than undergraduate or postgraduate training or professional development. PMID:17324238

Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children.

PubMed

Colan, Steven D

2015-08-01

In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional imaging, and strain and strain rate were either novel or non-existent and have now moved into the main stream. Cardiac magnetic resonance imaging (MRI) had very limited availability, and since that time imaging and assessment of myocardial iron content, delayed gadolinium enhancement, and extracellular volume have moved into the mainstream. The only devices discussed in the International Society for Heart and Lung Transplantation guidelines were extracorporeal membrane oxygenators, pacemakers, and defibrillators. Since that time, ventricular assist devices have become mainstream. Despite the relative lack of randomised controlled trials in paediatric heart failure, advances continue to occur. These advances warrant implementation of an update and review process, something that is best done under the auspices of the national and international cardiology societies. A joint activity that includes the International Society for Heart and Lung Transplantation, American College of Cardiology/American Heart Association, the Association for European Paediatric and Congenital Cardiology (AEPC), European Society of Cardiology, Canadian Cardiovascular Society, and others will have more credibility than independent efforts by any of these organisations.

Building capacity in the rural physiotherapy workforce: a paediatric training partnership.

PubMed

Williams, E N; McMeeken, J M

2014-01-01

Building capacity in the rural physiotherapy workforce: a paediatric training partnership' provided 6 months postgraduate paediatric clinical and academic training for two physiotherapists in rural Australia. It is described as a model for improving services and workforce retention. The need for 'an appropriate, skilled and well-supported health workforce' is the third goal in Australia's National Strategic Framework for Rural and Remote Health 2011. The World Health Organization recently published its first global policy for improving the retention of rural and remote health workers. Education is its first recommendation and aims to 'design continuing education and professional development programmes that meet the needs of rural health workers and that are accessible from where they live and work, so as to support their retention …'. Additionally, '… to be successful, continuing education needs to be linked to career paths, as well as with other education interventions'. The problem is a lack of paediatric physiotherapy expertise in rural areas due to an absence of postgraduate clinical training opportunities in the rural workforce. The result is fragmented local services for families who are forced to travel to metropolitan services, costly in terms of both time and money. The aims were to improve local paediatric physiotherapy clinical services, provide physiotherapists additional access to professional development and subsequently provide a career path to retain these health professionals. Evaluation of the project used purpose-built questionnaires as there are no specific indicators to monitor the performance of systems and services that are available to children and families in Australia. The paediatric physiotherapy training program was enabled through initial funding for a 12-month pilot project. Further government funding built on that success for this reported 6-month project. Funding to employ the postgraduate physiotherapists was essential to the success of the clinical training program, and lack of future funding is a barrier to its sustainability. The program included the consolidation of the initial management and education committees and the expert reference group. Weekly tutorials, case studies and presentations formed an important part of clinical rotation between hospital outpatients, specialist school and the disability sector. This increased the provision of skilled paediatric physiotherapy services close to home in a timely fashion not previously available. Concurrently, the training increased the clinicians' paediatric knowledge and confidence, promoting workforce retention by providing a career pathway. The senior clinicians who provided clinical supervision reported that it enabled succession planning through introduction of appropriately skilled younger peers to their clinical practice. Project recommendations are that funding and stakeholder partnerships are necessary to enable health professionals to undertake postgraduate clinical training in paediatrics in rural areas. The partnership should include education providers (university), rural health service providers (hospital) and community or disability services (government and non-government) with financial recognition of expertise in the rural workforce for clinical supervision. The training experience was reported as a very positive experience from trainees, families, clinical supervisors, managers, academics and paediatricians. Lack of continued funding to educate skilled postgraduate paediatric physiotherapy clinicians means that rural children with physical disabilities will continue to be disadvantaged.

Meet TOM - the world's first open chest paediatric/adult manikin.

PubMed

Dix, Ann

2016-07-20

Aged 15, TOM is a model patient. He has suffered more than his fair share of life-threatening events and never complains. But then TOM is not your average sick teenager - he is the world's first open chest paediatric/adult manikin.

The transition to clinical expert: enhanced decision making for children aged less than 5 years attending the paediatric ED with acute respiratory conditions.

PubMed

Bowen, Leah; Shaw, Alison; Lyttle, Mark D; Purdy, Sarah

2017-02-01

Rates of unplanned paediatric admissions are persistently high. Many admissions are short-stay events, lasting less than 48 hours. This qualitative research explores factors that influence clinical decision making in the paediatric ED (PED) for children under 5 attending with acute respiratory conditions, focusing on how management decisions adapt with increasing experience. Semi-structured interviews were conducted with 15 PED clinicians (doctors, emergency nurse practitioners and registered nurses) with varying levels of experience in paediatric emergency medicine (PEM), emergency medicine or paediatrics. Audio-recorded interviews were transcribed and analysed thematically. There were clear differences in decision-making approaches between experienced clinicians and junior staff. The latter were more risk adverse, relying heavily on guidelines, set admission criteria, clinical theory and second opinions. This was particularly true for doctors. 'Informal' learning was apparent in accounts from less-experienced doctors and nurses, whereby tacit knowledge and risk management played an increasing role in the development of clinical intuition that permitted rapid assessment and treatment of young patients. The emergence of intuition entwined with approaches to risk management and the role of these skills in clinical decision making, carry implications for the development of training programmes for clinicians working in PEM. Enhanced training for such groups to permit development of the supplementary skills described in this study could have the ability to improve care delivery and even reduce paediatric admissions. 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/.

Important issues in the justification of a control treatment in paediatric drug trials.

PubMed

Kelly, Lauren E; Davies, Elin Haf; Saint-Raymond, Agnes; Tomasi, Paolo; Offringa, Martin

2016-10-01

The value of comparative effectiveness trials in informing clinical and policy decisions depends heavily on the choice of control arm (comparator). Our objective is to identify challenges in comparator reasoning and to determine justification criteria for selecting a control arm in paediatric clinical trials. A literature search was completed to identify existing sources of guidance on comparator selection. Subsequently, we reviewed a randomly selected sample of comparators selected for paediatric investigation plans (PIPs) adopted by the Paediatric Committee of the European Medicines Agency in 2013. We gathered descriptive information and evaluated their review process to identify challenges and compromises between regulators and sponsors with regard to the selection of the comparator. A tool to help investigators justify the selection of active controls and placebo arms was developed using the existing literature and empirical data. Justifying comparator selection was a challenge in 28% of PIPs. The following challenging paediatric issues in the decision-making process were identified: use of off-label medications as comparators, ethical and safe use of placebo, duration of placebo use, an undefined optimal dosing strategy, lack of age-appropriate safety and efficacy data, and drug dosing not supported by extrapolation of safety/efficacy evidence from other populations. In order to generate trials that will inform clinical decision-making and support marketing authorisations, researchers must systemically and transparently justify their selection of the comparator arm for their study. This report highlights key areas for justification in the choice of comparator in paediatric clinical trials. 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/

Evaluation of the peer teaching program at the University Children´s Hospital Essen - a single center experience.

PubMed

Büscher, Rainer; Weber, Dominik; Büscher, Anja; Hölscher, Maite; Pohlhuis, Sandra; Groes, Bernhard; Hoyer, Peter F

2013-01-01

Since 1986 medical students at the University Children's Hospital Essen are trained as peers in a two week intensive course in order to teach basic paediatric examination techniques to younger students. Student peers are employed by the University for one year. Emphasis of the peer teaching program is laid on the mediation of affective and sensomotorical skills e.g. get into contact with parents and children, as well as manual paediatric examination techniques. The aim of this study is to analyse whether student peers are able to impart specific paediatric examination skills as good as an experienced senior paediatric lecturer. 123 students were randomly assigned to a group with either a senior lecturer or a student peer teacher. Following one-hour teaching-sessions in small groups students had to demonstrate the learned skills in a 10 minute modified OSCE. In comparison to a control group consisting of 23 students who never examined a child before, both groups achieved a significantly better result. Medical students taught by student peers almost reached the same examination result as the group taught by paediatric teachers (21,7±4,1 vs. 22,6±3,6 of 36 points, p=0,203). Especially the part of the OSCE where exclusively practical skills where examined revealed no difference between the two groups (7,44±2,15 vs. 7,97±1,87 of a maximum of 16 points, p=0,154). The majority of students (77%) evaluated peer teaching as stimulating and helpful. The results of this quantitative teaching study reveal that peer teaching of selected skills can be a useful addition to classical paediatric teaching classes.

Teaching paediatric basic life support in medical schools using peer teaching or video demonstration: A prospective randomised trial.

PubMed

Stephan, Frederik; Groetschel, Hanjo; Büscher, Anja K; Serdar, Deniz; Groes, Kjell A; Büscher, Rainer

2018-05-13

The outcome of children with an out-of-hospital cardiac arrest is still poor, but bystander cardiopulmonary resuscitation can increase survival and minimise severe neurological sequelae. While teaching basic life support is standardised in emergency medicine classes, paediatric basic life support (PBLS) in neonates and toddlers is under-represented in paediatric curricula during university education. The appropriate mixture of E-learning and peer teaching lessons remains controversial in teaching paediatric basic skills. However, an increasing number of medical schools and paediatric classes switch their curricula to much cheaper and less tutor-dependent E-learning modules. We hypothesise that a peer teaching lesson is superior to a PBLS video demonstration with co-extensive contents and improves knowledge, skills and adherence to resuscitation guidelines. Eighty-eight medical students were randomly assigned to a video PBLS lesson (n = 44) or a peer teaching group (n = 44). An objective structured clinical examination was performed immediately after the class and at the end of the semester. Students taught by a peer teacher performed significantly better immediately after the initial course and at the end of the semester when compared to the video-trained group (P = 0.008 and P = 0.003, respectively). In addition, a borderline regression analysis also revealed a better resuscitation performance of students instructed in the peer teaching group. In our setting, peer teaching is superior and more sustainable than a co-extensive video demonstration alone when teaching PBLS to medical students. However, additional studies with combinations of different teaching methods are necessary to evaluate long-term outcomes. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Reconstruction of paediatric organ doses from axial CT scans performed in the 1990s - range of doses as input to uncertainty estimates.

PubMed

Olerud, Hilde M; Toft, Benthe; Flatabø, Silje; Jahnen, Andreas; Lee, Choonsik; Thierry-Chef, Isabelle

2016-09-01

To assess the range of doses in paediatric CT scans conducted in the 1990s in Norway as input to an international epidemiology study: the EPI-CT study, http://epi-ct.iarc.fr/ . National Cancer Institute dosimetry system for Computed Tomography (NCICT) program based on pre-calculated organ dose conversion coefficients was used to convert CT Dose Index to organ doses in paediatric CT in the 1990s. Protocols reported from local hospitals in a previous Norwegian CT survey were used as input, presuming these were used without optimization for paediatric patients. Large variations in doses between different scanner models and local scan parameter settings are demonstrated. Small children will receive a factor of 2-3 times higher doses compared with adults if the protocols are not optimized for them. For common CT examinations, the doses to the active bone marrow, breast tissue and brain may have exceeded 30 mGy, 60 mGy and 100 mGy respectively, for the youngest children in the 1990s. The doses children received from non-optimised CT examinations during the 1990s are of such magnitude that they may provide statistically significant effects in the EPI-CT study, but probably do not reflect current practice. • Some organ doses from paediatric CT in the 1990s may have exceeded 100 mGy. • Small children may have received doses 2-3 times higher compared with adults. • Different scanner models varied by a factor of 2-3 in dose to patients. • Different local scan parameter settings gave dose variations of a factor 2-3. • Modern CTs and age-adjusted protocols will give much lower paediatric doses.

Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research

PubMed Central

Holley, A.L.; Wilson, A.C.; Noel, M.; Palermo, T.M.

2018-01-01

Background and objective The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology. Databases and data treatment Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms ‘child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder’. Studies were retrieved and reviewed based on relevance to the topic. Results Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain. Conclusions Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. PMID:27275585

Evaluation of three paediatric weight estimation methods in Singapore.

PubMed

Loo, Pei Ying; Chong, Shu-Ling; Lek, Ngee; Bautista, Dianne; Ng, Kee Chong

2013-04-01

Rapid paediatric weight estimation methods in the emergency setting have not been evaluated for South East Asian children. This study aims to assess the accuracy and precision of three such methods in Singapore children: Broselow-Luten (BL) tape, Advanced Paediatric Life Support (APLS) (estimated weight (kg) = 2 (age + 4)) and Luscombe (estimated weight (kg) = 3 (age) + 7) formulae. We recruited 875 patients aged 1-10 years in a Paediatric Emergency Department in Singapore over a 2-month period. For each patient, true weight and height were determined. True height was cross-referenced to the BL tape markings and used to derive estimated weight (virtual BL tape method), while patient's round-down age (in years) was used to derive estimated weights using APLS and Luscombe formulae, respectively. The percentage difference between the true and estimated weights was calculated. For each method, the bias and extent of agreement were quantified using Bland-Altman method (mean percentage difference (MPD) and 95% limits of agreement (LOA)). The proportion of weight estimates within 10% of true weight (p₁₀) was determined. The BL tape method marginally underestimated weights (MPD +0.6%; 95% LOA -26.8% to +28.1%; p₁₀ 58.9%). The APLS formula underestimated weights (MPD +7.6%; 95% LOA -26.5% to +41.7%; p₁₀ 45.7%). The Luscombe formula overestimated weights (MPD -7.4%; 95% LOA -51.0% to +36.2%; p₁₀ 37.7%). Of the three methods we evaluated, the BL tape method provided the most accurate and precise weight estimation for Singapore children. The APLS and Luscombe formulae underestimated and overestimated the children's weights, respectively, and were considerably less precise. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Medical service use in children with cerebral palsy: The role of child and family factors characteristics.

PubMed

Meehan, Elaine M; Reid, Susan M; Williams, Katrina J; Freed, Gary L; Sewell, Jillian R; Reddihough, Dinah S

2016-06-01

The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their child's appointments with general practitioners and public and private paediatric medical specialists over the preceding 12 months. Information on family characteristics and finances was also collected. Data on CP severity and complexity were extracted from the CP Register. Three hundred and fifty parents and carers (39%) participated. Of these, 83% reported that their child had ≥1 appointment with a general practitioner over the preceding 12 months, while 84% had ≥1 appointment with a public or private paediatric medical specialist. Overall, 58% of children saw 2-5 different paediatric medical specialists, while 9% had appointments with ≥6 clinicians. Children with severe and complex CP were more likely to have had ≥1 appointment with a publically funded paediatric medical specialist and had seen a greater number of different clinicians over the study period. Family characteristics were not associated with service use. Children with CP are managed by a number of paediatric medical specialists, and they continue to see a range of specialists throughout adolescence. In Victoria, differences in service use are not based on family characteristics; instead the highest service users are those with severe and complex CP. For this group, care co-ordination and information sharing between treating clinicians are important, if gaps in care are to be avoided. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Transitional care in clinical networks for young people with juvenile idiopathic arthritis: current situation and challenges.

PubMed

Cruikshank, Mary; Foster, Helen E; Stewart, Jane; Davidson, Joyce E; Rapley, Tim

2016-04-01

Clinical networks for paediatric and adolescent rheumatology are evolving, and their effect and role in the transition process between paediatric and adult services are unknown. We therefore explored the experiences of those involved to try and understand this further. Health professionals, young people with juvenile idiopathic arthritis and their families were recruited via five national health service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sector. Variation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encounters. Providing equitable high-quality clinically effective services for transition across the UK has a long way to go. There is a call from within the sector for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organisational change and the interpersonal skills required for collaborative working. Key messages • Transitional care in clinical networks requires collaborative working and an effective interface with paediatric and adult rheumatology.• Professional centrism and historic encounters may affect collaborative relationships within clinical networks.• Education programmes need to support the development of interpersonal skills and change management, to facilitate professionals in networks delivering transitional care.

Complementary and alternative medicine use among paediatric emergency department patients.

PubMed

Taylor, David McDonald; Dhir, Reetika; Craig, Simon S; Lammers, Thalia; Gardiner, Kaya; Hunter, Kirrily; Joffe, Paul; Krieser, David; Babl, Franz E

2015-09-01

To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators. A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM. The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P < 0.001), those with European ethnicity (P = 0.046) and among those with chronic disease (P < 0.01). Fish oil, garlic, chamomile and acidophilus were the most commonly used CAM. Only 4.4% of CAM use was reported to the ED doctor. There were reports of potentially dangerous CAM use (St John's wort, ginseng). Parents/carers who had administered CAM were more likely to report that CAMs are safe, drug free and could prevent illness (P < 0.01). In addition, a number of this group reported that CAMs are more effective than prescription medicines and safe when taken with prescription medicines. CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way?

PubMed Central

Mueller, Rebekka; Ziade, Farah; Pittet, Valérie; Fournier, Nicolas; Ezri, Jessica; Schoepfer, Alain; Schibli, Susanne; Spalinger, Johannes; Braegger, Christian

2016-01-01

Background and Aims: Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents. Methods: Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn’s Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents’ age, origin, education and marital status. Results: We included 110 children and parents (59 Crohn’s disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as ‘mood’, ‘family’ and ‘friends’ domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on ‘school performance’ and ‘physical activity’ domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores. Conclusion: Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education. PMID:26519462

Recent progress in immune-based interventions to prevent HIV-1 transmission to children.

PubMed

Voronin, Yegor; Jani, Ilesh; Graham, Barney S; Cunningham, Coleen K; Mofenson, Lynne M; Musoke, Philippa M; Permar, Sallie R; Scarlatti, Gabriella

2017-12-01

Globally, 150,000 new paediatric human immunodeficiency virus type 1 (HIV-1) infections occurred in 2015. There remain complex challenges to the global elimination of paediatric HIV-1 infection. Thus, for the global community to achieve elimination of new paediatric HIV-1 infections, innovative approaches need to be explored. Immune-based approaches to prevention of mother-to-child transmission (MTCT) may help fill some of the remaining gaps and provide new opportunities to achieve an AIDS-free generation. Immune-based interventions to prevent MTCT of HIV-1 may include paediatric HIV vaccines and passive immunization approaches. Recent discoveries providing evidence of robust immune responses to HIV in infants open new and exciting prospects for paediatric HIV vaccines. Moreover, successful vaccination of infants has a different set of requirements than vaccination of adults and may be easier to achieve. Proof-of-concept has been established over the last two decades that passively administered HIV-1 Env-specific monoclonal antibody (mAbs) can prevent chimeric simian human immunodeficiency virus (SHIV) transmission to newborn nonhuman primates. There has been tremendous progress in isolating and characterizing broadly neutralizing antibodies to HIV, and clinical testing of these antibodies for treatment and prevention in both infants and adults is a major effort in the field. Immune-based interventions need to be actively explored as they can provide critically important tools to address persistent challenges in MTCT prevention. It is a pivotal time for the field with active discussions on the best strategy to further reduce HIV infection of infants and accomplish the World Health Organization Fast-Track 2030 goals to eliminate new paediatric HIV infections. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Review of paediatric cardiology services in district general hospitals in the United Kingdom.

PubMed

Andrews, Hannah; Singh, Yogen

2016-03-01

Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

[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.

Vedolizumab in Paediatric Inflammatory Bowel Disease: A Retrospective Multi-Centre Experience From the Paediatric IBD Porto Group of ESPGHAN.

PubMed

Ledder, Oren; Assa, Amit; Levine, Arie; Escher, Johanna C; de Ridder, Lissy; Ruemmele, Frank; Shah, Neil; Shaoul, Ron; Wolters, Victorien M; Rodrigues, Astor; Uhlig, Holm H; Posovsky, Carsten; Kolho, Kaija-Leena; Jakobsen, Christian; Cohen, Shlomi; Shouval, Dror S; de Meij, Tim; Martin-de-Carpi, Javier; Richmond, Lisa; Bronsky, Jiri; Friedman, Mira; Turner, Dan

2017-10-01

Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with inflammatory bowel disease [IBD], but the data in paediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-centre paediatric IBD cohort. Retrospective review of children [aged 2-18 years] treated with vedolizumab from 19 centres affiliated with the Paediatric IBD Porto group of ESPGHAN. Primary outcome was Week 14 corticosteroid-free remission [CFR]. In all, 64 children were included (32 [50%] male, mean age 14.5 ± 2.8 years, with a median follow-up 24 weeks [interquartile range 14-38; range 6-116]); 41 [64%] cases of ulcerative colitis/inflammatory bowel disease unclassified [UC/IBD-U] and 23 [36%] Crohn's disease [CD]. All were previously treated with anti-tumour necrosis factor [TNF] [28% primary failure, 53% secondary failure]. Week 14 CFR was 37% in UC, and 14% in CD [P = 0.06]. CFR by last follow-up was 39% in UC and 24% in CD [p = 0.24]. Ten [17%] children required surgery, six of whom had colectomy for UC. Concomitant immunomodulatory drugs did not affect remission rate [42% vs 35%; p = 0.35 at Week 22]. There were three minor drug-related adverse events. Only 3 of 16 children who underwent endoscopic evaluation had mucosal healing after treatment (19%). Vedolizumab was safe and effective in this cohort of paediatric refractory IBD. These data support previous findings of slow induction rate of vedolizumab in CD and a trend to be less effective compared with patients with UC. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

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

Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way?

PubMed

Mueller, Rebekka; Ziade, Farah; Pittet, Valérie; Fournier, Nicolas; Ezri, Jessica; Schoepfer, Alain; Schibli, Susanne; Spalinger, Johannes; Braegger, Christian; Nydegger, Andreas

2016-03-01

Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents. Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn's Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents' age, origin, education and marital status. We included 110 children and parents (59 Crohn's disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as 'mood', 'family' and 'friends' domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on 'school performance' and 'physical activity' domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores. Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Case mix in paediatric rheumatology: implications for training in Australia.

PubMed

Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

2012-05-01

Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Epidemiology of paediatric presentations with musculoskeletal problems in primary care.

