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Sample records for pediatric longitudinal evaluation

  1. Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain.

    PubMed

    Kashikar-Zuck, Susmita; Carle, Adam; Barnett, Kimberly; Goldschneider, Kenneth R; Sherry, David D; Mara, Constance A; Cunningham, Natoshia; Farrell, Jennifer; Tress, Jenna; DeWitt, Esi Morgan

    2016-02-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative is a comprehensive strategy by the National Institutes of Health to support the development and validation of precise instruments to assess self-reported health domains across healthy and disease-specific populations. Much progress has been made in instrument development, but there remains a gap in the validation of PROMIS measures for pediatric chronic pain. The purpose of this study was to investigate the construct validity and responsiveness to change of 7 PROMIS domains for the assessment of children (ages: 8-18) with chronic pain--Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function, and Peer Relationships. The PROMIS measures were administered at the initial visit and 2 follow-up visits at an outpatient chronic pain clinic (CPC; N = 82) and at an intensive amplified musculoskeletal pain day-treatment program (N = 63). Aim 1 examined construct validity of PROMIS measures by comparing them with corresponding "legacy" measures administered as part of usual care in the CPC sample. Aim 2 examined sensitivity to change in both CPC and amplified musculoskeletal pain samples. Longitudinal growth models showed that PROMIS' Pain Interference, Anxiety, Depression, Mobility, Upper Extremity, and Peer Relationship measures and legacy instruments generally performed similarly with slightly steeper slopes of improvement in legacy measures. All 7 PROMIS domains showed responsiveness to change. Results offered initial support for the validity of PROMIS measures in pediatric chronic pain. Further validation with larger and more diverse pediatric pain samples and additional legacy measures would broaden the scope of use of PROMIS in clinical research.

  2. Longitudinal evaluation of Patient Reported Outcomes Measurement Information Systems (PROMIS) measures in pediatric chronic pain

    PubMed Central

    Kashikar-Zuck, Susmita; Carle, Adam; Barnett, Kimberly; Goldschneider, Kenneth R.; Sherry, David D.; Mara, Constance A.; Cunningham, Natoshia; Farrell, Jennifer; Tress, Jenna; DeWitt, Esi Morgan

    2015-01-01

    The Patient Reported Outcomes Measurement Information System (PROMIS) initiative is a comprehensive strategy by the National Institutes of Health to support the development and validation of precise instruments to assess self-reported health domains across healthy and disease-specific populations. Much progress has been made in instrument development but there remains a gap in the validation of PROMIS measures for pediatric chronic pain. The purpose of this study was to investigate the construct validity and responsiveness to change of seven PROMIS domains for the assessment of children (ages 8-18) with chronic pain – Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function and Peer Relationships. PROMIS measures were administered at the initial visit and two follow-up visits at an outpatient chronic pain clinic (CPC; N=82) and at an intensive amplified pain day-treatment program (AMP; N= 63). Aim 1 examined construct validity of PROMIS measures by comparing them with corresponding “legacy” measures administered as part of usual care in the CPC sample. Aim 2 examined sensitivity to change in both CPC and AMP samples. Longitudinal growth models showed that PROMIS Pain Interference, Anxiety, Depression, Mobility, Upper Extremity and Peer Relationship measures and legacy instruments generally performed similarly with slightly steeper slopes of improvement in legacy measures. All seven PROMIS domains showed responsiveness to change. Results offered initial support for the validity of PROMIS measures in pediatric chronic pain. Further validation with larger and more diverse pediatric pain samples and additional legacy measures would broaden the scope of use of PROMIS in clinical research. PMID:26447704

  3. Longitudinally extensive optic neuritis in pediatric patients.

    PubMed

    Graves, Jennifer; Kraus, Verena; Soares, Bruno P; Hess, Christopher P; Waubant, Emmanuelle

    2015-01-01

    Extensive optic nerve demyelinating lesions on magnetic resonance imaging (MRI) in adults could indicate a diagnosis other than multiple sclerosis with worse prognosis such as neuromyelitis optica. We report the frequency of longitudinally extensive lesions in children with first events of optic neuritis. Subjects had brain or orbit MRI within 3 months of onset and were evaluated at the University of California, San Francisco, Pediatric Multiple Sclerosis Center. Lesion length, determined by T2 hyperintensity or contrast enhancement, was blindly graded as absent, focal or longitudinally extensive (at least 2 contiguous segments of optic nerve). Of 25 subjects, 9 (36%) had longitudinally extensive optic neuritis. Extensive lesions were not associated with non-multiple sclerosis versus multiple sclerosis diagnosis (P = 1.00). No association between age and lesion extent was observed (P = .26). Prospective studies are needed to determine if longitudinally extensive optic neuritis can predict visual outcome.

  4. Longitudinal clinical and radiographic evaluation of severely intruded permanent incisors in a pediatric population.

    PubMed

    Neto, José Jeová Siebra Moreira; Gondim, Juliana Oliveira; de Carvalho, Fernanda Matias; Giro, Elisa Maria Aparecida

    2009-10-01

    Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7-14 years and 8 months). Mean time elapsed to follow-up was 26.6 months (range 10-51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre-injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post-injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root

  5. Longitudinal functional performance among children with cochlear implants and disabilities: a prospective study using the Pediatric Evaluation of Disability Inventory.

    PubMed

    Wiley, Susan; Meinzen-Derr, Jareen; Grether, Sandra; Choo, Daniel I; Hughes, Michelle L

    2012-05-01

    Functional outcomes are important in children with cochlear implants (CI) and additional disabilities as studies on auditory skill and speech/language development may not identify functional benefits from implantation. This study sought to measure functional performance skills of young children with developmental disabilities post-CI. Eight children with cognitive disabilities undergoing cochlear implantation were enrolled in a prospective study of language and functional abilities; 6 with 1 year follow-up were included in the analysis. Functional performance was measured using Pediatric Evaluation of Disability Inventory (PEDI), providing standardized (mean: 50) and scaled scores (range: 0-100) of functional domains: Self-Care, Mobility and Social Function. The PEDI was administered pre-implant, 6 and 12 months post-implantation along with language testing at the same intervals. All children had cognitive disability; 5 also had motor delay. The ages at CI ranged from 13.8 to 134 months. For functional abilities, children did not make significant changes in domain-specific standard scores over 1 year. Children made progress in scaled scores by 1-year post-implant. The largest increase for all domains occurred in the first 6 months (7-11.5 point increase). For language abilities, children made a median 5.5-month increase in receptive language age (p=0.06) and 5-month increase in expressive language age (p=0.03) in the first year post-CI with no change in language quotients. Receptive language level was significantly (p<0.05) associated with increasing scores in the domains of Self-Care and Social Function. This is the first study to measure daily functional abilities in children with implants and disabilities using a standardized tool. Although our small group of complex children did not have an increase in standard scores (gap-closing trajectories), they made progress in skill development on scaled scores. Receptive language appears to play a key role in social

  6. Pediatrics Residents' Confidence and Performance Following a Longitudinal Quality Improvement Curriculum

    PubMed Central

    Courtlandt, Cheryl; Noonan, Laura; Koricke, Maureen Walsh; Zeskind, Philip Sanford; Mabus, Sarah; Feld, Leonard

    2016-01-01

    Background Quality improvement (QI) training is an integral part of residents' education. Understanding the educational value of a QI curriculum facilitates understanding of its impact. Objective The purpose of this study was to evaluate the effects of a longitudinal QI curriculum on pediatrics residents' confidence and competence in the acquisition and application of QI knowledge and skills. Methods Three successive cohorts of pediatrics residents (N = 36) participated in a longitudinal curriculum designed to increase resident confidence in QI knowledge and skills. Key components were a succession of progressive experiential projects, QI coaching, and resident team membership culminating in leadership of the project. Residents completed precurricular and postcurricular surveys and demonstrated QI competence by performance on the pediatric QI assessment scenario. Results Residents participating in the Center for Advancing Pediatric Excellence QI curriculum showed significant increases in pre-post measures of confidence in QI knowledge and skills. Coaching and team leadership were ranked by resident participants as having the most educational value among curriculum components. A pediatric QI assessment scenario, which correlated with resident-perceived confidence in acquisition of QI skills but not QI knowledge, is a tool available to test pediatrics residents' QI knowledge. Conclusions A 3-year longitudinal, multimodal, experiential QI curriculum increased pediatrics residents' confidence in QI knowledge and skills, was feasible with faculty support, and was well-accepted by residents. PMID:26913107

  7. Longitudinal analysis of a pediatric rheumatology clinic population.

    PubMed

    Rosenberg, Alan M

    2005-10-01

    To analyze a prospectively maintained pediatric rheumatology clinic disease registry. A total of 3269 consecutive referrals to the Pediatric Rheumatology Clinic, University of Saskatchewan, during the period 1981-2004 were analyzed. Among 3269 patients, a diagnosis was established in 2098 (64.2%). Within this group, 72 subjects (3.4%) were determined to be healthy. Of the remaining 2026 diagnosed patients (62.0% of the total population), 1032 (50.9%) had a rheumatic disease and 994 (49.1%) a nonrheumatic disease. A diagnosis was not established in 1171 patients (35.8%). Among the 1032 patients with a rheumatic disease, 326 (31.6%) had juvenile rheumatoid arthritis (JRA), 360 (34.9%) a spondyloarthropathy (SpA), and 225 (21.8%) a collagen vascular/connective tissue rheumatic disease. The remaining 121 patients with a rheumatic disease (11.7%) had a variety of other conditions. Of the 994 nonrheumatic disease patients, 37 (3.7%) with ocular inflammatory conditions had been referred to exclude an associated rheumatic disease. The remaining group of 957 patients comprised 345 (36.1%) with an orthopedic, mechanical or traumatic condition, 231 (24.1%) had an infection, 45 (4.7%) a hematologic or neoplastic disease, and 336 (35.1%) a variety of other conditions. Current clinic point prevalences for JRA, SpA, and collagen vascular diseases are 35.0, 16.9 and 17.7/100,000, respectively. The mean annual clinic referral incidences of JRA, SpA, and collagen vascular/connective tissue diseases were, respectively, 4.7, 5.2, and 1.7/100,000 children. Disease registries help establish the frequencies and spectrum of childhood rheumatic diseases and the role of pediatric rheumatology programs in evaluating and caring for children with a wide variety of conditions. Longitudinal disease registries aid in characterizing clinical, epidemiologic, and demographic features of childhood rheumatic diseases.

  8. A longitudinal analysis of the pediatric surgeon workforce.

    PubMed

    O'Neill, J A; Gautam, S; Geiger, J D; Ein, S H; Holder, T M; Bloss, R S; Krummel, T M

    2000-09-01

    To describe the trends in the pediatric surgeon workforce during the last 25 years and to provide objective data useful for planning graduate medical education requirements. In 1975, the Study on U.S. Surgical Services (SOSSUS) was published, including a model to survey staffing. A pediatric surgeon workforce study was initiated in conjunction with SOSSUS as a population, supply, and need-based study. The study has been updated every 5 years using the same study model, with the goals of determining the number and distribution of pediatric surgeons in the United States, the number needed and where, and the number of training programs and trainee output required to fill estimated staffing needs. This is the only such longitudinal workforce analysis of a surgical specialty. Questionnaires were sent to 100 pediatric surgeons representing the 62 standard metropolitan statistical areas (SMSAs) in the United States with a population of 200,000 or more to verify the names and locations of all active pediatric surgeons and to gain information about the 5-year need for new pediatric surgeons by region. A program was developed to predict the number of pediatric surgeons relative to the total population and the 0-to-17-year-old population in the subsequent 30 years using updated data on the present number and ages of pediatric surgeons, age-specific death and retirement rates, projections of U.S. population by age group, and varying numbers of trainees graduated per year. As each 5-year update was done, previous projections were compared with actual numbers of pediatric surgeons found. The trends during the last 25 years were analyzed and compared and additional information regarding the demographics of practice, trends in reimbursement, and volume and scope of surgery was obtained. The birth rate has been stable since 1994. The 0-to-17-year-old population has been increasing at 0.65% per year; a 0.64% annual rate is projected to 2040. At present, 661 pediatric surgeons are

  9. A Longitudinal Analysis of the Pediatric Surgeon Workforce

    PubMed Central

    O’Neill, James A.; Gautam, Shiva; Geiger, James D.; Ein, Sigmund H.; Holder, Thomas M.; Bloss, Robert S.; Krummel, Thomas M.

    2000-01-01

    Objective To describe the trends in the pediatric surgeon workforce during the last 25 years and to provide objective data useful for planning graduate medical education requirements. Summary Background Data In 1975, the Study on U.S. Surgical Services (SOSSUS) was published, including a model to survey staffing. A pediatric surgeon workforce study was initiated in conjunction with SOSSUS as a population, supply, and need-based study. The study has been updated every 5 years using the same study model, with the goals of determining the number and distribution of pediatric surgeons in the United States, the number needed and where, and the number of training programs and trainee output required to fill estimated staffing needs. This is the only such longitudinal workforce analysis of a surgical specialty. Methods Questionnaires were sent to 100 pediatric surgeons representing the 62 standard metropolitan statistical areas (SMSAs) in the United States with a population of 200,000 or more to verify the names and locations of all active pediatric surgeons and to gain information about the 5-year need for new pediatric surgeons by region. A program was developed to predict the number of pediatric surgeons relative to the total population and the 0-to-17-year-old population in the subsequent 30 years using updated data on the present number and ages of pediatric surgeons, age-specific death and retirement rates, projections of U.S. population by age group, and varying numbers of trainees graduated per year. As each 5-year update was done, previous projections were compared with actual numbers of pediatric surgeons found. The trends during the last 25 years were analyzed and compared and additional information regarding the demographics of practice, trends in reimbursement, and volume and scope of surgery was obtained. Results The birth rate has been stable since 1994. The 0-to-17-year-old population has been increasing at 0.65% per year; a 0.64% annual rate is projected

  10. International longitudinal pediatric reference standards for bone mineral content.

    PubMed

    Baxter-Jones, Adam D G; Burrows, Melonie; Bachrach, Laura K; Lloyd, Tom; Petit, Moira; Macdonald, Heather; Mirwald, Robert L; Bailey, Don; McKay, Heather

    2010-01-01

    To render a diagnosis pediatricians rely upon reference standards for bone mineral density or bone mineral content, which are based on cross-sectional data from a relatively small sample of children. These standards are unable to adequately represent growth in a diverse pediatric population. Thus, the goal of this study was to develop sex and site-specific standards for BMC using longitudinal data collected from four international sites in Canada and the United States. Data from four studies were combined; Saskatchewan Paediatric Bone Mineral Accrual Study (n=251), UBC Healthy Bones Study (n=382); Penn State Young Women's Health Study (n=112) and Stanford's Bone Mineral Accretion study (n=423). Males and females (8 to 25 years) were measured for whole body (WB), total proximal femur (PF), femoral neck (FN) and lumbar spine (LS) BMC (g). Data were analyzed using random effects models. Bland-Altman was used to investigate agreement between predicted and actual data. Age, height, weight and ethnicity independently predicted BMC accrual across sites (P<0.05). Compared to White males, Asian males had 31.8 (6.8) g less WB BMC accrual; Hispanic 75.4 (28.2) g less BMC accrual; Blacks 82.8 (26.3) g more BMC accrual with confounders of age, height and weight controlled. We report similar findings for the PF and FN. Models for females for all sites were similar with age, height and weight as independent significant predictors of BMC accrual (P<0.05). We provide a tool to calculate a child's BMC Z-score, accounting for age, size, sex and ethnicity. In conclusion, when interpreting BMC in pediatrics we recommend standards that are sex, age, size and ethnic specific.

  11. Comparison of Segmental Versus Longitudinal Intravascular Ultrasound Analysis for Pediatric Cardiac Allograft Vasculopathy.

    PubMed

    Kuhn, M A; Burch, M; Chinnock, R E; Fenton, M J

    2017-10-01

    Intravascular ultrasound (IVUS) has been routinely used in some centers to investigate cardiac allograft vasculopathy in pediatric heart transplant recipients. We present an alternative method using more sophisticated imaging software. This study presents a comparison of this method with an established standard method. All patients who had IVUS performed in 2014 were retrospectively evaluated. The standard technique consisted of analysis of 10 operator-selected segments along the vessel. Each study was re-evaluated using a longitudinal technique, taken at every third cardiac cycle, along the entire vessel. Semiautomatic edge detection software was used to detect vessel imaging planes. Measurements included outer and inner diameter, total and luminal area, maximal intimal thickness (MIT), and intimal index. Each IVUS was graded for severity using the Stanford classification. All results were given as mean ± standard deviation (SD). Groups were compared using Student t test. A P value <.05 was considered significant. There were 59 IVUS studies performed on 58 patients. There was no statistically significant difference between outer diameter, inner diameter, or total area. In the longitudinal group, there was a significantly smaller luminal area, higher MIT, and higher intimal index. Using the longitudinal technique, there was an increase in Stanford classification in 20 patients. The longitudinal technique appeared more sensitive in assessing the degree of cardiac allograft vasculopathy and may play a role in the increase in the degree of thickening seen. It may offer an alternative way of grading severity of cardiac allograft vasculopathy in pediatric heart transplant recipients. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. A longitudinal analysis of data quality in a large pediatric data research network.

    PubMed

    Khare, Ritu; Utidjian, Levon; Ruth, Byron J; Kahn, Michael G; Burrows, Evanette; Marsolo, Keith; Patibandla, Nandan; Razzaghi, Hanieh; Colvin, Ryan; Ranade, Daksha; Kitzmiller, Melody; Eckrich, Daniel; Bailey, L Charles

    2017-11-01

    PEDSnet is a clinical data research network (CDRN) that aggregates electronic health record data from multiple children's hospitals to enable large-scale research. Assessing data quality to ensure suitability for conducting research is a key requirement in PEDSnet. This study presents a range of data quality issues identified over a period of 18 months and interprets them to evaluate the research capacity of PEDSnet. Results were generated by a semiautomated data quality assessment workflow. Two investigators reviewed programmatic data quality issues and conducted discussions with the data partners' extract-transform-load analysts to determine the cause for each issue. The results include a longitudinal summary of 2182 data quality issues identified across 9 data submission cycles. The metadata from the most recent cycle includes annotations for 850 issues: most frequent types, including missing data (>300) and outliers (>100); most complex domains, including medications (>160) and lab measurements (>140); and primary causes, including source data characteristics (83%) and extract-transform-load errors (9%). The longitudinal findings demonstrate the network's evolution from identifying difficulties with aligning the data to a common data model to learning norms in clinical pediatrics and determining research capability. While data quality is recognized as a critical aspect in establishing and utilizing a CDRN, the findings from data quality assessments are largely unpublished. This paper presents a real-world account of studying and interpreting data quality findings in a pediatric CDRN, and the lessons learned could be used by other CDRNs.

  13. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury.

    PubMed

    Babikian, Talin; Satz, Paul; Zaucha, Ken; Light, Roger; Lewis, Richard S; Asarnow, Robert F

    2011-09-01

    Comprehensive reviews of neurocognitive outcomes following mild, uncomplicated traumatic brain injury (TBI) in children have shown minimal effects on neurocognition, especially in methodologically rigorous studies. In this study, we report longitudinal (1, 6, and 12 months post injury) results in four domains of neurocognitive functioning in a large sample of children with mild TBI (n = 124, ages 8-17 at injury) relative to two demographically matched control groups (other injury: n = 94 and non-injury: n = 106). After accounting for age and parental education, significant main effects of group were observed on 7 of the 10 neurocognitive tests. However, these differences were not unique to the TBI sample but were found between both the TBI and other injury groups relative to the non-injured group, suggesting a general injury effect. Effects were primarily within the domains measuring memory, psychomotor processing speed, and language. This is the largest longitudinal study to date of neurocognitive outcomes at discrete time points in pediatric mild TBI. When controlling for pre-injury factors, there is no evidence of long-term neurocognitive impairment in this group relative to another injury control group. The importance of longitudinal analyses and use of appropriate control groups are discussed in the context of evaluating the effects of mild TBI on cognition.

  14. An evaluation of pediatric asthma educational resources.

    PubMed

    Nicholas, David B; Dell, Sharon D; Fleming-Carroll, Bonnie; Selkirk, Enid K

    2009-01-01

    The purpose of this study was to evaluate newly developed educational resources for children with asthma. Children with asthma, their parents, and pediatric health care professionals were invited to review age-appropriate asthma resources. Key findings revealed: (1) the perceived usefulness of these resources, particularly for creating discussion opportunities between children and their caregivers through implemented resource use; (2) the need for health education materials to balance goals of depth of information versus child enjoyment in order to increase effective knowledge transfer and application; and (3) a renewed call for future educational resources to be both relevant and interactive in their outreach and engagement of children, potentially involving mediums of advanced technology. Clinical experience and the literature note a current lack of pediatric asthma education materials. The positive findings of this review of novel educational materials in asthma address an important gap relative to pediatric practice, resource evaluation, and knowledge translation.

  15. Longitudinal radiographic behavior of accessory navicular in pediatric patients.

    PubMed

    Knapik, Derrick M; Guraya, Sahejmeet S; Conry, Keegan T; Cooperman, Daniel R; Liu, Raymond W

    2016-12-01

    An accessory navicular is generally asymptomatic and discovered incidentally on radiographs. The natural history of an accessory navicular in the pediatric population is largely undescribed. The medical charts of 261 pediatric subjects undergoing 2620 annual unilateral radiographs of the foot and ankle (age range 0.25-7 years at enrollment) were reviewed. Radiographs were examined to determine the incidence of accessory navicular, with focus on the age at appearance and, if present, the age at fusion. Skeletal maturity was graded based on ossification pattern of the calcaneal apophysis. Accessory navicular was identified in 19 subjects (n = 12 males, n = 7 females, p = 0.43), appearing significantly earlier in the female subjects than in the male ones (p = 0.03). Fusion was documented in 42% (n = 8) of subjects, occurring at a mean (±standard deviation) age of 12.5 ± 1.0 years in females and 14.1 ± 2.7 years in males. Skeletal maturity grading demonstrated comparable stages of maturity at the time of fusion between male and female subjects (p = 0.5). Based on an analysis of 160 subjects with serial images extending at least one standard deviation past the mean age of appearance, the overall incidence was 12%. Our review of pediatric subjects showed that accessory navicular appeared earlier in females than in males. Fusion occurred in 42% of patients at comparable levels of skeletal maturity between the male and female subjects. No significant differences in overall incidence, skeletal maturity, fusion rate, or age of fusion were noted between the male and female subjects.

  16. No Clinically Significant Difference Between Adult and Pediatric IKDC Subjective Knee Evaluation Scores in Adults.

    PubMed

    Stegmeier, Nicole; Oak, Sameer R; O'Rourke, Colin; Strnad, Greg; Spindler, Kurt P; Jones, Morgan; Farrow, Lutul D; Andrish, Jack; Saluan, Paul

    Two versions of the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form currently exist: the original version (1999) and a recently modified pediatric-specific version (2011). Comparison of the pediatric IKDC with the adult version in the adult population may reveal that either version could be used longitudinally. We hypothesize that the scores for the adult IKDC and pediatric IKDC will not be clinically different among adult patients aged 18 to 50 years. Randomized crossover study design. Level 2. The study consisted of 100 participants, aged 18 to 50 years, who presented to orthopaedic outpatient clinics with knee problems. All participants completed both adult and pediatric versions of the IKDC in random order with a 10-minute break in between. We used a paired t test to test for a difference between the scores and a Welch's 2-sample t test to test for equivalence. A least-squares regression model was used to model adult scores as a function of pediatric scores, and vice versa. A paired t test revealed a statistically significant 1.6-point difference between the mean adult and pediatric scores. However, the 95% confidence interval (0.54-2.66) for this difference did not exceed our a priori threshold of 5 points, indicating that this difference was not clinically important. Equivalence testing with an equivalence region of 5 points further supported this finding. The adult and pediatric scores had a linear relationship and were highly correlated with an R(2) of 92.6%. There is no clinically relevant difference between the scores of the adult and pediatric IKDC forms in adults, aged 18 to 50 years, with knee conditions. Either form, adult or pediatric, of the IKDC can be used in this population for longitudinal studies. If the pediatric version is administered in adolescence, it can be used for follow-up into adulthood.

  17. Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment.

    PubMed

    Ryan, Nicholas P; van Bijnen, Loeka; Catroppa, Cathy; Beauchamp, Miriam H; Crossley, Louise; Hearps, Stephen; Anderson, Vicki

    2016-04-01

    Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0-15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8 weeks post-injury (M=39.25, SD=27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child's social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child's environment and

  18. Longitudinal relations between obesity and hypertension following pediatric renal transplantation.

    PubMed

    Denburg, Michelle R; Pradhan, Madhura; Shults, Justine; Jones, Abigail; Palmer, Jo Ann; Baluarte, H Jorge; Leonard, Mary B

    2010-10-01

    Obesity and hypertension frequently complicate renal transplantation (RTxp). The objective was to assess relations among obesity, hypertension, and glucocorticoids in pediatric RTxp recipients. A retrospective cohort study was carried out in 141 RTxp recipients, 2-21 years of age, with >or=12 months of follow-up. Body mass index Z-score (BMI-Z), systolic and diastolic blood pressure Z-scores (SBP-Z and DBP-Z), and medications at 1, 3, 6, and 12 months and annually thereafter were recorded. Quasi-least squares regression analysis was used. The prevalence of obesity (BMI>or=95th percentile) increased from 13% at baseline to >30% from 3 months onward. Greater glucocorticoid exposure (mg/kg/day) was associated with greater increases in BMI-Z (p<0.001). This association was greater in males, younger recipients, and those with lower baseline BMI-Z (all interactions p<0.02). The prevalence of systolic hypertension (SBP>or=95th percentile) was 73% at 1 month and >or=40% at all follow-up visits. Greater glucocorticoid exposure (p<0.001) and increases in BMI-Z (p=0.005) were independent determinants of SBP-Z over time. Cyclosporine (versus tacrolimus) was independently associated with greater SBP-Z and DBP-Z (p=0.001). Sustained obesity and hypertension frequently complicated pediatric RTxp. Obesity was an independent determinant of systolic hypertension. Strategies are needed to prevent obesity and its impact on hypertension, cardiovascular disease, and allograft survival.

  19. How Do US Pediatric Residency Programs Teach and Evaluate Community Pediatrics and Advocacy Training?

    PubMed

    Lichtenstein, Cara; Hoffman, Benjamin D; Moon, Rachel Y

    2017-07-01

    In 2013, the Accreditation Council for Graduate Medical Education updated requirements for training in community pediatrics and advocacy in pediatric residency programs. In light of this update, the aim of this study was to better understand how community pediatrics is being taught and evaluated in pediatric residency programs in the United States. Cross-sectional exploratory study using a Web-based survey of pediatric residency program directors in September 2014. Questions focused on teaching and evaluation of 10 community pediatrics competencies. Of 85 programs (43% response rate), 30% offered a separate training track and/or 6-block individualized curriculum in community pediatrics or advocacy. More than 75% required all residents to learn 7 of 10 competencies queried. Respondents in urban settings were more likely to teach care of special populations (P = .02) and public speaking (P < .01). Larger programs were more likely to teach (P = .04) and evaluate (P = .02) community-based research. Experiential learning and classroom-based didactics were the most frequent teaching methodologies. Many programs used multiple teaching methodologies for all competencies. Observation was the most frequent evaluation technique used; portfolio review and written reflection were also commonly reported. Our findings show a strong emphasis on community pediatrics and advocacy teaching among responding US pediatric residency programs. Although respondents reported a variety of teaching and evaluation methods, there were few statistically significant differences between programs. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Radiographic Evaluation of Common Pediatric Elbow Injuries

    PubMed Central

    DeFroda, Steven F.; Hansen, Heather; Gil, Joseph A.; Hawari, Ashraf H.; Cruz, Aristides I.

    2017-01-01

    Normal variations in anatomy in the skeletally immature patient may be mistaken for fracture or injury due to the presence of secondary centers of ossification. Variations in imaging exist from patient to patient based on sex, age, and may even vary from one extremity to the other on the same patient. Despite differences in the appearance of the bony anatomy of the elbow there are certain landmarks and relationships, which can help, distinguish normal from abnormal. We review common radiographic parameters and pitfalls associated in the evaluation of pediatric elbow imaging. We also review common clinical diagnoses in this population. PMID:28286625

  1. Abdominal Trauma Evaluation for the Pediatric Surgeon.

    PubMed

    Drexel, Sabrina; Azarow, Kenneth; Jafri, Mubeen A

    2017-02-01

    Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. The assessment of abdominal trauma in children must be conducted expeditiously and thoroughly. Physical examination, laboratory testing, and imaging are central to trauma evaluation. In children with minor injury, protocols may help to limit the use of ionizing radiation. Children with significant abdominal injury who are unstable should be resuscitated with blood products and undergo emergent surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Head and Cervical Spine Evaluation for the Pediatric Surgeon.

    PubMed

    Arbuthnot, Mary K; Mooney, David P; Glenn, Ian C

    2017-02-01

    This article is designed to guide pediatric surgeons in the evaluation and stabilization of blunt head and cervical spine injuries in pediatric patients. Trauma remains the number one cause of morbidity and mortality among children, and the incidence of head injuries continues to rise. Cervical spine injuries, on the other hand, are unusual but can be devastating if missed. This article highlights the pathophysiology unique to pediatric head and cervical spine trauma as well as keys to clinical and diagnostic evaluation.

  3. Evaluation of pediatric community field trips.

    PubMed

    Molnar, E T; Knasel, A L

    1987-05-01

    A field trip program for junior medical students on a pediatric clinical clerkship acquainted students with the care of normal and handicapped children in community settings of school, day care center, residential treatment, or diagnostic facilities.A program evaluation by pre and post-trip survey demonstrated a positive change in students' knowledge and attitude in general, which was unaffected by such factors as sex, previous experience in a medical setting, and previous experience with handicapped children.As an integral part of the pediatric clerkship, the field trip appears to have been a positive experience for students, as it met their educational and emotional needs. Subjective evaluation indicated that many students formed insightful and compassionate judgments about handicapped children.Although the increase in knowledge and sensitivity of the students, as reflected in the pre-and post-test, was not statistically significant, the benefit to the students, to the personnel of the agencies, and ultimately to the children and families with whom they dealt during their professional careers was important.

  4. Evaluation of Pediatric Community Field Trips

    PubMed Central

    Molnar, Eva T.; Knasel, Anne L.

    1987-01-01

    A field trip program for junior medical students on a pediatric clinical clerkship acquainted students with the care of normal and handicapped children in community settings of school, day care center, residential treatment, or diagnostic facilities. A program evaluation by pre and post-trip survey demonstrated a positive change in students' knowledge and attitude in general, which was unaffected by such factors as sex, previous experience in a medical setting, and previous experience with handicapped children. As an integral part of the pediatric clerkship, the field trip appears to have been a positive experience for students, as it met their educational and emotional needs. Subjective evaluation indicated that many students formed insightful and compassionate judgments about handicapped children. Although the increase in knowledge and sensitivity of the students, as reflected in the pre-and post-test, was not statistically significant, the benefit to the students, to the personnel of the agencies, and ultimately to the children and families with whom they dealt during their professional careers was important. PMID:3586049

  5. Evaluation of a Training to Improve Management of Pediatric Overweight

    ERIC Educational Resources Information Center

    Hinchman, Josephine; Beno, Luke; Dennison, David; Trowbridge, Frederick

    2005-01-01

    Introduction: Despite widespread concern about pediatric obesity, health care professionals report low proficiency for identifying and treating this condition. This paper reports on the evaluation of pediatric overweight assessment and management training for clinicians and staff in a managed care system. The training was evaluated for its impact…

  6. Stress responses after pediatric bone marrow transplantation: preliminary results of a prospective longitudinal study.

    PubMed

    Stuber, M L; Nader, K; Yasuda, P; Pynoos, R S; Cohen, S

    1991-11-01

    This paper reports the preliminary findings of a longitudinal prospective study of young children undergoing bone marrow transplantation. Symptoms of post-traumatic stress were seen in these children up to 12 months after transplant. The bone marrow transplantation survivors demonstrated more denial and avoidance and fewer arousal symptoms than has been noted in children traumatized by a violent life threat, such as a sniper attack. These data suggest the use of post-traumatic stress as a model in understanding some of the symptoms of pediatric bone marrow transplantation survivors and may be applicable to other children exposed to the double life threat of serious illness and intensive medical intervention.

  7. Longitudinal myelitis, aseptic meningitis, and conus medullaris infarction as presenting manifestations of pediatric systemic lupus erythematosus.

    PubMed

    Katramados, A M; Rabah, R; Adams, M D; Huq, A H M M; Mitsias, P D

    2008-04-01

    A healthy boy developed subacutely progressive quadriparesis, complicated by sudden paraplegia, fever, and meningeal signs, diagnosed as longitudinal myelitis, aseptic meningitis, and conus medullaris infarction and identified as the presenting manifestations of neuropsychiatric systemic lupus erythematosus. Rapid expansion of the conus on serial neuroimaging led to emergent decompressive laminectomy and cord biopsy showing vasculitis and cord infarction. The patient had partial recovery after treatment with high-dose steroids. Increased vigilance is required when pediatric patients develop a similar subacute presentation on the ground of active systemic lupus erythematosus because it may herald the onset of a catastrophic neurological syndrome.

  8. Rubric Evaluation of Pediatric Emergency Medicine Fellows

    PubMed Central

    Hsu, Deborah C.; Macias, Charles G.

    2010-01-01

    Objectives To develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess. Methods This is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument. Results A total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues >1.0; each contained ≥4 items, with factor loadings >0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training. Conclusion A substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation. PMID:22132272

  9. Evaluation of pediatric patients with hepatitis A.

    PubMed

    Çetinkaya, Bilge; Tezer, Hasan; Özkaya Parlakay, Aslinur; Revide Sayli, Tulin

    2014-03-13

    Hepatitis A is the most common form of acute viral hepatitis worldwide, especially in children. The clinical severity of the hepatitis A virus (HAV) infection varies from an asymptomatic infection to a fulminant disease. In this study, we aimed to evaluate characteristics of pediatric patients diagnosed with HAV infection. Patients younger than 18 years of age admitted between January 1, 2006 and January 1, 2011 to our hospital, an important reference center located in the middle part of Turkey, diagnosed as having hepatitis A were evaluated. Of 427 patients, 49.4% were female and 50.6% were male. Hospitalization rate of the patients was 28.3%. The reason for hospitalization was vomitting in 58.7% of the patients and abdominal pain in 28%. The mean time of hospitalization was 5.2 ± 4.5 (1-40) days. There was no significant difference in hospitalization time by age. Vomiting and abdominal pain were significantly more common, and PT and aPTT levels were significantly elevated in patients with elevated AST and ALT levels over 1000 IU/L (p < 0.001). PT elevation was present in 15.2% of the patients, aPTT elevation in 11.9%, leukopenia in 16.6%, and thrombocytopenia in 2.6%. In terms of atypical course, four patients (0.9%) had cholestatic hepatitis, one had recurrent hepatitis, and one had fulminant hepatitis, yet no mortality was observed. Atypical courses of hepatitis A were more scarce in pediatric patients, but careful follow-up of patients with AST and ALT levels > 1000 IU/L is necessary.

  10. [Comprehensive evaluation of cefotetan in pediatrics].

    PubMed

    Fujii, R; Meguro, H; Yoshioka, H; Fujita, K; Maruyama, S; Sanae, N; Nagamatsu, I; Okuno, A; Izumi, Y; Aoyama, R

    1983-06-01

    Fundamental and clinical studies on cefotetan (CTT), a new cephamycin antibiotic, were carried out under a joint study programme in pediatric field, and the following results were obtained. Pharmacokinetic study In 20 pediatric patients with normal renal function, weighing 15 to 48 kg, CTT was injected intravenously at 20 mg/kg in 3 to 5 minutes. The mean blood concentration of CTT was 215.6 micrograms/ml at 15 minutes after the end of injection, 90.7 micrograms/ml at 1 hour, 57.2 micrograms/ml at 2 hours, 33.9 micrograms/ml at 4 hours and 10.2 micrograms/ml at 8 hours. The half-life of the drug in the beta-phase, computed from the mean blood concentrations up to 8 hours postdosing, was 2.61 hours. The peak of the mean urinary excretion of cefotetan appeared in 0 to 2 hours after the injection and 36.5% of the dose was recovered in the urine. The mean excretion at 0 to 8 hours was 68.1%. Clinical study Clinical effects of CTT was evaluated in 285 patients with 287 diseases, since 1 patient had both pneumonia and erysipelas, and another both pneumonia and acute otitis media. Daily dosage of CTT ranged from 15 to 123 mg/kg, and 266 patients (93.3%) received the drug either 2 or 3 times daily. The clinical response was seen in 83.3% of the 6 cases with sepsis, 89.3% of the 122 cases with pneumonia with or without pyothorax, 96.2% of the 52 cases with either acute bronchitis or tonsillitis, 92.5% of the 67 cases with urinary tract infection and 92.5% of the 40 cases with other infections. The causative organisms were detected in 160 patients and the rate of complete disappearance was 80.6%. Out of 310 patients, side effects were seen in 9 cases, diarrhea in 8 (2.6%) and rash in 1 (0.3%). Abnormal clinical laboratory findings were seen in 24 cases, elevation of serum transaminases in 19 (7.8%), elevation of TTT and LDH in 1 (0.4%) and eosinophilia in 4 (1.6%). None of these cases showed serious side effects or abnormal clinical laboratory findings. From the above

  11. Pediatric status epilepticus: identification and evaluation.

    PubMed

    Freilich, Emily R; Schreiber, John M; Zelleke, Tesfaye; Gaillard, William D

    2014-12-01

    Status epilepticus is an acute neurologic emergency, the incidence of which is increasing in the United States as the definition evolves and our detection abilities improve. We will present the current definition of status epilepticus, including a recently modified operational definition for use in the clinical setting. We will also provide updates on identifying children in status epilepticus, etiologic considerations, and the rationale for diagnostic testing. Recent data reveal the benefits of MRI vs. computed tomography in new-onset status epilepticus, as well as high rates of identification of electrographic seizures in patients with unexplained acute encephalopathy in pediatric ICU settings. Genetic testing should be considered in young children with recurrent status epilepticus. Prompt recognition and diagnostic evaluation of the child in status epilepticus will help identify causes, which may require specific treatment, and help in the management of this life-threatening condition. Laboratory work, neuroimaging, electroencephalogram or continuous video electroencephalogram, lumbar puncture, and genetic testing may be considered in the evaluation of the child in status epilepticus.

  12. Intravenous Immunoglobulin Therapy in Pediatric Narcolepsy: A Nonrandomized, Open-Label, Controlled, Longitudinal Observational Study

    PubMed Central

    Lecendreux, Michel; Berthier, Johanna; Corny, Jennifer; Bourdon, Olivier; Dossier, Claire; Delclaux, Christophe

    2017-01-01

    Study Objectives: Previous case reports of intravenous immunoglobulins (IVIg) in pediatric narcolepsy have shown contradictory results. Methods: This was a nonrandomized, open-label, controlled, longitudinal observational study of IVIg use in pediatric narcolepsy with retrospective data collection from medical files obtained from a single pediatric national reference center for the treatment of narcolepsy in France. Of 56 consecutively referred patients with narcolepsy, 24 received IVIg (3 infusions administered at 1-mo intervals) in addition to standard care (psychostimulants and/or anticataplectic agents), and 32 continued on standard care alone (controls). Results: For two patients in each group, medical files were unavailable. Of the 22 IVIg patients, all had cerebrospinal fluid (CSF) hypocretin ≤ 110 pg/mL and were HLA-DQB1*06:02 positive. Of the 30 control patients, 29 were HLA-DQB1*06:02 positive and of those with available CSF measurements, all 12 had hypocretin ≤ 110 pg/mL. Compared with control patients, IVIg patients had shorter disease duration, shorter latency to sleep onset, and more had received H1N1 vaccination. Mean (standard deviation) follow-up length was 2.4 (1.1) y in the IVIg group and 3.9 (1.7) y in controls. In multivariate-adjusted linear mixed-effects analyses of change from baseline in Ullanlinna Narcolepsy Scale (UNS) scores, high baseline UNS, but not IVIg treatment, was associated with a reduction in narcolepsy symptoms. On time-to-event analysis, among patients with high baseline UNS scores, control patients achieved a UNS score < 14 (indicating remission) less rapidly than IVIg patients (adjusted hazard ratio 0.18; 95% confidence interval: 95% confidence interval: 0.03, 0.95; p = 0.043). Shorter or longer disease duration did not influence treatment response in any analysis. Conclusions: Overall, narcolepsy symptoms were not significantly reduced by IVIg. However, in patients with high baseline symptoms, a subset of IVIg

  13. Pediatric delirium: evaluating the gold standard.

    PubMed

    Silver, Gabrielle; Kearney, Julia; Traube, Chani; Atkinson, Thomas M; Wyka, Katarzyna E; Walkup, John

    2015-06-01

    Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists. Critically ill patients (N = 17), 0-21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual-IV (DSM-IV) (comparable to DSM-V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval. Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81-1.00). In our study cohort, the psychiatric interview and exam, long considered the "gold standard" in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.

  14. Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program.

    PubMed

    Albert, Jennifer B; Heinrichs-Breen, Jody; Belmonte, Frank W

    2017-11-01

    The American Academy of Pediatrics recommends that pediatricians promote and help manage breastfeeding. However, research has shown that they are not adequately prepared. To address this gap, a 2-week mandatory lactation rotation program was developed for first-year pediatric residents. Research aim: The aim of the study was to provide a lactation education program and to measure the residents' knowledge and perceived confidence regarding breastfeeding. This longitudinal self-report pretest/posttest study was conducted with a convenience sample of 45 first-year pediatric residents. Each resident spent a minimum of 50 hours with an International Board Certified Lactation Consultant. To measure breastfeeding knowledge and clinical confidence, the American Academy of Pediatrics' Breastfeeding Residency Curriculum pretest was used 4 times: first and last day of the rotation and at 6 and 12 months postrotation. Test and confidence scores were evaluated. Statistically significant differences in knowledge were found between test 1 when compared with tests 2, 3, and 4 ( p < .001). No significant differences were found between tests 2, 3, and 4 ( p > .05). The abilities to "adequately address parents' questions" and to "completely manage common problems" were significant, with confidence increasing in tests 2, 3, and 4 ( p < .001). As a result of an innovative, comprehensive educational lactation program, the pediatric residents' knowledge and perceived confidence related to breastfeeding significantly increased.

  15. Evaluation of pediatric CPR course on knowledge of pediatric residents--before and after ACLS course.

    PubMed

    Soltani, Alireza Ebrahim; Khan, Zahid Hussain; Arbabi, Shahriar; Hossini, Babak; Nahvi, Hedaiatollah; Agamohammadi, Asghar

    2009-02-01

    An evaluation was conducted on the knowledge gained by pediatric residents on CPR, before and after a PALS (Pediatric Advanced Cardiac Life Support) course. Following an examination of all pediatric residents at Tehran University of Medical Sciences, they were divided into two groups: non-trained (Group 1) and a group scheduled to undergone training (Group 2). A course on ACLS was conducted. Examination were performed before and after the ACLS course. The mean of the examination prior to the course in Group 1 and 2 was low, reflecting no significant differences between the Groups. Examination after the ACLS course showed a statistically significant improvement in Group 2 (P < or = 0.05). It is concluded that knowledge of pediatric residents was low before ACLS course and enhanced after the course.