PubMed

Tan, Albert; Strauss, Victoria Y; Protheroe, Joanne; Dunn, Kate M

2018-02-06

Musculoskeletal disease is a common cause of morbidity, but there is a paucity of musculoskeletal research focusing on paediatric populations, particularly in primary care settings. In particular, there is limited information on population consultation frequency in paediatric populations, and frequency varies by age and sex. Few studies have examined paediatric musculoskeletal consultation frequency for different body regions. The objective was to determine the annual consultation prevalence of regional musculoskeletal problems in children in primary care. Musculoskeletal codes within the Read morbidity Code system were identified and grouped into body regions. Consultations for children aged three to seventeen in 2006 containing these codes were extracted from recorded consultations at twelve general practices contributing to a general practice consultation database (CiPCA). Annual consultation prevalence per 10,000 registered persons for the year 2006 was determined, stratified by age and sex, for problems in individual body regions. Over 8 % (8.27%, 95% CI 7.86 to 8.68%) of the 16,862 children consulted with a musculoskeletal problem during 2006. Annual consultation prevalence for any musculoskeletal problem was significantly higher in males than females (male: female prevalence ratio 1.18, 95% CI 1.06 to 1.31). Annual consultation prevalence increased with age and the most common body regions consulted for were the foot, knee and back all of which had over 100 consultations (109, 104 and 101 respectively) per 10,000 persons per year. This study provides new and detailed information on patterns of paediatric musculoskeletal consultations in primary care. Musculoskeletal problems in children are varied and form a significant part of the paediatric primary care workload. The findings of this study may be used as a resource for planning future studies.

Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis.

PubMed

Pradas-Hernández, Laura; Ariza, Tania; Gómez-Urquiza, José Luis; Albendín-García, Luis; De la Fuente, Emilia I; Cañadas-De la Fuente, Guillermo A

2018-01-01

Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature. The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment. For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation "burnout AND "pediatric nurs*", and was conducted in July 2017. The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25-37%); (ii) depersonalisation, 21% (95% CI: 11-33%); (iii) low personal accomplishment, 39% (95% CI: 28-50%). A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to burnout.

Global shortage of neonatal and paediatric antibiotic trials: rapid review.

PubMed

Thompson, Georgina; Barker, Charlotte I; Folgori, Laura; Bielicki, Julia A; Bradley, John S; Lutsar, Irja; Sharland, Mike

2017-10-13

There have been few clinical trials (CTs) on antibiotics that inform neonatal and paediatric drug labelling. The rate of unlicensed and off-label prescribing in paediatrics remains high. It is unclear whether the current neonatal and paediatric antibiotic research pipeline is adequate to inform optimal drug dosing. Using the ClinicalTrials.gov registry, this review aims to establish the current global status of antibiotic CTs in children up to 18 years of age. Studies were identified using key word searches of the ClinicalTrials.gov registry and were manually filtered using prespecified inclusion/exclusion criteria. 76 registered open CTs of antibiotics in children were identified globally; 23 (30%) were recruiting newborns (only 8 (11%) included preterm neonates), 52 (68%) infants and toddlers, 58 (76%) children and 54 (71%) adolescents. The majority of registered trials were late phase (10 (15%) phase 3 and 23 (35%) phase 4/pharmacovigilance). Two-thirds were sponsored by non-profit organisations, compared with pharmaceutical companies (50 (66%) vs 26 (34%), respectively). A greater proportion of non-profit funded trials were efficacy-based strategic trials (n=34, 68%), in comparison with industry-led trials, which were most often focused on safety or pharmacokinetic data (n=17, 65%). Only 2 of the 37 antibiotics listed on the May 2016 Pew Charitable Trusts antibiotic development pipeline, currently being studied in adults, appear to be currently recruiting in open paediatric CTs. This review highlights that very few paediatric antibiotic CTs are being conducted globally, especially in neonates. There is a striking disparity noted between antibiotic drug development programmes in adults and children. © 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.

Digital stethoscopes compared to standard auscultation for detecting abnormal paediatric breath sounds.

PubMed

Kevat, Ajay C; Kalirajah, Anaath; Roseby, Robert

2017-07-01

Our study aimed to objectively describe the audiological characteristics of wheeze and crackles in children by using digital stethoscope (DS) auscultation, as well as assess concordance between standard auscultation and two different DS devices in their ability to detect pathological breath sounds. Twenty children were auscultated by a paediatric consultant doctor and digitally recorded using the Littman™ 3200 Digital Electronic Stethoscope and a Clinicloud™ DS with smart device. Using spectrographic analysis, we found those with clinically described wheeze had prominent periodic waveform segments spanning expiration for a period of 0.03-1.2 s at frequencies of 100-1050 Hz, and occasionally spanning shorter inspiratory segments; paediatric crackles were brief discontinuous sounds with a distinguishing waveform. There was moderate concordance with respect to wheeze detection between digital and standard binaural stethoscopes, and 100% concordance for crackle detection. Importantly, DS devices were more sensitive than clinician auscultation in detecting wheeze in our study. Objective definition of audio characteristics of abnormal paediatric breath sounds was achieved using DS technology. We demonstrated superiority of our DS method compared to traditional auscultation for detection of wheeze. What is Known: • The audiological characteristics of abnormal breath sounds have been well-described in adult populations but not in children. • Inter-observer agreement for detection of pathological breath sounds using standard auscultation has been shown to be poor, but the clinical value of now easily available digital stethoscopes has not been sufficiently examined. What is New: • Digital stethoscopes can objectively define the nature of pathological breath sounds such as wheeze and crackles in children. • Paediatric wheeze was better detected by digital stethoscopes than by standard auscultation performed by an expert paediatric clinician.

A paediatric and perinatal HIV/AIDS leadership initiative in Kingston, Jamaica.

PubMed

Christie, C D C

2004-10-01

In Jamaica 1-2% of pregnant women are HIV-positive; 876 HIV-positive pregnant women will deliver and at least 283 newly infected HIV-infected infants will be born in 2003; HIV/AIDS is the leading cause of death in children aged one to four years. We describe a collaborative "Town and Gown" programme to address the paediatric and perinatal HIV epidemic in Kingston. A team of academic and government healthcare personnel, comprising paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data management and information technology personnel collaborated to address this public health emergency. A five-point plan was implemented This comprised leadership and training of a core group of paediatric/perinatal HIVprofessionals to serve Greater Kingston and St Catherine and be a model for the rest of Jamaica. Mother-to-child transmission of HIV/AIDS is prevented by counselling and HIV-testing women in the antenatal clinics, giving azidothymidine (AZT) to HIV pregnant women beginning at 28 weeks gestation, throughout labour and to the HIV-exposed infants for the first six weeks of life. A unified parallel programme for identifying the HIV-infected infant and delivering paediatric HIV care at the major paediatric centres was implemented In three years, over 30,000 pregnant women are being tested for HIV; 600 HIV-exposed babies are being identified and about 140 paediatric HIV infections will be prevented The team is building research capacity which emphasizes a strong outcomes-based research agenda and implementation of clinical trials. We are collaborating, locally, regionally and internationally. Collaboratively, the mission of reducing mother-to-child transmission of HIV/AIDS and improving the quality of life for those already living and affected by HIV/AIDS can be achieved.

A model for peer-assisted learning in paediatrics.

PubMed

Gandhi, Ajay; Primalani, Nishal; Raza, Sadaf; Marlais, Matko

2013-10-01

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 paediatrics has not been evaluated in the literature. This study aimed to evaluate a student-led paediatrics 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 practice (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 paediatrics 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 paediatrics to increase student confidence and potentially increase recruitment to paediatrics. © 2013 John Wiley & Sons Ltd.

[The way we were. On the centenary of the first Spanish Congress of Paediatrics in Palma de Mallorca (1914-2014)].

PubMed

Ponte Hernando, F; Zafra Anta, M; Fernández Menéndez, J M; Gorrotxategi Gorrotxategi, P; Bassat, Q; Fernández Teijeiro, J J; de Arana Amurrio, J I; García Nieto, V

2014-06-01

Between the 19th and 25th April 1914, the First Spanish Congress of Paediatrics was held in Palma de Mallorca under the slogan "Protect the Children". The specialty had broken away a few years earlier from its secular connection with Obstetrics and Gynaecology, both in its teaching aspect as well as regarding healthcare. With the newly created Chairs in Childhood Diseases, in a way this Congress meant the coming-of age and debut int society of paediatrics in our country. Prof. Martínez Vargas, a university professor in Barcelona, was the Chairman, and soul of the congress. There was a need to face a very high rate of infant mortality. The Congress responded to that social and sanitary/health demand with the participation of over three hundred pediatricians, including foreign representatives from Belgium, France, Russia and Latin America. The activities were divided into four sections: Childcare, Child Medicine, Surgery and Health, and accredited lecturers gave master classes on the most pressing issues of child pathology of the time. One hundred years on, what we are today is the fruit gathered by those who preceded us. Some were brilliant figures in paediatrics and others, the majority, anonymous paediatricians. They dedicated their lives, their science and their best smile to child care. The way we were and the way we are. With legitimate pride and satisfaction, it is an honour for the Group on the History of Paediatrics and AEP Documentation to celebrate this centennial commemoration in the framework of the Annals of Paediatrics. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

[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 (NO 2 ) 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 SO 2 , CO, NOx and NO 2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO 2 levels exceeded 40μg/m 3 . In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO 2 levels (3.630, 95% CI: 0.691-6.570), and negative with temperature (-5,957, 95% CI: -8.665 to -3.248). NO 2 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.

Attitudes towards fever amongst UK paediatric intensive care staff.

PubMed

Brick, Thomas; Agbeko, Rachel S; Davies, Patrick; Davis, Peter J; Deep, Akash; Fortune, Peter-Marc; Inwald, David P; Jones, Amy; Levin, Richard; Morris, Kevin P; Pappachan, John; Ray, Samiran; Tibby, Shane M; Tume, Lyvonne N; Peters, Mark J

2017-03-01

The role played by fever in the outcome of critical illness in children is unclear. This survey of medical and nursing staff in 35 paediatric intensive care units and transport teams in the United Kingdom and Ireland established attitudes towards the management of children with fever. Four hundred sixty-two medical and nursing staff responded to a web-based survey request. Respondents answered eight questions regarding thresholds for temperature control in usual clinical practice, indications for paracetamol use, and readiness to participate in a clinical trial of permissive temperature control. The median reported threshold for treating fever in clinical practice was 38 °C (IQR 38-38.5 °C). Paracetamol was reported to be used as an analgesic and antipyretic but also for non-specific comfort indications. There was a widespread support for a clinical trial of a permissive versus a conservative approach to fever in paediatric intensive care units. Within a trial, 58% of the respondents considered a temperature of 39 °C acceptable without treatment. Staff on paediatric intensive care units in the United Kingdom and Ireland tends to treat temperatures within the febrile range. There was a willingness to conduct a randomized controlled trial of treatment of fever. What is known: • The effect of fever on the outcome in paediatric critical illness is unknown. • Paediatricians have traditionally been reluctant to allow fever in sick children. What is new: • Paediatric intensive care staff report a tendency towards treating fever, with a median reported treatment threshold of 38 °C. • There is widespread support amongst PICU staff in the UK for a randomized controlled trial of temperature in critically ill children. • Within a trial setting, PICU staff attitudes to fever are more permissive than in clinical practice.

Initial in vitro testing of a paediatric continuous-flow total artificial heart.

PubMed

Fukamachi, Kiyotaka; Karimov, Jamshid H; Horvath, David J; Sunagawa, Gengo; Byram, Nicole A; Kuban, Barry D; Moazami, Nader

2018-06-01

Mechanical circulatory support has become standard therapy for adult patients with end-stage heart failure; however, in paediatric patients with congenital heart disease, the options for chronic mechanical circulatory support are limited to paracorporeal devices or off-label use of devices intended for implantation in adults. Congenital heart disease and cardiomyopathy often involve both the left and right ventricles; in such cases, heart transplantation, a biventricular assist device or a total artificial heart is needed to adequately sustain both pulmonary and systemic circulations. We aimed to evaluate the in vitro performance of the initial prototype of our paediatric continuous-flow total artificial heart. The paediatric continuous-flow total artificial heart pump was downsized from the adult continuous-flow total artificial heart configuration by a scale factor of 0.70 (1/3 of total volume) to enable implantation in infants. System performance of this prototype was evaluated using the continuous-flow total artificial heart mock loop set to mimic paediatric circulation. We generated maps of pump performance and atrial pressure differences over a wide range of systemic vascular resistance/pulmonary vascular resistance and pump speeds. Performance data indicated left pump flow range of 0.4-4.7 l/min at 100 mmHg delta pressure. The left/right atrial pressure difference was maintained within ±5 mmHg with systemic vascular resistance/pulmonary vascular resistance ratios between 1.4 and 35, with/without pump speed modulation, verifying expected passive self-regulation of atrial pressure balance. The paediatric continuous-flow total artificial heart prototype met design requirements for self-regulation and performance; in vivo pump performance studies are ongoing.

Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians.

PubMed

Eich, Christoph; Russo, Sebastian G; Heuer, Jan F; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus

2009-08-01

In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the characteristics of OOH paediatric emergencies. We retrospectively evaluated all OOH paediatric emergencies (0-14 years) within a 9-year period and attended by physician-staffed ground- or helicopter-based emergency medical service (EMS or HEMS) teams from our centre. We identified 2271 paediatric emergencies, making up 6.3% of all cases (HEMS 8.5%). NACA scores IV-VII were assigned in 27.3% (HEMS 32.0%). The leading diagnosis groups were age dependent: respiratory disorders (infants 34.5%, toddlers 21.8%, school children 15.0%), convulsions (17.2%, 43.2%, and 16.0%, respectively), and trauma (16.0%, 19.5%, and 44.4%, respectively). Endotracheal intubation was performed in 4.2% (HEMS 7.6%) and intraosseous canulation in 0.7% (HEMS 1.0%) of children. Cardiopulmonary resuscitation (CPR) was commenced in 2.3% (HEMS 3.4%). Thoracocentesis, chest drain insertion and defibrillation were rarities. HEMS physicians attended a particularly high fraction of drowning (80.0%), head injury (73.9%) and SIDS (60.0%) cases, whereas 75.6% of all respiratory emergencies were attended by ground-based EPs. Our data suggest that EPs need to be particularly confident with the care of children suffering respiratory disorders, convulsions, and trauma. The incidence of severe paediatric OOH emergencies requiring advanced interventions is higher in HEMS-attended cases. However, well-developed skills in airway management, CPR, and intraosseous canulation in children are essential for all EPs.

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.

Paediatric nurses' understanding of the process and procedure of double-checking medications.

PubMed

Dickinson, Annette; McCall, Elaine; Twomey, Bernadette; James, Natalie

2010-03-01

To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC). A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process. A descriptive qualitative design was used. Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis. This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients. While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.

Instrument validation process: a case study using the Paediatric Pain Knowledge and Attitudes Questionnaire.

PubMed

Peirce, Deborah; Brown, Janie; Corkish, Victoria; Lane, Marguerite; Wilson, Sally

2016-06-01

To compare two methods of calculating interrater agreement while determining content validity of the Paediatric Pain Knowledge and Attitudes Questionnaire for use with Australian nurses. Paediatric pain assessment and management documentation was found to be suboptimal revealing a need to assess paediatric nurses' knowledge and attitude to pain. The Paediatric Pain Knowledge and Attitudes Questionnaire was selected as it had been reported as valid and reliable in the United Kingdom with student nurses. The questionnaire required content validity determination prior to use in the Australian context. A two phase process of expert review. Ten paediatric nurses completed a relevancy rating of all 68 questionnaire items. In phase two, five pain experts reviewed the items of the questionnaire that scored an unacceptable item level content validity. Item and scale level content validity indices and intraclass correlation coefficients were calculated. In phase one, 31 items received an item level content validity index <0·78 and the scale level content validity index average was 0·80 which were below levels required for acceptable validity. The intraclass correlation coefficient was 0·47. In phase two, 10 items were amended and four items deleted. The revised questionnaire provided a scale level content validity index average >0·90 and an intraclass correlation coefficient of 0·94 demonstrating excellent agreement between raters therefore acceptable content validity. Equivalent outcomes were achieved using the content validity index and the intraclass correlation coefficient. To assess content validity the content validity index has the advantage of providing an item level score and is a simple calculation. The intraclass correlation coefficient requires statistical knowledge, or support, and has the advantage of accounting for the possibility of chance agreement. © 2016 John Wiley & Sons Ltd.

[The prevention of pressure sores in paediatric intensive care].

PubMed

Thueux, Emilie

2014-01-01

In paediatric intensive care, children develop pressure sores as a result of various mechanical and clinical factors. The prevention and assessment of the risk of pressure sores constitute a key concern for the nursing teams which establish prevention strategies adapted to the young patients.

Twenty-nine-month follow-up of a paediatric zirconia dental crown.

PubMed

Lopez Cazaux, Serena; Hyon, Isabelle; Prud'homme, Tony; Dajean Trutaud, Sylvie

2017-06-14

The aim of this paper is to present the long-term follow-up of one paediatric zirconia crown on a deciduous molar. Preformed crowns are part of the armamentarium in paediatric dentistry. In recent years, aesthetic alternatives to preformed metal crowns have been developed, first preveneered crowns and then zirconia crowns. This paper describes the restoration of a primary molar with a zirconia crown (EZ-Pedo, Loomis, California, USA) in an 8-year-old boy. In this clinical case, the protocol for the implementation and maintenance of zirconia crowns is detailed. The patient was followed up for 29 months until the natural exfoliation of his primary molar. The adaptation of the zirconia crown, the gingival health and the wear on the opposing tooth were considered. In this case, the paediatric zirconia crown allowed sustainable functional restoration while restoring a natural appearance of the tooth. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology

PubMed Central

Freebody, John; Wegner, Eva A; Rossleigh, Monica A

2014-01-01

Positron emission tomography (PET) is a minimally invasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Traditionally the value of PET and PET/computed tomography (CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these modalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indications for 2-deoxy-2-(18F)fluoro-D-glucose (FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type I. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology. PMID:25349660

Paediatric surgery outreach: analysis of referrals to a tertiary paediatric surgery service to plan an outreach programme Kwa-Zulu Natal, South Africa.

PubMed

Manickchund, Yashoda; Hadley, G P

2017-10-01

Paediatric surgical disease is a neglected health problem. Patients travel great distances to tertiary level care for management. This study aimed at analysing referral patterns to design an outreach programme for paediatric surgery in KwaZulu Natal. Data forms of patients referred to the service between January and July 2016 were correlated with the clinical record. Delays in management were compared to morbidity and mortality. Out of 781, 158 referrals were accepted as emergencies. The majority (62%) were children aged < 1 year. Gastro-intestinal problems (38.4%) and congenital anomalies (26.9%) formed the majority. Patients who died had a significantly longer delay in transfer. Longer total delay was associated with statistically significant greater morbidity. In a setting where a large rural population is served by single-centre tertiary care, delays exist and contribute to morbidity. The authors advocate the establishment of an outreach programme to address these issues.

Accelerated oral nanomedicine discovery from miniaturized screening to clinical production exemplified by paediatric HIV nanotherapies

PubMed Central

Giardiello, Marco; Liptrott, Neill J.; McDonald, Tom O.; Moss, Darren; Siccardi, Marco; Martin, Phil; Smith, Darren; Gurjar, Rohan; Rannard, Steve P.; Owen, Andrew

2016-01-01

Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes. PMID:27767027

Patient participation, a prerequisite for care: A grounded theory study of healthcare professionals' perceptions of what participation means in a paediatric care context.

PubMed

Carlsson, Ing-Marie; Nygren, Jens M; Svedberg, Petra

2018-01-01

To explore healthcare professionals' perceptions of what patient participation means in a paediatric care context . A qualitative explorative design with grounded theory. Fifteen healthcare professionals who worked in paediatric care settings were either interviewed or asked open-ended questions in a survey, during December 2015-May 2016. Grounded theory was used as a method. The study results provide a theoretical conceptualization of what patient participation meant for healthcare professionals in paediatric care and how participation was enabled. The core category "participation a prerequisite for care" emerged as the main finding explaining the concept as ethical, practical and integrated in the care givers way of working. However, the concept was implicit in the organization. Four additional categories illustrated the healthcare professionals' different strategies used to enhance patient participation; "meeting each child where the child is," "building a relationship with the child," "showing respect for each individual child" and "making the most of the moment."

Osmotic demyelination syndrome associated with hypophosphataemia: 2 cases and a review of literature.

PubMed

Turnbull, Jessica; Lumsden, Daniel; Siddiqui, Ata; Lin, Jean-Pierre; Lim, Ming

2013-04-01

Central and extrapontine myelinolysis are collectively known as osmotic demyelination syndrome. This encephalopathic illness has been well documented in the adult literature, occurring most commonly in the context of chronic alcoholism, correction of hyponatraemia and liver transplantation. Aetiology and outcome in the paediatric population are less well understood. Two cases of osmotic demyelination syndrome occurring in children with transient severe hypophosphataemia during the course of their illness are presented. Both had very different neurological outcomes, but the changes of central and extrapontine myelinolysis were apparent on neuroimaging. Sixty-one cases in the paediatric literature were then reviewed. We summarize aetiology and outcome in paediatric cases of osmotic demyelination syndrome and postulate a role for hypophosphataemia as a contributing factor in the development of these sometimes devastating conditions. Hypophosphataemia may contribute to the risk of developing osmotic demyelination syndrome in at-risk paediatric patients and further study of this association should be undertaken. ©2012 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

Delivering pediatric HIV care in resource-limited settings: cost considerations in an expanded response.

PubMed

Tolle, Michael A; Phelps, B Ryan; Desmond, Chris; Sugandhi, Nandita; Omeogu, Chinyere; Jamieson, David; Ahmed, Saeed; Reuben, Elan; Muhe, Lulu; Kellerman, Scott E

2013-11-01

If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.

[The latest in paediatric resuscitation recommendations].

PubMed

López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio

2017-04-01

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Approaching the third decade of paediatric palliative oncology investigation: historical progress and future directions

PubMed Central

Rosenberg, Abby R; Wolfe, Joanne

2017-01-01

Paediatric palliative care (PPC) endeavours to alleviate the suffering and improve the quality of life of children with serious illnesses and their families. In the past two decades since WHO defined PPC and called for its inclusion in paediatric oncology care, rigorous investigation has provided important insights. For example, the first decade of research focused on end-of-life experiences of the child and the family, underscoring the high prevalence of symptom burden, the barriers to parent–provider concordance with regards to prognosis, as well as the need for bereavement supports. The second decade expanded PPC oncology investigation to include the entire cancer continuum and the voices of patients. Other studies identified the need for support of parents, siblings, and racial and ethnic minority groups. Promising interventions designed to improve outcomes were tested in randomised clinical trials. Future research will build on these findings and pose novel questions about how to continue to reduce the burdens of paediatric cancer. PMID:29333484

Paediatric obstructive sleep apnoea: is our operative management evidence-based?

PubMed

Pabla, L; Duffin, J; Flood, L; Blackmore, K

2018-04-01

Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence. A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment. There are many gaps in the evidence base for the surgical correction of obstructive sleep apnoea. There is emerging evidence favouring subtotal tonsillectomy. There is continuing uncertainty around the prediction of the level of post-operative care that any individual child might require. The long-term benefit of surgical correction is a particularly fertile ground for further research.

[Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)].

PubMed

Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Saavedra Lozano, J

2015-09-01

The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Decision Making in Paediatric Cardiology. Are We Prone to Heuristics, Biases and Traps?

PubMed

Ryan, Aedin; Duignan, Sophie; Kenny, Damien; McMahon, Colin J

2018-01-01

Hidden traps in decision making have been long recognised in the behavioural economics community. Yet we spend very limited, if any time, analysing our decision-making processes in medicine and paediatric cardiology. Systems 1 and 2 thought processes differentiate between rapid emotional thoughts and slow deliberate rational thoughts. For fairly clear cut medical decisions, in-depth analysis may not be needed, but in our field of paediatric cardiology it is not uncommon for challenging cases and occasionally 'simple' cases to generate significant debate and uncertainty as to the best decision. Although morbidity and mortality meetings frequently highlight poor outcomes for our patients, they often neglect to analyse the process of thought which underlined those decisions taken. This article attempts to review commonly acknowledged traps in decision making in the behavioural economics world to ascertain whether these heuristics translate to decision making in the paediatric cardiology environment. We also discuss potential individual and collective solutions to pitfalls in decision making.

Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

PubMed

Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

2014-04-01

Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

PACE: Pharmacists use the power of communication in paediatric asthma.

PubMed

Elaro, Amanda; Shah, Smita; Pomare, Luca N; L Armour, Carol; Z Bosnic-Anticevich, Sinthia

2014-10-01

Paediatric asthma is a public health burden in Australia despite the availability of national asthma guidelines. Community pharmacy interventions focusing on paediatric asthma are scarce. Practitioner Asthma Communication and Education (PACE) is an evidence-based program, developed in the USA for general practice physicians, aimed at addressing the issues of poor clinician-patient communication in the management of paediatric asthma. This program has been shown to improve paediatric asthma management practices of general practitioners in the USA and Australia. The development of a PACE program for community pharmacists will fill a void in the current armamentarium for pharmacist-patient care. To adapt the educational program, PACE, to the community pharmacy setting. To test the feasibility of the new program for pharmacy and to explore its potential impact on pharmacists' communication skills and asthma related practices. Community pharmacies located within the Sydney metropolitan. The PACE framework was reviewed by the research team and amended in order to ensure its relevance within the pharmacy context, thereby developing PACE for Pharmacy. Forty-four pharmacists were recruited and trained in small groups in the PACE for Pharmacy workshops. Pharmacists' satisfaction and acceptability of the workshops, confidence in using communication strategies pre- and post-workshop and self-reported behaviour change post workshop were evaluated. Pharmacist self-reported changes in communication and teaching behaviours during a paediatric asthma consultation. All 44 pharmacists attended both workshops, completed pre- and post-workshop questionnaires and provided feedback on the workshops (100 % retention). The participants reported a high level of satisfaction and valued the interactive nature of the workshops. Following the PACE for Pharmacy program, pharmacists reported significantly higher levels in using the communication strategies, confidence in their application and their helpfulness. Pharmacists checked for written asthma self-management plan possession and inhaler device technique more regularly, and provided verbal instructions more frequently to paediatric asthma patients/carers at the initiation of a new medication. This study provides preliminary evidence that the PACE program can be translated into community pharmacy. PACE for Pharmacy positively affected self-reported communication and education behaviours of pharmacists. The high response rate shows that pharmacists are eager to expand on their clinical role in primary healthcare.

Informed consent in paediatric critical care research--a South African perspective.

PubMed

Morrow, Brenda M; Argent, Andrew C; Kling, Sharon

2015-09-09

Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive. By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa. Voluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent. Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices. We propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child's participation in clinical research when it is ethically justifiable and in the best interests of both child participant and parent. Where appropriate, alternatives to prospective informed consent should be considered to ensure that important paediatric critical care research can be undertaken in South Africa, whilst being cognisant of research risk. This document could provide a basis for debate on consent options in paediatric critical care research and contribute to efforts to advocate for South African law reform.

Paediatric injuries at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 150 cases

PubMed Central

2013-01-01

Background Injuries continue to be the leading cause of death and disability for children. The is a paucity of published data on paediatric injuries in our local environment. This study describes the etiological spectrum, injury characteristics and treatment outcome of paediatric injuries in our local setting and provides baseline data for establishment of prevention strategies as well as treatment guidelines. Methods This was a descriptive cross-sectional study involving paediatric injury patients admitted to Bugando Medical Centre from August 2011 to April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 12.0. Results A total of 150 patients were studied. The age of patients ranged from 1 month to 10 years with a median age of 5 years. The male to female ratio was 2.3:1. Road traffic accident was the most common cause of injury (39.3%) and motorcycle (71.2%) was responsible for the majority of road traffic accidents. Only 11 (7.3%) patients received pre-hospital care. The head /neck (32.7%) and musculoskeletal (28.0%) were the most frequent body region injured. Open wounds (51.4%), foreign bodies (31.3%) and fractures (17.3%) were the most common type of injuries sustained. The majority of patients 84 (56.0%) were treated surgically. Complication rate was 3.9%. The mean duration of hospitalization was 9.7 ± 13.1 days. Mortality rate was 12.7%. Age of the patient (< 5 years), late presentation and presence of complications were the main predictors of length of hospital stay (P < 0.001), whereas burn injuries, severe head injuries and severity of injury (Paediatric trauma score = 0–5) significantly predicted mortality (P < 0.0001). Conclusion Paediatric injuries resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of paediatric injuries in this region. PMID:24499558

Bloodstream infection in paediatric cancer centres--leukaemia and relapsed malignancies are independent risk factors.

PubMed

Ammann, R A; Laws, H J; Schrey, D; Ehlert, K; Moser, O; Dilloo, D; Bode, U; Wawer, A; Schrauder, A; Cario, G; Laengler, A; Graf, N; Furtwängler, R; Simon, A

2015-05-01

In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%). In 57%, the BSI occurred in inpatients, in 79% after conventional chemotherapy. Only 56 % of the patients showed neutropenia at BSI onset. Eventually, patients with acute lymphoblastic leukaemia (ALL) or acute myeloblastic leukaemia (AML), relapsed malignancy and patients with a Broviac faced an increased risk of BSI in the multivariate analysis. Relapsed malignancy (16%) was an independent risk factor for all BSI and for Gram-positive BSI. This study confirms relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. On a unit level, data on BSIs in this high-risk population derived from prospective surveillance are not only mandatory to decide on empiric antimicrobial treatment but also beneficial in planning and evaluating preventive bundles. • Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in paediatric cancer patients mainly outside the stem cell transplantation setting during conventional intensive therapy and argues for prospective surveillance programmes to target and evaluate preventive bundle interventions.

Genetic testing for paediatric neurological disorders.

PubMed

Valente, Enza Maria; Ferraris, Alessandro; Dallapiccola, Bruno

2008-12-01

Paediatric neurological disorders encompass a large group of clinically heterogeneous diseases, of which some are known to have a genetic cause. Over the past few years, advances in nosological classifications and in strategies for molecular testing have substantially improved the diagnosis, genetic counselling, and clinical management of many patients, and have facilitated the possibility of prenatal diagnoses for future pregnancies. However, the increasing availability of genetic tests for paediatric neurological disorders is raising important questions with regard to the appropriateness, choice of protocols, interpretation of results, and ethical and social concerns of these services. In this Review, we discuss these topics and how these concerns affect genetic counselling.

Intravenous maintenance fluid therapy in children.

PubMed

McNab, Sarah

2016-02-01

Intravenous fluids are frequently used in paediatrics but have been associated with significant adverse outcomes. Understanding the composition of fluid prescribed and administering an appropriate rate is essential for safe fluid administration, along with regular monitoring. Recent evidence has shown that using an isotonic fluid with a sodium concentration similar to plasma can decrease the risk of hyponatraemia without an increase in adverse effects. This should lead to a change in guidelines: isotonic fluid should now be used as the primary maintenance intravenous fluid given to the majority of children. © 2016 The Author Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

PubMed Central

Trevisi, P.; Zanoletti, E.; Cazzador, D.; Volo, T.; Emanuelli, E.; Martini, A.

2017-01-01

SUMMARY In the last 20 years, neonatal survival has progressively increased due to the constant amelioration of neonatal medical treatment and surgical techniques. Thus, the number of children with congenital malformations and severe chronic pathologies who need rehabilitative care has progressively increased. Rehabilitation programs for paediatric patients with disorders of voice, speech and language, communication and hearing, deglutition and breathing are not widely available in hospital settings or in long-term care facilities. In most countries, the number of physicians and technicians is still inadequate; moreover, multidisciplinary teams dedicated to paediatric patients are quite rare. The aim of the present study is to present some new trends in ENT paediatric rehabilitation. PMID:28530252

An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital.

PubMed

Mali, Swapna; Dash, Lona; Gautam, Vikas; Shastri, Jayanthi; Kumar, Sunil

2017-01-01

Burkholderia cepacia complex (Bcc) has emerged as a serious nosocomial pathogen worldwide especially in patients with indwelling catheters and cystic fibrosis. Bcc is a common contaminant of pharmaceutical products. We describe an outbreak of Bcc bacteraemia amongst children admitted in Paediatric Intensive Care Unit (PICU) and paediatric ward at a tertiary care hospital, Mumbai, in Western India. Blood culture samples from paediatric patients yielded growth of non-fermenting, oxidase positive, motile, Gram negative bacilli (NFGNB) (76/909) over a period of 8 months. Based on conventional biochemical tests and antimicrobial susceptibility testing, these isolates were provisionally identified as Bcc. The increased, repeated and continued isolation of Bcc alerted the possibility of an outbreak confined to PICU and paediatric ward. Active surveillance was undertaken to trace the source and contain the outbreak. Isolates were subjected to recA polymerase chain reaction (PCR) and Expanded multilocus sequence typing (EMLST). Surveillance revealed the presence of Bcc on the upper surface of rubber stopper of sealed multidose amikacin vials. Isolates from blood culture and rubber stoppers were confirmed as Bcc by recA PCR. EMLST revealed that these isolates shared an identical novel sequence type 824 proving clonality. Timely interventions instituted led to control of the outbreak. This study highlights the importance of identification and molecular characterization of Bcc to establish its role in infection and outbreak.

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists.

PubMed

Diercke, Katja; Ollinger, Isabelle; Bermejo, Justo Lorenzo; Stucke, Kathrin; Lux, Christopher J; Brunner, Monika

2012-01-01

BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

European Paediatric Formulation Initiative (EuPFI)-Formulating Ideas for Better Medicines for Children.

PubMed

Salunke, Smita; Liu, Fang; Batchelor, Hannah; Walsh, Jenny; Turner, Roy; Ju, Tzuchi Rob; Tuleu, Catherine

2017-02-01

The European Paediatric Formulation Initiative (EuPFI), founded in 2007, aims to promote and facilitate the preparation of better and safe medicines for children through linking research and information dissemination. It brings together the capabilities of the industry, academics, hospitals, and regulators within a common platform in order to scope the solid understanding of the major issues, which will underpin the progress towards the future of paediatric medicines we want.The EuPFI was formed in parallel to the adoption of regulations within the EU and USA and has served as a community that drives research and dissemination through publications and the organisation of annual conferences. The membership and reach of this group have grown since its inception in 2007 and continue to develop and evolve to meet the continuing needs and ambitions of research into and development of age appropriate medicines. Five diverse workstreams (age-appropriate medicines, Biopharmaceutics, Administration Devices, Excipients and Taste Assessment & Taste Masking (TATM)) direct specific workpackages on behalf of the EuPFI. Furthermore, EuPFI interacts with multiple diverse professional groups across the globe to ensure efficient working in the area of paediatric medicines. Strong commitment and active involvement of all EuPFI stakeholders have proved to be vital to effectively address knowledge gaps related to paediatric medicines, discuss potential areas for further research and identify issues that need more attention and analysis in the future.

[Diagnostic yield of paediatric respiratory samples in the Balearic Islands Sentinel Influenza Surveillance Network].

PubMed

Reina, J; Nicolau, A; Galmes, A; Arbona, B

2009-05-01

Influenza disease is subjected to surveillance by national networks (RC) that predict the epidemic behaviour by reporting clinical and virological data. To evaluate the effectiveness of the paediatric respiratory samples in the Balearic Islands RC in the last five epidemic seasons. A breath sample was taken from paediatric patients in the RC who had flu symptoms. The samples were inoculated in the MDCK cell line. We reviewed the epidemiological data of patients with a culture positive to influenza A and B. A total of 338 pharyngeal swabs from the RC were analysed during the study period. Of these, 65 (19.3%) belonged to <14 years old patients, and 44.6% of the samples were positive as opposed to 39.1% of adult respiratory samples. The influenza A virus was isolated in 24 paediatric samples (82.7%) and the influenza B virus in 5 (17.3%). The mean age of the paediatric patients of the RC who were positive was 8.5 years. Only 3 patients in the 0-4 year old group were positive (10.3%) and 26 patients (89.7%) in the 5-14 years old group. In spite that paediatricians represented only 22% of the RC doctors and obtain the 19.3% of all respiratory samples, the percentage and effectiveness of these is higher that that obtained in the adult population.

Continuous medical education (CME): do we need CME for paediatric environmental medicine in Europe?

PubMed

Boese-O'Reilly, Stephan

2007-10-01

The knowledge about the influence of environmental hazards on children's health is increasing enormously. European Ministers of Health and Environment, like many other stakeholders, identified the environmental hazards in Europe for the health of children as so serious, that they called for a "Children's Environment and Health Action Plan for Europe (CEHAPE)" approved in June 2004. The knowledge of paediatricians and other health care providers on children's health and environment in Europe is insufficient, due to the lack of training in environmental medicine for medical students, clinical trainees and postgraduates. Only continuous medical education in environmental medicine can help to fill this gap of knowledge and is thereby urgently needed. The World Health Organization developed a training package for health care providers for children's health and environment, containing excellent material for paediatric training events. The International Network on Children's Health, Environment and Safety (INCHES) developed additional training material for paediatricians within the Children's Health, Environment and Safety Training (CHEST) project. The German Network Children's Health and Environment offers training for paediatric doctors' assistants in primary prevention. To improve knowledge about children's health and environment at all levels in paediatric settings, greater efforts of national institutions, paediatric associations and other institutions are necessary. It is time to strengthen existing structures and to introduce, where necessary, new structures for training in environmental medicine.

A prospective observational study investigating all children presenting to a specialty paediatric burns centre.

PubMed

Stockton, K A; Harvey, J; Kimble, R M

2015-05-01

The aim of this study was to describe the mechanism of injury and outcome of all children who presented to The Stuart Pegg Paediatric Burns Centre (SPPBC) with a burn injury in the year 2013. A detailed proforma was completed prospectively at time of presentation to hospital. During the one year period, 758 children with a median age of 2 years 3 months presented with a burn injury. Overall, 12.7% of patients (n=96) were initially treated as inpatients. Similarities existed between in and outpatients. Over half the children admitted had a scald injury (53.1%). Whilst slightly higher than the outpatient scald rate of 43.1% there was no statistical significant difference. However, there was a significant difference between inpatients and outpatients with respect to other mechanisms of injury. Contact burns were under represented in inpatients (27.1%) compared to outpatients (44.5%), p<0.05. In contrast, flame burns were over represented in inpatients, 11.5% compared to outpatients, 2.9% (p<0.05). Paediatric burns are a common cause of childhood injury. The majority of children present with small to medium sized partial thickness injuries and are managed as outpatients. In order to understand the true impact of paediatric burn injury and to develop appropriate targeted injury prevention campaigns, data repositories must include detailed information regarding outpatient paediatric burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes.

PubMed

Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

2012-02-01

To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. Paediatric residency program at BC Children's Hospital, Vancouver, British Columbia. The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

PubMed Central

Waldman, Amy; Ghezzi, Angelo; Bar-Or, Amit; Mikaeloff, Yann; Tardieu, Marc; Banwell, Brenda

2015-01-01

The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood—and adolescent—onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed. PMID:25142460

[Alessandro Laurinsich, the key player in the progress of paediatrics in the 20(th) century].

PubMed

Farnetani, I; Farnetani, F

2007-02-01

Alessandro Laurinsich was one of the greatest Italian paediatricians of the 20(th) century. He was born in Monfalcone (it was the province of Trieste, but now it belongs to Gorizia) on 29(th) May 1899. After having completed secondary school in Trieste, he obtained a medical degree with honours in 1922 at the University of Naples and entered the paediatric clinic run by Rocco Jemma. Laurinsich was in charge of teaching at the clinic of infectious diseases from 1937 to 1940. During this period he focused on the study of tuberculosis in children, the first applications of pnemoencephalography in Italy, but also studied different malignant tumors of the kidney, neurological and psychological disorders in children, as well as educational problems. In 1940 he had a teaching post in the peadiatric clinic at the University of Siena and remained until 1945 when he moved to Parma. He worked with illegitimate children as well as evacuees. During the 1945-46 academic year, Alessandro Laurinsich was called to direct the paediatric clinic of Parma University where he created a series of paediatric centres and took many initiatives in the area. In 1961 he was offered the paediatric teaching post at the University of Milan, but inexplicably refused it. He was Dean of the faculty of Medicine from 1956 to 1968. He passed away on 2(nd) February 1969 in Parma.

A survey of exercise advice and recommendations in United Kingdom paediatric cardiac clinics.

PubMed

Williams, Craig A; Gowing, Lucy; Horn, Richard; Stuart, Alan Graham

2017-07-01

Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics. A three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice. There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity. Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

Development and validation of a tool to improve paediatric referral/consultation communication.

PubMed

Stille, Christopher J; Mazor, Kathleen M; Meterko, Vanessa; Wasserman, Richard C

2011-08-01

To develop a template to promote brief but high-quality communication between paediatric primary care clinicians and consulting specialists. Through an iterative process with academic and community-based paediatric primary care providers and specialists, the authors identified what content elements would be of value when communicating around referrals. The authors then developed a one-page template to encourage both primary care and specialty clinicians to include these elements when communicating about referrals. Trained clinician reviewers examined a sample of 206 referrals from community primary care providers (PCPs) to specialists in five paediatric specialties at an academic medical centre, coding communication content and rating the overall value of the referral communication. The relationship between the value ratings and each content element was examined to determine which content elements contributed to perceived value. Almost all content elements were associated with increased value as rated by clinician reviewers. The most valuable communications from PCP to specialist contained specific questions for the specialist and/or physical exam features, and the most valuable from specialist to PCP contained brief education for the PCP about the condition; all three elements were found in a minority of communications reviewed. A limited set of communication elements is suitable for a brief communication template in communication from paediatric PCPs to specialists. The use of such a template may add value to interphysician communication.

Paediatric and adolescent traumatic gastrointestinal injuries: results of a European multicentre analysis.

PubMed

Fischerauer, E E; Zötsch, S; Capito, C; Bonnard, A; Sárközy, S; Berndt, J; Hosie, S; Beltra Pico, R; Steinau, G; Wiejek, A; Czauderna, P; Çelik, A; Lain Fernandez, A; Ibanez, V M; Esposito, C; Saxena, A K

2013-10-01

Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort. Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010. Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries. Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Paediatric Palliative Care and Intellectual Disability--A Unique Context

ERIC Educational Resources Information Center

Duc, Jacqueline K.; Herbert, Anthony Robert; Heussler, Helen S.

2017-01-01

Background: Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care. Method: This study describes the complex care of children with life-limiting conditions and intellectual…

Systemic exposure to menthol following administration of peppermint oil to paediatric patients

USDA-ARS?s Scientific Manuscript database

Peppermint oil (PMO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Despite its increasing paediatric use, as in irritable bowel syndrome (IBS) treatment, the pharmacokinetics (PK) of menthol in children given PMO has not been explored. Single-site, exploratory p...

Aetiology of Intellectual Disability in Paediatric Outpatients in Northern India

ERIC Educational Resources Information Center

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

2011-01-01

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

Neuropsychological Differences between Survivors of Supratentorial and Infratentorial Brain Tumours

ERIC Educational Resources Information Center

Patel, S. K.; Mullins, W. A.; O'Neil, S. H.; Wilson, K.

2011-01-01

Background: The purpose of this study is to evaluate the relationship between brain tumour location and core areas of cognitive and behavioural functioning for paediatric brain tumour survivors. The extant literature both supports and refutes an association between paediatric brain tumour location and neurocognitive outcomes. We examined…

[Liposomal cytarabine for the treatment of leptomeningeal dissemination of central nervous system tumours in children and adolescents].