  16. Parent-Reported Social Outcomes After Treatment for Pediatric Embryonal Tumors: A Prospective Longitudinal Study

    PubMed Central

    Brinkman, Tara M.; Palmer, Shawna L.; Chen, Si; Zhang, Hui; Evankovich, Karen; Swain, Michelle A.; Bonner, Melanie J.; Janzen, Laura; Knight, Sarah; Armstrong, Carol L.; Boyle, Robyn; Gajjar, Amar

    2012-01-01

    Purpose To examine longitudinal parent-reported social outcomes for children treated for pediatric embryonal brain tumors. Patients and Methods Patients (N = 220) were enrolled onto a multisite clinical treatment protocol. Parents completed the Child Behavior Checklist/6-18 at the time of their child's diagnosis and yearly thereafter. A generalized linear mixed effects model regression approach was used to examine longitudinal changes in parent ratings of social competence, social problems, and withdrawn/depressed behaviors with demographic and treatment factors as covariates. Results During the 5-year period following diagnosis and treatment, few patients were reported to have clinically elevated scores on measures of social functioning. Mean scores differed significantly from population norms, yet remained within the average range. Several factors associated with unfavorable patterns of change in social functioning were identified. Patients with high-risk treatment status had a greater increase in parent-reported social problems (P = .001) and withdrawn/depressed behaviors (P = .01) over time compared with average-risk patients. Patients with posterior fossa syndrome had greater parent-reported social problems over time (P = .03). Female patients showed higher withdrawn/depressed scores over time compared with male patients (P < .001). Patient intelligence, age at diagnosis, and parent education level also contributed to parent report of social functioning. Conclusion Results of this study largely suggest positive social adjustment several years after diagnosis and treatment of a pediatric embryonal tumor. However, several factors, including treatment risk status and posterior fossa syndrome, may be important precursors of long-term social outcomes. Future research is needed to elucidate the trajectory of social functioning as these patients transition into adulthood. PMID:23071220

  17. Parent-reported social outcomes after treatment for pediatric embryonal tumors: a prospective longitudinal study.

    PubMed

    Brinkman, Tara M; Palmer, Shawna L; Chen, Si; Zhang, Hui; Evankovich, Karen; Swain, Michelle A; Bonner, Melanie J; Janzen, Laura; Knight, Sarah; Armstrong, Carol L; Boyle, Robyn; Gajjar, Amar

    2012-11-20

    To examine longitudinal parent-reported social outcomes for children treated for pediatric embryonal brain tumors. Patients (N=220) were enrolled onto a multisite clinical treatment protocol. Parents completed the Child Behavior Checklist/6-18 at the time of their child's diagnosis and yearly thereafter. A generalized linear mixed effects model regression approach was used to examine longitudinal changes in parent ratings of social competence, social problems, and withdrawn/depressed behaviors with demographic and treatment factors as covariates. During the 5-year period following diagnosis and treatment, few patients were reported to have clinically elevated scores on measures of social functioning. Mean scores differed significantly from population norms, yet remained within the average range. Several factors associated with unfavorable patterns of change in social functioning were identified. Patients with high-risk treatment status had a greater increase in parent-reported social problems (P=.001) and withdrawn/depressed behaviors (P=.01) over time compared with average-risk patients. Patients with posterior fossa syndrome had greater parent-reported social problems over time (P=.03). Female patients showed higher withdrawn/depressed scores over time compared with male patients (P<.001). Patient intelligence, age at diagnosis, and parent education level also contributed to parent report of social functioning. Results of this study largely suggest positive social adjustment several years after diagnosis and treatment of a pediatric embryonal tumor. However, several factors, including treatment risk status and posterior fossa syndrome, may be important precursors of long-term social outcomes. Future research is needed to elucidate the trajectory of social functioning as these patients transition into adulthood.

  18. Prospective evaluation of a pediatric inpatient early warning scoring system.

    PubMed

    Tucker, Karen M; Brewer, Tracy L; Baker, Rachel B; Demeritt, Brenda; Vossmeyer, Michael T

    2009-04-01

    The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12-month period. PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84-0.94, p < .001). The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration.

  19. Pediatric vestibular evaluation: two children with sensorineural hearing loss.

    PubMed

    Valente, L Maureen; Goebel, Joel A; Sinks, Belinda

    2012-04-01

    These two cases illustrate several important areas of vestibular evaluation with children. The two case reports represent two children who display very different vestibular findings despite having significant sensorineural hearing loss. These case reports highlight that pediatric findings can differ significantly from adult findings, stressing the importance of comparing pediatric results with pediatric normative data. These two cases also highlight that vestibular techniques may successfully be adapted for use with hearing-impaired children. That is, rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials can be adapted to use with children, including those who demonstrate significant sensorineural hearing loss. Although there is a paucity of research and clinical work in this area, some investigators (Eviatar and Eviatar, 1977; Buchman et al, 2004; Jacot et al, 2009) have reported very rapid recovery from pediatric vestibular deficits. However, it is important for audiologists to be aware that techniques may successfully be adapted for children and that many children should undergo thorough vestibular evaluation.

  20. Early evaluation and resuscitation of the pediatric trauma patient.

    PubMed

    DeRoss, Anthony L; Vane, Dennis W

    2004-05-01

    Trauma is the leading case of death for children in the United States. Effective initial resuscitation of pediatric trauma patients can reduce mortality. Guidelines have been developed to facilitate patient care in a systematic and productive manner. Advances have been made in both diagnostic and therapeutic methods. The evaluation and treatment of trauma patients will continue to engage pediatric surgeons as efforts in trauma prevention become more successful.

  1. An evaluation of pediatric residency education in conveying immunization knowledge.

    PubMed

    Link, Ellen A; Kreiter, Clarence D; D'Alessandro, Donna M

    2010-07-01

    The Accreditation Council of Graduate Medical Education now requires all pediatric residency training programs assess medical knowledge competency. The goal of this project was to determine whether pediatric residency training using patient-based/experiential teaching made residents competent in the area of immunization knowledge or whether additional teaching strategies might need to be developed. Cross-sectional and longitudinal study designs were used to determine improvement in immunization knowledge on a multiple-choice quiz over the 3 years of residency training. Both the cross-sectional and longitudinal data showed a statistically significant improvement in performance between residency training Years 1 and 2 but not between Years 2 and 3 on the quiz. This statistically significant relationship by year of training was seen despite the modest reliability of the short quiz and the sample size. This study shows that pediatric residency education using patient-based/experiential teaching is effective in teaching first year residents about immunization knowledge but is not as effective for 2nd- and 3rd-year residents. Other instructional methods such as computer-based cases could be employed during the 2nd and 3rd years.

  2. Innovative Evaluation of Dexterity in Pediatrics

    PubMed Central

    Duff, Susan V.; Aaron, Dorit H.; Gogola, Gloria R.; Valero-Cuevas, Francisco J.

    2015-01-01

    Study Design Review paper Introduction Hand dexterity is multifaceted and essential to the performance of daily tasks. Timed performance and precision demands are the most common features of quantitative dexterity testing. Measurement concepts such as rate of completion, in-hand manipulation and dynamic force control of instabilities are being integrated into assessment tools for the pediatric population. Purpose To review measurement concepts inherent in pediatric dexterity testing and introduce concepts that are infrequently measured or novel as exemplified with two assessment tools. Methods Measurement concepts included in common assessment tools are introduced first. We then describe seldom measured and novel concepts embedded in two instruments; the Functional Dexterity Test (FDT) and the Strength-Dexterity (SD) Test. Discussion The inclusion of measurement concepts and tools that are infrequently measured or novel in our repertoire of assessments potentially aids our understanding of atypical dexterity contributing to the design of targeted therapy programs. PMID:25835255

  3. Longitudinal changes in medical complications in adults with pediatric-onset spinal cord injury

    PubMed Central

    Hwang, Miriam; Zebracki, Kathy; Chlan, Kathleen M.; Vogel, Lawrence C.

    2014-01-01

    Objectives To determine longitudinal changes in the occurrence of medical complications in adults with pediatric-onset spinal cord injury (SCI). Design Longitudinal study of long-term outcomes. Setting Community. Participants Individuals who had sustained an SCI before age 19, were 23 years of age or older at initial interview, and followed annually between 1996 and 2011. They were classified into four American Spinal Injury Association (ASIA) Impairment Scale (AIS) severity groups: C1–4 AIS ABC, C5–8 AIS ABC, T1–S5 AIS ABC, AIS D. Outcome measures Generalized estimating equation (GEE) models were formulated to obtain the odds ratio (OR) of having a medical complication over time. Results A total of 1793 interviews were conducted among 226 men and 125 women (86% Caucasian; age at baseline, 26.7 ± 3.6 years; time since injury at baseline, 12.9 ± 5.2 years). Odds of complication occurrence over time varied among severity groups, with increased ORs of severe urinary tract infection (1.05, confidence interval (CI) 1.02–1.09), autonomic dysreflexia (AD) (1.09, CI 1.05–1.14), spasticity (1.06, CI 1.01–1.11), pneumonia/respiratory failure (1.09, CI 1.03–1.16), and hypertension/cardiac disease (1.07, CI 1.01–1.15) in the C1-4 ABC group; AD (1.08, CI 1.04–1.13) and pneumonia/respiratory failure (1.09, CI 1.02–1.16) in the C5–8 ABC group; and hypertension/cardiac disease (1.08, CI 1.02–1.14) in the T1–S5 ABC group. Upper extremity joint pain had increased odds of occurrence in all injury severity groups. Conclusion The significantly increased odds of having medical complications over time warrants awareness of risk factors and implementation of preventive measures to avoid adverse consequences of complications and to maintain independence in individuals with pediatric-onset SCI. PMID:24090490

  4. [Evaluation of predictability and refractive changes in pediatric pseudophakia].

    PubMed

    Arámbulo de Borin, O; Paz, M; González, K

    2013-09-01

    Evaluate the predictability of the postoperative refraction and refractive changes in pediatric pseudophakia. Prospective, longitudinal follow-up on patients under the age of 15 years operated on for a cataract with intraocular lens, with 5 continuous years of follow-up. The patients were divided into 4 groups according to age at the time of the surgery: group from 0 to 2 years old, from 3 to 5 years old, from 6 to 8 years old, and 9 years and over. Error prediction and refractive change were studied. Statistical analysis was performed using the Student t and ANOVA test. A total of 60 eyes were included (44 patients). No significant differences were found between the unilateral and bilateral group. The prediction error in the 0 to 2 years group was 1.5±1.8 D, significantly higher than in the other groups (ANOVA P=.01). Refractive change in 5 years of the group of 0 to 2 years was -4.7±3.4 D (ANOVA P=.0002), while in the other groups it was significantly lower, with no differences between them. The 0 to 2 years group was less hyperopic than expected, 100% within the accepted of 2 standard deviations, but with a high variability. The refractive change observed in this group coincides with previous reports that the largest growth and increase in axial length occurs during the first 2 years. The calculation and use of an IOL in children has a better immediate refractive prediction, and at long term in those older than 2 years of age. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  5. Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): design and methods.

    PubMed

    Dallas, Ronald H; Wilkins, Megan L; Wang, Jichuan; Garcia, Ana; Lyon, Maureen E

    2012-09-01

    As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-month post-intervention. The primary outcome measures will be in congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice.

  6. Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): Design and Methods

    PubMed Central

    Dallas, Ronald H.; Wilkins, Megan L.; Wang, Jichuan; Garcia, Ana; Lyon, Maureen E.

    2012-01-01

    As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-months post-intervention. The primary outcome measures will be congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice. PMID:22664645

  7. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices

    PubMed Central

    Kapoor, Ashna; Indushekar, KR; Saraf, Bhavna G; Sheoran, Neha

    2016-01-01

    Introduction Dentifrices are available in different formulations and more commonly a single dentifrice is used by whole family; be it an adult or child. However, concerns over high fluoride in pediatric formulations coupled with inability of the children to spit have led to recommendations to minimize fluoride ingestion during toothbrushing by using a small amount of toothpaste by children and incorporating minimal quantity of fluoride in the toothpastes. Literature is scarce on the remineralization potential of popularly known Indian pediatric dentifrices; hence, pediatric dentifrices containing lesser concentration of fluoride have been marketed relatively recently for the benefit of children without posing a threat of chronic fluoride toxicity at the same time. Aim and objectives The present study was undertaken to evaluate and compare the remineralization potential of three commercially available Indian pediatric dentifrices with different compositions on artificially induced carious lesions in vitro through scanning electron microscopy (SEM). Materials and methods The present in vitro study was conducted on 45 sound extracted primary molar surfaces divided into three groups (15 each). Artificial demineralization was carried out, followed by remineralization using dentifrice slurry as per the group allocation. All the samples were studied for remineralization using SEM and the results statistically compared. Results All three dentifrices tested showed remineralization; although insignificantly different from each other but significantly higher compared to the demineralizing surface. Conclusion One can use pediatric dentifrices for preventing dental caries and decelerating lesion progression with an added advantage of lower fluoride toxicity risk. How to cite this article Kapoor A, Indushekar KR, Saraf BG, Sheoran N, Sardana D. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices. Int J Clin Pediatr Dent 2016;9(3):186-191. PMID

  8. Current Trends, Evaluation, and Management of Pediatric Nephrolithiasis.

    PubMed

    Hernandez, Joel D; Ellison, Jonathan S; Lendvay, Thomas S

    2015-10-01

    The incidence of pediatric nephrolithiasis has been steadily increasing for the past several decades, with a concomitant concerning increase in health care costs and burden to children with this disease. Recent population-based studies have also demonstrated a change in the current trends of pediatric nephrolithiasis that is characterized by a significant increase in the number of girls now being affected. While changes in diet and lifestyle, obesity prevalence, and even imaging practices have been proposed to contribute to the recent increase in pediatric nephrolithiasis, a definite underlying cause remains elusive. This situation is complicated by the fact that, unlike in adults, the trends occurring in pediatric nephrolithiasis have not been studied rigorously, which contributes to the paucity of data in children. The level of concern with the increasing incidence is raised by factors unique to pediatric nephrolithiasis that could expose an affected child to more complications. Factors such as variable clinical presentation, high recurrence of kidney stones associated with abnormalities of metabolism and the urinary tract, and the possible presence of rare genetic kidney stone diseases would require physicians to comprehensively evaluate patients presenting with kidney stones. The goal of evaluation is to identify modifiable risk factors and abnormalities for which targeted therapy can be prescribed. The goals of medical and surgical treatments are to eliminate the burden of kidney stones and prevent recurrence while simultaneously minimizing complications from interventions. Patients at high risk may benefit from a specialized kidney stone clinic staffed by a pediatric nephrologist, urologist, dietitian, and clinical nurse. Such a multidisciplinary clinic can help provide the medical and surgical support needed for patients at high risk and offer key opportunities to learn more about pediatric nephrolithiasis, thereby fueling the much-needed research in this

  9. [Evaluation of formal elements of Spanish pediatrics journals].

    PubMed

    Aleixandre-Benavent, R; González de Dios, J; Valderrama-Zurián, F J; Bolaños Pizarro, M; Valderrama-Zurián, J C

    2007-03-01

    Standardization of scientific journals is indispensable for accurate transmission of knowledge, since it guarantees the universality and reproducibility of research. The objective of this study was to evaluate the formal elements of Spanish pediatrics journals. In 2005, we studied the characteristics of Spanish biomedical journals with special emphasis on Spanish pediatrics journals. The form used for the selection of journals for inclusion in the database Indice Médico Español (IME) was employed to evaluate 65 distinct characteristics in each journal. The parameters were grouped in the following five categores: journal presentation, presentation of the articles, scientific and editorial committees, content characteristics, and dissemination parameters. The journals with the highest overall scores were Anales de Pediatría (63 points out of a maximum of 82), followed by Pediatría de Atención Primaria (53 points), Acta Pediátrica Española and Cirugía Pediátrica (55 points each), Pediatrika (53 points), and Revista Española de Pediatría (48 points). The score obtained by Anales de Pediatría places this journal in the top 10 Spanish journals included in IME. Spanish pediatrics journals meet most of the formal elements required of biomedical journals, although some aspects could be improved, such as deficiencies in the frequency and regularity of publication, mention of the dates of manuscript receipt and acceptance, the lack of a clear description of the editorial process of manuscript selection and peer review, the absence of committee members' institutional affiliations, and the absence of articles by non-Spanish authors.

  10. A survey of parent satisfaction with pediatric neuropsychological evaluations.

    PubMed

    Bodin, Doug; Beetar, John T; Yeates, Keith Owen; Boyer, Katrina; Colvin, Andrew N; Mangeot, Shanley

    2007-12-01

    Satisfaction with pediatric neuropsychological evaluations was surveyed by asking parents or guardians of children who completed pediatric neuropsychological evaluations at a large children's hospital over a 2-year period to complete a 30-item rating scale. The scale included items drawn from published measures of consumer satisfaction, and incorporated a well-validated measure of general satisfaction. A total of 338 surveys were distributed, with 117 completed, for a return rate of 35%. Respondents were generally similar to non-respondents, except that respondents had a higher average level of maternal education and were more likely to have been referred for neuropsychological evaluations by sources outside the hospital. Parents were generally satisfied with pediatric neuropsychological evaluations, although some parents indicated that the evaluations did not provide as much help as expected. A factor analysis of the survey instrument revealed four dimensions of satisfaction: General Satisfaction, Clinician Acceptance/Empathy, Provision of Help, and Facilities/Administrative Assistance. Maternal education was negatively correlated with all four factors, but no other demographic, patient, or clinician variables were significantly related to satisfaction. Future studies could survey physicians and educators to provide a more complete understanding of satisfaction with pediatric neuropsychological evaluations.

  11. Pediatric nasal fractures: evaluation and management.

    PubMed

    Desrosiers, Arthur E; Thaller, Seth R

    2011-07-01

    Nasal fractures have been reported as 1 of the 3 most commonly encountered pediatric facial bone fractures. The most common causes of nasal fractures in this age group are auto accidents (40%), sports injuries (25%), intended injuries (15%), and home injuries (10%). Nasal fractures are usually treated with closed reduction (Higuera S, Lee EI, Stal S. Nasal trauma and the deviated nose. Plast Reconstr Surg 2007;120:64S-75S). This results in a significant incidence of posttraumatic deformities, often requiring secondary surgical treatment. For this reason, it is paramount to pay careful attention to the underlying structural nasal anatomy during the initial diagnosis and management.

  12. Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review

    PubMed Central

    Gibson, Edward; Begum, Najida; Sigmundsson, Birgir; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

    2016-01-01

    ABSTRACT This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation — 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD). PMID:26837602

  13. Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review.

    PubMed

    Gibson, Edward; Begum, Najida; Sigmundsson, Birgir; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

    2016-05-03

    This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation - 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD).

  14. Evaluating the effectiveness of pediatric pain management guidelines.

    PubMed

    Habich, Michele; Wilson, Deeanna; Thielk, Dana; Melles, Grace L; Crumlett, Hillary S; Masterton, Joyce; McGuire, Julie

    2012-08-01

    In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Longitudinal Investigation of Adaptive Functioning Following Conformal Irradiation for Pediatric Craniopharyngioma and Low-Grade Glioma

    SciTech Connect

    Netson, Kelli L.; Conklin, Heather M.; Wu, Shengjie; Xiong, Xiaoping; Merchant, Thomas E.

    2013-04-01

    Purpose: Children treated for brain tumors with conformal radiation therapy experience preserved cognitive outcomes. Early evidence suggests that adaptive functions or independent-living skills may be spared. This longitudinal investigation prospectively examined intellectual and adaptive functioning during the first 5 years following irradiation for childhood craniopharyngioma and low-grade glioma (LGG). The effect of visual impairment on adaptive outcomes was investigated. Methods and Materials: Children with craniopharyngioma (n=62) and LGG (n=77) were treated using conformal or intensity modulated radiation therapy. The median age was 8.05 years (3.21-17.64 years) and 8.09 years (2.20-19.27 years), respectively. Serial cognitive evaluations including measures of intelligence quotient (IQ) and the Vineland Adaptive Behavior Scales (VABS) were conducted at preirradiation baseline, 6 months after treatment, and annually through 5 years. Five hundred eighty-eight evaluations were completed during the follow-up period. Results: Baseline assessment revealed no deficits in IQ and VABS indices for children with craniopharyngioma, with significant (P<.05) longitudinal decline in VABS Communication and Socialization indices. Clinical factors associated with more rapid decline included females and preirradiation chemotherapy (interferon). The only change in VABS Daily Living Skills correlated with IQ change (r=0.34; P=.01) in children with craniopharyngioma. Children with LGG performed below population norms (P<.05) at baseline on VABS Communication, Daily Living Indices, and the Adaptive Behavior Composite, with significant (P<.05) longitudinal decline limited to VABS Communication. Older age at irradiation was a protective factor against longitudinal decline. Severe visual impairment did not independently correlate with poorer adaptive outcomes for either tumor group. Conclusions: There was relative sparing of postirradiation functional outcomes over time in this sample

  16. Longitudinal investigation of adaptive functioning following conformal irradiation for pediatric craniopharyngioma and low-grade glioma.