PubMed

Moreno, Lucas; García Ariza, Miguel Angel; Cruz, Ofelia; Calvo, Carlota; Fuster, Jose Luis; Salinas, Jose Antonio; Moscardo, Cristina; Portugal, Raquel; Merino, Jose Manuel; Madero, Luis

2016-11-01

Leptomeningeal dissemination in paediatric central nervous system (CNS) tumours is associated with a poor outcome, and new therapeutic strategies are desperately needed. One of the main difficulties in the treatment of CNS tumours is blood brain barrier penetration. Intrathecal therapy has shown to be effective in several paediatric tumours. The aim of this article is to review the data available on the use of liposomal cytarabine for paediatric patients with leptomeningeal dissemination of CNS tumours, including the pharmacology, administration route, safety and efficacy data. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

The relationship between European paediatricians and commerce: ethical principles in paediatrics working group recommendations. Confederation of European Societies of Paediatrics (CESP).

PubMed

Chambers, T L

2000-01-01

It is important that doctors have an ethically proper relationship with commercial interests. The relationship between paediatricians, paediatric societies and industry is probably healthy. To further the interests of patients it is important that it remains so. This mentionship would be undermined if: there was a perceived conflict of interests between paediatricians, their patients and industry; paediatricians were seen to endorse companies whose marketing and other practices were unethical. It will be enhanced if: paediatricians did not receive individual gain from industry; industrial support for educational and research activities, whether to individuals or institutions, is open, proportionate and accountable.

Out-of-hours work: what is the training value for paediatric senior house officers?

PubMed

Onyon, Clare; Wall, David; Goodyear, Helen

2007-02-01

Out-of-hours work is needed for recognition of training posts. This article looks at the opinions of paediatric senior house officers on the training value of this work. Although senior house officers felt out-of-hours work was important for training, suggested improvements are discussed.

School Psychologists' Perceptions of Primary Care Partnerships: Implications for Building the Collaborative Bridge

ERIC Educational Resources Information Center

Bradley-Klug, Kathy L.; Jeffries-DeLoatche, Kendall L.; Walsh, Audra St. John; Bateman, Lisa P.; Nadeau, Josh; Powers, Derek J.; Cunningham, Jennifer

2013-01-01

There is a critical need to increase communication and collaboration across the educational and medical systems on behalf of students with paediatric health issues. The purpose of the current study was to investigate school psychologists' perceptions of their communication and collaboration practices with paediatric professionals (e.g.…

Reduced N400 Semantic Priming Effects in Adult Survivors of Paediatric and Adolescent Traumatic Brain Injury

ERIC Educational Resources Information Center

Knuepffer, C.; Murdoch, B. E.; Lloyd, D.; Lewis, F. M.; Hinchliffe, F. J.

2012-01-01

The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning…

The innovation of the subspecialty of Paediatric Virology: An interview with Research Professor of Molecular Virology Anna Kramvis

PubMed Central

Mammas, Ioannis N.; Spandidos, Demetrios A.

2017-01-01

Professor Anna Kramvis, Research Professor of Molecular Virology at the University of the Witwatersrand in Johannesburg, South Africa, talks about direct-acting antiviral treatments against hepatitis C virus (HCV), as well as the perspective of the development of an effective vaccine against HCV. She emphasises the necessity of vaccination against hepatitis B virus (HBV), highlighting that it is very important that vaccination should be administered at birth in order to prevent mother-to-child transmission (MTCT) of HBV. Professor Kramvis states that vaccination against HBV is safe and that HBV and HCV infections are not contraindications for breastfeeding. Regarding the challenge of Paediatric Virology, she believes that it is a field that during the last years is increasing exponentially, while she concurs that Paediatric Virology subspecialty will be a popular choice for infectious diseases subspecialists. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Kramvis will give her key lecture on MTCT of HBV and HCV. PMID:29042915

The innovation of the subspecialty of Paediatric Virology: An interview with Research Professor of Molecular Virology Anna Kramvis.

PubMed

Mammas, Ioannis N; Spandidos, Demetrios A

2017-10-01

Professor Anna Kramvis, Research Professor of Molecular Virology at the University of the Witwatersrand in Johannesburg, South Africa, talks about direct-acting antiviral treatments against hepatitis C virus (HCV), as well as the perspective of the development of an effective vaccine against HCV. She emphasises the necessity of vaccination against hepatitis B virus (HBV), highlighting that it is very important that vaccination should be administered at birth in order to prevent mother-to-child transmission (MTCT) of HBV. Professor Kramvis states that vaccination against HBV is safe and that HBV and HCV infections are not contraindications for breastfeeding. Regarding the challenge of Paediatric Virology, she believes that it is a field that during the last years is increasing exponentially, while she concurs that Paediatric Virology subspecialty will be a popular choice for infectious diseases subspecialists. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Kramvis will give her key lecture on MTCT of HBV and HCV.

Bridging the knowledge-resuscitation gap for children: Still a long way to go

PubMed Central

Goldman, Ran D; Ho, Kendall; Peterson, Robert; Kissoon, Niranjan

2007-01-01

The American Heart Association, along with the International Liaison Committee on Resuscitation, recently made changes to the paediatric resuscitation guidelines. Knowledge translation (KT) is imperative, but there is a lack of sufficient evidence for appropriate methodologies for implementation of these guidelines. Paediatric resuscitation presents many challenges; cases happen infrequently, affording few opportunities for implementation of the new guidelines, and are highly stressful and filled with uncertainty. Some KT strategies have shown some success in causing a notable degree of change in behaviour, but none have shown a striking difference when used alone. Previous efforts to disseminate current guidelines centred on development of courses for health care providers and preparing paediatric residents and paediatricians for circumstances they could encounter with paediatric acute illness. None of the studies assessing these techniques measured direct patient outcomes, and only a few demonstrated some long-term knowledge acquisition among trainees. The purpose of the present review was to illuminate the challenges, offer future directions for KT and outline potentially more effective methodologies and strategies to overcome current barriers. PMID:19030414

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Special considerations in paediatric burn patients

PubMed Central

Sharma, Ramesh Kumar; Parashar, Atul

2010-01-01

Burn injuries are a major cause of morbidity and mortality in children. In India, the figure constitutes about one-fourth of the total burn accidents. The management of paediatric burns can be a major challenge for the treating unit. One has to keep in mind that “children are not merely small adults”; there are certain features in this age group that warrant special attention. The peculiarities in the physiology of fluid and electrolyte handling, the uniqueness of the energy requirement and the differences in the various body proportions in children dictate that the paediatric burn management should be taken with a different perspective than for adults. This review article would deal with the special situations that need to be addressed while treating this special class of thermal injuries. We must ensure that not only the children survive the initial injury, but also the morbidity and complications are minimized. If special care is taken during the initial management of paediatric burn injuries, these children can be effectively integrated into the society as very useful and productive members. PMID:21321657

Paediatric electrical burn injuries: experience from a tertiary care burns unit in North India

PubMed Central

Srivastava, S.; Patil, A.N.; Bedi, M.; Tawar, R.S.

2017-01-01

Summary Electrical burn injuries in the paediatric age group constitute a small proportion of all burn cases and cause significant morbidity and long-term psychosocial impact. The objective of this study was to evaluate various aspects of electrical burn injuries in the paediatric age group in our region. A retrospective review was done of all paediatric electrical burns admitted to a tertiary care burns unit over a period of 12 months (January 2016 to December 2016). There were 77 cases of electrical burns under the age of 16 years. High voltage burns predominated and older age groups were more frequently affected. Male:female ratio was 4.1:1. Amputations were required in 18 (23%), skin grafting in 52 (67%) and flap cover in 29 (37%) patients. There were unfavourable outcomes in 32% patients with a mortality rate of 7.8%. Significant association was found between unfavourable outcomes and high voltage burn injuries and length of hospital stay. The impact of electrical burn injuries is substantial and can be reduced by simple preventive measures such as educating parents, improving health infrastructure and adherence to safety regulations.

Pharmacokinetic/pharmacodynamic modelling approaches in paediatric infectious diseases and immunology☆

PubMed Central

Barker, Charlotte I.S.; Germovsek, Eva; Hoare, Rollo L.; Lestner, Jodi M.; Lewis, Joanna; Standing, Joseph F.

2014-01-01

Pharmacokinetic/pharmacodynamic (PKPD) modelling is used to describe and quantify dose–concentration–effect relationships. Within paediatric studies in infectious diseases and immunology these methods are often applied to developing guidance on appropriate dosing. In this paper, an introduction to the field of PKPD modelling is given, followed by a review of the PKPD studies that have been undertaken in paediatric infectious diseases and immunology. The main focus is on identifying the methodological approaches used to define the PKPD relationship in these studies. The major findings were that most studies of infectious diseases have developed a PK model and then used simulations to define a dose recommendation based on a pre-defined PD target, which may have been defined in adults or in vitro. For immunological studies much of the modelling has focused on either PK or PD, and since multiple drugs are usually used, delineating the relative contributions of each is challenging. The use of dynamical modelling of in vitro antibacterial studies, and paediatric HIV mechanistic PD models linked with the PK of all drugs, are emerging methods that should enhance PKPD-based recommendations in the future. PMID:24440429

Teleconsultation in children with abdominal pain: a comparison of physician triage recommendations and an established paediatric telephone triage protocol.

PubMed

Staub, Gabrielle Marmier; von Overbeck, Jan; Blozik, Eva

2013-09-30

Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system.

Paediatric Eye Services: How Much of the Workload Is Amblyopia-Related?

PubMed

Stewart, Catherine E; Shah, Shaheen; Wren, Siobhan; Roberts, Clare J

2016-09-01

The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia. Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary's Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance. Seven hundred and four patients had appointments booked at St Mary's and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary's and 9% at Hillingdon; P=0.75). Of the 704 patients, 533 (St Mary's, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related. Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits.

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.

Vaccination in paediatric patients with auto-immune rheumatic diseases: a systemic literature review for the European League against Rheumatism evidence-based recommendations.

PubMed

Heijstek, M W; Ott de Bruin, L M; Borrow, R; van der Klis, F; Koné-Paut, I; Fasth, A; Minden, K; Ravelli, A; Abinun, M; Pileggi, G; Borte, M; Bijl, M; Wulffraat, N M

2011-12-01

To analyze available evidence on vaccinations in paediatric patients with rheumatic and autoinflammatory diseases. This evidence formed the basis of the recently constructed European League against Rheumatism (EULAR) recommendations for vaccination of these patients. A systematic literature review in the MEDLINE and EMBASE databases was conducted using various terms for vaccinations, paediatric rheumatic and autoinflammatory diseases and immunosuppressive drugs. Only papers on paediatric patients (<18 years of age) were selected. A panel of 13 experts in the field graded methodological quality and extracted data using predefined criteria. 27 papers were available. No studies were found on autoinflammatory diseases. 14 studies considered live-attenuated vaccines. Evidence so far supports the safety and immunogenicity of non-live composite vaccines, although studies were underpowered to accurately assess safety. Live-attenuated vaccines did not cause disease flares or severe adverse events, not even in patients on methotrexate and low dose glucocorticosteroids. Seven patients on anti-TNFalpha therapy were described receiving the live-attenuated measles, mumps, rubella (n=5) or varicella (n=2) booster without severe adverse events. Data on safety and efficacy of vaccinations in paediatric patients with rheumatic diseases is reassuring, but too limited to draw definite conclusions. More research is needed on the safety and efficacy of especially live-attenuated vaccines in patients with rheumatic and autoinflammatory diseases using high dose immunosuppressive drugs. Copyright © 2011 Elsevier B.V. All rights reserved.

Paediatric health economic evaluations: a world view.

PubMed

Ungar, Wendy J

2007-01-01

As economic evaluation methods evolve, their applicability to special populations, such as children, has received increased scrutiny. The objective was to review paediatric health economic evaluations published over the last quarter century, comment on trends, discuss gaps between developed and developing nations, and point to future directions for research. Data compiled for the Paediatric Economic Database Evaluation (PEDE) project to 2003 were used to describe temporal and geographic trends and evaluate the frequency of intervention categories and conditions studied. The volume of paediatric health economic evaluations rose rapidly since 1980. Studies of infective/parasitic diseases, congenital anomalies and complications of pregnancy accounted for the majority. Prevention rather than treatment was emphasized. Most evaluations performed since 1998 (78%) were cost-effectiveness analyses. Cost-utility analyses were rare. The US produced half of all publications, with the U.K. contributing 12%. Economic evaluations from developing countries were uncommon, despite an urgent need for evidence-based decision-making in these regions. The interventions studied reflected local health priorities; HIV and malaria prevention were more commonly studied in developing nations, whereas treatments for asthma and birth malformations were more often evaluated in developed nations. Despite global initiatives to combat disease, developing nations rely on foreign research to inform implementation of local health programs. There is a need for better methods for data transfer and extrapolation. Future research must focus on paediatric models of costs and consequences and the development of tools to measure long-term effects.

Clinical Profile of Cardiac Arrhythmias in Children Attending the Out Patient Department of a Tertiary Paediatric Care Centre in Chennai

PubMed Central

Sundararajan, Premkumar; Sangaralingam, Thangavelu

2016-01-01

Introduction The presentation of symptoms of paediatric arrhythmias vary depending on the age and underlying heart disease. Physical examination of children with important arrhythmias may be entirely normal. Aim Aim is to study the characteristics of cardiac arrhythmias in paediatric patients in a tertiary paediatric care centre in Chennai, India. Materials and Methods The participants (n=60) were from birth to 12 years of age. Patients with sinus arrhythmias, sinus tachycardia and sinus bradycardia were excluded. Proportions of various parameters of interest like clinical features, age and sex distribution and underlying heart disease of children presenting with cardiac arrhythmias were arrived. Statistical analysis was performed using SPSS version 16.0. Results Ventricular ectopics were the most common type of arrhythmias observed in the present study followed by Sinus Node Dysfunction (SND). The most common type of SND was sino atrial arrest. Supra ventricular tachycardia was the most frequently sustained tachyarrhythmia in the present study. An increased association of WPW (Wolf Parkinson White Syndrome) with specific congenital cardiac defects was noted. Conclusion Cardiac arrhythmias in children can present at anytime from fetal life to adolescence and their recognition requires high index of suspicion. While majority of children with arrhythmias have structurally normal heart, they are frequently encountered in children with underlying heart disease. Treatment of paediatric arrhythmias should be guided by the severity of the patient, the structure and function of the heart. PMID:28208963

Distribution of branchial anomalies in a paediatric Asian population.

PubMed

Teo, Neville Wei Yang; Ibrahim, Shahrul Izham; Tan, Kun Kiaang Henry

2015-04-01

The objective of the present study was to review the distribution and incidence of branchial anomalies in an Asian paediatric population and highlight the challenges involved in the diagnosis of branchial anomalies. This was a retrospective chart review of all paediatric patients who underwent surgery for branchial anomalies in a tertiary paediatric hospital from August 2007 to November 2012. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings and histology results. Branchial anomalies were classified based on the results of the review. A total of 28 children underwent surgery for 30 branchial anomalies during the review period. Two children had bilateral branchial anomalies requiring excision. Of the 30 branchial anomalies, 7 (23.3%) were first branchial anomalies, 5 (16.7%) were second branchial anomalies, 3 (10.0%) were third branchial anomalies, and 4 (13.3%) were fourth branchial anomalies (one of the four patients with fourth branchial anomalies had bilateral branchial anomalies). In addition, seven children had 8 (26.7%) branchial anomalies that were thought to originate from the pyriform sinus; however, we were unable to determine if these anomalies were from the third or fourth branchial arches. There was inadequate information on the remaining 3 (10.0%) branchial anomalies for classification. The incidence of second branchial anomalies appears to be lower in our Asian paediatric population, while that of third and fourth branchial anomalies was higher. Knowledge of embryology and the related anatomy of the branchial apparatus is crucial in the identification of the type of branchial anomaly.

Prehospital paediatric emergencies treated by an Australian helicopter emergency medical service.

PubMed

Barker, Claire L; Weatherall, Andrew D

2014-04-01

The aim of this study was to describe the mechanism and severity of injuries in the paediatric population treated by an Australian helicopter emergency medical service and to examine the frequency and nature of interventions performed. This information is important for planning education and continuing professional development in prehospital medicine. The study is a retrospective cohort analysis of 349 patients under the age of 16 treated by CareFlight in Sydney, Australia, between April 2007 and April 2012. Data collected included age, type of incident, medication and fluid administered, procedures performed, receiving hospital, 24 h and 30-day mortality and injuries sustained. Falls (33%), motor vehicle incidents (30%), sport injury (14%) and immersion injury (12%) were the most common mechanisms. A total of 27 children died within 30 days; nontrauma cases were proportionally overrepresented in the deaths. With respect to tasking, 59% cases involved a severely or significantly injured child. Among the children, 97% with a traumatic mechanism were transferred directly to a paediatric trauma centre.In addition, 81% of children had at least one intervention by the helicopter emergency medical services team at the incident scene, most commonly intravenous cannulation (61%), crystalloid bolus (29%), intubation (21%) and intravenous analgesia administration (15%). Paediatric prehospital patients can be of high dependency, requiring urgent critical care procedures. Training in prehospital medicine should include paediatrics. It is essential that practitioners maintain skills in venous access, airway management and provision of adequate analgesia in children.

The ESSKA paediatric anterior cruciate ligament monitoring initiative.

PubMed

Moksnes, Håvard; Engebretsen, Lars; Seil, Romain

2016-03-01

To survey and describe the treatment of paediatric anterior cruciate ligament (ACL) injuries performed by orthopaedic surgeons affiliated with the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). A closed e-survey was submitted to all registered members and affiliates of ESSKA in July 2013. All recipients were invited to participate in the survey by answering 34 questions online. The list of potential respondents was extracted from the ESSKA office database. Invitation was sent to 2236 ESSKA members and affiliates, and received 491 (22%) unique responses. Among the respondents, 445 (91%) were orthopaedic surgeons, with 354 (72%) stating that they were involved in treatment of paediatric ACL injuries. The main findings were that there are substantial differences with regard to preferred treatment algorithms, surgical techniques and long-term follow-up procedures. The summed estimate of skeletally immature children with ACL injury seen by the responders in 2012 was minimum 1923 individuals, and a minimum of 102 clinically relevant post-operative growth disturbances were registered. The present survey documents that the incidences of paediatric ACL injuries and idiopathic growth disturbances may be higher than previously estimated. Treatment algorithms and surgical techniques are highly diverse, and consensus could not be identified. It is worrying that only half the surgeons reported to follow-up children until skeletal maturity after surgical treatment. The results of this survey highlight the importance of international multicentre studies on paediatric ACL treatment and the development of an outcome registry to enable prospective data collections. IV.

'Kids need to talk too': inclusive practices for children's healthcare education and participation.

PubMed

Koller, Donna

2017-09-01

To examine how children with chronic medical conditions view healthcare education and decision-making and to propose the application of the universal design for learning in paediatric settings. Children and adolescents with chronic medical conditions tend to be excluded from healthcare decision-making. In schools, the universal design for learning promotes access to education and participation in school communities for all children, regardless of their disabilities or medical needs, rendering it an appropriate model for children's participation in healthcare decision-making. This article presents findings from a qualitative study with 26 children and adolescents with chronic medical conditions about their views and experiences with healthcare education and decision-making. Twenty-six children and adolescents with chronic medical conditions were interviewed using semi-structured interviews. Findings provide evidence that clinical practices often fail to provide equal opportunities for paediatric patients to understand their condition, share their views and/or participate in decisions regarding their care. In response to ongoing concerns about paediatric decision-making, we propose that the universal design for learning be adapted in paediatrics. The model presents exemplary programmes as inclusive, accounting for the needs of all children through multiple means of engagement and expression. A discussion of how the principles of universal design for learning could be applied in paediatric settings is offered for the purpose of advancing ethical and psychosocial care for all children regardless of their age, developmental capacity or condition. © 2016 John Wiley & Sons Ltd.

Can paediatric medical students devise a satisfactory standard of examination for their colleagues?

PubMed

Cunningham, S

1999-06-01

To determine what standard paediatric medical students would set for examining their peers and how that would compare with the university standard. Single blinded computer marked examination with questionnaire. University medical school. Medical students during their final paediatric attachment. Medical students asked to derive 10, five branch negatively marked multiple choice questions (MCQs) to a standard that would fail those without sufficient knowledge. Each 10 were then assessed by another student as to the degree of difficulty and the relevance to paediatrics. One year later student peers sat a mock MCQ examination derived from a random 40 questions (unaware that the mock MCQs had been derived by peers). Comparison of marks obtained in mock and final MCQ examinations; student perception of the standard in the two examinations assessed by questionnaire. 44 students derived 439 questions, of which 83% were considered an appropriate standard by a classmate. One year later 62 students sat the mock examination. Distribution of marks was better in the mock MCQ examination than the final MCQ examination. Students considered the mock questions to be a more appropriate standard (72% v 31%) and the topics more relevant (88% v 64%) to paediatric medical students. Questions were of a similar clarity in both examinations (73% v 78%). Students in this study were able to derive an examination of a satisfactory standard for their peers. Involvement of students in deriving examination standards may give them a better appreciation of how standards should be set and maintained.

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

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

PubMed Central

Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

2012-01-01

OBJECTIVE: To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. DESIGN: Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. SETTING: Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia. INTERVENTIONS: The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. RESULTS: A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. CONCLUSIONS: A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes. PMID:23372405

What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study.

PubMed

Sefton, G; McGrath, C; Tume, L; Lane, S; Lisboa, P J G; Carrol, E D

2015-04-01

The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital. The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p<0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p=0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p=0.002). There was a non-significant reduction in mortality (p=0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved. Copyright © 2014 Elsevier Ltd. All rights reserved.

Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

PubMed

Sulafa, K M Ali

2010-07-01

Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

PubMed

Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

2009-05-01

Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Paediatric bacterial keratitis cases in Shanghai: microbiological profile, antibiotic susceptibility and visual outcomes

PubMed Central

Hong, J; Chen, J; Sun, X; Deng, S X; Chen, L; Gong, L; Cao, W; Yu, X; Xu, J

2012-01-01

Purpose The purpose of this study was to review the microbiological profile, in vitro antibiotic susceptibility and visual outcomes of paediatric microbial keratitis in Shanghai, China over the past 6 years. Methods Medical records of patients aged ≤16 years were reviewed, who were diagnosed as having bacterial keratitis between 1 January 2005 and 31 December 2010. Bacterial culture results and in vitro antibiotic susceptibility were analysed. A logistic regression analysis was conducted to evaluate the relationship between visual impairment and possible risk factors. Results Eighty consecutive cases of paediatric bacterial keratitis cases were included, among which 59 were identified as having positive culture. Staphylococcus epidermidis was the most commonly isolated organism (n=23; 39.0%), followed by Streptococcus pneumoniae (n=11; 18.6%) and Pseudomonas aeruginosa (n=6; 10.2%). Antibiotic sensitivities revealed that tested bacteria had low resistance rates to fluoroquinolones and aminoglycosides (8.3–18.4% and 12.5–24.4%, respectively). Multivariate logistic regression analysis proved that visual impairment was significantly associated with Gram-negative bacterial infection (odds ratio (OR)=7.626; P=0.043) and an increasing number of resistant antibiotics (OR=0.385; P=0.040). Conclusions S. epidermidis was the most common isolated organism in Shanghai paediatric keratitis. The fluoroquinolones and aminoglycosides remained good choices for treating these patients. Gram-negative bacterial infection and an increasing number of resistant antibiotics were associated with worse visual prognoses in paediatric keratitis. PMID:23079751

Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis.

PubMed

Kjellberg, Ann Thurin; Carlsson, Per; Bergh, Christina

2006-01-01

Transfer of several embryos after IVF results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we demonstrated that a single embryo transfer (SET) strategy, including one fresh single embryo transfer and, if no live birth, one additional frozen-thawed SET, resulted in a live-birth rate that was not substantially lower than after double embryo transfer (DET) but markedly reduced the multiple birth rate. We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies. In addition, maternal and paediatric outcomes between the two groups were compared. The SET strategy resulted in lower average total costs from treatment until 6 months after delivery. There were a few more deliveries with at least one live-born child in the DET group. The incremental cost per extra delivery in the DET alternative was high, 71 940. The rates of prematurely born and low birthweight children were significantly lower with the SET strategy. There were also markedly fewer maternal and paediatric complications in the SET group. The SET strategy is superior to the DET strategy, when number of deliveries with at least one live-born child, incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration. The findings do not support continuing transfers of two embryos in this group of patients.

Paediatric international travellers from Greece: characteristics and pre-travel recommendations.

PubMed

Maltezou, Helena C; Pavli, Androula; Spilioti, Athina; Katerelos, Panos; Theodoridou, Maria

2012-05-01

The aim of this study was to describe the children who seek pre-travel advice in Greece. During 2008-2010, 4065 persons sought pre-travel services in the 57 Prefectures, including 128 (3.15%) children <15 years. Main travel destinations were sub-Saharan Africa (54 children; 42.2%), South America (18; 14.1%), the Middle East (16; 12.5%), the Indian subcontinent (12; 9.4%), and South East Asia (7; 5.5%). Seventy-six children (59.4%) stayed for <1 month, 34 (26.6%) for 1-6 months, and 10 (7.8%) for >6 months. Recreation was the main purpose of travel (81 children; 63.3%), followed by work (24; 18.8%), and to visit friends and relatives (VFRs) (14; 10.9%). Paediatric travellers VFRs stayed more frequently in local residences compared to non-VFR paediatric travellers (85.7% and 20.2%). Children stayed more frequently in local residences and travelled more frequently for recreational purposes or to VFRs (27.3%, 63.3%, and 10.9%, respectively), compared to older travellers (11.9%, 58.8%, and 4%, respectively). Malaria chemoprophylaxis was prescribed for 64.8% of children travelling to sub-Saharan Africa. This study demonstrated clearly that only a very small number of international paediatric travellers seek pre-travel services in Greece. Communication strategies to access paediatric travellers should be developed in order to improve travel medicine services for children in Greece. Copyright © 2012 Elsevier Ltd. All rights reserved.

First Implementation of Transfusion Consent Policy in Oman: Audit of compliance from a tertiary care university hospital.

PubMed

Al-Riyami, Arwa Z; Al-Ghafri, Naif; Zia, Fehmida; Al-Huneini, Mohammed; Al-Rawas, Abdul-Hakeem; Al-Kindi, Salam; Jose, Sachin; Al-Khabori, Murtadha; Al-Sabti, Hilal; Daar, Shahina

2016-08-01

Transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH. The medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information. In total, the records of 446 transfused patients (299 adult and 147 paediatric patients) were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists (95% and 97%, respectively). Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details (20-25%). In most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended.

The influence of personality traits and socio-demographic characteristics on paediatric nurses' compassion satisfaction and fatigue.

PubMed

Chen, Yi-Pin; Tsai, Jung-Mei; Lu, Ming-Huei; Lin, Li-Man; Lu, Ching-Hui; Wang, Kai-Wei K

2018-05-01

To explore the level of and the association between, compassion satisfaction and fatigue of paediatric nurses; to determine the association between personality traits and compassion satisfaction and fatigue; to identify the determinants of compassion satisfaction and fatigue. Paediatric nurses are prone to experiencing compassion fatigue associated with caring for children with illness and their families, yet its connection with nurses' personality traits remains unknown. A cross-sectional descriptive study design was used. The data collection used three instruments measuring socio-demography, responses to the compassion satisfaction and fatigue test and the revised NEO personality inventory. The study used descriptive, correlation and multiple regression analysis for the data collected between April - July 2014. From 173 female paediatric nurses, two-thirds worked in critical care units and indicated a satisfactory level of compassion satisfaction and a low level of compassion fatigue, despite a lack of association between the two concepts. Four determinants-agreeableness, extraversion, conscientiousness and engaging with outdoor activities-were predictive and explained 43.6% of total variance of compassion satisfaction. Two risk factors of compassion fatigue identified were less emotional stability and singlehood (marital status) and these explained 26.1% of total variance of compassion fatigue. Support for improving agreeableness and emotional stability in paediatric nurses' workplaces including involvement in the outdoor activities and an increase in social connection may enhance compassion satisfaction and prevent exhaustive compassion fatigue. © 2017 John Wiley & Sons Ltd.

Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management.

PubMed

Perez, Arnaldo; Holt, Nicholas; Gokiert, Rebecca; Chanoine, Jean-Pierre; Legault, Laurent; Morrison, Katherine; Sharma, Arya; Ball, Geoff

2015-05-01

Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. To understand parents' reasons for declining tertiary-level health services for paediatric weight management. Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents' responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents' reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children's lack of motivation); and situational factors (eg, weather). Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents' intention to initiate treatment and address reasons for noninitiation that are within their control.

Prevalence of etravirine (ETR)-RAMs at NNRTI failure and predictors of resistance to ETR in a large Italian resistance database (ARCA).

PubMed

Rusconi, S; Adorni, F; Bruzzone, B; Di Biagio, A; Meini, G; Callegaro, A; Punzi, G; Boeri, E; Pecorari, M; Monno, L; Gianotti, N; Butini, L; Galli, L; Polilli, E; Galli, M

2013-10-01

The prevalence of drug resistance associated with the failure of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and the predictors of resistance to Etravirine (ETR) were assessed in 2854 subjects: 39 < 18 (paediatric) and 2815 ≥ 18 (adult) years old. These subjects failed to respond to their current NNRTI treatment, were three-class experienced and had been exposed to NNRTI for ≥3 months. A total of 1827 adult (64.9%) and 32 paediatric subjects (82.1%) harboured the virus with at least one ETR mutation. V179I, Y181C and G190A were the most frequent mutations in both groups. A significantly increased risk of ETR resistance with all three algorithms (Monogram (MGR) >3, Tibotec (TBT) >2 and enhanced MGR (ENH) ≥4) emerged in the paediatric population. Multivariate analysis revealed an increased risk of developing TBT >2 for NNRTI exposure, ENH ≥4 for NNRTI and EFV exposure in paediatric subjects; NVP exposure and higher (≥3.5 log10) HIV-RNA values for all three algorithms in adult subjects, whereas CD4 ≥ 200/μL appeared to be protective. The risk of being ETR resistant was more than doubled for paediatric vs. adult subjects, probably due to a more extensive use of NNRTI and an incomplete virological control. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Fifty years of Australian pediatric gastroenterology.

PubMed

Cameron, Don

2009-10-01

When the Gastroenterological Society of Australia (GESA) began 50 years ago there were very few pediatric gastroenterologists in the world. The 'Mother' of Paediatric Gastroenterology was Australian Charlotte ('Charlo') Anderson who established one of the world's first pediatric gastroenterology units in Melbourne in the early 1960s. Her earlier work in Birmingham had identified gluten as the component of wheat responsible for celiac disease and helped separate maldigestion (cystic fibrosis) and mucosal malabsorption. The first comprehensive textbook of Paediatric Gastroenterology was edited by Charlotte Anderson and Valerie Burke in 1975. Rudge Townley succeeded Charlotte Anderson in Melbourne and went on to further develop small bowel biopsy techniques making it a safe, simple, and quick procedure that led to much greater understanding of small bowel disease and ultimately the discovery of Rotavirus by Ruth Bishop et al. and subsequently to Rotavirus immunization. Australian Paediatric Gastroenterology subsequently developed rapidly with units being established in all mainland capital cities by the end of the 1970s. The Australian Society of Paediatric Gastroenterology Hepatology and Nutrition (AuSPGHAN) was established in the 1980s. Australians have contributed significantly in many areas of gastroenterology in infants, children, and adolescents including celiac disease, cystic fibrosis, liver disease, transplantation, gastrointestinal infection, allergy, indigenous health, inflammatory bowel disease, gastrointestinal motility, and the development of novel tests of gastrointestinal function and basic science. There have also been major contributions to nutrition in cystic fibrosis, end-stage liver disease, and intestinal failure. The future of Australian Paediatric Gastroenterology is in good hands.

Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis

PubMed Central

Pradas-Hernández, Laura; Gómez-Urquiza, José Luis; Albendín-García, Luis; De la Fuente, Emilia I.; Cañadas-De la Fuente, Guillermo A.

2018-01-01

Introduction Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature. Objective The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment. Method For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation “burnout AND “pediatric nurs*””, and was conducted in July 2017. Results The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25–37%); (ii) depersonalisation, 21% (95% CI: 11–33%); (iii) low personal accomplishment, 39% (95% CI: 28–50%). Conclusions A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to burnout. PMID:29694375

Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles.

PubMed

Rodríguez-Rey, Rocío; Palacios, Alba; Alonso-Tapia, Jesús; Pérez, Elena; Álvarez, Elena; Coca, Ana; Mencía, Santiago; Marcos, Ana; Mayordomo-Colunga, Juan; Fernández, Francisco; Gómez, Fernando; Cruz, Jaime; Ordóñez, Olga; Llorente, Ana

2018-03-28

Our aims were (1) to explore the prevalence of burnout syndrome (BOS) and posttraumatic stress disorder (PTSD) in a sample of Spanish staff working in the paediatric intensive care unit (PICU) and compare these rates with a sample of general paediatric staff and (2) to explore how resilience, coping strategies, and professional and demographic variables influence BOS and PTSD. This is a multicentre, cross-sectional study. Data were collected in the PICU and in other paediatric wards of nine hospitals. Participants consisted of 298 PICU staff members (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in non-critical paediatric units (53 physicians, 104 nurses, and 32 nursing assistants). They completed the Brief Resilience Scale, the Coping Strategies Questionnaire for healthcare providers, the Maslach Burnout Inventory, and the Trauma Screening Questionnaire. Fifty-six percent of PICU working staff reported burnout in at least one dimension (36.20% scored over the cut-off for emotional exhaustion, 27.20% for depersonalisation, and 20.10% for low personal accomplishment), and 20.1% reported PTSD. There were no differences in burnout and PTSD scores between PICU and non-PICU staff members, either among physicians, nurses, or nursing assistants. Higher burnout and PTSD rates emerged after the death of a child and/or conflicts with patients/families or colleagues. Around 30% of the variance in BOS and PTSD is predicted by a frequent usage of the emotion-focused coping style and an infrequent usage of the problem-focused coping style. Interventions to prevent and treat distress among paediatric staff members are needed and should be focused on: (i) promoting active emotional processing of traumatic events and encouraging positive thinking; (ii) developing a sense of detached concern; (iii) improving the ability to solve interpersonal conflicts, and (iv) providing adequate training in end-of-life care. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Radiation from CT scans in paediatric trauma patients: Indications, effective dose, and impact on surgical decisions.

PubMed

Livingston, Michael H; Igric, Ana; Vogt, Kelly; Parry, Neil; Merritt, Neil H

2014-01-01

The purpose of this study was to determine the effective dose of radiation due to computed tomography (CT) scans in paediatric trauma patients at a level 1 Canadian paediatric trauma centre. We also explored the indications and actions taken as a result of these scans. We performed a retrospective review of paediatric trauma patients presenting to our centre from January 1, 2007 to December 31, 2008. All CT scans performed during the initial trauma resuscitation, hospital stay, and 6 months afterwards were included. Effective dose was calculated using the reported dose length product for each scan and conversion factors specific for body region and age of the patient. 157 paediatric trauma patients were identified during the 2-year study period. Mean Injury Severity Score was 22.5 (range 12-75). 133 patients received at least one CT scan. The mean number of scans per patient was 2.6 (range 0-16). Most scans resulted in no further action (56%) or additional imaging (32%). A decision to perform a procedure (2%), surgery (8%), or withdrawal of life support (2%) was less common. The average dose per patient was 13.5mSv, which is 4.5 times the background radiation compared to the general population. CT head was the most commonly performed type of scan and was most likely to be repeated. CT body, defined as a scan of the chest, abdomen, and/or pelvis, was associated with the highest effective dose. CT is a significant source of radiation in paediatric trauma patients. Clinicians should carefully consider the indications for each scan, especially when performing non-resuscitation scans. There is a need for evidence-based treatment algorithms to assist clinicians in selecting appropriate imaging for patients with severe multisystem trauma. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

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

2017-03-29

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. Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. 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. 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. 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/.

Investigating the mechanical response of paediatric bone under bending and torsion using finite element analysis.

PubMed

Altai, Zainab; Viceconti, Marco; Offiah, Amaka C; Li, Xinshan

2018-03-10

Fractures of bone account 25% of all paediatric injuries (Cooper et al. in J Bone Miner Res 19:1976-1981, 2004. https://doi.org/10.1359/JBMR.040902 ). These can be broadly categorised into accidental or inflicted injuries. The current clinical approach to distinguish between these two is based on the clinician's judgment, which can be subjective. Furthermore, there is a lack of studies on paediatric bone to provide evidence-based information on bone strength, mainly due to the difficulties of obtaining paediatric bone samples. There is a need to investigate the behaviour of children's bones under external loading. Such data will critically enhance our understanding of injury tolerance of paediatric bones under various loading conditions, related to injuries, such as bending and torsional loads. The aim of this study is therefore to investigate the response of paediatric femora under two types of loading conditions, bending and torsion, using a CT-based finite element approach, and to determine a relationship between bone strength and age/body mass of the child. Thirty post-mortem CT scans of children aged between 0 and 3 years old were used in this study. Two different boundary conditions were defined to represent four-point bending and pure torsional loads. The principal strain criterion was used to estimate the failure moment for both loading conditions. The results showed that failure moment of the bone increases with the age and mass of the child. The predicted failure moment for bending, external and internal torsions were 0.8-27.9, 1.0-31.4 and 1.0-30.7 Nm, respectively. To the authors' knowledge, this is the first report on infant bone strength in relation to age/mass using models developed from modern medical images. This technology may in future help advance the design of child, car restrain system, and more accurate computer models of children.

Outcomes of children admitted to intensive care after out-of-hospital cardiac arrest in Victoria, Australia.

PubMed

Forrest, Anri; Butt, Warwick W; Namachivayam, Siva P

2017-06-01

Paediatric out-of-hospital cardiac arrest (OHCA) is an uncommon event but is associated with high mortality and severe neurological sequelae among survivors. Most studies of paediatric OHCA are population-based, with very few reports on the cohort admitted to the paediatric intensive care unit (PICU). We sought to determine outcomes and predictors of neurologically intact survival in these children admitted to the PICU. Retrospective analysis of data prospectively collected from the PICU and emergency department (ED) databases and cross-checked with medical records and coronial reports for January 2005 to December 2014. Neurological outcome was assessed using the Paediatric Cerebral Performance Category scale. Survival with a favourable neurological outcome at hospital discharge. In the 10 years, 283 children presented with OHCA. After 16 study exclusions (because of cardiopulmonary resuscitation [CPR] duration < 1 min or age > 16 years), there were 121 children who died in the ED and 146 admitted to the PICU. Among the PICU cohort, hospital survival with favourable neurological outcome was 42% (60 of 143), and at 1 year after arrest it was 41% (59 of 143). The following factors were associated with the primary outcome: bystander CPR (odds ratio [OR], 4.74 [95% CI, 1.49-15.05]); cardiac aetiology (OR, 6.40 [95% CI, 1.65-24.76]); male sex (OR, 0.32 [95% CI, 0.12- 0.84]); and CPR duration: = 20 min v 0-5 min (OR, 0.05 [95% CI, 0.01-0.16]) and 6-20 min v 0-5 min (OR, 0.45 [95% CI, 0.16-1.28]). Bystander CPR and primary cardiac aetiology had strong associations with survival with a favourable neurological outcome after paediatric OHCA. Maximising CPR education for the community, and targeting people most likely to witness a paediatric OHCA may further improve outcomes.

Sudden death in paediatrics as a traumatic experience for critical care nurses.

PubMed

Lima, Lígia; Gonçalves, Sandra; Pinto, Cândida

2018-01-01

Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients. © 2017 British Association of Critical Care Nurses.

Patterns of paediatric emergency presentations to a tertiary referral centre in the Northern Territory.

PubMed

Buntsma, Davina; Lithgow, Anna; O'Neill, Evan; Palmer, Didier; Morris, Peter; Acworth, Jason; Babl, Franz E

2017-12-01

To describe epidemiological data concerning paediatric attendances at the ED of Royal Darwin Hospital (RDH). We conducted a retrospective cohort study of paediatric emergency presentations to the RDH ED during 2004 and 2013. Epidemiological data, including demographics, admission rates and diagnostic grouping, were analysed using descriptive and comparative statistical methods. We compared data with findings from a baseline epidemiological study by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) conducted in 2004. A total of 12 745 and 15 378 paediatric presentations (age 0-18 years) to the RDH ED were analysed for the years 2004 and 2013 respectively. In 2004, the mean age of children presenting to RDH was 7.1 years, and 56.0% were female. Indigenous patients accounted for 31.2% of presentations at RDH and were significantly more likely to be admitted than non-Indigenous patients (31.6% vs 12.8%, OR 3.24, 95% CI 2.95-3.55). Children <5 years old accounted for the highest number of presentations (45.2%) and admissions (51.2%), and there was a high proportion of adolescent presentations (18.0%). Similar to the PREDICT study, viral infectious conditions (bronchiolitis, gastroenteritis, upper respiratory tract infections) were the most common cause for presentations. Key differences included a higher proportion of patients presenting with cellulitis and head injury at RDH and an increasing proportion of adolescent psychiatric presentations at RDH from 2004 to 2013. This study provides important information regarding paediatric presentations to a major referral hospital in the Northern Territory. Overall, there was a disproportionate rate of presentation and admission among Indigenous children. Other key findings were higher proportions of cellulitis, head injury and adolescent presentations. These findings can assist in service planning and in directing future research specific to children in the Northern Territory. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

PubMed

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

2010-08-01

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

Causes and outcome of late referral of children who develop end-stage kidney disease.

PubMed

Kennedy, Sean E; Bailey, Rohan; Kainer, Gad

2012-03-01

This study aims to characterise the timing of referral to a paediatric nephrology unit of children who develop end-stage kidney disease (ESKD). This study also aims to determine whether late referral (LR) influences outcomes and to explore factors that may lead to LR. A retrospective case review of all incident patients with ESKD who received renal replacement therapy (RRT) at a single paediatric centre. Time between referral to a paediatric nephrologist and commencement of RRT, demographic and clinical data were collated. Estimated glomerular filtration rate (eGFR) at referral was calculated using height and creatinine. LR was defined as having an eGFR ≤ 30 mL/min/1.73 m(2) when first seen by a paediatric nephrologist. RRT was initiated for 74 patients < 18 years of age between 1988 and 2010. The median age at referral was 2.0 years (birth-15.9 years) and age at RRT was 10.0 years (6 days-17.4 years). Children referred before age 1 year (41%) had a more prolonged course before ESKD. Median (interquartile range) eGFR at referral of children > 1 year was 27.2 (9.0-52.0) mL/min/1.73 m(2) . Twenty-two (55%) of these children were referred late (LR) with an eGFR ≤ 30 mL/min/1.73 m(2) . LR patients were more likely to have glomerulonephritis or haemolytic uraemic syndrome and to live in a remote or outer regional area. LR patients had higher urea, lower haemoglobin and were more likely to receive haemodialysis via a vascular catheter. A significant proportion of children who develop ESKD are referred late to nephrology units with potentially preventable complications. Aetiology of renal disease and geographic isolation contribute to LR. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Similar outcome of upfront-unrelated and matched sibling stem cell transplantation in idiopathic paediatric aplastic anaemia. A study on behalf of the UK Paediatric BMT Working Party, Paediatric Diseases Working Party and Severe Aplastic Anaemia Working Party of EBMT.

PubMed

Dufour, Carlo; Veys, Paul; Carraro, Elisa; Bhatnagar, Neha; Pillon, Marta; Wynn, Rob; Gibson, Brenda; Vora, Ajay J; Steward, Colin G; Ewins, Anna M; Hough, Rachael E; de la Fuente, Josu; Velangi, Mark; Amrolia, Persis J; Skinner, Roderick; Bacigalupo, Andrea; Risitano, Antonio M; Socie, Gerard; Peffault de Latour, Regis; Passweg, Jakob; Rovo, Alicia; Tichelli, André; Schrezenmeier, Hubert; Hochsmann, Britta; Bader, Peter; van Biezen, Anja; Aljurf, Mahmoud D; Kulasekararaj, Austin; Marsh, Judith C; Samarasinghe, Sujith

2015-11-01

We explored the feasibility of unrelated donor haematopoietic stem cell transplant (HSCT) upfront without prior immunosuppressive therapy (IST) in paediatric idiopathic severe aplastic anaemia (SAA). This cohort was then compared to matched historical controls who had undergone first-line therapy with a matched sibling/family donor (MSD) HSCT (n = 87) or IST with horse antithymocyte globulin and ciclosporin (n = 58) or second-line therapy with unrelated donor HSCT post-failed IST (n = 24). The 2-year overall survival in the upfront cohort was 96 ± 4% compared to 91 ± 3% in the MSD controls (P = 0·30) and 94 ± 3% in the IST controls (P = 0·68) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (P = 0·02).The 2-year event-free survival in the upfront cohort was 92 ± 5% compared to 87 ± 4% in MSD controls (P = 0·37), 40 ± 7% in IST controls (P = 0·0001) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (n = 24) (P = 0·02). Outcomes for upfront-unrelated donor HSCT in paediatric idiopathic SAA were similar to MSD HSCT and superior to IST and unrelated donor HSCT post-IST failure. Front-line therapy with matched unrelated donor HSCT is a novel treatment approach and could be considered as first-line therapy in selected paediatric patients who lack a MSD. © 2015 John Wiley & Sons Ltd.

Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

PubMed

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

2016-11-01

Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Successful clinical outcomes following decentralization of tertiary paediatric HIV care to a community-based paediatric antiretroviral treatment network, Chiangrai, Thailand, 2002 to 2008

PubMed Central

Hansudewechakul, Rawiwan; Naiwatanakul, Thananda; Katana, Abraham; Faikratok, Worawan; Lolekha, Rangsima; Thainuea, Vorapathu; McConnell, Michelle S

2012-01-01

Introduction Most paediatric antiretroviral treatments (ARTs) in Thailand are limited to tertiary care hospitals. To decentralize paediatric HIV treatment and care, Chiangrai Prachanukroh Hospital (CRH) strengthened a provincial paediatric HIV care network by training community hospital (CH) care teams to receive referrals of children for community follow-up. In this study, we assessed factors associated with death and clinical outcomes of HIV-infected children who received care at CRH and CHs after implementation of a community-based paediatric HIV care network. Methods Clinical records were abstracted for all children who initiated ART at CRH. Paired Wilcoxon signed rank tests were used to assess CD4% and virological change among all children. Cox proportional hazard models were used to assess factors associated with death. Treatment outcomes (CD4%, viral load (VL) and weight-for-age Z-score (WAZ)) were compared between CRH and CH children who met the criteria for analysis. Results Between February 2002 and April 2008, 423 HIV-infected children initiated ART and 410 included in the cohort analysis. Median follow-up for the cohort was 28 months (interquartile range (IQR)=12 to 42); 169 (41%) children were referred for follow-up at CH. As of 31 March 2008, 42 (10%) children had died. Baseline WAZ (<−2 (p=0.001)) and baseline CD4% (<5% (p=0.015)) were independently associated with death. At 48 months, 86% of ART-naïve children in follow-up had VL<400 copies/ml. For sub-group analysis, 133 children at CRH and 154 at CHs were included for comparison. Median baseline WAZ was lower in CH children than in CRH children (p=0.001); in both groups, WAZ, CD4% and VL improved after ART with no difference in rate of WAZ and CD4% gain (p=0.421 and 0.207, respectively). Conclusions Children at CHs had more severe immunological suppression and low WAZ at baseline. Community- and tertiary care-based paediatric ART follow-ups result in equally beneficial outcomes with the strengthening of a provincial referral network between tertiary and community care. Nutrition interventions may benefit children in community-based HIV treatment and care. PMID:23078768

Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew - case identification rates and effect on the Sydney paediatric trauma system.

PubMed

Garner, Alan A; Lee, Anna; Weatherall, Andrew

2012-12-18

Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC. Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available. Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P < 0.001). Direct transport to a PTC was more likely to occur when the HEMS dispatch system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01). Physician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports directly to a PTC and with faster times to arrival.

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds.

PubMed

Trevatt, Alexander E J; Kirkham, Emily N; Allix, Bradley; Greenwood, Rosemary; Coy, Karen; Hollén, Linda I; Young, Amber E R

2016-09-01

There is a paucity of evidence guiding management of small area partial thickness paediatric scalds. This has prevented the development of national management guidelines for these injuries. This research aimed to investigate whether a lack of evidence for national guidelines has resulted in variations in both management and outcomes of paediatric small area scalds across England and Wales (E&W). A national survey of initial management of paediatric scalds ≤5% Total Body Surface Area (%TBSA) was sent to 14 burns services in E&W. Skin graft rates of anonymised burns services over seven years were collected from the international Burns Injury Database (iBID). Average skin grafting rates across services were compared. Length of stay and proportion of patients receiving general anaesthesia for dressing application at each service were also compared. All 14 burns services responded to the survey. Only 50% of services had a protocol in place for the management of small area burns. All protocols varied in how partial thickness paediatrics scalds ≤5% TBSA should be managed. There was no consensus as to which scalds should be treated using biosynthetic dressings. Data from iBID for 11,917 patients showed that the average reported skin grafting rate across all burns services was 2.3% (95% CI 2.1, 2.6) but varied from 0.3% to 7.1% (P<0.001). Service provider remained associated with likelihood of skin grafting when variations in the %TBSA case mix seen by each service were controlled for (χ(2)=87.3, P<0.001). The use of general anaesthetics across services varied between 0.6 and 35.5% (P<0.001). The median length of stay across services varied from 1 to 3 days (P<0.001). A lack of evidence guiding management of small-area paediatric scalds has resulted in variation in management of these injuries across E&W. There is also significant variation in outcomes for these injuries. Further research is indicated to determine if care pathways and outcomes are linked. An evidence-based national policy for the management of small area paediatric scalds would ensure that high quality, standardised care is delivered throughout E&W and variations in outcome are reduced. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Trends in cause and place of death for children in Portugal (a European country with no Paediatric palliative care) during 1987-2011: a population-based study.

PubMed

Forjaz de Lacerda, Ana; Gomes, Barbara

2017-12-22

Children and adolescents dying from complex chronic conditions require paediatric palliative care. One aim of palliative care is to enable a home death if desired and well supported. However, there is little data to inform care, particularly from countries without paediatric palliative care, which constitute the majority worldwide. This is an epidemiological study analysing death certificate data of decedents aged between 0 and 17 years in Portugal, a developed Western European country without recognised provision of paediatric palliative care, from 1987 to 2011. We analysed death certificate data on cause and place of death; the main outcome measure was home death. Complex chronic conditions included cancer, cardiovascular, neuromuscular, congenital/genetic, respiratory, metabolic, gastro-intestinal, renal, and haematology/immunodeficiency conditions. Multivariate analysis determined factors associated with home death in these conditions. Annual deaths decreased from 3268 to 572. Of 38,870 deaths, 10,571 were caused by complex chronic conditions, their overall proportion increasing from 23.7% to 33.4% (22.4% to 45.4% above age 1-year). For these children, median age of death increased from 0.5 to 4.32-years; 19.4% of deaths occurred at home, declining from 35.6% to 11.5%; factors associated with home death were year of death (adjusted odds ratio 0.89, 95% confidence interval 0.89-0.90), age of death (6-10 year-olds 21.46, 16.42-28.04, reference neonates), semester of death (October-March 1.18, 1.05-1.32, reference April-September), and cause of death (neuromuscular diseases 1.59, 1.37-1.84, reference cancer), with wide regional variation. This first trend analysis of paediatric deaths in Portugal (an European country without paediatric palliative care) shows that palliative care needs are increasing. Children are surviving longer and, in contrast with countries where paediatric palliative care is thriving, there is a long-term trend of dying in hospital instead of at home. Age, diagnosis, season and region are associated with home death, and should be considered when planning services to support families choosing this option. Priorities should address needs of the youngest children, those with cancer, neuromuscular and cardiovascular conditions, as well as inequities related to place of residence.

Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital.

PubMed

Featherstone, N C; Somani, B K; Griffin, S J

2017-04-01

The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown. To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years. A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed. From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5). Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications. The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units. Copyright © 2016. Published by Elsevier Ltd.

[The medicine use pathway in paediatrics].

PubMed

Didelot, Nicolas

2016-01-01

The medicine use pathway is a process which is constantly evolving in order to comply with intangible rules. As in other therapeutic fields, the drug regimen in paediatrics must tolerate no error and must be able to detect all warning signs, however minor, in order to optimise this approach. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Summary Report: 62nd Annual Congress - British Association of Paediatric Surgeons Cardiff, Wales, UK, July 22nd- 24th, 2015.

PubMed

Davenport, Mark

2016-02-01

The 62nd British Association of Paediatric Surgeons (BAPS) Annual Conference was held July 22-24, 2015, in Cardiff, Wales. This congress issue contains papers presented during the open sessions and transcripts based on invited lectures. Copyright © 2015 Elsevier Inc. All rights reserved.

[A scale for the assessment of the risk of pressure sores in paediatric intensive care].

PubMed

Weigel, Virginie

2014-01-01

Pressure sores are a frequent complication in paediatric intensive care. A multi-disciplinary nursing team has drawn up an assessment scale for the risk of pressure sores and has put in place guidelines for caring for children in intensive care. Prevention actions are thereby adapted to each young patient.

Inequalities in the Provision of Paediatric Speech and Language Therapy Services across London Boroughs

ERIC Educational Resources Information Center

Pring, Tim

2016-01-01

Background: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. Aims: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. Methods & Procedures: Information on the…

An Overview of a UK Paediatric Visual Impaired Population and Low Vision Aid Provision

ERIC Educational Resources Information Center

Theodorou, Nana; Shipman, Tracey

2013-01-01

A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of…

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.

Challenges in paediatric procedural sedation: political, economic, and clinical aspects.

PubMed

Mason, K P

2014-12-01

Paediatric sedation has expanded in volume and demand over the past decade. In parallel with the increasing demand for and delivery of sedation by multi-specialty providers, conflicting political agendas have surfaced. With a limited selection of sedatives and few new sedatives to market over the past decade, some providers utilize agents that formerly were considered exclusive for administration by anaesthesiologists. This review highlights the important contributions to paediatric sedation over the past century. Considerations include the barriers and politics that impede progress and also future advances and contributions that may lie ahead. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A comprehensive review of paediatric low-grade diffuse glioma: pathology, molecular genetics and treatment.

PubMed

Ryall, Scott; Tabori, Uri; Hawkins, Cynthia

2017-04-01

Gliomas are the most common central nervous system neoplasms affecting children and can be both high- and low-grade. Paediatric low-grade glioma may be either World Health Organization grade I or grade II. Despite being classified as grade II diffuse astrocytoma, these neoplasms arising in children are distinct clinically and molecularly from their adult counterparts. They do not tend to progress to higher grade lesions and only rarely harbour an IDH mutation. Here, we review the clinical, histologic and molecular features of paediatric grade II diffuse glioma, highlighting their diagnostic criteria, prevalence across brain locations, their most common molecular features and how to test for them, and lastly the current status of therapeutic options available for their treatment.

The World Congress of Paediatric Cardiology and Cardiac Surgery: a short factual history by Jane Somerville.

PubMed

Somerville, Jane

2012-12-01

The World Congress of Paediatric Cardiology and Cardiac Surgery has survived with minimal assets and simple organisation. Each congress is special, taking on the humour, flavour, and culture of the organising country. It is hard work for a few organisers and money is hard to raise. The steering committee works closely, fairly, and successfully, and even though accused of being secretive and effete that does not matter. It is efficient and produces successful, happy world congresses, where all involved with the speciality are welcome. With so many "grown-ups" with congenital heart disease, it is no longer just a paediatric problem - maybe the name of this congress must change again. Regardless, the flag must fly on.

Incorporating educative environments into the holistic care of paediatric patients.

PubMed

Wilks, Susan E; Green, Julie B; Zazryn, Tsharni R

2012-08-01

Hospital settings can, and should, create educative spaces and learning opportunities as part of their holistic care for young patients. The purpose of this paper is to examine the evidence for creating high quality, child-centred learning environments within paediatric settings. We explore the impact of physical spaces on learning; the literature on developmental stages of learning for children and young people as it relates to learning environments; and the literature on learning in out-of-school settings, particularly as this applies to children who are separated from their daily communities. As all paediatric settings can create opportunities for the ongoing educational development of their patients, this paper presents a way forward for this approach to holistic care.

Pharmacokinetic studies in children: recommendations for practice and research.

PubMed

Barker, Charlotte I S; Standing, Joseph F; Kelly, Lauren E; Hanly Faught, Lauren; Needham, Allison C; Rieder, Michael J; de Wildt, Saskia N; Offringa, Martin

2018-04-19

Optimising the dosing of medicines for neonates and children remains a challenge. The importance of pharmacokinetic (PK) and pharmacodynamic (PD) research is recognised both in medicines regulation and paediatric clinical pharmacology, yet there remain barriers to undertaking high-quality PK and PD studies. While these studies are essential in understanding the dose-concentration-effect relationship and should underpin dosing recommendations, this review examines how challenges affecting the design and conduct of paediatric pharmacological studies can be overcome using targeted pharmacometric strategies. Model-based approaches confer benefits at all stages of the drug life-cycle, from identifying the first dose to be used in children, to clinical trial design, and optimising the dosing regimens of older, off-patent medications. To benefit patients, strategies to ensure that new PK, PD and trial data are incorporated into evidence-based dosing recommendations are needed. This review summarises practical strategies to address current challenges, particularly the use of model-based (pharmacometric) approaches in study design and analysis. Recommendations for practice and directions for future paediatric pharmacological research are given, based on current literature and our joint international experience. Success of PK research in children requires a robust infrastructure, with sustainable funding mechanisms at its core, supported by political and regulatory initiatives, and international collaborations. There is a unique opportunity to advance paediatric medicines research at an unprecedented pace, bringing the age of evidence-based paediatric pharmacotherapy into sight. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia

PubMed Central

2012-01-01

Background Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04. Methods Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions. Results Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively. Conclusions Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population. PMID:23259969

Improving paediatric asthma care in Zambia

PubMed Central

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

2015-01-01

Abstract Problem In 2008, the prevalence of paediatric asthma in Zambia was unknown and the national treatment guideline was outdated. Approach 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. Local setting 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. Relevant changes 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. Lessons learnt 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. PMID:26600616

Distribution of branchial anomalies in a paediatric Asian population

PubMed Central

Teo, Neville Wei Yang; Ibrahim, Shahrul Izham; Tan, Kun Kiaang Henry

2015-01-01

INTRODUCTION The objective of the present study was to review the distribution and incidence of branchial anomalies in an Asian paediatric population and highlight the challenges involved in the diagnosis of branchial anomalies. METHODS This was a retrospective chart review of all paediatric patients who underwent surgery for branchial anomalies in a tertiary paediatric hospital from August 2007 to November 2012. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings and histology results. Branchial anomalies were classified based on the results of the review. RESULTS A total of 28 children underwent surgery for 30 branchial anomalies during the review period. Two children had bilateral branchial anomalies requiring excision. Of the 30 branchial anomalies, 7 (23.3%) were first branchial anomalies, 5 (16.7%) were second branchial anomalies, 3 (10.0%) were third branchial anomalies, and 4 (13.3%) were fourth branchial anomalies (one of the four patients with fourth branchial anomalies had bilateral branchial anomalies). In addition, seven children had 8 (26.7%) branchial anomalies that were thought to originate from the pyriform sinus; however, we were unable to determine if these anomalies were from the third or fourth branchial arches. There was inadequate information on the remaining 3 (10.0%) branchial anomalies for classification. CONCLUSION The incidence of second branchial anomalies appears to be lower in our Asian paediatric population, while that of third and fourth branchial anomalies was higher. Knowledge of embryology and the related anatomy of the branchial apparatus is crucial in the identification of the type of branchial anomaly. PMID:25917471

Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

PubMed

Menachem, S; Sharfman, Z T; Perets, I; Arami, A; Eyal, G; Drexler, M; Chechik, O

2016-06-01

To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1-16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Computational hybrid anthropometric paediatric phantom library for internal radiation dosimetry

NASA Astrophysics Data System (ADS)

Xie, Tianwu; Kuster, Niels; Zaidi, Habib

2017-04-01

Hybrid computational phantoms combine voxel-based and simplified equation-based modelling approaches to provide unique advantages and more realism for the construction of anthropomorphic models. In this work, a methodology and C++ code are developed to generate hybrid computational phantoms covering statistical distributions of body morphometry in the paediatric population. The paediatric phantoms of the Virtual Population Series (IT’IS Foundation, Switzerland) were modified to match target anthropometric parameters, including body mass, body length, standing height and sitting height/stature ratio, determined from reference databases of the National Centre for Health Statistics and the National Health and Nutrition Examination Survey. The phantoms were selected as representative anchor phantoms for the newborn, 1, 2, 5, 10 and 15 years-old children, and were subsequently remodelled to create 1100 female and male phantoms with 10th, 25th, 50th, 75th and 90th body morphometries. Evaluation was performed qualitatively using 3D visualization and quantitatively by analysing internal organ masses. Overall, the newly generated phantoms appear very reasonable and representative of the main characteristics of the paediatric population at various ages and for different genders, body sizes and sitting stature ratios. The mass of internal organs increases with height and body mass. The comparison of organ masses of the heart, kidney, liver, lung and spleen with published autopsy and ICRP reference data for children demonstrated that they follow the same trend when correlated with age. The constructed hybrid computational phantom library opens up the prospect of comprehensive radiation dosimetry calculations and risk assessment for the paediatric population of different age groups and diverse anthropometric parameters.

Ultrarush schedule of subcutaneous immunotherapy with modified allergen extracts is safe in paediatric age.

PubMed

Morais-Almeida, Mário; Arêde, Cristina; Sampaio, Graça; Borrego, Luis Miguel

2016-01-01

Traditional subcutaneous immunotherapy up dosing with allergenic extracts has been shown to be associated with frequent adverse reactions. In recent studies it has been demonstrated that using modified extracts, namely allergoids, it is a safe and effective procedure particularly on accelerated schedules. However data assessing its safety in paediatric age is scarce. To evaluate the safety profile in paediatric population of using modified allergen extracts, in an ultrarush schedule, to reach the maintenance dose in the first day. We included children undergoing treatment with subcutaneous immunotherapy during a five-year period, using modified aeroallergen extracts, depigmented, polymerized with glutaraldehyde and adsorbed on aluminium hydroxide using an ultrarush induction phase. The type of adverse reactions during the ultrarush protocol was recorded. We studied 100 paediatric patients (57 males) with a mean age of 11.6 years (5 to 18 years; standard deviation, 3.3), all with moderate to severe persistent rhinitis, with or without allergic conjunctivitis, asthma and atopic eczema, sensitized to mites and/or pollens. All reached the maintenance dose of 0.5 mL in the first day, except 1 child. During the ultrarush protocol the total number of injections was 199. There were 21 local adverse reactions in 11 patients, 11 immediate and 10 delayed; from those, had clinical relevance 1 immediate and 4 delayed. Systemic reactions were recorded in 2 cases, both immediate and mild. The ultrarush protocol, without premedication, was a safe alternative to be used in paediatric age during the induction phase of subcutaneous immunotherapy using allergoid depigmented extracts.

Ultrarush schedule of subcutaneous immunotherapy with modified allergen extracts is safe in paediatric age

PubMed Central

Arêde, Cristina; Sampaio, Graça; Borrego, Luis Miguel

2016-01-01

Background Traditional subcutaneous immunotherapy up dosing with allergenic extracts has been shown to be associated with frequent adverse reactions. In recent studies it has been demonstrated that using modified extracts, namely allergoids, it is a safe and effective procedure particularly on accelerated schedules. However data assessing its safety in paediatric age is scarce. Objective To evaluate the safety profile in paediatric population of using modified allergen extracts, in an ultrarush schedule, to reach the maintenance dose in the first day. Methods We included children undergoing treatment with subcutaneous immunotherapy during a five-year period, using modified aeroallergen extracts, depigmented, polymerized with glutaraldehyde and adsorbed on aluminium hydroxide using an ultrarush induction phase. The type of adverse reactions during the ultrarush protocol was recorded. Results We studied 100 paediatric patients (57 males) with a mean age of 11.6 years (5 to 18 years; standard deviation, 3.3), all with moderate to severe persistent rhinitis, with or without allergic conjunctivitis, asthma and atopic eczema, sensitized to mites and/or pollens. All reached the maintenance dose of 0.5 mL in the first day, except 1 child. During the ultrarush protocol the total number of injections was 199. There were 21 local adverse reactions in 11 patients, 11 immediate and 10 delayed; from those, had clinical relevance 1 immediate and 4 delayed. Systemic reactions were recorded in 2 cases, both immediate and mild. Conclusion The ultrarush protocol, without premedication, was a safe alternative to be used in paediatric age during the induction phase of subcutaneous immunotherapy using allergoid depigmented extracts. PMID:26844218

Paediatric dental general anaesthesia rates and dental caries regionally and in districts in the former north western region.