    PubMed

    Netson, Kelli L; Conklin, Heather M; Wu, Shengjie; Xiong, Xiaoping; Merchant, Thomas E

    2013-04-01

    Children treated for brain tumors with conformal radiation therapy experience preserved cognitive outcomes. Early evidence suggests that adaptive functions or independent-living skills may be spared. This longitudinal investigation prospectively examined intellectual and adaptive functioning during the first 5 years following irradiation for childhood craniopharyngioma and low-grade glioma (LGG). The effect of visual impairment on adaptive outcomes was investigated. Children with craniopharyngioma (n=62) and LGG (n=77) were treated using conformal or intensity modulated radiation therapy. The median age was 8.05 years (3.21-17.64 years) and 8.09 years (2.20-19.27 years), respectively. Serial cognitive evaluations including measures of intelligence quotient (IQ) and the Vineland Adaptive Behavior Scales (VABS) were conducted at preirradiation baseline, 6 months after treatment, and annually through 5 years. Five hundred eighty-eight evaluations were completed during the follow-up period. Baseline assessment revealed no deficits in IQ and VABS indices for children with craniopharyngioma, with significant (P<.05) longitudinal decline in VABS Communication and Socialization indices. Clinical factors associated with more rapid decline included females and preirradiation chemotherapy (interferon). The only change in VABS Daily Living Skills correlated with IQ change (r=0.34; P=.01) in children with craniopharyngioma. Children with LGG performed below population norms (P<.05) at baseline on VABS Communication, Daily Living Indices, and the Adaptive Behavior Composite, with significant (P<.05) longitudinal decline limited to VABS Communication. Older age at irradiation was a protective factor against longitudinal decline. Severe visual impairment did not independently correlate with poorer adaptive outcomes for either tumor group. There was relative sparing of postirradiation functional outcomes over time in this sample. Baseline differences in functional abilities before

  17. Nutritional risk and anthropometric evaluation in pediatric liver transplantation

    PubMed Central

    Zamberlan, Patrícia; Leone, Cláudio; Tannuri, Uenis; de Carvalho, Werther Brunow; Delgado, Artur Figueiredo

    2012-01-01

    OBJECTIVE: To analyze the nutritional status of pediatric patients after orthotopic liver transplantation and the relationship with short-term clinical outcome. METHOD: Anthropometric evaluations of 60 children and adolescents after orthotopic liver transplantation, during the first 24 hours in a tertiary pediatric intensive care unit. Nutritional status was determined from the Z score for the following indices: weight/age, height/age or length/age, weight/height or weight/length, body mass index/age, arm circumference/age and triceps skinfold/age. The severity of liver disease was evaluated using one of the two models which was adequated to the patients' age: 1. Pediatric End-stage Liver Disease, 2. Model for End-Stage Liver Disease. RESULTS: We found 50.0% undernutrition by height/age; 27.3% by weight/age; 11.1% by weight/height or weight/length; 10.0% by body mass index/age; 61.6% by arm circumference/age and 51.0% by triceps skinfold/age. There was no correlation between nutritional status and Pediatric End-stage Liver Disease or mortality. We found a negative correlation between arm circumference/age and length of hospitalization. CONCLUSION: Children with chronic liver diseases experience a significant degree of undernutrition, which makes nutritional support an important aspect of therapy. Despite the difficulties in assessment, anthropometric evaluation of the upper limbs is useful to evaluate nutritional status of children before or after liver transplantation. PMID:23295591

  18. Evaluation of an Outreach Activity of Pediatric Clerkship Training

    ERIC Educational Resources Information Center

    Parcel, Guy S.; And Others

    1977-01-01

    An opportunity for medical students to observe and interact with children in a setting outside the clinical environment was introduced as part of ambulatory pediatric clerkship training. Evaluation of the program indicated its overall effectiveness as well as areas for which changes are suggested. (LBH)

  19. Concussion evaluation and management in pediatrics.

    PubMed

    Rivera, Robin G; Roberson, Susan P; Whelan, Margaret; Rohan, Annie

    2015-01-01

    Concussions are among the most complex injuries to assess and manage in sports medicine and primary care. Sports concussion in youth has received much attention in recent years because research shows that improperly managed concussion can lead to long-term cognitive deficits and mental health problems. There are several notable risk factors affecting the incidence and severity of concussion in school-age children and adolescents, including a history of a previous concussion. A more conservative approach for return to activities following concussion has been proposed for children and adolescents. Programs of individualized, stepwise increases in physical activity have largely replaced use of algorithms for assigning a grade and activity expectations to concussions. Although validity and reliability testing is ongoing to support use of concussion assessment instruments in pediatric patients, it is practical and appropriate that clinicians incorporate symptom checklists, sideline and balance assessment tools, and neurocognitive assessment instruments into their practice in accordance with evidence-based guidelines.

  20. Review for the generalist: evaluation of pediatric hip pain

    PubMed Central

    Houghton, Kristin M

    2009-01-01

    Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population. PMID:19450281

  1. Statewide Longitudinal Hospital Use and Charges for Pediatric and Adolescent Patients With Cancer

    PubMed Central

    Kaul, Sapna; Barbeau, Bree; Wright, Jennifer; Fluchel, Mark; Kirchhoff, Anne C.; Nelson, Richard E.

    2015-01-01

    Purpose: We investigated longitudinal hospitalization outcomes (total charges, hospital days and admissions) among pediatric and adolescent patients with cancer compared with individuals from the general population without cancer using a novel and efficient three-step regression procedure. Methods: The statewide Utah Population Database, with linkages to the Utah Cancer Registry, was used to identify 1,651 patients who were diagnosed with cancer from 1996 to 2009 at ages 0 to 21 years. A comparison group of 4,953 same-sex and -age individuals was generated from birth certificates. Claims-based hospitalization data from 1996 to 2012 were retrieved from the Utah Department of Health. Using the regression method, we estimated survival (differences due to survival) and intensity (differences due to resource accumulation) effects of the cancer diagnosis on hospitalization outcomes within 10 years after diagnosis. Results: At 10 years after diagnosis, on average, patients with cancer incurred $51,723 (95% CI, $48,100 to $58,284) more in charges, spent 30 additional days (95% CI, 27.7 to 36.1 days) in the hospital, and had 5.7 (95% CI, 5.4 to 6.4) more admissions than the comparison group. Our analyses showed that the highest hospitalization burden occurred during the first 4 years of diagnosis. Patients with leukemia incurred the greatest hospitalization burden throughout the 10 years from diagnosis. Intensity effects explained the majority of differences in hospital outcomes. Conclusion: Our results suggest that children and adolescents who were diagnosed with cancer in 2014 in the United States will incur over $800 million more in hospital charges than individuals without cancer by 2024. Interventions to reduce this burden should be explored in conjunction with improving health and survival outcomes. PMID:26105667

  2. Evaluation of pediatric manual wheelchair mobility using advanced biomechanical methods.

    PubMed

    Slavens, Brooke A; Schnorenberg, Alyssa J; Aurit, Christine M; Graf, Adam; Krzak, Joseph J; Reiners, Kathryn; Vogel, Lawrence C; Harris, Gerald F

    2015-01-01

    There is minimal research of upper extremity joint dynamics during pediatric wheelchair mobility despite the large number of children using manual wheelchairs. Special concern arises with the pediatric population, particularly in regard to the longer duration of wheelchair use, joint integrity, participation and community integration, and transitional care into adulthood. This study seeks to provide evaluation methods for characterizing the biomechanics of wheelchair use by children with spinal cord injury (SCI). Twelve subjects with SCI underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Upper extremity joint kinematics, forces, and moments were computed using inverse dynamics methods with our custom model. The glenohumeral joint displayed the largest average range of motion (ROM) at 47.1° in the sagittal plane and the largest average superiorly and anteriorly directed joint forces of 6.1% BW and 6.5% BW, respectively. The largest joint moments were 1.4% body weight times height (BW × H) of elbow flexion and 1.2% BW × H of glenohumeral joint extension. Pediatric manual wheelchair users demonstrating these high joint demands may be at risk for pain and upper limb injuries. These evaluation methods may be a useful tool for clinicians and therapists for pediatric wheelchair prescription and training.

  3. Evaluating Digital Libraries: A Longitudinal and Multifaceted View.

    ERIC Educational Resources Information Center

    Marchionini, Gary

    2000-01-01

    The Perseus Digital Library (PDL), under continuous development since 1987, is one of the primary digital resources for the humanities. A summary of the PDL genesis and current status is given and the multifaceted and longitudinal evaluation effort is described. A brief synthesis of results is provided and reflections on the evaluation along with…

  4. Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury.

    PubMed

    Ryan, Nicholas P; Catroppa, Cathy; Beare, Richard; Coleman, Lee; Ditchfield, Michael; Crossley, Louise; Beauchamp, Miriam H; Anderson, Vicki A

    2015-03-01

    The purpose of the present investigation was to evaluate the contribution of age-at-insult and brain pathology on longitudinal outcome and recovery of pragmatic language in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with mild to severe TBI (n=112) were categorized according to timing of brain insult: (i) Middle Childhood (5-9 years; n=41); (ii) Late Childhood (10-11 years; n=39); and (iii) Adolescence (12-15 years; n=32) and group-matched for age, gender and socio-economic status (SES) to a typically developing (TD) control group (n=43). Participants underwent magnetic resonance imaging (MRI) including a susceptibility weighted imaging (SWI) sequence 2-8 weeks after injury and were assessed on measures of pragmatic language and behavioural functioning at 6- and 24-months after injury. Children and adolescents with TBI of all severity levels demonstrated impairments in these domains at 6-months injury before returning to age-expected levels at 2-years post-TBI. However, while adolescent TBI was associated with post-acute disruption to skills that preceded recovery to age-expected levels by 2-years post injury, the middle childhood TBI group demonstrated impairments at 6-months post-injury that were maintained at 2-year follow up. Reduced pragmatic communication was associated with frontal, temporal and corpus callosum lesions, as well as more frequent externalizing behaviour at 24-months post injury. Findings show that persisting pragmatic language impairment after pediatric TBI is related to younger age at brain insult, as well as microhemorrhagic pathology in brain regions that contribute to the anatomically distributed social brain network. Relationships between reduced pragmatic communication and more frequent externalizing behavior underscore the need for context-sensitive rehabilitation programs that aim to increase interpersonal effectiveness and reduce risk for maladaptive behavior trajectories into the

  5. Pediatric advance care planning (pACP) for teens with cancer and their families: Design of a dyadic, longitudinal RCCT.

    PubMed

    Curtin, Katherine B; Watson, Anne E; Wang, Jichuan; Okonkwo, Obianuju C; Lyon, Maureen E

    2017-08-24

    Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14-20years old with cancer and their family decision maker (≥18years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Applicability of the pediatric evaluation of disability inventory in Slovenia.

    PubMed

    Srsen, Katja Groleger; Vidmar, Gaj; Zupan, Anton

    2005-05-01

    In the process of developmental (re)habilitation, determination of the functional abilities of an individual is an important step. For that we need appropriate measurement instruments. Because we do not have such measurement instruments in Slovenia, we chose the Pediatric Evaluation of Disability Inventory (PEDI), translated it, and applied it in daily practice to assess its usefulness and applicability. The purpose of the study was to find out whether the functional abilities of the population of Slovene children evaluated with the Pediatric Evaluation of Disability Inventory is comparable to the American normative data. We also wanted to assess the possible influence of gender, parent education, community size, and the presence of siblings on children's functional abilities. The Pediatric Evaluation of Disability Inventory was administered in the form of a structured interview to the parents of 147 healthy children in three age groups (0.5-1 year, 3-3.5 years, and 5-5.5 years) in different health care centers in Slovenia. Data analysis showed significant differences in functional skills and caregiver assistance scale scores when comparing the Slovene sample with the American normative data, particularly in the youngest age group. Slovene children were found consistently to be different (scoring either higher or lower) from American children at comparable ages in several functional skills and caregiver assistance scales. The analysis also confirmed the importance of gender and the presence of siblings for gaining higher scores on some of the functional skills and caregiver assistance scales. The level of parent education did not prove to have a significant impact on the results. Our results suggest that the American normative data are not completely appropriate for reference purposes in Slovenia. The results are in agreement with the findings of other studies, demonstrating the importance of ascertaining intercultural differences. We believe that adaptation and

  7. Evaluating pharmaceutical waste disposal in pediatric units.

    PubMed

    Almeida, Maria Angélica Randoli de; Wilson, Ana Maria Miranda Martins; Peterlini, Maria Angélica Sorgini

    2016-01-01

    To verify the disposal of pharmaceutical waste performed in pediatric units. A descriptive and observational study conducted in a university hospital. The convenience sample consisted of pharmaceuticals discarded during the study period. Handling and disposal during preparation and administration were observed. Data collection took place at pre-established times and was performed using a pre-validated instrument. 356 drugs disposals were identified (35.1% in the clinic, 31.8% in the intensive care unit, 23.8% in the surgical unit and 9.3% in the infectious diseases unit). The most discarded pharmacological classes were: 22.7% antimicrobials, 14.8% electrolytes, 14.6% analgesics/pain killers, 9.5% diuretics and 6.7% antiulcer agents. The most used means for disposal were: sharps' disposable box with a yellow bag (30.8%), sink drain (28.9%), sharps' box with orange bag (14.3%), and infectious waste/bin with a white bag (10.1%). No disposal was identified after drug administration. A discussion of measures that can contribute to reducing (healthcare) waste volume with the intention of engaging reflective team performance and proper disposal is necessary. Verificar o descarte dos resíduos de medicamentos realizado em unidades pediátricas. Estudo descritivo e observacional, realizado em um hospital universitário. A amostra de conveniência foi constituída pelos medicamentos descartados durante o período de estudo. Observaram-se a manipulação e o descarte durante o preparo e a administração. A coleta dos dados ocorreu em horários preestabelecidos e realizada por meio de instrumento pré-validado. Identificaram-se 356 descartes de medicamentos (35,1% na clínica, 31,8% na unidade de cuidados intensivos, 23,8% na cirúrgica e 9,3% na infectologia). As classes farmacológicas mais descartadas foram: 22,7% antimicrobianos, 14,8% eletrólitos, 14,6% analgésicos, 9,5% diuréticos e 6,7% antiulcerosos. Vias mais utilizadas: caixa descartável para perfurocortante com

  8. An Evaluation of PET Based on Longitudinal Data.

    ERIC Educational Resources Information Center

    Mandeville, Garrett K.

    Although teacher inservice programs based on Madeline Hunter's Program for Effective Teaching (PET) have become very popular in U.S. schools, there is little evidence that the Hunter model ultimately results in increased student achievement. This longitudinal study attempts to evaluate the effects of Hunter-based staff development programs on…

  9. Longitudinal Evaluation of the Brighter Futures Program. Final Report.

    ERIC Educational Resources Information Center

    Emihovich, Catherine; Davis, Terry

    This report provides information on the longitudinal evaluation of the Brighter Futures program in Florida, a teen pregnancy prevention program which created support groups for mothers age 16 and younger in order to prevent their having second pregnancies. Other program goals were to ensure that the girls finish high school and plan for a career,…

  10. Pre-, Post-, and Longitudinal Evaluation of Juvenile Justice Education.

    ERIC Educational Resources Information Center

    Major, Aline K.; Chester, Deborah R.; McEntire, Ranee; Waldo, Gordon P.; Blomberg, Thomas G.

    2002-01-01

    Describes two stages of the Juvenile Justice Educational Enhancement Program's pre-, post-, and longitudinal evaluation research and reports on the pilot studies used to explore how to design statewide research on pre- and post-assessment scores and community reintegration outcomes. Findings suggest that higher performing programs produce greater…

  11. Prospective Longitudinal Analysis of Immune Responses in Pediatric Subjects After Pharyngeal Acquisition of Group A Streptococci.

    PubMed

    Hysmith, Nicholas D; Kaplan, Edward L; Cleary, P Patrick; Johnson, Dwight R; Penfound, Thomas A; Dale, James B

    2017-06-01

    Despite the significant burden of disease associated with infection by group A streptococcus (GAS), little is known about the human immune response to GAS antigens after natural infection. We evaluated 195 serum samples obtained prospectively over a consecutive 24-month period from 41 pediatric subjects who experienced a new pharyngeal GAS acquisition. An enzyme-linked immunoassay was used to determine the kinetics and antigen specificity of antibodies against 13 shared GAS antigens and 18 type-specific M peptides. The majority of the antigens tested are currently being considered as vaccine candidates. Twelve M types of GAS were recovered from 41 subjects who experienced 51 new GAS acquisitions that elicited antibody responses against at least 1 of the 31 antigens tested (immunologically significant new GAS acquisitions). The immune responses to the 13 shared antigens were highly variable. Increases in antibody levels were detected against a mean of 3.5 shared antigens (range, 1-8). Antibody responses to the homologous M peptide were observed in 32 (63%) of the 51 episodes. Seven subjects acquired more than 1 M type of GAS. There were no new immunologically significant acquisitions of an M type against which the subject had preexisting antibodies to the homologous M peptide. Of the subjects with new GAS acquisition, 65% were asymptomatic, yet immune responses were detected against 1 or more GAS antigens. Immune responses to streptolysin O and/or deoxyribonuclease B were observed after 67% of the new GAS acquisitions. Persistently positive (>12 weeks) throat culture results were returned for 20% of the 41 subjects despite immune responses to homologous M peptides and/or shared antigens. The availability of throat culture results, GAS isolates, and serial serum samples collected prospectively over a 2-year period of observation provided a unique opportunity for us to assess the serologic status of pediatric subjects before and after new pharyngeal acquisitions of

  12. Pediatrics

    NASA Technical Reports Server (NTRS)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  13. An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery.

    PubMed

    Mogensen, Stefan; Lubenow, Norbert; Nilsson, Pelle; Engquist, Henrik; Knutsson, Folke; Enblad, Per; Nowinski, Daniel; Frykholm, Peter

    2017-07-01

    Surgical correction for craniosynostosis is often associated with significant perioperative hemorrhage. We implemented a transfusion strategy with a strict protocol including transfusion triggers, frequent assessment of coagulation tests, and the use of a novel transfusion unit, the mixed pediatric unit. The aim of the study was to evaluate if the applied transfusion strategy could reduce total blood loss and number of blood donors. Children <1 year old admitted for craniosynostosis surgery were included for the study. On the day before surgery, an adult red blood cell unit was mixed with plasma and split into two mixed pediatric units-one intended for intraoperative use and the other saved for the postoperative period. A series of blood samples were obtained for standard coagulation parameters as well as thromboelastography to evaluate potential coagulopathy. Estimated blood loss, the number of additional standard packed red cell units opened in the first 24 h after surgery, the volume of fluid administered, and the total transfusion volumes were compared to a historical control group with similar age and characteristics. Nineteen infants were included in the study group, and were compared to 21 historical controls. There was a significant reduction of intraoperative transfusion volume. Twelve patients were transfused postoperatively, but in 8 of these additional exposure to packed red cell donor blood was avoided by using the saved mixed pediatric unit. In the historical controls, a total of 10 packed red cell units were used in nine patients postoperatively. No additional transfusions of plasma, platelets, fibrinogen, or tranexamic acid were needed in either group, and the coagulation parameters including thromboelastography remained within their respective normal ranges in the study group. For craniofacial surgery in infants, moderate perioperative blood loss and avoidance of coagulopathy is possible when a multifactorial approach is implemented. In this

  14. Evaluation of forensic cases admitted to pediatric intensive care unit

    PubMed Central

    Duramaz, Burcu Bursal; Yıldırım, Hamdi Murat; Kıhtır, Hasan Serdar; Yeşilbaş, Osman; Şevketoğlu, Esra

    2015-01-01

    Aim: This study aimed to determine the epidemiological and clinical characteristics of pediatric forensic cases to contribute to the literature and to preventive health care services. Material and Methods: Pediatric forensic cases hospitalized in our pediatric intensive care unit below the age of 17 years were reviewed retrospectively (January 2009–June 2014) . The patients were evaluated in two groups as physical traumas (Group A) and poisonings (Group B). The patients’ age, gender, complaints at presentation, time of presentation and referral (season, time) and, mortality rates were determined. Cases of physical trauma (Group A) were classified as traffic accidents, falling down from height, falling of device, drowning, electric shock, burns and child abuse. Poisonings (Group B) were classified as pharmaceuticals, pesticides, other chemicals and unknown drug poisonings. Results: Two hundred twenthy cases were included. The mean age was 5.1+3.1 years. One hundred fifteen (%52.5) of the cases were male and 105 (%47.5) were female. Group A consisted of 62 patients and Group B consisted of 158 patients. The patients presented most frequently in summer months. The most common reason for presentation was falling down from height (12.7%) in Group A and accidental drug poisoning (most frequently antidepressants) in Group B. The mortality rate was 5%. Conclusion: Forensic cases in the pediatric population (physical trauma and poisoning) are preventable health problems. Especially, preventive approach to improve the environment for falling down from height must be a priority. Increasing the awareness of families and the community on this issue, in summer months during which forensic cases are observed most frequently can contribute to a reduction in the number of cases. PMID:26568689

  15. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction

    PubMed Central

    Friedberg, Mark K.; Nestaas, Eirik; Michel-Behnke, Ina

    2016-01-01

    Abstract Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging–derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH. PMID:27162612

  16. Sonographic evaluation of pediatric localized scleroderma: preliminary disease assessment measures

    PubMed Central

    2010-01-01

    Background Our earlier work in the ultrasonograpy of localized scleroderma (LS) suggests that altered levels of echogenicity and vascularity can be associated with disease activity. Utrasound is clinically benign and readily available, but can be limited by operator dependence. We present our efforts to standardize image acquisition and interpretation of pediatric LS to better evaluate the correlation between specific sonographic findings and disease activity. Methods Several meetings have been held among our multi-center group (LOCUS) to work towards standardizing sonographic technique and image interpretation. Demonstration and experience in image acquisition were conducted at workshop meetings. Following meetings in 2007, an ultrasound measure was developed to standardize evaluation of differences in echogenicity and vascularity. Based upon our initial observations, we have labeled this an ultrasound disease activity measure. This preliminary measure was subsequently evaluated on over 180 scans of pediatric LS lesions. This review suggested that scoring levels should be expanded to better capture the range of observed differences. The revised levels and their definitions were formulated at a February 2009 workshop meeting. We have also developed assessments for scoring changes in tissue thickness and lesion size to better determine if these parameters aid evaluation of disease state. Results We have standardized our protocol for acquiring ultrasound images of pediatric LS lesions. A wide range of sonographic differences has been seen in the dermis, hypodermis, and deep tissue layers of active lesions. Preliminary ultrasound assessments have been generated. The disease activity measure scores for altered levels of echogenicity and vascularity in the lesion, and other assessments score for differences in lesion tissue layer thickness and changes in lesion size. Conclusions We describe the range of sonographic differences found in pediatric LS, and present our

  17. Clinical Evaluation and Parental Satisfaction with Pediatric Zirconia Anterior Crowns.

    PubMed

    Holsinger, Daniel M; Wells, Martha H; Scarbecz, Mark; Donaldson, Martin

    2016-01-01

    The purpose of this study was to evaluate the clinical success of and parental satisfaction with anterior pediatric zirconia crowns. A retrospective analysis of maxillary anterior pediatric zirconia crowns was performed. Crowns were evaluated for retention, gingival health, color match, contour, marginal integrity, and opposing tooth wear. Parental satisfaction regarding the esthetics of the crowns and parental perception of the impact of treatment on the child's appearance and oral health were evaluated by questionnaire. Fifty-seven crowns were evaluated in 18 children. Eight teeth were lost to exfoliation, three were extracted due to pathology, and two crowns debonded, leaving 44 available for examination. The average crown age at time of examination was 20.8 months. Sixteen crowns (36 percent) displayed gingival inflammation and color mismatch. No recurrent caries or opposing tooth wear was noted. Parents reported high satisfaction with the color, size, and shape of the crowns. The majority of parents reported that crowns improved the appearance and oral health of their child (78 percent and 83 percent, respectively). Eight-nine percent of parents reported that they would highly recommend these crowns. Zirconia crowns are clinically acceptable restorations in the primary maxillary anterior dentition. Parental satisfaction with zirconia crowns is high.

  18. Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment

    PubMed

    Tiyyagura, Gunjan; Beucher, Meghan; Bechtel, Kirsten

    2017-07-01

    Emergency clinicians are likely to encounter physical abuse in children, and they must be prepared to recognize its many manifestations and take swift action. Pediatric nonaccidental injury causes considerable morbidity and mortality that can often be prevented by early recognition. Nonaccidental injuries present with a wide array of symptoms that may appear to be medically inconsequential (such as bruising in a premobile infant), but are actually sentinel injuries indicative of child abuse. This issue provides guidance regarding factors that contribute to abuse in children, key findings on history and physical examination that should trigger an evaluation for physical abuse, and laboratory and radiologic tests to perform when child abuse is suspected.

  19. Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics.

    PubMed

    Segal, Lee S; Plantikow, Carla; Hall, Randon; Wilson, Kristina; Shrader, M Wade

    2015-01-01

    Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric orthopaedic practice. A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. Surveys are randomly mailed out to families seen in our clinic by the survey vendor, and the results are determined on a quarterly basis. We distributed the same survey in a similar manner in our clinic. The results of the surveys, external/mailed (EXM) versus internal/point of care (INP) over the same 3-month time period (second quarter 2013) were compared. The survey questions are dichotomized from an ordinal scale into either excellent (9 to 10) or not excellent (0 to 8) commonly used in patient satisfaction methodology. We evaluated the raw data from the INP surveys for the question on provider rating by evaluating the mean score, the standard excellent response (9 to 10), and an expanded excellent response (8 to 10). Response rate was 72/469 (15.4%) for EXM, and 231/333 (69.4%) for INP. An excellent response for the "rating your provider" question was 72.2% (EXM) versus 84.8% (INP) (P=0.015). Our analysis of the raw data (INP) has a mean rating of 9.42. The expanded scale (8 to 10) for an excellent response increased the provider rating to 94.4% (P=0.001). Waiting time response within 15 minutes was the only item that correlated with rating of provider (P=0.02). For the majority of the items, the INP responses were consistently higher than the EXM responses, including 6/7 responses that were statistically significant (P<0.05). As mandated by the Centers for Medicare and Medicaid Services, patient satisfaction surveys will be

  20. Longitudinal evaluation of a live interactive video baccalaureate nursing program.

    PubMed

    Martin, Pam; Klotz, Linda; Alfred, Danita

    2007-01-01

    Beginning with a brief history of a community-inspired distance education initiative, the authors describe how one college of nursing offers an entire generic bachelor of science in nursing program over live interactive video for nursing students at 2 distance sites. The 10-year longitudinal evaluation of student and program outcomes is presented. Student and program success is evidenced by congruence of grades and National Council Licensure Exam (NCLEX) pass rates between sites.

  1. Part I--Evaluation of pediatric post-traumatic headaches.

    PubMed

    Pinchefsky, Elana; Dubrovsky, Alexander Sasha; Friedman, Debbie; Shevell, Michael

    2015-03-01

    Brain injury is one of the most common injuries in the pediatric age group, and post-traumatic headache is one of the most common symptoms following mild traumatic brain injury in children. This is an expert opinion-based two-part review on pediatric post-traumatic headaches. Part I will focus on an overview and approach to the evaluation of post-traumatic headache. Part II will focus on the medical management of post-traumatic headache. Relevant articles were reviewed, and an algorithm is proposed. We review the epidemiology, classification, pathophysiology, and clinical approach to evaluating patients with post-traumatic headache. A comprehensive history and physical examination are fundamental to identifying the headache type(s). Identifying the precise headache phenotype is important to help guide treatment. Most of the post-traumatic headaches are migraine or tension type, but occipital neuralgia, cervicogenic headache, and medication overuse headache also occur. Postconcussive signs often resolve within 1 month, and individuals whose signs persist longer may benefit from an interprofessional approach. Rigorous evaluation and diagnosis are vital to treating post-traumatic headaches effectively. A multifaceted approach is needed to address all the possible contributing factors to the headaches and any comorbid conditions that may delay recovery or alter treatment choices. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Evaluation of a New Pediatric Positive Airway Pressure Mask

    PubMed Central

    Kushida, Clete A.; Halbower, Ann C.; Kryger, Meir H.; Pelayo, Rafael; Assalone, Valerie; Cardell, Chia-Yu; Huston, Stephanie; Willes, Leslee; Wimms, Alison J.; Mendoza, June

    2014-01-01

    Study Objectives: The choice and variety of pediatric masks for continuous positive airway pressure (CPAP) is limited in the US. Therefore, clinicians often prescribe modified adult masks. Until recently a mask for children aged < 7 years was not available. This study evaluated apnea-hypopnea index (AHI) equivalence and acceptability of a new pediatric CPAP mask for children aged 2-7 years (Pixi; ResMed Ltd, Sydney, Australia). Methods: Patients aged 2-7 years were enrolled and underwent in-lab baseline polysomnography (PSG) using their previous mask, then used their previous mask and the VPAP III ST-A flow generator for ≥ 10 nights at home. Thereafter, patients switched to the Pixi mask for ≥ 2 nights before returning for a PSG during PAP therapy via the Pixi mask. Patients then used the Pixi mask at home for ≥ 21 nights. Patients and their parents/guardians returned to the clinic for follow-up and provided feedback on the Pixi mask versus their previous mask. Results: AHI with the Pixi mask was 1.1 ± 1.5/h vs 2.6 ± 5.4/h with the previous mask (p = 0.3538). Parents rated the Pixi mask positively for: restfulness of the child's sleep, trouble in getting the child to sleep, and trouble in having the child stay asleep. The Pixi mask was also rated highly for leaving fewer or no marks on the upper lip and under the child's ears, and being easy to remove. Conclusions: The Pixi mask is suitable for children aged 2-7 years and provides an alternative to other masks available for PAP therapy in this age group. Citation: Kushida CA, Halbower AC, Kryger MH, Pelayo R, Assalone V, Cardell CY, Huston S, Willes L, Wimms AJ, Mendoza J. Evaluation of a new pediatric positive airway pressure mask. J Clin Sleep Med 2014;10(9):979-984. PMID:25142768

  3. Longitudinal DXA Studies: Minimum scanning interval for pediatric assessment of body fat

    USDA-ARS?s Scientific Manuscript database

    The increased prevalence of obesity in the United States, has led to the increased use of dual-energy X-ray absorptiometry (DXA) for assessment of body fat mass (TBF) in pediatric populations. We examined DXA precision, in order to determine suitable scanning intervals for the measurement of change...

  4. Longitudinal DXA studies: minimum scanning interval for pediatric assessment of body fat

    USDA-ARS?s Scientific Manuscript database

    The increased prevalence of obesity in the United States has led to the increased use of Dual-energy X-ray absorptiometry (DXA) for assessment of body fat (TBF). The importance of early intervention has focused attention on pediatric populations. We used DXA precision analyses to determine suitable ...

  5. Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria.

    PubMed

    Heman-Ackah, Selena E; Roland, J Thomas; Haynes, David S; Waltzman, Susan B

    2012-02-01

    Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.

  6. Cost of Unnecessary Testing in the Evaluation of Pediatric Syncope.

    PubMed

    Redd, Connor; Thomas, Cameron; Willis, Martha; Amos, Michelle; Anderson, Jeffrey

    2017-08-01

    Syncope is a common and a typically benign clinical problem in children and adolescents. The majority of tests ordered in otherwise healthy pediatric patients presenting with syncope have low diagnostic yield. This study quantifies testing and corresponding patient charges in a group of pediatric patients presenting for outpatient evaluation for syncope. Patients seen between 3/2011 and 4/2013 in the multi-disciplinary Syncope Clinic at Cincinnati Children's Hospital Medical Center were enrolled in a registry which was reviewed for patient information. The electronic medical record was used to determine which syncope patients underwent cardiac (electrocardiogram, echocardiogram, or exercise testing) or neurologic (head CT/MRI or electroencephalogram) testing within the interval from 3 months before to 3 months after the Syncope Clinic visit. Testing charges were obtained through hospital billing records. 442 patients were included for analysis; 91% were Caucasian; 65.6% were female; median age was 15.1 years (8.1-21.2 years). Cardiac and neurologic testing was common in this population. While some testing was performed during the Syncope Clinic visit, 46% of the testing occurred before or after the visit. A total of $1.1 million was charged to payers for cardiac and neurological testing with an average total charge of $2488 per patient. Despite the typically benign etiology of pediatric syncope, patients often have expensive and unnecessary cardiac and/or neurologic testing. Reducing or eliminating this unnecessary testing could have a significant impact on healthcare costs, especially as the economics of healthcare shift to more capitated systems.

  7. Is subjective outcome evaluation related to objective outcome evaluation? Insights from a longitudinal study in Hong Kong.

    PubMed

    Shek, Daniel T L

    2014-06-01

    Empirical studies investigating the inter-relationships among subjective outcomes and objective outcomes are sparse in the scientific literature. This study examined the relationship between these 2 forms of outcome evaluation data in Chinese adolescents, utilizing longitudinal data. In Wave 3 and Wave 4 of a randomized group trial, 2,784 Chinese secondary school students responded to the Chinese Positive Youth Development Scale (CPYDS) assessing objective outcome at pretest (Wave 3) and posttest (Wave 4). Students in the experimental schools also responded to a measure of client satisfaction assessing the subjective outcome of a positive youth development program at posttest (Wave 4). Subjective outcome evaluation measures (eg, process, program, and effectiveness) at Wave 3 were significantly correlated with CPYDS scores at Wave 4 and difference scores. Subjective outcome evaluation measures also predicted changes in the objective outcome evaluation measures scores across time. The present findings replicated the previous findings that subjective outcome and objective outcome evaluation findings were intimately related, and subjective outcome measures predicted posttest measures and their changes over time. The present study suggests that subjective outcome evaluation findings may yield useful information regarding program effectiveness in youth work settings. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  8. Longitudinal electroencephalographic (EEG) findings in pediatric anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis: the Padua experience.

    PubMed

    Nosadini, Margherita; Boniver, Clementina; Zuliani, Luigi; de Palma, Luca; Cainelli, Elisa; Battistella, Pier Antonio; Toldo, Irene; Suppiej, Agnese; Sartori, Stefano

    2015-02-01

    To contribute to characterize electroencephalographic (EEG) activity in pediatric anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis, we reviewed electroclinical data of 5 children with anti-NMDA receptor encephalitis diagnosed in our department. We identified 4 longitudinal electroencephalographic phases: in the early phase, background activity was normal, with intermixed nonreactive slow waves; in the florid phase, background activity deteriorated with appearance of sequences of peculiar rhythmic theta and/or delta activity unrelated to clinical changes, unresponsive to stimuli and antiepileptic medications; in the recovery phase, these sequences decreased and reactive posterior rhythm re-emerged; electroencephalogram normalized 2 to 5 months after onset. In conclusion, in the presence of evocative clinical history, recognizing a characteristic longitudinal electroencephalographic activity could provide ancillary aspects addressing the diagnosis and the overall management of children with anti-N-methyl-d-aspartate receptor encephalitis; in particular, knowing that peculiar and recurrent paroxysmal nonepileptic rhythmic theta-delta patterns can occur in these patients could help distinguish paroxysmal epileptic and nonepileptic electroencephalographic activity.

  9. UTI: diagnosis and evaluation in symptomatic pediatric patients.

    PubMed

    Heldrich, F J; Barone, M A; Spiegler, E

    2000-08-01

    We retrospectively reviewed data on 260 hospitalized pediatric patients with symptomatic urinary tract infection (UTI). To ascertain the colony-forming units (CFU)/mL compatible with the diagnosis of UTI, a culture from a catheterized urine specimen containing >1,000 CFU/mL was considered diagnostic of UTI and resulted in imaging by renal ultrasound, voiding cystourethrography, and renal nuclear scan with Tc99m dimercaptosuccinic acid (DMSA). A positive DMSA renal scan is indicative of pyelonephritis. We used logistic regression analysis to determine which patient characteristics were predictive of pyelonephritis. We determined that, in hospitalized pediatric patients, the colony count of the positive urine culture, the type of organism grown in culture, and the voiding cystourethrography (VCUG) result (positive or negative for vesicoureteral reflux) did not predict which patients had pyelonephritis. In females, advancing age of the patient and positive renal ultrasound results were predictive of which patients had pyelonephritis when we controlled for other factors. We feel this emphasizes the importance of a thorough evaluation of hospitalized symptomatic patients, including patients with colony counts of 1,000 to 50,000 CFU/mL, to locate the level of infection and plan appropriate therapy.

  10. [Evaluation of imported pediatric malaria management in northern France].

    PubMed

    Elmansouf, L; Dubos, F; Dauriac, A; Courouble, C; Pruvost, I; Dervaux, B; Martinot, A

    2011-03-01

    The study's objective was to evaluate the adequacy of treatment to recommendations, for the management of pediatric malaria. A descriptive, retrospective, multicentre cohort study was conducted over a 7-year period (2000-2006) in 18 pediatric and infectious diseases units in northern France. All children, under 18 years of age, having consulted in one of these hospitals and for whom the diagnosis of malaria has been made by blood smear and/or thick drop examination, were included. One hundred and thirty-three cases of imported malaria were reported. Among the 120 available files, 23 documented severe malaria. Treatment documentation was available for 115 patients. This treatment was initiated orally in 47 cases and intravenously in 68 cases. Intravenous quinine was the first-line treatment in 58% of cases. Halofantrine was the first-line oral treatment. No change was observed along the 6 years. Only 32% of management was in adequacy with recommendations. Five therapeutic failures were recorded. The optimal application of recommendations would have saved 117 days in terms of hospital stay, corresponding to 54,000 €. The French Infectious Disease Society (SPILF) recommendations were not well observed. This inappropriate management was responsible for treatment failures and increased costs. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  11. Evaluating the Pediatric Early Warning Score (PEWS) System for Admitted Patients in the Pediatric Emergency Department

    PubMed Central

    Gold, Delia L.; Mihalov, Leslie K.; Cohen, Daniel M.

    2015-01-01

    Objectives The Pediatric Early Warning Score (PEWS) systems were developed to provide a reproducible assessment of a child’s clinical status while hospitalized. Most studies investigating the PEWS evaluate its usefulness in the inpatient setting. Limited studies evaluate the effectiveness and integration of PEWS in the pediatric emergency department (ED). The goal of this study was to explore the test characteristics of an ED-assigned PEWS score for intensive care unit (ICU) admission or clinical deterioration in admitted patients. Methods This was a prospective 12-month observational study of patients, aged 0 to 21 years, admitted from the ED of an urban, tertiary care children’s hospital. ED nurses were instructed in PEWS assignment and electronic medical record (EMR) documentation. Interrater reliability between nurses was evaluated. PEWS scores were measured at initial assessment (P0) and time of admission (P1). Patients were stratified into outcome groups: those admitted to the ICU either from the ED or as transfers from the floor and those admitted to the floor only. Clinical deterioration was defined as transfer to the ICU within 6 hours or within 6 to 24 hours of admission. PEWS scores and receiver operating characteristic (ROC) curves were compared for patients admitted to the floor, ICU, and with clinical deterioration. Results The authors evaluated 12,306 consecutively admitted patients, with 99% having a PEWS documented in the EMR. Interrater reliability was excellent (intraclass coefficient 0.91). A total of 1,300 (10.6%) patients were admitted to the ICU and 11,066 (89.4%) were admitted to the floor. PEWS scores were higher for patients in the ICU group (P0 = 2.8, SD ± 2.4; P1 = 3.2, SD ± 2.4; p < 0.0001) versus floor patients (P0 = 0.7, SD ± 1.2; P1 = 0.5, SD ± 0.9; p < 0.0001). To predict the need for ICU admission, the optimal cutoff points on the ROC are P0 = 1 and P1 = 2, with areas under the ROC curve (AUCs) of 0.79 and 0

  12. Differential diagnosis and evaluation in pediatric inflammatory demyelinating disorders.

    PubMed

    Rostasy, Kevin; Bajer-Kornek, Barbara; Venkateswaran, Sunita; Hemingway, Cheryl; Tardieu, Marc

    2016-08-30

    Major advances have been made in the clinical and radiologic characterization of children presenting with the different forms of an acquired inflammatory demyelinating syndrome (ADS) such as acute disseminating encephalomyelitis, neuromyelitis optica spectrum disorders, and clinically isolated syndromes. Nevertheless, a proportion of cases that present with similar symptoms are due to a broad spectrum of other inflammatory disorders affecting the white matter, primary CNS tumors, or neurometabolic diseases. The clinician therefore has to be aware of the different forms of ADS, the risk factors for a chronic-relapsing course, and features that indicate an alternative diagnosis. The goal of this article is therefore to provide an outline of a pathway for evaluating pediatric patients with a presumed inflammatory demyelinating disorder and discussing the spectrum of the more common differential diagnoses.

  13. Comparison of the validity of direct pediatric developmental evaluation versus developmental screening by parent report

    USDA-ARS?s Scientific Manuscript database

    To compare the validity of direct pediatric developmental evaluation with developmental screening by parent report, parents completed a developmental screen (the Child Development Review), a pediatrician performed a direct developmental evaluation (Capute Scales), and a psychologist administered the...

  14. Alterations of the Subgingival Microbiota in Pediatric Crohn's Disease Studied Longitudinally in Discovery and Validation Cohorts.

    PubMed

    Kelsen, Judith; Bittinger, Kyle; Pauly-Hubbard, Helen; Posivak, Leah; Grunberg, Stephanie; Baldassano, Robert; Lewis, James D; Wu, Gary D; Bushman, Frederic D

    2015-12-01

    Oral manifestations are common in Crohn's disease (CD). Here we characterized the subgingival microbiota in pediatric patients with CD initiating therapy and after 8 weeks to identify microbial community features associated with CD and therapy. Pediatric patients with CD were recruited from The Children's Hospital of Pennsylvania. Healthy control subjects were recruited from primary care or orthopedics clinic. Subgingival plaque samples were collected at initiation of therapy and after 8 weeks. Treatment exposures included 5-ASAs, immunomodulators, steroids, and infliximab. The microbiota was characterized by 16S rRNA gene sequencing. The study was repeated in separate discovery (35 CD, 43 healthy) and validation cohorts (43 CD, 31 healthy). Most subjects in both cohorts demonstrated clinical response after 8 weeks of therapy (discovery cohort 88%, validation cohort 79%). At week 0, both antibiotic exposure and disease state were associated with differences in bacterial community composition. Seventeen genera were identified in the discovery cohort as candidate biomarkers, of which 11 were confirmed in the validation cohort. Capnocytophaga, Rothia, and TM7 were more abundant in CD relative to healthy controls. Other bacteria were reduced in abundance with antibiotic exposure among CD subjects. CD-associated genera were not enriched compared with healthy controls after 8 weeks of therapy. Subgingival microbial community structure differed with CD and antibiotic use. Results in the discovery cohort were replicated in a separate validation cohort. Several potentially pathogenic bacterial lineages were associated with CD but were not diminished in abundance by antibiotic treatment, suggesting targets for additional surveillance.

  15. Evaluation of pediatric cochlear implant care throughout Europe: Is European pediatric cochlear implant care performed according to guidelines?

    PubMed

    Bruijnzeel, Hanneke; Bezdjian, Aren; Lesinski-Schiedat, Anke; Illg, Angelika; Tzifa, Konstance; Monteiro, Luisa; Volpe, Antonio Della; Grolman, Wilko; Topsakal, Vedat

    2017-09-19

    International guidelines indicate that children with profound hearing loss should receive a cochlear implant (CI) soon after diagnosis in order to optimize speech and language rehabilitation. Although prompt rehabilitation is encouraged by current guidelines, delays in cochlear implantation are still present. This study investigated whether European countries establish timely pediatric CI care based on epidemiological, commercial, and clinical data. An estimation of the number of pediatric CI candidates in European countries was performed and compared to epidemiological (Euro-CIU), commercial (Cochlear(®)), and clinical (institutional) age-at-implantation data. The ages at implantation of pediatric patients in eight countries (the Netherlands, Belgium, Germany, the United Kingdom, France, Turkey, Portugal, and Italy) between 2005 and 2015 were evaluated. From 2010 onwards, over 30% of the pediatric CI candidates were implanted before 24 months of age. Northern European institutions implanted children on average around 12 months of age, whereas southern European institutions implanted children after 18 months of age. The Netherlands and Germany implanted earliest (between 6 and 11 months). Implemented newborn hearing screening programs and reimbursement rates of CIs vary greatly within Europe due to local, social, financial, and political differences. However, internationally accepted recommendations are applicable to this heterogeneous European CI practice. Although consensus on early pediatric cochlear implantation exists, this study identified marked delays in European care. Regardless of the great heterogeneity in European practice, reasons for latency should be identified on a national level and possibilities to prevent avoidable future implantation delays should be explored to provide national recommendations.

  16. A Report on Longitudinal Evaluations of Preschool Programs. Volume I: Longitudinal Evaluations.

    ERIC Educational Resources Information Center

    Ryan, Sally, Ed.

    This document reviews the findings of relatively small, controlled, long-term evaluations of preschool programs in various parts of the country. It is an attempt to clarify unresolved issues arising from the Westinghouse Learning Corporation Report on the impact of Project Head Start. Generally, this review focuses on the following question: What…

  17. Evolution of Pediatric Chronic Disease Treatment Decisions: A Qualitative, Longitudinal View of Parents' Decision-Making Process.