PubMed

Jones, C; Taylor, G; Morrant, A; Cook, G

1998-09-01

To chart paediatric dental general anaesthesia activity following implementation of the Poswillo Report recommendations and to characterise the relationship between dmft/DMFT and rates of paediatric dental general anaesthesia. An ecological study, using results of the NHS dental epidemiological surveys and routine NHS activity data. The general, community and hospital dental services. Former regional and district health authorities' residents. Correlations between the regional and district rates of dental general anaesthesia and dmft/DMFT from the NHS dental epidemiology surveys. About half of all paediatric dental general anaesthetics are carried out in the General Dental Service. There were significant correlations between regional mean dmft/DMFT and under 18 combined dental general anaesthesia rates in 1991/2 and 1992/3. In the North West Region there were significant correlations between 0-4-year-old district dental general anaesthesia rates and dmft of 5-year-old children in 1989/90 (r = 0.45, P < 0.05) and 0-17-year-old district dental general anaesthesia rates and 12-year-old DMFT (r = 0.49, P < 0.05) in 1992/3. The number of paediatric dental general anaesthetics provided since the Poswillo Report was implemented (1991) has increased in the last two years (1993/4 and 1994/5). District rates of dental general anaesthesia bore little relation to dental need as measured by dmft/DMFT, except in 1989/90 for 5-year-old children and in 1992/3 for 12-year-old children. This suggests dental general anaesthesia is not provided in response to dental needs at a district health authority level.

Prices paid for adult and paediatric antiretroviral treatment by low- and middle-income countries in 2012: high, low or just right?

PubMed

Perriëns, Joseph H; Habiyambere, Vincent; Dongmo-Nguimfack, Boniface; Hirnschall, Gottfried

2014-01-01

A viable market for antiretroviral drugs in low- and middle-income countries is key to the continued scale-up of antiretroviral treatment. We describe the price paid by low- and middle-income countries for 10 first- and 7 second-line adult and paediatric treatment regimens from 2003 to 2012, and compare the price of their finished formulations with the price of their active pharmaceutical ingredients in 2005, 2007, 2010 and 2012. Between 2003 and 2012 the median price of adult first-line treatment regimens per treatment-year decreased from USD499 to USD122, and that of second-line regimens from USD2,934 to USD497. In 2005 adult formulations were sold for a price 170% higher than the cost of their active pharmaceutical ingredients. This margin had decreased to 28% in 2012. Between 2004 and 2013, the price of paediatric treatment per treatment-year decreased from USD585 to USD147 for first-line and from USD763 to USD288 for second-line treatment. In 2005, paediatric treatment regimens were sold at a price 231% higher than the cost of their active pharmaceutical ingredients. This margin remained high and was 195% in 2012. The prices paid for antiretroviral drugs by low- and middle-income countries decreased between 2003 and 2012. Although the margins on their sale decreased, there is likely still space for price reduction, especially for the more recent World Health Organization recommended adult first-line regimens and for paediatric treatment.

Paediatric cardiology fellowship training: effect of work-hour regulations on scholarly activity.

PubMed

Ronai, Christina; Lang, Peter

2017-01-01

In 2003, work-hour regulations were implemented by the Accreditation Council for Graduate Medical Education. Much has been published regarding resident rest and quality of life as well as patient safety. There has been no examination on the effect of work-hour restrictions on academic productivity of fellows in training. Paediatric subspecialty fellows have a scholarly requirement mandated by the American Board of Pediatrics. We have examined the impact of work-hour restrictions on the scholarly productivity of paediatric cardiology fellows during their fellowship. We conducted a literature search for all paediatric cardiology fellows between 1998 and 2007 at a single academic institution as first or senior authors on papers published during their 3-year fellowship and 3 years after completion of their categorical fellowship (n=63, 30 fellows before 2003 and 33 fellows after 2003). The numbers of first- or senior-author fellow publications before and after 2003 were compared. We also collected data on final paediatric cardiology subspecialty career choice. There was no difference in the number of fellow first-author publications before and after 2003. Before work-hour restrictions, the mean number of publications per fellow was 2.1 (±2.2), and after work-hour restrictions it was 2.0 (±1.8), (p=0.89). By subspecialty career choice, fellows who select electrophysiology, preventative cardiology, and heart failure always published within the 6-year time period. Since the implementation of work-hour regulations, total number of fellow first-authored publications has not changed. The role of subspecialty choice may play a role in academic productivity of fellows in training.

A Pediatric Cardiology Fellowship Boot Camp improves trainee confidence.

PubMed

Allan, Catherine K; Tannous, Paul; DeWitt, Elizabeth; Farias, Michael; Mansfield, Laura; Ronai, Christina; Schidlow, David; Sanders, Stephen P; Lock, James E; Newburger, Jane W; Brown, David W

2016-12-01

Introduction New paediatric cardiology trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have limited or no exposure during residency. The Pediatric Cardiology Fellowship Boot Camp (PCBC) at Boston Children's Hospital was designed to provide incoming fellows with an intensive exposure to congenital cardiac pathology and a broad overview of major areas of paediatric cardiology practice. The PCBC curriculum was designed by core faculty in cardiac pathology, echocardiography, electrophysiology, interventional cardiology, exercise physiology, and cardiac intensive care. Individual faculty contributed learning objectives, which were refined by fellowship directors and used to build a programme of didactics, hands-on/simulation-based activities, and self-guided learning opportunities. A total of 16 incoming fellows participated in the 4-week boot camp, with no concurrent clinical responsibilities, over 2 years. On the basis of pre- and post-PCBC surveys, 80% of trainees strongly agreed that they felt more prepared for clinical responsibilities, and a similar percentage felt that PCBC should be offered to future incoming fellows. Fellows showed significant increase in their confidence in all specific knowledge and skills related to the learning objectives. Fellows rated hands-on learning experiences and simulation-based exercises most highly. We describe a novel 4-week-long boot camp designed to expose incoming paediatric cardiology fellows to the broad spectrum of knowledge and skills required for the practice of paediatric cardiology. The experience increased trainee confidence and sense of preparedness to begin fellowship-related responsibilities. Given that highly interactive activities were rated most highly, boot camps in paediatric cardiology should strongly emphasise these elements.

Accurate diagnosis of CHD by Paediatricians with Expertise in Cardiology.

PubMed

Jacob, Hannah C; Massey, Hannah; Yates, Robert W M; Kelsall, A Wilfred

2017-08-01

Introduction Paediatricians with Expertise in Cardiology assess children with a full history, examination, and often perform an echocardiogram. A minority are then referred to an outreach clinic run jointly with a visiting paediatric cardiologist. The accuracy of the echocardiography diagnosis made by the Paediatrician with Expertise in Cardiology is unknown. Materials and methods We conducted a retrospective review of clinic letters for children seen in the outreach clinic for the first time between March, 2004 and March, 2011. Children with CHD diagnosed antenatally or elsewhere were excluded. We recorded the echocardiography diagnosis made by the paediatric cardiologist and previously by the Paediatrician with Expertise in Cardiology. The Paediatrician with Expertise in Cardiology referred 317/3145 (10%) children seen in the local cardiac clinics to the outreach clinic over this period, and among them 296 were eligible for inclusion. Their median age was 1.5 years (range 1 month-15.1 years). For 244 (82%) children, there was complete diagnostic agreement between the Paediatrician with Expertise in Cardiology and the paediatric cardiologist. For 29 (10%) children, the main diagnosis was identical with additional findings made by the paediatric cardiologist. The abnormality had resolved in 17 (6%) cases by the time of clinic attendance. In six (2%) patients, the paediatric cardiologist made a different diagnosis. In total, 138 (47%) patients underwent a surgical or catheter intervention. Discussion Paediatricians with Expertise in Cardiology can make accurate diagnoses of CHD in children referred to their clinics. This can allow effective triage of children attending the outreach clinic, making best use of limited specialist resources.

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.

European Antibiotic Awareness Day 2017: training the next generation of health care professionals in antibiotic stewardship.

PubMed

Schrier, Lenneke; Hadjipanayis, Adamos; Del Torso, Stefano; Stiris, Tom; Emonts, Marieke; Dornbusch, Hans Juergen

2018-02-01

Antimicrobial stewardship (AMS) aims to optimise treatment, minimise the risk of adverse effects and reduce health care costs. In addition, it is recognised as a key component to stop the current spread of antimicrobial resistance in Europe. Educational programmes are particularly important for the successful implementation of AMS. Training should start during medical school, continue during clinical training and be reinforced throughout postgraduate training. National core curricula for paediatric training should include passive and active training of competencies needed for AMS and future paediatricians should be skilled in taking leadership roles in AMS initiatives. Other core members of the paediatric AMS team should also receive training focused on the unique medical needs of the paediatric patient. Ideally, all communities, hospitals and health regions in Europe should have AMS that serve all patient types, including children. We all have the responsibility to ensure that existing antibiotics remain effective. What is Known: • Antimicrobial stewardship (AMS) is a key component to stop the current spread of antimicrobial resistance • Educational programmes are particularly important for the successful implementation of AMS What is New: • All medical doctors in Europe who will be undertaking significant practice in child health should master the competencies needed to prescribe antibiotics to children rationally as described in the European Academy of Paediatrics (EAP) Curriculum for Common Trunk Training in Paediatrics • Interdisciplinary approaches of education need to be developed, as all hospitals and health regions in Europe ideally should have AMS programmes that serve all patient types, including children.

WHO and national lists of essential medicines in Mexico, Central and South America, and the Caribbean: are they adequate to promote paediatric endocrinology and diabetes care?

PubMed Central

Rowlands, Amanda; Acosta-Gualandri, Alejandra; Guevara-Aguirre, Jaime; Chanoine, Jean-Pierre

2016-01-01

Paediatric endocrinology and diabetes is a paediatric specialty with less common conditions and higher cost medicines. Access to medicines for our specialty in low and middle income countries remains limited. We analysed the content of the WHO (children and adults) and of all available national Model Lists of Essential Medicines (EMLs) for Mexico, the Caribbean, Central and South America from a paediatric endocrinology and diabetes standpoint. A master list of medicines deemed necessary in paediatric endocrinology and diabetes was established and compared with the WHO and national EMLs, taking into account the gross national income. The WHO EMLs, which are largely recognised as an international benchmark and drive the content of the national EMLs, included many but not all medicines present on our master list. Interestingly, several national EMLs from richer countries included medicines that were not present in the WHO EMLs. Our analysis suggests that these medicines could be considered by the WHO for inclusion in their EMLs, which may promote the adoption of more medicines by individual countries. We also propose several changes to the WHO and national EMLs that could facilitate access to medicines in our specialty: age cut-off for a child using physical maturity rather than a set age limit; greater standardisation of the formatting of the national EMLs for easier comparison and collaborations between countries; greater emphasis on age-specificity and population-specificity for some medicines; and formatting of the EMLs in a disease-focused manner rather than as individual medicines. PMID:28588968

Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease.

PubMed

Wiskin, A E; Owens, D R; Cornelius, V R; Wootton, S A; Beattie, R M

2012-08-01

There has been increasing interest in the use of nutrition risk assessment tools in paediatrics to identify those who need nutrition support. Four non-disease specific screening tools have been developed, although there is a paucity of data on their application in clinical practice and the degree of inter-tool agreement. The concurrent validity of four nutrition screening tools [Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Simple Paediatric Nutrition Risk Score (PNRS)] was examined in 46 children with inflammatory bowel disease. Degree of malnutrition was determined by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria. There was good agreement between STAMP, STRONGkids and PNRS (kappa > 0.6) but there was only modest agreement between PYMS and the other scores (kappa = 0.3). No children scored low risk with STAMP, STRONGkids or PNRS; however, 23 children scored low risk with PYMS. There was no agreement between the risk tools and the degree of malnutrition based on anthropometric data (kappa < 0.1). Three children had anthropometry consistent with malnutrition and these were all scored high risk. Four children had body mass index SD scores < -2, one of which was scored at low nutrition risk. The relevance of nutrition screening tools for children with chronic disease is unclear. In addition, there is the potential to under recognise nutritional impairment (and therefore nutritional risk) in children with inflammatory bowel disease. © 2012 The Authors. Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

Integration of high-fidelity simulator in third-year paediatrics clerkship.

PubMed

Ortiz, Nerian; Pedrogo, Yasmin; Bonet, Nydia

2011-06-01

Simulation in medicine is a useful tool for assessing clinical competencies. The liaison committee on medical education expects students to have simulation experiences in the curriculum. The integration of simulators has been encouraged for clinical clerkships. The use of the human simulator in a safe environment should result in enhanced teamworking, communication and critical thinking skills. During the academic year 2007-08, a formative activity using the simulator was implemented in the paediatrics clerkship. The objectives included exposing students to an emergent general paediatric medical scenario using the human simulator. It was imperative that students would adequately go through the critical thinking process. The paediatrics clerkship has incorporated a formative activity using the high-fidelity simulator. A faculty member debriefed the students, and feedback was offered. A total of 124 students participated in the activity. Ninety-eight percent agreed that the use of the simulator in a scenario such as the one presented allowed for a better understanding of the clinical issues studied in the clerkship. More than 85 percent of the students recommended the integration of the simulator in other major clinical clerkships. Performance in the objective structured clinical exam (OSCE) at the end of the clerkship has improved after the implementation of this formative activity. The use of the high-fidelity simulator during the paediatrics clerkship has been identified as an excellent teaching tool. This formative activity has been deemed successful by the students, who feel that it serves as an extra tool to strengthen learned concepts and skills. © Blackwell Publishing Ltd 2011.

Inadequate vitamin D levels are associated with culture positive sepsis and poor outcomes in paediatric intensive care.

PubMed

Onwuneme, Chike; Carroll, Aoife; Doherty, Dermot; Bruell, Heike; Segurado, Ricardo; Kilbane, Mark; Murphy, Nuala; McKenna, Malachi J; Molloy, Eleanor J

2015-10-01

This study aimed to assess vitamin D status, and its determinants, in paediatric patients with suspected sepsis who were admitted to a paediatric intensive care unit (PICU). We also investigated the association between vitamin D status and clinical outcomes. Serum 25-hydroxy vitamin D (25OHD) and clinical determinants were prospectively assessed in children with suspected sepsis (<12 years old) admitted to the PICU. The relationship between 25OHD and clinical outcomes was evaluated. Vitamin D status was also assessed in control children of a similar age. We enrolled 120 children with suspected sepsis admitted to the PICU and 30 paediatric controls. 25OHD was <50 nmol/L in 59% of the children admitted to the PICU and 25OHD was lower than in the controls (47 ± 29 vs 66 ± 26 nmol/L, p < 0.001). After adjusting for potential confounders, 25OHD was strongly associated with culture positive sepsis (p < 0.001), the paediatric index of mortality (p = 0.026) and the duration of mechanical ventilation (p = 0.008). There was a negative correlation between 25OHD and C-reactive protein (CRP): each 0.1% decrease in 25OHD increased CRP (p = 0.04). Children admitted to the PICU with suspected sepsis had lower 25OHD than controls and inadequate 25OHD status was associated with confirmed sepsis and poor outcomes. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Drug approval processes in Australian Paediatric Hospitals.

PubMed

Sinha, Y K; Craig, J C; Barclay, P; Taitz, J; South, M; Coulthard, K; Pearson, C; Erickson, S; Brien, J E

2010-09-01

To describe and evaluate the decision-making processes for drug approval in Australian paediatric hospitals. Multicentre descriptive study involving face-to-face interviews of drug and therapeutics committee chairs and secretaries, review of committee documents and drug submissions for all Australian paediatric hospital drug and therapeutics committees over a 1-year period. All eight paediatric hospitals in Australia. Eight committee chairs and seven secretaries or delegates. Total drug expenditure, number of formulary submissions, individual-patient use approvals and approval rates for each hospital from 1 July 2006 to 30 June 2007, stratified by therapeutic class. Qualitative description of the approval processes. Total drug expenditure varied from $A1.7 million (US$1.5 million) to $A11.1 million (US$9.8 million) per hospital. The number of formulary submissions also varied, from 7 to 21, but approval rate was high (76%-100%) and not significantly different among hospitals (p=0.17). Several committees approved identical submissions for five drugs. The number of individual-patient use applications varied considerably, ranging from 10 to 456 per hospital. Where estimable, individual-patient use approval was 76%-100% and variable (p=0.03). Quality of evidence relating to safety and efficacy of drugs being considered was regarded as the most important factors influencing decision making, with the cost less important. Most committees had poor infrastructural support for approval processes. No committee formally included a pharmaco-economic evaluation. Most drug submissions in tertiary paediatric hospitals are approved; however, workload, drug expenditure and individual-patient use schemes vary considerably. Duplication of effort occurs, and few committees are resourced sufficiently given their terms of reference.

Paediatric chronic fatigue syndrome: complex presentations and protracted time to diagnosis.

PubMed

Knight, Sarah; Harvey, Adrienne; Lubitz, Lionel; Rowe, Kathy; Reveley, Colette; Veit, Frederike; Hennel, Sabine; Scheinberg, Adam

2013-11-01

The diagnosis and management of paediatric chronic fatigue syndrome (CFS) remain ongoing challenges for paediatric clinicians, particularly given its unknown aetiology and the little research on effective treatments for this condition. The aim of this study was to describe the presenting features of new patients attending a specialist chronic fatigue clinic at a tertiary-level Australian children's hospital. The medical records of all patients with an initial consultation at the chronic fatigue clinic over a 12-month period were reviewed using a standardised data collection template. Functional impact was based on school attendance and classified according to the National Institute of Health and Clinical Excellence guidelines (2007). A total of 99 patients attending the clinic were identified. Of these, 59 were diagnosed with CFS. Median age was 15.4 years with almost two-thirds of patients of female sex. Median time between symptom onset and diagnosis was 15.5 months. There was a high occurrence of fatigue, sleep disturbance, pain, postexertional malaise, and autonomic and cognitive symptoms in the group. The functional impact of CFS was classified as mild for 20%, moderate for 66% and severe for 14% of patients. Most young people diagnosed with CFS experience symptoms for a protracted period, with considerable functional impact prior to initial tertiary service consultation. This audit has identified important areas for research, practice development and education in relation to the management of patients with CFS. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Access to care for children and young people diagnosed with localized scleroderma or juvenile SSc in the UK.

PubMed

Hawley, Daniel P; Baildam, Eileen M; Amin, Tania S; Cruikshank, Mary K; Davidson, Joyce E; Dixon, Jennifer; Martin, Neil S; Ohlsson, Victoria; Pilkington, Clarissa; Rangaraj, Satyapal; Riley, Philip; Sundaramoorthy, Chitra; Walsh, Jo; Foster, Helen E

2012-07-01

To describe pathways of care and referral to paediatric rheumatology from onset of first symptom (noticed by the patient or their family) to diagnosis for children and young people diagnosed with localized scleroderma (LS) or juvenile SSc (jSSc). Retrospective case note audit of patients under paediatric rheumatology care who presented during January 2005-January 2010. Data included disease subtype, sex, age at key points in the referral pathway and health care professional (HCP) contact. All patient and HCP data were pseudo-anonymized in accordance with good clinical practice. Data were from eight UK centres that saw 89 cases: 62 females, 26 males; 73 LS, 16 jSSc. Median time from first symptom to first HCP review was 4 (range 0-72) months (LS) and 1 (range 0-50) month (jSSc). Median time from first symptom to paediatric rheumatology review was 15 (range 1-103) months (LS) and 7 (range 0-50) months (jSSc). Median time from first HCP review to first paediatric rheumatology review was 11 (range 0-103) months (LS) and 2 (range 0-10) months. First HCP seen (74%) was usually a general practitioner. The referring HCP to paediatric rheumatology was usually a dermatologist (56%) for LS. Median time from first symptom to diagnosis was 13 (range 1-102) months (LS) and 8 (range 1-50) months (jSSc). A prolonged interval occurs from first symptom to definitive diagnosis, which may adversely affect outcome. There is a need to raise awareness of this rare diagnosis and facilitate earlier recognition.

Parent participation in paediatric rehabilitation treatment centres in the Netherlands: a parents' viewpoint.

PubMed

Siebes, R C; Wijnroks, L; Ketelaar, M; van Schie, P E M; Gorter, J W; Vermeer, A

2007-03-01

The importance of family-centred care and services has been increasingly emphasized in paediatric rehabilitation. One aspect of family-centred care is parent involvement in their child's treatment. The aims of this study were (1) to describe how, and to what extent parents are involved in the paediatric rehabilitation treatment process in the Netherlands; (2) to determine the level of parents' satisfaction about the services they and their child have received; and (3) to describe what ideas parents have to enhance their involvement in the treatment process. A total of 679 parents of children aged 1-20 years who participated in our longitudinal study on family centred care in the Netherlands. The children had various diagnoses and were treated in nine out of 23 Dutch paediatric rehabilitation centres. A random sample of 75 parents was interviewed within 4 weeks after completion of the Measure of Processes of Care and the Client Satisfaction Questionnaire. A Quality of Care cycle with six stages was used to structure the evaluation. The data showed that parents are involved in all stages of their child's rehabilitation process in various ways. The average level of parent satisfaction about the services received was high. According to the interviewed parents, the communication between professionals and parents, parents' involvement in goal setting, and parents' involvement in treatment could be improved upon. Parents are to a large extent involved in all stages of the treatment process in Dutch paediatric rehabilitation settings. Although parents valued the services received, they suggested various ways to enhance parent participation.

Joint programmes in paediatric cardiothoracic surgery: a survey and descriptive analysis.

PubMed

DeCampli, William M

2011-12-01

Joint programmes, as opposed to regionalisation of paediatric cardiac care, may improve outcomes while preserving accessibility. We determined the prevalence and nature of joint programmes. We sent an online survey to 125 paediatric cardiac surgeons in the United States in November, 2009 querying the past or present existence of a joint programme, its mission, structure, function, and perceived success. A total of 65 surgeon responses from 65 institutions met the criteria for inclusion. Of the 65 institutions, 22 currently or previously conducted a joint programme. Compared with primary institutions, partner institutions were less often children's hospitals (p = 0.0004), had fewer paediatric beds (p = 0.005), and performed fewer cardiac cases (p = 0.03). Approximately 47% of partner hospitals performed fewer than 50 cases per year. The median distance range between hospitals was 41-60 miles, ranging from 5 to 1000 miles. Approximately 54% of partner hospitals had no surgeon working primarily on-site, and 31% of the programmes conducted joint conferences. Approximately 67% of the programmes limited the complexity of cases at the partner hospital, and 83% of the programmes had formal contracts between hospitals. Of the six programmes whose main mission was to increase referrals to the primary hospital, three were felt to have failed. Of the nine programmes whose mission was to increase regional quality, eight were felt to be successful. Joint programmes in paediatric cardiac surgery are common but are heterogeneous in structure and function. Programmes whose mission is to improve the quality of regional care seem more likely to succeed. Joint programmes may be a practical alternative to regionalisation to achieve better outcomes.