    PubMed

    Lipstein, Ellen A; Britto, Maria T

    2015-08-01

    In the context of pediatric chronic conditions, patients and families are called upon repeatedly to make treatment decisions. However, little is known about how their decision making evolves over time. The objective was to understand parents' processes for treatment decision making in pediatric chronic conditions. We conducted a qualitative, prospective longitudinal study using recorded clinic visits and individual interviews. After consent was obtained from health care providers, parents, and patients, clinic visits during which treatment decisions were expected to be discussed were video-recorded. Parents then participated in sequential telephone interviews about their decision-making experience. Data were coded by 2 people and analyzed using framework analysis with sequential, time-ordered matrices. 21 families, including 29 parents, participated in video-recording and interviews. We found 3 dominant patterns of decision evolution. Each consisted of a series of decision events, including conversations, disease flares, and researching of treatment options. Within all 3 patterns there were both constant and evolving elements of decision making, such as role perceptions and treatment expectations, respectively. After parents made a treatment decision, they immediately turned to the next decision related to the chronic condition, creating an iterative cycle. In this study, decision making was an iterative process occurring in 3 distinct patterns. Understanding these patterns and the varying elements of parents' decision processes is an essential step toward developing interventions that are appropriate to the setting and that capitalize on the skills families may develop as they gain experience with a chronic condition. Future research should also consider the role of children and adolescents in this decision process. © The Author(s) 2015.

  18. Adolescent Depression: Evaluating Pediatric Residents' Knowledge, Confidence, and Interpersonal Skills Using Standardized Patients

    ERIC Educational Resources Information Center

    Lewy, Colleen; Sells, C. Wayne; Gilhooly, Jennifer; McKelvey, Robert

    2009-01-01

    Objective: The authors aim to determine whether pediatric residents used DSM-IV criteria to diagnose major depressive disorder and how this related to residents' confidence in diagnosis and treatment skills before and after clinical training with depressed adolescents. Methods: Pediatric residents evaluated two different standardized patients…

  19. Review for the generalist: evaluation of pediatric foot and ankle pain

    PubMed Central

    Houghton, Kristin M

    2008-01-01

    Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population. PMID:18400098

  20. Evaluating the quality of Internet health resources in pediatric urology.

    PubMed

    Fast, Angela M; Deibert, Christopher M; Hruby, Gregory W; Glassberg, Kenneth I

    2013-04-01

    Many patients and their parents utilize the Internet for health-related information, but quality is largely uncontrolled and unregulated. The Health on the Net Foundation Code (HONcode) and DISCERN Plus were used to evaluate the pediatric urological search terms 'circumcision,' 'vesicoureteral reflux' and 'posterior urethral valves'. A google.com search was performed to identify the top 20 websites for each term. The HONcode toolbar was utilized to determine whether each website was HONcode accredited and report the overall frequency of accreditation for each term. The DISCERN Plus instrument was used to score each website in accordance with the DISCERN Handbook. High and low scoring criteria were then compared. A total of 60 websites were identified. For the search terms 'circumcision', 'posterior urethral valves' and 'vesicoureteral reflux', 25-30% of the websites were HONcode certified. Out of the maximum score of 80, the average DISCERN Plus score was 60 (SD = 12, range 38-78), 40 (SD = 12, range 22-69) and 45 (SD = 19, range 16-78), respectively. The lowest scoring DISCERN criteria included: 'Does it describe how the treatment choices affect overall quality of life?', 'Does it describe the risks of each treatment?' and 'Does it provide details of additional sources of support and information?' (1.35, 1.83 and 1.95 out of 5, respectively). These findings demonstrate the poor quality of information that patients and their parents may use in decision-making and treatment choices. The two lowest scoring DISCERN Plus criteria involved education on quality of life issues and risks of treatment. Physicians should know how to best use these tools to help guide patients and their parents to websites with valid information. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  1. Alterations of the Subgingival Microbiota in Pediatric Crohn's Disease Studied Longitudinally in Discovery and Validation Cohorts

    PubMed Central

    Kelsen, Judith; Bittinger, Kyle; Pauly-Hubbard, Helen; Posivak, Leah; Grunberg, Stephanie; Baldassano, Robert; Lewis, James D; Wu, Gary D; Bushman, Frederic D

    2016-01-01

    Background Oral manifestations are common in Crohn's disease (CD). Here we characterized the subgingival microbiota in pediatric CD patients initiating therapy and after 8 weeks to identify microbial community features associated with CD and therapy. Methods Pediatric CD patients were recruited from The Children's Hospital of Pennsylvania. Healthy control subjects were recruited from primary care or orthopedics clinic. Subgingival plaque samples were collected at initiation of therapy and after 8 weeks. Treatment exposures included 5-ASAs, immunomodualtors, steroids, and infliximab. The microbiota was characterized by 16S rRNA gene sequencing. The study was repeated in separate discovery (35 CD, 43 healthy) and validation cohorts (43 CD, 31 healthy). Results A majority of subjects in both cohorts demonstrated clinical response after 8 weeks of therapy (discovery cohort 88%, validation cohort 79%). At week 0, both antibiotic exposure and disease state were associated with differences in bacterial community composition. Seventeen genera were identified in the discovery cohort as candidate biomarkers, of which 11 were confirmed in the validation cohort. Capnocytophaga, Rothia, and TM7 were more abundant in CD relative to healthy controls. Other bacteria were reduced in abundance with antibiotic exposure among CD subjects. CD-associated genera were not enriched compared to healthy controls after 8 weeks of therapy. Conclusions Subgingival microbial community structure differed with CD and antibiotic use. Results in the discovery cohort were replicated in a separate validation cohort. Several potentially pathogenic bacterial lineages were associated with CD but were not diminished in abundance by antibiotic treatment, suggesting targets for additional surveillance. PMID:26288001

  2. The Latent Curve ARMA (P, Q) Panel Model: Longitudinal Data Analysis in Educational Research and Evaluation

    ERIC Educational Resources Information Center

    Sivo, Stephen; Fan, Xitao

    2008-01-01

    Autocorrelated residuals in longitudinal data are widely reported as common to longitudinal data. Yet few, if any, researchers modeling growth processes evaluate a priori whether their data have this feature. Sivo, Fan, and Witta (2005) found that not modeling autocorrelated residuals present in longitudinal data severely biases latent curve…

  3. Evaluating Hospice and Palliative Medicine Education in Pediatric Training Programs.

    PubMed

    Singh, Arun L; Klick, Jeffrey C; McCracken, Courtney E; Hebbar, Kiran B

    2017-08-01

    Hospice and Palliative Medicine (HPM) competencies are of growing importance in training general pediatricians and pediatric sub-specialists. The Accreditation Council for Graduate Medical Education (ACGME) emphasized pediatric trainees should understand the "impact of chronic disease, terminal conditions and death on patients and their families." Currently, very little is known regarding pediatric trainee education in HPM. We surveyed all 486 ACGME-accredited pediatric training program directors (PDs) - 200 in general pediatrics (GP), 57 in cardiology (CARD), 64 in critical care medicine (CCM), 69 in hematology-oncology (ONC) and 96 in neonatology (NICU). We collected training program's demographics, PD's attitudes and educational practices regarding HPM. The complete response rate was 30% (148/486). Overall, 45% offer formal HPM curriculum and 39% offer a rotation in HPM for trainees. HPM teaching modalities commonly reported included conferences, consultations and bedside teaching. Eighty-one percent of all respondents felt that HPM curriculum would improve trainees' ability to care for patients. While most groups felt that a HPM rotation would enhance trainees' education [GP (96%), CARD (77%), CCM (82%) and ONC (95%)], NICU PDs were more divided (55%; p < 0.05 for all comparisons vs. NICU). While most programs report perceived benefit from HPM training, there remains a paucity of opportunities for pediatric trainees. Passive teaching methods are frequently utilized in HPM curricula with minimal diversity in methods utilized to teach HPM. Opportunities to further emphasize HPM in general pediatric and pediatric sub-specialty training remains.

  4. Determinants and Regression Equations for the Calculation of z Scores of Left Ventricular Tissue Doppler Longitudinal Indexes in a Healthy Italian Pediatric Population.

    PubMed

    Fibbi, Veronica; Ballo, Piercarlo; Favilli, Silvia; Spaziani, Gaia; Calabri, Giovanni B; Pollini, Iva; Zuppiroli, Alfredo; Chiappa, Enrico

    2015-01-01

    Aim. We investigated the predictors of tissue Doppler left ventricular (LV) longitudinal indexes in a healthy Italian pediatric population and established normative data and regression equations for the calculation of z scores. Methods and Results. A total of 369 healthy subjects aged 1-17 years (age of 6.4 ± 1.1 years, 49.1% female) underwent echocardiography. LV peak longitudinal velocity at systole (s (')), early diastole (e (')), and late diastole (a (')) was determined by tissue Doppler. The ratio of peak early diastolic LV filling velocity to e (') was calculated. Age was the only independent determinant of s (') (β = 0.491, p < 0.0001) and the strongest determinant of e (') (β = 0.334, p < 0.0001) and E/e (') (β = -0.369, p < 0.0001). Heart rate was the main determinant of a (') (β = 0.265, p < 0.0001). Male gender showed no effects except for a weak association with lateral s ('), suggesting no need of gender-specific reference ranges. Age-specific reference ranges, regression equations, and scatterplots for the calculation of z scores were determined for each index. Conclusion. In a pediatric Italian population, age was the strongest determinant of LV longitudinal dynamics. The availability of age-specific normality data for the calculation of z scores may allow for correctly detecting LV dysfunction in pediatric pathological populations.

  5. Determinants and Regression Equations for the Calculation of z Scores of Left Ventricular Tissue Doppler Longitudinal Indexes in a Healthy Italian Pediatric Population

    PubMed Central

    Fibbi, Veronica; Ballo, Piercarlo; Spaziani, Gaia; Calabri, Giovanni B.; Pollini, Iva; Zuppiroli, Alfredo; Chiappa, Enrico

    2015-01-01

    Aim. We investigated the predictors of tissue Doppler left ventricular (LV) longitudinal indexes in a healthy Italian pediatric population and established normative data and regression equations for the calculation of z scores. Methods and Results. A total of 369 healthy subjects aged 1–17 years (age of 6.4 ± 1.1 years, 49.1% female) underwent echocardiography. LV peak longitudinal velocity at systole (s'), early diastole (e'), and late diastole (a') was determined by tissue Doppler. The ratio of peak early diastolic LV filling velocity to e' was calculated. Age was the only independent determinant of s' (β = 0.491, p < 0.0001) and the strongest determinant of e' (β = 0.334, p < 0.0001) and E/e' (β = −0.369, p < 0.0001). Heart rate was the main determinant of a' (β = 0.265, p < 0.0001). Male gender showed no effects except for a weak association with lateral s', suggesting no need of gender-specific reference ranges. Age-specific reference ranges, regression equations, and scatterplots for the calculation of z scores were determined for each index. Conclusion. In a pediatric Italian population, age was the strongest determinant of LV longitudinal dynamics. The availability of age-specific normality data for the calculation of z scores may allow for correctly detecting LV dysfunction in pediatric pathological populations. PMID:26759729

  6. Staged imaging pathway for the evaluation of pediatric appendicitis.

    PubMed

    Chien, Ming; Habis, Arie; Glynn, Loretto; O'Connor, Ann; Smith, Tracie L; Prendergast, Francis

    2016-07-01

    Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy. Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation. There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87.1-13.4 % for evaluations positive for appendicitis (decrease 84.6 %, p < 0.0001) and 82.6-9.2 % for evaluations negative for appendicitis (decrease 88.9 %, p < 0.0001). Use of CT during any point in the evaluation decreased from 91.7 to 25.1 % (decrease 72.6 %, p < 0.0001). The negative appendectomy rate was similar; 5.4 % prior, 4.9 % post (p = 0.955). The missed appendicitis rate did not statistically change; 1.1 % prior, 3.7 % post (p = 0.523). The perforation rate was not statistically altered; 6.5 % prior; 9.8 % post (p = 0.421). 350 less patients underwent CT during the year following the pathway. The staged imaging pathway resulted in a marked decrease in children exposed to CT without compromising diagnostic accuracy.

  7. Evaluation of entrance surface air kerma in pediatric chest radiography

    NASA Astrophysics Data System (ADS)

    Porto, L.; Lunelli, N.; Paschuk, S.; Oliveira, A.; Ferreira, J. L.; Schelin, H.; Miguel, C.; Denyak, V.; Kmiecik, C.; Tilly, J.; Khoury, H.

    2014-11-01

    The objective of this study was to evaluate the entrance surface air kerma in pediatric chest radiography. An evaluation of 301 radiographical examinations in anterior-posterior (AP) and posterior-anterior (PA) (166 examinations) and lateral (LAT) (135 examinations) projections was performed. The analyses were performed on patients grouped by age; the groups included ages 0-1 y, 1-5 y, 5-10 y, and 10-15 y. The entrance surface air kerma was determined with DoseCal software (Radiological Protection Center of Saint George's Hospital, London) and thermoluminescent dosimeters. Two different exposure techniques were compared. The doses received by patients who had undergone LAT examinations were 40% higher, on average, those in AP/PA examinations because of the difference in tube voltage. A large high-dose “tail” was observed for children up to 5 y old. An increase in tube potential and corresponding decrease in current lead to a significant dose reduction. The difference between the average dose values for different age ranges was not practically observed, implying that the exposure techniques are still not optimal. Exposure doses received using the higher tube voltage and lower current-time product correspond to the international diagnostic reference levels.

  8. Effects of pediatric first aid training on preschool teachers: a longitudinal cohort study in China

    PubMed Central

    2014-01-01

    Background Unintentional injuries are a major cause of death among children. Data suggest that the retention of knowledge and skills about first aid declined over time. The purpose of this study was to assess the effects of pediatric first aid training among teachers. Methods A stratified random sampling method was used to select 1,067 teachers. The selected trainees received pediatric first aid training. Follow-up assessments were conducted 6 months, 9 months and 4 years following the training. A standardized collection of demographics was performed, and participants were given a questionnaire to indicate knowledge of and emotions about first aid. Results In the pretest, 1067 people responded with a mean of 21.0 correct answers to 37 questions, whereas in the post-test period, the mean score increased to 32.2 correct answers of 37 questions (P <0.001). There was a decrease in scores from post-test to 6 months, 9 months and 4 years after the training. However, the mean at the 6-month, 9-month and 4-year marks were higher than the pretest mean (P < 0.001). A total of 82.8% of the participants achieved a pass mark of 80% or above; 42.8% of participants achieved the pass mark at 6 months, 41.7% at 9 months and 11.7% at 4 years (compared with pre-test, P < 0.001). The mean score of the subjects’ emotions in the post-test period increased to 81 (P < 0.001). The mean scores of emotions at 9 months or 4 years were higher than the pretest mean (P < 0.001). At the 4-year mark, the majority of preschool staff (>70%) had administered correct first aid for injuries. Conclusions This study demonstrated that the acquisition of knowledge, both short and long term, significantly improves. Despite appreciable decreases in knowledge long term, knowledge retention was modest but stable. PMID:25152013

  9. Effects of pediatric first aid training on preschool teachers: a longitudinal cohort study in China.

    PubMed

    Li, Feng; Sheng, Xiaoyang; Zhang, Jinsong; Jiang, Fan; Shen, Xiaoming

    2014-08-24

    Unintentional injuries are a major cause of death among children. Data suggest that the retention of knowledge and skills about first aid declined over time. The purpose of this study was to assess the effects of pediatric first aid training among teachers. A stratified random sampling method was used to select 1,067 teachers. The selected trainees received pediatric first aid training. Follow-up assessments were conducted 6 months, 9 months and 4 years following the training. A standardized collection of demographics was performed, and participants were given a questionnaire to indicate knowledge of and emotions about first aid. In the pretest, 1067 people responded with a mean of 21.0 correct answers to 37 questions, whereas in the post-test period, the mean score increased to 32.2 correct answers of 37 questions (P <0.001). There was a decrease in scores from post-test to 6 months, 9 months and 4 years after the training. However, the mean at the 6-month, 9-month and 4-year marks were higher than the pretest mean (P < 0.001). A total of 82.8% of the participants achieved a pass mark of 80% or above; 42.8% of participants achieved the pass mark at 6 months, 41.7% at 9 months and 11.7% at 4 years (compared with pre-test, P < 0.001). The mean score of the subjects' emotions in the post-test period increased to 81 (P < 0.001). The mean scores of emotions at 9 months or 4 years were higher than the pretest mean (P < 0.001). At the 4-year mark, the majority of preschool staff (>70%) had administered correct first aid for injuries. This study demonstrated that the acquisition of knowledge, both short and long term, significantly improves. Despite appreciable decreases in knowledge long term, knowledge retention was modest but stable.

  10. Central line-associated blood stream infections in pediatric ICUs: Longitudinal trends and compliance with bundle strategies

    PubMed Central

    Edwards, Jeffrey D; Herzig, Carolyn TA; Liu, Hangsheng; Pogorzelska-Maziarz, Monika; Zachariah, Philip; Dick, Andrew W; Saiman, Lisa; Stone, Patricia W; Furuya, E Yoko

    2015-01-01

    Background Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICU), the current extent of CL bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention. Methods Longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors/managers of infection prevention & control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011/12 PICU CLABSI rates and infection prevention practices were examined. Results Reported CLABSI rates decreased during the study period, from 5.8 per 1000 line days in 2006 to 1.4 in 2011/12 (P<0.001). While 73% of PICUs had policies for all central line prevention practices, only 35% of those with policies reported ≥95% compliance. PICUs with ≥95% compliance with central line infection prevention policies had lower reported CLABSI rates, but this association was statistically insignificant. Conclusions There was a non-significant trend in decreasing CLABSI rates as PICUs improved bundle policy compliance. Given that few PICUs reported full compliance with these policies, PICUs increasing their efforts to comply with these policies may help reduce CLABSI rates. PMID:25952048

  11. Effects of communication styles on marital satisfaction and distress of parents of pediatric cancer patients: a prospective longitudinal study.

    PubMed

    Wijnberg-Williams, Barbara J; Van de Wiel, Harry B M; Kamps, Willem; Hoekstra-Weebers, Josette E H M

    2015-01-01

    The aim of this study was to examine the longitudinal effects of communication styles on marital satisfaction and distress of parents of children treated for cancer. Marital dissatisfaction (Maudsley Marital Questionnaire), intimacy, avoidance, destructive and incongruent communication (Communication Skills Inventory) and psychological distress (General Health Questionnaire) were assessed in 115 parents of pediatric cancer patients shortly after diagnosis (T1) and 5 years later (T2). Only mothers' marital dissatisfaction increased significantly over time. No gender differences in dissatisfaction were found. Mothers had a significantly higher lack of intimacy score than fathers. All T1 communication styles were significantly univariately related to fathers' and mothers' T2 marital dissatisfaction, while not to T2 distress. Mothers' T1 marital dissatisfaction accounted for 67% and fathers' for 12% in the explained variance of T2 dissatisfaction. T1 destructive communication uniquely affected fathers' T2 marital dissatisfaction and T1 avoidant communication that of mothers. Five years after cancer diagnosis in their children, the quality of parents' marital relationships seemed largely unchanged. Parents' use of communication skills at diagnosis appeared to have limited effect on their marital dissatisfaction and no effect on their distress 5 years later. While avoidant communication seemed indicative of mothers' marital distress, fathers' seemed affected by destructive communication. Copyright © 2014 John Wiley & Sons, Ltd.

  12. Evaluation of thermal gradients in longitudinal spin Seebeck effect measurements

    NASA Astrophysics Data System (ADS)

    Sola, A.; Kuepferling, M.; Basso, V.; Pasquale, M.; Kikkawa, T.; Uchida, K.; Saitoh, E.

    2015-05-01

    In the framework of the longitudinal spin Seebeck effect (LSSE), we developed an experimental setup for the characterization of LSSE devices. This class of device consists in a layered structure formed by a substrate, a ferrimagnetic insulator (YIG) where the spin current is thermally generated, and a paramagnetic metal (Pt) for the detection of the spin current via the inverse spin-Hall effect. In this kind of experiments, the evaluation of a thermal gradient through the thin YIG layer is a crucial point. In this work, we perform an indirect determination of the thermal gradient through the measurement of the heat flux. We developed an experimental setup using Peltier cells that allow us to measure the heat flux through a given sample. In order to test the technique, a standard LSSE device produced at Tohoku University was measured. We find a spin Seebeck SSSE coefficient of 2.8 × 10 - 7 V K-1.

  13. Evaluation of Anaphylaxis Management in a Pediatric Emergency Department.

    PubMed

    Sidhu, Natasha; Jones, Stacie; Perry, Tamara; Thompson, Tonya; Storm, Elizabeth; Melguizo Castro, Maria S; Nick, Todd G

    2016-08-01

    In 2006, the National Institute of Allergy and Infectious Disease established evidence-based treatment guidelines for anaphylaxis. The purpose of our study was to evaluate provider adherence to guidelines-based management for anaphylaxis in a tertiary care pediatric emergency department (ED). Retrospective chart review was conducted of patients (0-18 years) presenting to the Arkansas Children Hospital ED from 2004 to 2011 for the treatment of anaphylaxis using International Classification of Diseases, Ninth Edition, codes. Multiple characteristics including demographics, clinical features, allergen source, and anaphylaxis management were collected. Fisher exact or χ tests were used to compare proportion of patients treated with intramuscular (IM) epinephrine in the preguideline versus postguideline period. Relative risk (RR) statistics were computed to estimate the ratio of patients who received self-injectable epinephrine prescription and allergy follow-up in the preguideline and postguideline groups. A total of 187 patients (median [range] age, 7 [1-18] years; 67% male; 48% African American) were evaluated. Food (44%) and hymenoptera stings (22%) were commonly described culprit allergens, whereas 29% had no identifiable allergen. Only 47% (n = 87) received epinephrine in the ED and 31% (n = 27) via the preferred IM route. Comparing postguideline (n = 126) versus preguideline (n = 61) periods demonstrated increase in the usage of the IM route (46% postguideline vs 6% preguideline; risk ratio (RR), 7.64; 95% confidence interval [CI], 2.04-46.0; P < 0.001). Overall, 61% (n = 115) of the patients received self-injectable epinephrine upon discharge, and there were no significant differences between the groups (64% postguideline vs 56% preguideline, P = 0.30). Postguideline patients were more likely to receive a prescription compared with preguideline patients (64% postguideline vs 56% preguideline; RR, 1.15; 95% CI, 0.89-1.55; P = 0.30). Only 45% (n = 85) received an

  14. Longitudinal renal function in pediatric heart transplant recipients: 20-years experience.

    PubMed

    Gupta, Punkaj; Rettiganti, Mallikarjuna; Gossett, Jeffrey M; Gardner, Megan; Bryant, Janet C; Noel, Tommy R; Knecht, Kenneth R

    2015-03-01

    This study was initiated to assess the temporal trends of renal function, and define risk factors associated with worsening renal function in pediatric heart transplant recipients in the immediate post-operative period. We performed a single-center retrospective study in children ≤18 yr receiving OHT (1993-2012). The AKIN's validated, three-tiered AKI staging system was used to categorize the degree of WRF. One hundred sixty-four patients qualified for inclusion. Forty-seven patients (28%) were classified as having WRF after OHT. Nineteen patients (11%) required dialysis after heart transplantation. There was a sustained and steady improvement in renal function in children following heart transplantation in all age groups, irrespective of underlying disease process. The significant factors associated with risk of WRF included body surface area (OR: 1.89 for 0.5 unit increase, 95% CI: 1.29-2.76, p = 0.001) and use of ECMO prior to and/or after heart transplantation (OR: 3.50, 95% CI: 1.51-8.13, p = 0.004). Use of VAD prior to heart transplantation was not associated with WRF (OR: 0.50, 95% CI: 0.17-1.51, p = 0.22). On the basis of these data, we demonstrate that worsening renal function improves early after orthotopic heart transplantation.

  15. Longitudinal evaluation of the Tobacco Stops With Me campaign.

    PubMed

    James, Shirley A; Rhoades, Rebekah R; Mushtaq, Nasir; Paulson, Sjonna; Beebe, Laura A

    2015-01-01

    Counter-marketing in tobacco control plays an important role in increasing smoking cessation, reducing overall tobacco use, and reducing exposure to secondhand smoke. To evaluate the Tobacco Stops With Me campaign in Oklahoma by determining awareness and impact on tobacco-related attitudes, knowledge, and behavior among tobacco users and non-users. A 2-year longitudinal population-based study of 4,001 Oklahomans aged 18-54 years was conducted to evaluate campaign-related changes in knowledge, attitudes, and behaviors. Baseline data were collected using landline and cellular phones in 2007 prior to the launch of the campaign, with follow-up surveys at 1 year after baseline (n=2,466) and 2 years after baseline (n=2,266). Data were analyzed in 2012 using methods appropriate for weighted longitudinal data. Overall campaign awareness was 81%. Exposure to Tobacco Stops With Me doubled quit attempts among tobacco users and increased knowledge about the harm of secondhand smoke. Tobacco non-users exposed to the campaign were 1.5 times more likely to help someone quit using tobacco than those not exposed, report that tobacco is a serious problem in Oklahoma, believe that tobacco companies should not be allowed to give away free samples or advertise at public events, and believe that smoking should be banned at public outdoor places. These findings were statistically significant after controlling for potential confounding variables. This study demonstrates the campaign's impact on tobacco-related attitudes, knowledge, and behaviors among both tobacco users and non-users. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Sleep Endoscopy in the Evaluation of Pediatric Obstructive Sleep Apnea

    PubMed Central

    Lin, Aaron C.; Koltai, Peter J.

    2012-01-01

    Pediatric obstructive sleep apnea (OSA) is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible. PMID:22518178

  17. Longitudinal study of cognitive and academic outcomes after pediatric liver transplantation.

    PubMed

    Sorensen, Lisa G; Neighbors, Katie; Martz, Karen; Zelko, Frank; Bucuvalas, John C; Alonso, Estella M

    2014-07-01

    To determine the evolution of cognitive and academic deficits and risk factors in children after liver transplantation. Patients ≥2 years after liver transplantation were recruited through Studies of Pediatric Liver Transplantation. Participants age 5-6 years at Time 1 completed the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wide Range Achievement Test, 4th edition, and Behavior Rating Inventory of Executive Function (BRIEF). Participants were retested at age 7-9 years, Time 2 (T2), by use of the Wechsler Intelligence Scales for Children, 4th edition, Wide Range Achievement Test, 4th edition, and BRIEF. Medical and demographic variables significant at P ≤ .10 in univariate analysis were fitted to repeated measures modeling predicting Full Scale IQ (FSIQ). Of 144 patients tested at time 1, 93 (65%) completed T2; returning patients did not differ on medical or demographic variables. At T2, more participants than expected had below-average FSIQ, Verbal Comprehension, Working Memory, and Math Computation, as well as increased executive deficits on teacher BRIEF. Processing Speed approached significance. At T2, 29% (14% expected) had FSIQ = 71-85, and 7% (2% expected) had FSIQ ≤70 (P = .0001). A total of 42% received special education. Paired comparisons revealed that, over time, cognitive and math deficits persisted; only reading improved. Modeling identified household status (P < .002), parent education (P < .01), weight z-score at liver transplantation (P < .03), and transfusion volume during liver transplantation (P < .0001) as predictors of FSIQ. More young liver transplantation recipients than expected are at increased risk for lasting cognitive and academic deficits. Pretransplant markers of nutritional status and operative complications predicted intellectual outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Evaluation of Vaccination Policies Among Utah Pediatric Clinic Employees.

    PubMed

    Luthy, Karlen E; Peterson, Tia B; Macintosh, Janelle L B; Eden, Lacey M; Beckstrand, Renea L; Wiley, Nathan H

    2016-01-01

    Pediatric health care settings are high-risk environments for spreading communicable and vaccine-preventable diseases from health care workers to susceptible patients. All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies. Half (n = 23) of Utah pediatric outpatient clinic managers recommend employee vaccinations, although employee refusal was allowed without consequence. Of all adult vaccines, influenza was most often included by managers as part of the employee vaccination policy. Some managers required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees. Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  19. Importance of genetic evaluation and testing in pediatric cardiomyopathy

    PubMed Central

    Tariq, Muhammad; Ware, Stephanie M

    2014-01-01

    Pediatric cardiomyopathies are clinically heterogeneous heart muscle disorders that are responsible for significant morbidity and mortality. Phenotypes include hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, left ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathy. There is substantial evidence for a genetic contribution to pediatric cardiomyopathy. To date, more than 100 genes have been implicated in cardiomyopathy, but comprehensive genetic diagnosis has been problematic because of the large number of genes, the private nature of mutations, and difficulties in interpreting novel rare variants. This review will focus on current knowledge on the genetic etiologies of pediatric cardiomyopathy and their diagnostic relevance in clinical settings. Recent developments in sequencing technologies are greatly impacting the pace of gene discovery and clinical diagnosis. Understanding the genetic basis for pediatric cardiomyopathy and establishing genotype-phenotype correlations may help delineate the molecular and cellular events necessary to identify potential novel therapeutic targets for heart muscle dysfunction in children. PMID:25429328

  20. Importance of genetic evaluation and testing in pediatric cardiomyopathy.

    PubMed

    Tariq, Muhammad; Ware, Stephanie M

    2014-11-26

    Pediatric cardiomyopathies are clinically heterogeneous heart muscle disorders that are responsible for significant morbidity and mortality. Phenotypes include hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, left ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathy. There is substantial evidence for a genetic contribution to pediatric cardiomyopathy. To date, more than 100 genes have been implicated in cardiomyopathy, but comprehensive genetic diagnosis has been problematic because of the large number of genes, the private nature of mutations, and difficulties in interpreting novel rare variants. This review will focus on current knowledge on the genetic etiologies of pediatric cardiomyopathy and their diagnostic relevance in clinical settings. Recent developments in sequencing technologies are greatly impacting the pace of gene discovery and clinical diagnosis. Understanding the genetic basis for pediatric cardiomyopathy and establishing genotype-phenotype correlations may help delineate the molecular and cellular events necessary to identify potential novel therapeutic targets for heart muscle dysfunction in children.

  1. Longitudinal Evaluation of Visual Function in Multiple Sclerosis

    PubMed Central

    Narayanan, Divya; Cheng, Han; Tang, Rosa A.; Frishman, Laura J.

    2015-01-01

    Purpose To evaluate longitudinal changes of visual function in relapsing-remitting multiple sclerosis (RRMS). Methods MfVEP, contrast sensitivity (CS) and Humphrey visual fields (HVF) were obtained at two visits (mean follow-up:1.5±0.9 years) in both eyes of 57 RRMS patients (53 eyes with optic neuritis (ON): 14 ON within 6 months (mo) of first visit (ON<6mo), 39 ON≥6mo, 57 non-ON). Longitudinal changes were assessed using mfVEP amplitude (logSNR), latency, CS and HVF mean deviation based on established 95% tolerance limits of test-retest variability. Results A significant percentage of ON<6mo eyes exceeded 95% tolerance limits for mfVEP logSNR (21%, p<0.05), latency (35%, p<0.01) and CS (31% p<0.001); more improved than worsened over time (14% vs 7% for logSNR, 21% vs 14% for latency and 31% vs 0% for CS). MfVEP latency decreased in 11% non-ON, 10% ON≥6mo, increased in 21%, and 10%, respectively (p<0.01 for all). Latency changes correlated negatively with baseline latency (r=-0.43,-0.45 for non-ON, ON≥6mo;p=0.0008). Although a non-significant percent of non-ON and ON≥6mo eyes exceeded tolerance limits for logSNR, CS or HVF; logSNR and latency changes correlated, and both measures correlated with changes in CS (r=0.47 to 0.79, p<0.01). Conclusions MfVEP, particularly latency, is potentially useful for assessing neuroprotective and remyelinating strategies in RRMS. PMID:26267060

  2. Longitudinal evaluation of bronchopulmonary disease in children with cystic fibrosis.

    PubMed

    Farrell, Philip M; Li, Zhanhai; Kosorok, Michael R; Laxova, Anita; Green, Christopher G; Collins, Jannette; Lai, Hui-Chuan; Makholm, Linda M; Rock, Michael J; Splaingard, Mark L

    2003-09-01

    Children with cystic fibrosis (CF) develop bronchopulmonary disease at variable ages. Determining the epidemiology of chronic lung disease and quantifying its severity, however, have been difficult in infants and young children. As part of the Wisconsin CF Neonatal Screening Project, we were presented with an ideal opportunity to assess longitudinally the evolution of symptoms, signs, and quantitative measures of CF respiratory disease. After newborn screening test results led to early recognition, 64 patients diagnosed at a median age of 6.71 weeks were enrolled and studied systematically at a median age of 11.3 years to obtain clinical information, chest radiographs, and pulmonary function tests. Our observations revealed that a frequent cough by history is evident by 10.5 months of age in half the patients. Quantitative chest radiology (CXR scoring) demonstrated that potentially irreversible abnormalities are present in half the children by 2 years. The severity of Wisconsin and Brasfield CXR scores increased in association with respiratory infections. Longitudinal progression of Wisconsin CXR scores was related to age (P < 0.001), pancreatic insufficiency (P = 0.005), and respiratory secretion cultures positive for Staphylococus aureas (P = 0.039). In contrast, serial spirometry showed limited sensitivity, as did lung volume determinations; neither was satisfactory as repeated measures with acceptable quality control until after 7 years of age. Time to event analyses revealed that half the patients had % predicted FEF(25-75) and FEV(1)/FVC values greater than 80% until 10.7 and 9.9 years, respectively. We conclude that of the methods evaluated, quantitative chest radiology is currently the best procedure for frequent assessment of bronchopulmonary disease in CF, and that radiographic progression is evident in approximately 85% of patients by 5 years of age. Our results also suggest that bronchiectasis and other radiographic evidence of chronic infection are

  3. A practical longitudinal model for evaluating growth in Gelbvieh cattle.

    PubMed

    Robbins, K R; Misztal, I; Bertrand, J K

    2005-01-01

    Genetic evaluation of growth in Gelbvieh beef cattle was examined by multiple-trait (MTM) and random regression (RRM) analysis. The data set comprised 541,108 animals with 1,120,086 records. Approximately 15% of the animals in the data set had at least one record measured outside of the accepted MTM age ranges for weaning weight (Wwt) and yearling weight (Ywt). Fourteen percent of Wwt records and 19% of Ywt records were measured outside the accepted ranges for MTM analysis, and thus were excluded from MTM evaluations. Two RRM evaluations were performed using cubic Legendre polynomials (RRML) and linear splines (RRMS) with three knots at 1, 205, and 365 d of age. Data Set 1 (d1) utilized all available records, whereas Data Set 2 (d2) included only records measured within MTM ranges (1 d, 160 to 250 d, and 320 to 410 d). The RRML models did not reach convergence until diagonalization was imposed. After diagonalization, it was found that all longitudinal models required fewer iterations to converge than the MTM. Correlations between the MTM, RRML-d2, and RRMS-d2 evaluations were >or=0.99 for all three traits, indicating that these models were equivalent when predicting breeding values from data within the MTM age ranges. Correlations between MTM, RRML-d1, and RRMS-d1 were >0.99 for Bwt and >0.95 for Wwt and Ywt. The lower correlations for Wwt and Ywt indicate that the added information does affect breeding value prediction. The RRM has the capability to incorporate records measured at all ages into genetic evaluations at a computing cost similar to the MTM.

  4. Modeling of longitudinal academic achievement scores after pediatric traumatic brain injury.

    PubMed

    Ewing-Cobbs, Linda; Barnes, Marcia; Fletcher, Jack M; Levin, Harvey S; Swank, Paul R; Song, James

    2004-01-01

    In a prospective longitudinal study, academic achievement scores were obtained from youth 5 to 15 years of age who sustained mild-moderate (n = 34) or severe (n = 43) traumatic brain injuries (TBI). Achievement scores were collected from baseline to 5 years following TBI and were subjected to individual growth curve analysis. The models fitted age at injury, years since injury, duration of impaired consciousness, and interaction effects to Reading Decoding, Reading Comprehension, Spelling, and Arithmetic standard scores. Although scores improved significantly over the follow-up relative to normative data from the standardization sample of the tests, children with severe TBI showed persistent deficits on all achievement scores in comparison to children with mild-moderate TBI. Interactions of the slope and age parameters for the Arithmetic and Reading Decoding scores indicated greater increases over time in achievement scores of the children injured at an older age, but deceleration in growth curves for the younger children with both mild-moderate and severe TBI. These results are compatible with the hypothesis that early brain injuries disrupt the acquisition of some academic skills. Hierarchical regression models revealed that indexes of academic achievement obtained 2 years following TBI had weak relations with the duration of impaired consciousness and socioeconomic status. In contrast, concurrent cognitive variables such as phonological processing and verbal memory accounted for more variability in academic scores. Given the significant and persistent decrement in basic academic skills in youth with severe TBI, it is clear that head-injured youth require intensive, long-term remediation and intervention not only of the academic skills themselves, but also of those cognitive abilities that support the development and maintenance of reading and math.

  5. [The system of evaluating the specialty of pediatrics in the Instituto Mexicano del Seguro Social].

    PubMed

    Jasso-Gutiérrez, L; Serafín-Anaya, F; López-Fuentes, G; Arnaíz-Toledo, C

    1993-11-01

    A system of evaluation applied to pediatric residents at the Mexican Institute of Social Security (IMSS) is presented. Historical precedents; deficiencies and modifications of the system are commented. Also institutional system of evaluation is described, with emphasis in education strategies: teaching-attendance-research. Usefulness of knowledge tests, supervision, and assessment of evaluation, are mentioned. Finally extrainstitutional evaluation strategies are considered.

  6. A Longitudinal Evaluation of the National Cancer Institute Science Enrichment Program.

    ERIC Educational Resources Information Center

    Manning, Colleen F.; Goodman, Irene F.

    This paper proposes the design and key methodological features of a longitudinal evaluation of the National Cancer Institute Science Enrichment Program (NCISEP). Goodman Research Group's (GRG) five-year longitudinal evaluation is designed as a randomized experiment with a control group and employs both quantitative and qualitative data collection…

  7. A Longitudinal Study of Growth and Relation With Anemia and Iron Overload in Pediatric Patients With Transfusion-dependent Thalassemia.

    PubMed

    Nokeaingtong, Kwannapas; Charoenkwan, Pimlak; Silvilairat, Suchaya; Saekho, Suwit; Pongprot, Yupada; Dejkhamron, Prapai

    2016-08-01

    Short stature is one of the most common endocrinopathies in transfusion-dependent thalassemia (TDT). This study aimed to determine the longitudinal pattern of growth in pediatric patients with TDT and study the relationship between growth and hemoglobin level, serum ferritin level/iron overload parameters, and other clinical factors. The interval height-for-age Z-scores (HAZ) of 50 patients with TDT, of a mean age of 13.3±2.8 years, were analyzed using linear mixed model analysis. Nineteen patients (38%) had short stature with HAZ≤-2.0. The prevalence of short stature increased with age. The estimated mean HAZ decreased by 0.19 SD per year from the age of 5 years until approximately 14 years (95% confidence interval [CI], -0.22 to -0.16, P<0.001). Male sex (estimate, -0.28; 95% CI, -0.43 to -0.14; P<0.001), mean 3-year hemoglobin level ≤8 g/dL (estimate, -0.36; 95% CI, -0.53 to -0.19; P<0.001), mean 3-year ferritin level ≥1800 ng/mL (estimate, -0.44; 95% CI, -0.59 to -0.29; P<0.001), and cardiac T2* ≤20 ms (estimate, -1.05; 95% CI, -1.34 to -0.77; P<0.001) were significantly associated with short stature. In conclusion, short stature in patients with TDT is common and relates significantly with increasing age, male sex, hemoglobin level, and iron overload status.

  8. Evaluation of Physicians’ Awareness of Pediatric Diseases in Iran

    PubMed Central

    Abolhassani, Hassan; Mirminachi, Babak; Daryabeigi, Maedeh; Agharahimi, Zahra; Aghamohammadi, Asghar; Rabbani, Ali; Rezaei, Nima

    2014-01-01

    Objective: Physicians’ awareness about pediatric health problems is very important in health system. This has not been investigated in Iran as yet. Therefore this study was conducted to characterize the knowledge of the Iranian physicians which has direct association with health status of children. Methods: One hundred and four physicians, mainly pediatric specialists (58.6%) working in the state hospitals (45.1%) were enrolled. They filled a valid and reliable questionnaire, containing 26 questions about basic and important pediatric issues before and after an educational pediatric program (EPP). Findings : Thirty nine (37.5%) physicians answered correctly more than 2/3 of all questions (passed the examination) before EPP, which increased to 42.3% after EEP. Subgroup analysis showed that the total scores of general practitioners (P=0.007) was significantly increased after the EPP. Moreover, physicians with shorter practicing time (P=0.006) and those with shorter time past graduation (P=0.01) had a significant improvement in their total scores after the program. The best scores of educational issues were documented in growth and development (16.0%; P=0.04), followed by dermatology (9.2%, P=0.04), urology (9.1%; P=0.04), and asthma and allergy (9.0%, P=0.04). Conclusion: This study revealed that there are gaps in the knowledge of professionals about the pediatric issues. PMID:25793051

  9. Upper extremity biomechanical model for evaluation of pediatric joint demands during wheelchair mobility.

    PubMed

    Paul, Alyssa J; Slavens, Brooke A; Graf, Adam; Krzak, Joseph; Vogel, Lawrence; Harris, Gerald F

    2012-01-01

    Current methods for evaluating upper extremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities.

  10. Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department.

    PubMed

    Bai, Wenyu; Golmirzaie, Kristine; Burke, Constance; Van Veen, Tara; Christensen, Robert; Voepel-Lewis, Terri; Malviya, Shobha

    2016-04-01

    There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital. All emergency tracheal intubation on inpatient units and the emergency department performed by pediatric anesthesiologists over a 7-year period in children <18 years were identified by querying our perioperative clinical information system. Medical records were comprehensively reviewed to describe the emergency intubation process and outcomes. One hundred and thirty-two intubations from 120 children (median age 3.3 years) were eligible. The majority of emergency tracheal intubations were successful with 1-2 laryngoscopy attempts, while 14 (10.6%) were difficult. Despite grade 3 view in 3/14 cases, the airway was secured after multiple direct laryngoscopy attempts. Eleven required use of an alternative airway device to secure the airway. A preexisting airway abnormality or craniofacial abnormality was present in 57% of cases with difficult intubation including half with micrognathia or retrognathia. Major intubation-related adverse events such as aspiration, occurred in 5 (3.8%) emergency tracheal intubations. Mild-to-moderate intubation-related adverse events occurred in 23 (17.4%) emergency tracheal intubations including mainstem bronchus intubation (13.6%). A significant rate of difficult intubation and mild-to-moderate intubation-related adverse events were found in emergency tracheal intubations on inpatient units and the emergency department in children performed by a pediatric anesthesiology emergency airway team. Difficult intubation was observed frequently in children with preexisting airway and craniofacial abnormalities and often required the use of an alternative airway device to

  11. Baylor Pediatric SBIRT Medical Residency Training Program: model description and evaluation.

    PubMed

    Bray, James H; Kowalchuk, Alicia; Waters, Vicki; Allen, Erin; Laufman, Larry; Shilling, Elizabeth H

    2014-01-01

    The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.

  12. Evaluation of a Longitudinal Advanced Pharmacy Practice Experience.

    PubMed

    Frasiolas, Jorie A; Wright, Kelly; Dzierba, Amy L

    2017-04-01

    Objective. To describe satisfaction and career path of students who participated in the longitudinal advanced pharmacy practice experience (APPE). Methods. A 3-part survey was administered to students enrolled between January 1, 2010, and December 31, 2013. The sections of the survey evaluated respondents' baseline characteristics, satisfaction, and career path. Results. Majority of the respondents had a GPA above 3.0 (91%), pharmacy school honors (84%), work experience in retail (16%) or multiple pharmacy sites (38%), and were members of at least one professional organization (76%). Sixty-nine percent reported that the program exceeded their expectations. Strengths included practice site consistency, rotation diversity, preceptors, presentations, and collaboration with health care professionals. Students gained approximately 76 hours of additional clinical experience, compared to if they completed rotations at individual sites. After graduation, more than half of the respondents accepted a pharmacy practice residency (67%). Conclusion. The results of this study support the need for APPE programs that prepare students to deliver advanced patient care, while providing them with professional development.