A 10 year epidemiological study of paediatric burns at the Welsh Centre for burns and plastic surgery.

PubMed

Sanyaolu, Leigh; Javed, Muhammad Umair; Eales, Micheal; Hemington-Gorse, Sarah

2017-05-01

Paediatric burns make up a significant proportion of burn injured patients seen within the hospital setting and worldwide account for a significant proportion of unintentional deaths. Currently there is limited data on severe paediatric burns requiring intensive care support. Our study aimed primarily to describe the epidemiology of severe burns admitted to the intensive care unit at our centre receiving fluid resuscitation over a 10 year period. A secondary aim was to describe the referrals patterns in general over the same time period. A retrospective analysis was performed for paediatric patients referred to our centre receiving fluid resuscitation and intensive care support from 2003 to 2013. We also analysed the patterns of referrals, admissions and need for surgical intervention over the same time period retrospectively. Children less than 5 years old made up 65% of admissions to intensive care and scald injuries (56%) were the commonest aetiology. Both total length of stay (25 days in 2003 to 10 days in 2013) and intensive care length of stay (7.2 days in 2003 to 3 days in 2013) decreased during the study and less patients underwent operative intervention. Referrals to our centre increased from 261 in 2003 to 366 in 2013, however admission rates declined from 145 to 85 during that time period. Currently there is limited data on severe burns within the paediatric population. Our study provides epidemiological data in this area, an important step for developing future prevention strategies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Safety and efficacy of active Leptospermum honey in neonatal and paediatric wound debridement.

PubMed

Amaya, R

2015-03-01

Safety is a critically important factor in the selection of products used in neonatal and paediatric wound care. Given the lack of standardisation of neonatal and paediatric wound care protocols, the goal of this study was to present data on the safety and efficacy of active Leptospermum honey (ALH) in this patient population. A multicentre, retrospective chart review was conducted at eight inpatient facilities and one outpatient clinic between October 2011 and March 2014. The number of applications of ALH, adverse events, and the success of debridement and wound healing were recorded. Data were collected on 115 neonatal and paediatric patients, with 121 wounds requiring debridement, treated with ALH. Patients were treated for an average of 18.7 days. ALH was well tolerated, with two (1.7%) patients reporting adverse events involving a transient stinging sensation on application, which did not prohibit additional applications of ALH. Successful debridement was achieved in 86.0% (104 wounds), and 77.7% (94 wounds) were successfully closed using nonsurgical intervention. Outcomes in neonates were similar to the overall paediatric population, with 86.1% (31/36) wounds successfully debrided with no adverse events. In a subset of six patients with available pre- and post-treatment data, no clinically meaningful changes in white blood cell counts or glucose levels were associated with the initiation of treatment with ALH. The results of this study support ALH as a safe and effective treatment option in this group of patients. This study was supported by a grant from Derma Sciences (Princeton, NJ USA). Dr Amaya is a paid speaker for Derma Sciences.

Paediatric sunburn: the experience of an Australian paediatric burns unit.

PubMed

Mah, Latifa; Di Giovine, Paul; Quinn, Linda; Sparnon, Anthony

2013-08-01

The number of hospital presentations and admissions for treatment of sunburn remains significant, despite efforts to educate the public regarding sun protection. Current literature chiefly examines public health campaigns and sun protection behaviours and attitudes. There are very few articles that explore paediatric sunburn requiring hospital presentation. This study was therefore undertaken to provide a snapshot of this issue and to identify patterns and causative factors in the development of severe sunburn requiring hospital presentation. Data were collected for retrospective analysis from case records of patients who presented with sunburn and were registered on the Burns Service database at the Women's and Children's Hospital in South Australia. This study includes patients who presented during the period of October 2006 to March 2011. There were 81 cases identified over the period of 2006-2011 from the Burns database that had sufficient information for the purpose of this study. Factors such as outdoor activity and water sports were predictably apparent, with patients being burned on days with extremely high ultraviolet ratings. Key patterns that emerged were location of sunburn and sun protection use, which were gender and age specific. Larger-scale studies are warranted to further delineate the contributing factors and to identify the specific populations of children at risk of sunburn. Future educational programmes can therefore target these subgroups and behaviours for effective prevention of sunburn. Tailored campaigns that address these factors may be of greater impact in reducing hospital presentations and admissions of significant sunburn. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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

PubMed

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

2015-10-01

Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

[Efficacy of treatment with I(131) in paediatric Graves disease].

PubMed

Enes Romero, P; Martín-Frías, M; de Jesús, M; Caballero Loscos, C; Alonso Blanco, M; Barrio Castellanos, R

2014-01-01

Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I(131), side effects, and hypothyroidism rates. A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I(131) (mean dose: 10.9±1.09 mCi). Remission with I(131) was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patients treated with I(131.) Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Trends in paediatric sport- and recreation-related injuries: An injury surveillance study at the British Columbia Children’s Hospital (Vancouver, British Columbia) from 1992 to 2005

PubMed Central

Pakzad-Vaezi, Kaivon; Singhal, Ash

2011-01-01

BACKGROUND: Sport- and recreation-related injuries are a major source of morbidity in the paediatric population. Long-term trends for these injuries are largely unknown. METHODS: A traumatic injury surveillance system (the Canadian Hospitals Injury Reporting and Prevention Program) was used to examine the demographics and trends of paediatric sports injuries in children who presented to or were directly admitted to the British Columbia Children’s Hospital (Vancouver, British Columbia) emergency department or intensive care unit from 1992 to 2005. RESULTS: Over the 14-year study period, there was a significant increase in sport- and recreation-related injuries among patients who presented to the British Columbia Children’s Hospital. Of 104,414 injuries between 1992 and 2005, 27,466 were related to sports and recreational activities. The number of sport-related injuries increased by 28%, while all-cause injuries did not change significantly. Males comprised 68% of the sport-related injuries, and both sexes displayed an increasing trend over time. Cycling, basketball, soccer and ice hockey were the top four injury-causing activities. The main body parts injured were the face, head and digits. CONCLUSIONS: Paediatric sports injuries significantly increased at the British Columbia Children’s Hospital over the 14-year study period. This is likely due to increased sport participation, increased risk associated with certain sports, or both. Trends in paediatric sports injury may be predicted by changes in popular media, possibly allowing prevention programs to help to avoid these injuries before they occur. PMID:22468125

Impairment and Coping in Children and Adolescents with Chronic Fatigue Syndrome: A Comparative Study with Other Paediatric Disorders

ERIC Educational Resources Information Center

Garralda, M. Elena; Rangel, Luiza

2004-01-01

Background: Functional impairment is a key feature of chronic fatigue syndrome (CFS) of childhood. Aim: To compare impairment, illness attitudes and coping mechanisms in childhood CFS and in other paediatric disorders. Method: Participants were 28 children and adolescents with CFS, 30 with juvenile idiopathic arthritis (JIA) and 27 with emotional…

'It is easy to find yourself working outside your comfort zone when working with autistic children'.

PubMed

Bellis, Wendy; Westgarth, David

2015-10-09

Wendy Bellis is Assistant Clinical Director and Specialist Paediatric Senior Dental Officer for Camden and Islington Community Dental Service (Whittington Health). She is considered a world renowned voice on autism and paediatric dentistry, and news editor David Westgarth sat down with her to discuss some of the challenges presented by autistic patients.

Randomized Controlled Trial of Full and Brief Cognitive-Behaviour Therapy and Wait-List for Paediatric Obsessive-Compulsive Disorder

ERIC Educational Resources Information Center

Bolton, Derek; Williams, Tim; Perrin, Sean; Atkinson, Linda; Gallop, Catherine; Waite, Polly; Salkovskis, Paul

2011-01-01

Background: Reviews and practice guidelines for paediatric obsessive-compulsive disorder (OCD) recommend cognitive-behaviour therapy (CBT) as the psychological treatment of choice, but note that it has not been sufficiently evaluated for children and adolescents and that more randomized controlled trials are needed. The aim of this trial was to…

The Self-Directed Learning Experience of Mothers Whose Child Has Had a Paediatric Stroke

ERIC Educational Resources Information Center

Grover, Kenda S.

2014-01-01

This study employed qualitative research methodology to explore the experiences of mothers who self-directed their learning following their child's stroke diagnosis. Paediatric stroke, although rare, is among the top 10 causes of death in children in the USA, but information about the cause, treatment and long-term impact are difficult to…

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

PubMed

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

2016-01-01

Based on an assessment of adverse events in a follow-up care and rehabilitation unit in paediatrics, audits were carried out of the medicine use pathway. The evaluation grid taken from this study today serves as a basis for the audits carried out on the medicine use pathway on a national level. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Paediatric oncology information pack for general practitioners

PubMed Central

James, J A; Harris, D J; Mott, M G; Oakhill, A

1988-01-01

An information pack covering important aspects of paediatric oncology has been developed for general practitioners. Sixty general practitioners who received the information pack found that it helped them in managing children with neoplastic disease and their families. The pack has also improved communications between the oncology unit and general practitioners. Similar packs could be produced by paediatricians working in other specialties. PMID:3122972

Recent advances in paediatric gastroenterology.

PubMed

Hansen, Richard; Russell, Richard K; Muhammed, Rafeeq

2015-09-01

Over the last few years, many changes have been introduced in the diagnosis and management of paediatric gastrointestinal problems. This review highlights the recent developments in Helicobacter pylori infection, eosinophilic oesophagitis, coeliac disease and inflammatory bowel disease. 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.

Physical activity for paediatric rheumatic diseases: standing up against old paradigms.

PubMed

Gualano, Bruno; Bonfa, Eloisa; Pereira, Rosa M R; Silva, Clovis A

2017-05-23

Over the past 50 years it has become clear that physical inactivity is associated with chronic disease risk. For several rheumatic diseases, bed rest was traditionally advocated as the best treatment, but several levels of evidence support the imminent paradigm shift from the prescription of bed rest to physical activity in individuals with paediatric rheumatic diseases, in particular juvenile systemic lupus erythematosus, juvenile idiopathic arthritis, juvenile fibromyalgia, and juvenile dermatomyositis. Increasing levels of physical activity can alleviate several symptoms experienced by patients with paediatric rheumatic diseases, such as low aerobic fitness, pain, fatigue, muscle weakness and poor health-related quality of life. Moreover, the propensity of patients with paediatric rheumatic diseases to be hypoactive - often due to social self-isolation, overprotection, and fear and/or ignorance on the part of parents, teachers and health practitioners - can be detrimental to general disease symptoms and function. In support of this rationale, a growing number of studies have demonstrated that the systemic benefits of exercise training clearly outweigh the risks in these diseases. In this sense, health professionals are advised to assess, track and fight against physical inactivity and sedentary behaviour on a routine basis, as they are invaluable health risk parameters in rheumatology.

Social media in paediatric heart disease: professional use and opportunities to improve cardiac care.

PubMed

Schumacher, Kurt R; Lee, Joyce M; Pasquali, Sara K

2015-12-01

Social media is any type of communication utilising electronic technology that follows two guiding principles: free publishing or sharing of content and ideas and group collaboration and inter-connectedness. Over the last 10 years, social media technology has made tremendous inroads into all facets of communication. Modalities such as Facebook, YouTube, and Twitter are no longer viewed as new communication technologies. Owing to their tremendous usage, they are now common ways to conduct a dialogue with individuals and groups. Greater than 91% of teenagers and 89% of young adults routinely use social media. Further, 24% of teenagers reported being online "almost constantly". These forms of communication are readily used by individuals cared for in the field of paediatric cardiology; thus, they should carry significant interest for cardiology care providers; however, social media's influence on medicine extends beyond use by patients. It directly affects all medical providers, both users and non-users. Further, social media has the ability to improve care for patients with paediatric heart disease. This article details social media's current influence on paediatric cardiology, including considerations for professional use of social media and potential opportunities to improve cardiac care.

Treating children with inflammatory bowel disease: Current and new perspectives

PubMed Central

Guariso, Graziella; Gasparetto, Marco

2017-01-01

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gut characterised by alternating periods of remission and relapse. Whilst the mechanism underlying this disease is yet to be fully understood, old and newer generation treatments can only target selected pathways of this complex inflammatory process. This narrative review aims to provide an update on the most recent advances in treatment of paediatric IBD. A MEDLINE search was conducted using “paediatric inflammatory bowel disease”, “paediatric Crohn’s disease”, “paediatric ulcerative colitis”, “treatment”, “therapy”, “immunosuppressant”, “biologic”, “monitoring” and “biomarkers” as key words. Clinical trials, systematic reviews, and meta-analyses published between 2014 and 2016 were selected. Studies referring to earlier periods were also considered in case the data was relevant to our scope. Major advances have been achieved in monitoring the individual metabolism, toxicity and response to relevant medications in IBD including thiopurines and biologics. New biologics acting on novel mechanisms such as selective interference with lymphocyte trafficking are emerging treatment options. Current research is investing in the development of reliable prognostic biomarkers, aiming to move towards personalised treatments targeted to individual patients. PMID:28852307

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).

PubMed

Ward, Elizabeth C; Hill, Anne E; Nund, Rebecca L; Rumbach, Anna F; Walker-Smith, Katie; Wright, Sarah E; Kelly, Kris; Dodrill, Pamela

2015-06-01

The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Age-related clinical and biological features of PTEN abnormalities in T-cell acute lymphoblastic leukaemia.

PubMed

Tesio, M; Trinquand, A; Ballerini, P; Hypolite, G; Lhermitte, L; Petit, A; Ifrah, N; Baruchel, A; Dombret, H; Macintyre, E; Asnafi, V

2017-12-01

The tumour suppressor gene PTEN is commonly altered in T-cell acute lymphoblastic leukaemia but its prognostic impact is still debated. We screened a cohort of 573 fully characterised adult and paediatric T-cell acute lymphoblastic leukaemia (T-ALL) patients for genomic PTEN abnormalities. PTEN-inactivating mutations and/or deletions were identified in 91 cases (16%), including 18% of paediatric (49/277) and 14% of adult cases (42/296). Thirty-four patients harboured only mutations, 12 cases demonstrated only large deletions and 9 only microdeletions. About 36 patients had combined alterations. Different mechanisms of PTEN inactivation predicted differences in the clinical outcome for both adult and paediatric patients treated according to the GRAALL03/05 and FRALLE2000 protocols. Whereas large deletions predicted lower 5-year overall survival (P=0.0053 in adults, P=0.001 in children) and disease-free survival (P=0.0009 in adults, P=0.0002 in children), mutations were not associated with a worse prognosis. The prognostic impact of PTEN loss is therefore linked to the underlying type of genomic abnormality, both in adult and paediatric T-ALLs, demonstrating that detailed analysis of the type of abnormality type would be useful to refine risk stratification.

[Disciplinary verdicts in cases of child abuse; lessons for paediatricians].

PubMed

Berkers, Gitte; Biesaart, Monique C I H; Leeuwenburgh-Pronk, Wendela G

2015-01-01

To give an overview of disciplinary cases regarding action taken by paediatricians and paediatric residents in cases of (suspected) child abuse and to discuss the considerations of the disciplinary board in these cases. Retrospective, descriptive study. We considered all disciplinary cases instigated from 2001 to 2013 against paediatricians or paediatric residents and selected complaints regarding action taken in cases of (suspected) child abuse. We divided these complaints into six categories and studied the considerations of the disciplinary board in these cases. From 33 disciplinary cases instigated from 2001 to 2013, we selected 76 complaints regarding action taken by paediatricians or paediatric residents in cases of (suspected) child abuse. The majority of these complaints concerned the reporting or requesting of information in the context of (suspected) child abuse. All of the complaints in the category 'unwarranted reporting of child abuse' were declared unfounded by the disciplinary judge. The disciplinary board declared all complaints unfounded in cases where the paediatrician or paediatric resident had followed the Dutch national protocol regarding reporting of child abuse and domestic violence. The disciplinary board examines whether action was taken in accordance with reasonable standards of professional competence and considers that paediatricians have an important role in identifying child abuse.

Paediatric x-ray examinations in Rio de Janeiro

NASA Astrophysics Data System (ADS)

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

2006-08-01

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

Paediatric team handover: a time to learn?

PubMed

Bradley, Stephen; Egan, John P; Henning, Marcus

2018-06-08

Paediatric team handovers provide medical professionals and students with the opportunity to exchange clinically relevant information about patients. This study explored the extent to which learning opportunities existed and were utilised within paediatric team handovers in New Zealand secondary hospitals. We undertook a qualitative, two-site case study within two paediatric departments in 2014 and 2015, and interviewed 29 participants, including medical students, junior doctors and consultants. We conducted a thematic analysis using a general inductive approach. Participants' narratives revealed that safe transfer of pertinent patient information between clinicians was the primary function of team handover. They described learning as an additional key component. Most learning opportunities were reported to be informal and opportunistic, related to the specific patients whose care was discussed within each handover. Handover team members indicated that implicit learning occurred as a feature of their handover experience. Learning opportunities exist within team handovers and the associated learning frequently occurs either opportunistically or implicitly. Adoption of a reflective approach to learning opportunities is likely to result in improved educational experiences for handover participants, particularly medical students and junior doctors. Handover represents a clinical event within which valuable workplace learning occurs.

Simulated learning environment experience in nursing students for paediatric practice.

PubMed

Mendoza-Maldonado, Yessy; Barría-Pailaquilén, René Mauricio

The training of health professionals requires the acquisition of clinical skills in a safe and efficient manner, which is facilitated by a simulated learning environment (SLE). It is also an efficient alternative when there are limitations for clinical practice in certain areas. This paper shows the work undertaken in a Chilean university in implementing paediatric practice using SLE. Over eight days, the care experience of a hospitalized infant was studied applying the nursing process. The participation of a paediatrician, resident physician, nursing technician, and simulated user was included in addition to the use of a simulation mannequin and equipment. Simulation of care was integral and covered interaction with the child and family and was developed in groups of six students by a teacher. The different phases of the simulation methodology were developed from a pedagogical point of view. The possibility of implementing paediatric clinical practice in an efficient and safe way was confirmed. The experience in SLE was highly valued by the students, allowing them to develop different skills and abilities required for paediatric nursing through simulation. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Nonspecific immunomodulators for recurrent respiratory tract infections, wheezing and asthma in children: a systematic review of mechanistic and clinical evidence.

PubMed

Esposito, Susanna; Soto-Martinez, Manuel E; Feleszko, Wojciech; Jones, Marcus H; Shen, Kun-Ling; Schaad, Urs B

2018-06-01

To provide an overview of the mechanistic and clinical evidence for the use of nonspecific immunomodulators in paediatric respiratory tract infection (RTI) and wheezing/asthma prophylaxis. Nonspecific immunomodulators have a long history of empirical use for the prevention of RTIs in vulnerable populations, such as children. The past decade has seen an increase in both the number and quality of studies providing mechanistic and clinical evidence for the prophylactic potential of nonspecific immunomodulators against both respiratory infections and wheezing/asthma in the paediatric population. Orally administered immunomodulators result in the mounting of innate and adaptive immune responses to infection in the respiratory mucosa and anti-inflammatory effects in proinflammatory environments. Clinical data reflect these mechanistic effects in reductions in the recurrence of respiratory infections and wheezing events in high-risk paediatric populations. A new generation of clinical studies is currently underway with the power to position the nonspecific bacterial lysate immunomodulator OM-85 as a potential antiasthma prophylactic. An established mechanistic and clinical role for prophylaxis against paediatric respiratory infections by nonspecific immunomodulators exists. Clinical trials underway promise to provide high-quality data to establish whether a similar role exists in wheezing/asthma prevention.

Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review.

PubMed

Bobrowski, A N; Torriani, M A; Sonego, C L; Carvalho, P H deA; Post, L K; Chagas Júnior, O L

2017-04-01

This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained. In the six cases in which treatment was surgery with titanium plate fixation, there were no postoperative complications, whereas in the 141 cases in which treatment was surgery with biodegradable plates, there were 12 postoperative complications, and in the 31 cases in which treatment was non-surgical, there were three postoperative complications. A connection between the best treatment and the number of postoperative complications in fractures of the dentate portion of the mandible in paediatric patients could not be established; however, the occurrence of postoperative complications was low for both surgical and non-surgical treatments. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The non specialist paediatric training registrar in the healthcare system.

PubMed

O'Neill, M B; Kumar, A

2012-01-01

This study evaluated the experiences of non Specialist Paediatric Training Registrars (nonSPTR) in the Irish Healthcare system. The survey explored their adaptation to the healthcare system, skill development, perceptions of training and career development inclusive of working conditions. Thirty nine (53%) doctors responded. The time spent in Paediatrics ranged from 3 to 19 years with a mean of 8.9 years. Nineteen (49%) had only worked in non regional hospitals and for 20 (51%) the mean time spent in regional hospitals was 2.6 years. The very positives experiences (likert scores 5/6) included journal appraisal for 19 (49%), clinical skill development for 17 (44%) and consultant feedback for 11 (28%).The very negative experiences were difficulty obtaining desired clinical posts for 16 (43%) doctors and only 5 (13%) were happy with their career progression. Thirty one (79.5%) cited specific barriers to career progression, with only 10 (25%) making an application to the Specialist Paediatrics Registrar (SPR) training programme. Solutions for the non SPTR difficulties include the expansion of the SPR programme and the utilization of a criterion based portfolio system to integrate the nonSPTR into formal training.

Parental satisfaction with paediatric care, triage and waiting times.

PubMed

Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

2014-04-01

The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.