  13. Evaluation of thermal gradients in longitudinal spin Seebeck effect measurements

    SciTech Connect

    Sola, A. Kuepferling, M.; Basso, V.; Pasquale, M.; Kikkawa, T.; Uchida, K.; Saitoh, E.

    2015-05-07

    In the framework of the longitudinal spin Seebeck effect (LSSE), we developed an experimental setup for the characterization of LSSE devices. This class of device consists in a layered structure formed by a substrate, a ferrimagnetic insulator (YIG) where the spin current is thermally generated, and a paramagnetic metal (Pt) for the detection of the spin current via the inverse spin-Hall effect. In this kind of experiments, the evaluation of a thermal gradient through the thin YIG layer is a crucial point. In this work, we perform an indirect determination of the thermal gradient through the measurement of the heat flux. We developed an experimental setup using Peltier cells that allow us to measure the heat flux through a given sample. In order to test the technique, a standard LSSE device produced at Tohoku University was measured. We find a spin Seebeck S{sub SSE} coefficient of 2.8×10{sup −7} V K{sup −1}.

  14. Medical students' assessment of pediatric patients - teaching and evaluation using video cases.

    PubMed

    Malon, Michelle; Cortes, Dina; Greisen, Gorm Ole

    2014-11-13

    We introduced video-based teaching in pediatrics. We evaluated the impact of a pediatric video program on student performance in assessing pediatric patients presented as video cases. The program consisted of a library of pediatric videos, and inclusion of these in the teaching and examination for pediatric medicine. Medical students on a pediatric clerkship at the University of Copenhagen assessed eight short pediatric video cases during autumn 2011 and spring 2012. Two independent observers evaluated a subset of records in a pilot study. A blind evaluation was made of the written records of 37 students before, and 58 students after, the introduction of the program using a Rubric score with four domains. The intraobserver interclass correlation coefficient was 0.94 and the interobserver interclass correlation was 0.71(n=25). The students' mean total Rubric score in spring 2012 (7.0) was significantly higher (p<0.001, 95% CI 1.34-3.20) than autumn 2011 (4.7). Cohen's d was 1.1 (95% CI 0.6-1.7). Single domains scores increased significantly for general assessment (1.30 versus 0.57) (p<0.002, 95% CI 0.45-1.18), recognition of principal symptoms (1.38 versus 0.81) (p<0.008, 95% CI 0.22-0.91), appropriate diagnosis (2.28 versus 1.78) (p<0.002, 95% CI 0.16-0.82) and consistency between observed symptoms and diagnosis (1.94 versus 1.57) (p=0.0482, 95% CI 0.00-0.79). Students improved in evaluating pediatric patients presented as video cases after the introduction of the program. The impact on real-life situations remains to be established.

  15. Thinking beyond Measurement, Description and Judgment: Fourth Generation Evaluation in Family-Centered Pediatric Healthcare Organizations

    ERIC Educational Resources Information Center

    Moreau, Katherine Ann; Clarkin, Chantalle Louise

    2012-01-01

    Background: Although pediatric healthcare organizations have widely implemented the philosophy of family-centered care (FCC), evaluators and health professionals have not explored how to preserve the philosophy of FCC in evaluation processes. Purpose: To illustrate how fourth generation evaluation, in theory, could facilitate collaboration between…

  16. Thinking beyond Measurement, Description and Judgment: Fourth Generation Evaluation in Family-Centered Pediatric Healthcare Organizations

    ERIC Educational Resources Information Center

    Moreau, Katherine Ann; Clarkin, Chantalle Louise

    2012-01-01

    Background: Although pediatric healthcare organizations have widely implemented the philosophy of family-centered care (FCC), evaluators and health professionals have not explored how to preserve the philosophy of FCC in evaluation processes. Purpose: To illustrate how fourth generation evaluation, in theory, could facilitate collaboration between…

  17. Evaluation of a Pediatric Early Warning Score Across Different Subspecialty Patients.

    PubMed

    Dean, Nathan P; Fenix, J B; Spaeder, Michael; Levin, Amanda

    2017-07-01

    To evaluate the ability of a Pediatric Early Warning Score to predict deterioration in different subspecialty patient populations. Single center, retrospective cohort study. Patients were classified into five groups: 1) cardiac; 2) hematology/oncology/bone marrow transplant; 3) surgical; 4) neurologic; and 5) general medical. The relationship between the Pediatric Early Warning Score and unplanned ICU transfer requiring initiation of specific ICU therapies (intubation, high-flow nasal cannula, noninvasive ventilation, inotropes, or aggressive fluid hydration within 12 hr of transfer) was evaluated. Tertiary care, free-standing, academic children's hospital. All hospitalized acute care patients admitted over a 6-month time period (September 2012 to March 2013). None. During the study time period, 33,800 patient-days and 136 deteriorations were evaluated. Area under the curve ranged from 0.88 (surgical) to 0.94 (cardiac). Sensitivities for a Pediatric Early Warning Score greater than or equal to 3 ranged from 75% (surgical) to 94% (cardiology) and number needed to evaluate to find one deterioration was 11.5 (neurologic) to 43 patients (surgical). Sensitivities for a Pediatric Early Warning Score greater than or equal to 4 ranged from 54% (general medical) to 79% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 5.5 (neurologic) to 12 patients (general medical). Sensitivities for a Pediatric Early Warning Score of greater than or equal to 5 ranged from 25% (surgical) to 58% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 3.5 (cardiac, hematology/oncology/bone marrow transplant, neurologic) to eight patients (surgical). An elevated Pediatric Early Warning Score is associated with ICU transfer and receipt of ICU-specific interventions in patients across different pediatric subspecialty patient populations.

  18. Reinvigorating pediatric care in an academic family medicine practice.

    PubMed

    Page, Cristen; Carlough, Martha C; Lam, Yee; Steiner, Julea

    2014-02-01

    Primary care access is critical for all populations, and family physicians remain a vital link to pediatric care, especially for rural/underserved areas and adolescents. Pediatric visits to family physicians have declined nationally, a trend also noted at the University of North Carolina (UNC) Family Medicine Center (FMC). Academic FMCs are challenged with maintaining their pediatric population in a competitive environment and providing excellent pediatric training to prepare residents to care for children. We investigated potential factors impacting pediatric visits with a goal of reversing this trend. We developed a 360-degree approach to examine and reinvigorate pediatric care and training in our practice. To determine which aspects of our practice made pediatric care challenging, we conducted focus groups with parents of former and current FMC pediatric practices. We used billing data to assess pediatric patient volume and performed chart audits to examine preventive health visits, immunizations, and developmental screening. We anonymously contacted local family medicine and pediatric practices to compare services offered in their practice versus ours. Resident in-training exam scores and graduate surveys were reviewed to assess our pediatric training. Based on our evaluation, we identified and implemented improvements in the areas of clinical quality interventions, provider/education competency, and community marketing/relationships. A longitudinal evaluation and quality improvement initiative positively impacted our pediatric practice and training. The 360-degree approach of quality improvement may be useful for other academic family practices that are challenged with pediatric volume.

  19. Proton magnetic resonance spectroscopy in pediatric obsessive-compulsive disorder: longitudinal study before and after treatment.

    PubMed

    Lázaro, Luisa; Bargalló, Núria; Andrés, Susana; Falcón, Carles; Morer, Astrid; Junqué, Carme; Castro-Fornieles, Josefina

    2012-01-30

    Abnormalities in neurochemical compounds in obsessive-compulsive disorder (OCD) may help increase our knowledge of neurobiological abnormalities in the fronto-subcortical circuits. The aims of this exploratory study were to identify with in vivo magnetic resonance spectroscopy ((1)H-MRS) the possible alterations in neurometabolites in a group of drug naïve children and adolescents with OCD in comparison with a control group and to determine whether there was any effect of treatment on the metabolite levels. Eleven OCD children and adolescents (age range 9-17 years; 6 male, 5 female) and twelve healthy subjects with similar age, sex and estimated intellectual quotient were studied. Proton magnetic resonance spectroscopy at 1.5 T was used. We placed 3 voxels, one bilaterally located involving anterior cingulate-medial frontal regions, and one in each striatal region involving the caudate and putaminal regions. Concentrations of creatine (Cr), myo-inositol (mI), total Cho (glycerophosphocholine+phosphocholine), total NAA (N-acetyl aspartate+N-acetyl aspartylglutamate), and total Glx (glutamate+glutamine) were calculated. We found significantly lower concentrations of total Cho in left striatum in OCD patients compared with healthy subjects. The difference in Cho concentrations in left striatum between the two groups did not change over time and persisted at follow-up assessment. Like the control subjects, OCD patients undergoing pharmacological treatment and clinical recovery showed no significant changes in neurometabolic activity between the first and second evaluations.

  20. Clinical Evaluation of Red Eyes in Pediatric Patients.

    PubMed

    Beal, Casey; Giordano, Beverly

    2016-01-01

    Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  1. Are pediatric critical care medicine fellowships teaching and evaluating communication and professionalism?

    PubMed

    Turner, David A; Mink, Richard B; Lee, K Jane; Winkler, Margaret K; Ross, Sara L; Hornik, Christoph P; Schuette, Jennifer J; Mason, Katherine; Storgion, Stephanie A; Goodman, Denise M

    2013-06-01

    To describe the teaching and evaluation modalities used by pediatric critical care medicine training programs in the areas of professionalism and communication. Cross-sectional national survey. Pediatric critical care medicine fellowship programs. Pediatric critical care medicine program directors. None. Survey response rate was 67% of program directors in the United States, representing educators for 73% of current pediatric critical care medicine fellows. Respondents had a median of 4 years experience, with a median of seven fellows and 12 teaching faculty in their program. Faculty role modeling or direct observation with feedback were the most common modalities used to teach communication. However, six of the eight (75%) required elements of communication evaluated were not specifically taught by all programs. Faculty role modeling was the most commonly used technique to teach professionalism in 44% of the content areas evaluated, and didactics was the technique used in 44% of other professionalism content areas. Thirteen of the 16 required elements of professionalism (81%) were not taught by all programs. Evaluations by members of the healthcare team were used for assessment for both competencies. The use of a specific teaching technique was not related to program size, program director experience, or training in medical education. A wide range of techniques are currently used within pediatric critical care medicine to teach communication and professionalism, but there are a number of required elements that are not specifically taught by fellowship programs. These areas of deficiency represent opportunities for future investigation and improved education in the important competencies of communication and professionalism.

  2. An impact evaluation of a newly developed pediatric cardiac intensive care unit.

    PubMed

    Welander, Michelle Hanna; Keller, Sheila D; Northington, LaDonna

    2015-01-01

    The highly complex pediatric patients with congenital heart disease require interprofessional teamwork and collaboration to ensure high-quality outcomes with low mortality and morbidity (Congenit Heart Dis. 2013;8:3-19). The purpose of this study was to conduct an impact evaluation for a newly formed pediatric cardiac intensive care unit (PCICU) and to answer: Is there a difference between the pediatric intensive care unit and the PCICU on clinical outcome measures of pediatric cardiac postoperative patients and nursing resources? A retrospective pretest/posttest design was used with the independent variables being type of intensive care unit. The confounding variables included demographic data, clinical outcome data, registered nurse (RN) staffing data, and RN turnover data. The setting was a large, level I pediatric medical and surgical intensive care unit (ICU) located at a children's hospital within an academic medical center. The population was pediatric cardiac postoperative patients. Patients excluded were those older than 18 years or cases without a Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality Category score of 1 through 5. Owen's impact evaluation method and descriptive statistical measures, t test and Pearson χ test, were used for analysis. Demographic data were comparable between the pediatric intensive care unit (n = 296) and PCICU (n = 333). No statistical differences were found in several of the clinical outcome measures. Statistically significant differences were found in surgeon (P = .00) and RN nursing hours per patient day for all cardiac patients (P = .01). The PCICU time frame had a higher RN turnover rate. The majority of quality measures were not statistically different between the 2 ICUs. Even though statistical significance was not reached, the clinical impact of the PCICU's reduction in patient infections, mortality, and ICU length of stay was noted. This evaluation has

  3. Condition Self-Management in Pediatric Spina Bifida: A Longitudinal Investigation of Medical Adherence, Responsibility-Sharing, and Independence Skills.

    PubMed

    Psihogios, Alexandra M; Kolbuck, Victoria; Holmbeck, Grayson N

    2015-09-01

    This study aimed to evaluate rates of medical adherence, responsibility, and independence skills across late childhood and adolescence in youth with spina bifida (SB) and to explore associations among these disease self-management variables. 111 youth with SB, their parents, and a health professional participated at two time points. Informants completed questionnaires regarding medical adherence, responsibility-sharing, and child independence skills. Youth gained more responsibility and independence skills across time, although adherence rates did not follow a similar trajectory. Increased child medical responsibility was related to poorer adherence, and father-reported independence skills were associated with increased child responsibility. This study highlights medical domains that are the most difficult for families to manage (e.g., skin checks). Although youth appear to gain more autonomy across time, ongoing parental involvement in medical care may be necessary to achieve optimal adherence across adolescence. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Distributive Justice Development: Cross-Cultural, Contextual, and Longitudinal Evaluations.

    ERIC Educational Resources Information Center

    Enright, Robert D.; And Others

    1984-01-01

    Study One examined Swedish and American children's understanding of what constitutes fair criteria for the distribution of goods (i.e., distributive justice). Study Two compared children's distributive justice in family and peer contexts, and Study Three attempted a longitudinal assessment of distributive justice reasoning in two different…

  5. Biomechanical Model for Evaluation of Pediatric Upper Extremity Joint Dynamics during Wheelchair Mobility

    PubMed Central

    Schnorenberg, Alyssa J.; Slavens, Brooke A.; Wang, Mei; Vogel, Lawrence; Smith, Peter; Harris, Gerald F.

    2014-01-01

    Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopaedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. PMID:24309622

  6. Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility.

    PubMed

    Schnorenberg, Alyssa J; Slavens, Brooke A; Wang, Mei; Vogel, Lawrence C; Smith, Peter A; Harris, Gerald F

    2014-01-03

    Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood.

  7. Longitudinal flexural mode utility in quantitative guided wave evaluation

    NASA Astrophysics Data System (ADS)

    Li, Jian

    2001-07-01

    Longitudinal Non-axisymmetric flexural mode utility in quantitative guided wave evaluation is examined for pipe and tube inspection. Attention is focused on hollow cylinders. Several source loading problems such as a partial-loading angle beam, an axisymmetric comb transducer and an angle beam array are studied. The Normal Mode Expansion method is employed to simulate the generated guided wave fields. For non-axisymmetric sources, an important angular profile feature is studied. Based on numerical calculations, an angular profile varies with frequency, mode and propagating distance. Since an angular profile determines the energy distribution of the guided waves, the angular profile has a great impact on the pipe inspection capability of guided waves. The simulation of non-axisymmetric angular profiles generated by partialloading is verified by experiments. An angular profile is the superposition of harmonic axisymmetric and non-axisymmetric modes with various phase velocities. A simpler equation is derived to calculate the phase velocities of the non-axisymmetric guided waves and is used for discussing the characteristics of non-axisymmetric guided waves. Angular profiles have many applications in practical pipe testing. The procedure of building desired angular profiles and also angular profile tuning is discussed. This angular profile tuning process is implemented by a phased transducer array and a special computational algorithm. Since a transducer array plays a critical role in guided wave inspection, the performance of a transducer array is discussed in terms of guided wave mode control ability and excitation sensitivity. With time delay inputs, a transducer array is greatly improved for its mode control ability and sensitivity. The algorithms for setting time delays are derived based on frequency, element spacing and phase velocity. With the help of the conclusions drawn on non- axisymmetric guided waves, a phased circumferential partial-loading array is

  8. A survey of program evaluation practices in family-centered pediatric rehabilitation settings.

    PubMed

    Moreau, Katherine A; Cousins, J Bradley

    2014-04-01

    Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to the family-centered service (FCS) philosophy. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators/service providers uphold FCS in their program evaluation activities. Through a questionnaire survey, this study aimed to document evaluators/service providers' perceptions of the level of program evaluation occurring in their Canadian pediatric rehabilitation centers. It also investigated the extent to which evaluators/service providers perceive program evaluation practices at their centers to be consistent with the FCS context of Canadian pediatric rehabilitation settings. The findings suggested that the amount of evaluation activities occurring within the respondents' centers is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the respondents' centers have limited resources for evaluation. The study also showed that staff members believe their centers' evaluation activities are somewhat consistent with FCS philosophy, but that improvements are needed.

  9. Enhancing pediatric residents' scholar role: the development of a Scholarly Activity Guidance and Evaluation program.

    PubMed

    Pound, Catherine M; Moreau, Katherine A; Ward, Natalie; Eady, Kaylee; Writer, Hilary

    2015-01-01

    Research training is essential to the development of well-rounded physicians. Although many pediatric residency programs require residents to complete a research project, it is often challenging to integrate research training into educational programs. We aimed to develop an innovative research program for pediatric residents, called the Scholarly Activity Guidance and Evaluation (SAGE) program. We developed a competency-based program which establishes benchmarks for pediatric residents, while providing ongoing academic mentorship. Feedback from residents and their research supervisors about the SAGE program has been positive. Preliminary evaluation data have shown that all final-year residents have met or exceeded program expectations. By providing residents with this supportive environment, we hope to influence their academic career paths, increase their research productivity, promote evidence-based practice, and ultimately, positively impact health outcomes.

  10. Enhancing pediatric residents' scholar role: the development of a Scholarly Activity Guidance and Evaluation program.

    PubMed

    Pound, Catherine M; Moreau, Katherine A; Ward, Natalie; Eady, Kaylee; Writer, Hilary

    2015-01-01

    Background Research training is essential to the development of well-rounded physicians. Although many pediatric residency programs require residents to complete a research project, it is often challenging to integrate research training into educational programs. Objective We aimed to develop an innovative research program for pediatric residents, called the Scholarly Activity Guidance and Evaluation (SAGE) program. Methods We developed a competency-based program which establishes benchmarks for pediatric residents, while providing ongoing academic mentorship. Results Feedback from residents and their research supervisors about the SAGE program has been positive. Preliminary evaluation data have shown that all final-year residents have met or exceeded program expectations. Conclusions By providing residents with this supportive environment, we hope to influence their academic career paths, increase their research productivity, promote evidence-based practice, and ultimately, positively impact health outcomes.

  11. Enhancing pediatric residents’ scholar role: the development of a Scholarly Activity Guidance and Evaluation program

    PubMed Central

    Pound, Catherine M.; Moreau, Katherine A.; Ward, Natalie; Eady, Kaylee; Writer, Hilary

    2015-01-01

    Background Research training is essential to the development of well-rounded physicians. Although many pediatric residency programs require residents to complete a research project, it is often challenging to integrate research training into educational programs. Objective We aimed to develop an innovative research program for pediatric residents, called the Scholarly Activity Guidance and Evaluation (SAGE) program. Methods We developed a competency-based program which establishes benchmarks for pediatric residents, while providing ongoing academic mentorship. Results Feedback from residents and their research supervisors about the SAGE program has been positive. Preliminary evaluation data have shown that all final-year residents have met or exceeded program expectations. Conclusions By providing residents with this supportive environment, we hope to influence their academic career paths, increase their research productivity, promote evidence-based practice, and ultimately, positively impact health outcomes. PMID:26059213

  12. Preclinical safety evaluations supporting pediatric drug development with biopharmaceuticals: strategy, challenges, current practices.

    PubMed

    Morford, LaRonda L; Bowman, Christopher J; Blanset, Diann L; Bøgh, Ingrid B; Chellman, Gary J; Halpern, Wendy G; Weinbauer, Gerhard F; Coogan, Timothy P

    2011-08-01

    Evaluation of pharmaceutical agents in children is now conducted earlier in the drug development process. An important consideration for this pediatric use is how to assess and support its safety. This article is a collaborative effort of industry toxicologists to review strategies, challenges, and current practice regarding preclinical safety evaluations supporting pediatric drug development with biopharmaceuticals. Biopharmaceuticals include a diverse group of molecular, cell-based or gene therapeutics derived from biological sources or complex biotechnological processes. The principles of preclinical support of pediatric drug development for biopharmaceuticals are similar to those for small molecule pharmaceuticals and in general follow the same regulatory guidances outlined by the Food and Drug Administration and European Medicines Agency. However, many biopharmaceuticals are also inherently different, with limited species specificity or immunogenic potential which may impact the approach taken. This article discusses several key areas to aid in the support of pediatric clinical use, study design considerations for juvenile toxicity studies when they are needed, and current practices to support pediatric drug development based on surveys specifically targeting biopharmaceutical development. © 2011 Wiley-Liss, Inc.

  13. Comparison of pediatric emergency physicians' and surgeons' evaluation and diagnosis of appendicitis.

    PubMed

    Kharbanda, Anupam B; Fishman, Steven J; Bachur, Richard G

    2008-02-01

    To compare the interexaminer reliability and ability to predict appendicitis between pediatric emergency physicians (EPs) and senior surgical residents. The authors conducted a prospective cohort study of children aged 3 to 18 years of age with signs and symptoms suspicious for appendicitis. Patients were initially examined by a pediatric EP attending and then by a consulting senior surgical resident. Physicians reported the presence or absence of specific historical and physical exam findings and predicted the likelihood the patient had appendicitis. Interexaminer reliability of historical and physical exam findings was compared (kappa statistic). Distributions and median probabilities of appendicitis were calculated for pediatric EP and surgeon predictions. The authors evaluated 350 patients with acute abdominal pain. Historical questions revealed slight to very good agreement (kappa statistic range 0.33-0.82) between physician types, whereas physical examination findings exhibited poor to fair agreement (range 0.14-0.48). Physicians predicted similar median probabilities of appendicitis for patients who were ultimately diagnosed with appendicitis (75% vs. 70%; p = 0.73) and patients without appendicitis (25% vs. 30%; p = 0.59). For a subset of patients given a > or = 90% predicted probability of appendicitis, pediatric EPs and senior surgical residents had similar accuracy (80% vs. 79%; p = 0.92). Similarly, among patients with < or = 10% predicted probability, pediatric EPs were correct in 95% and senior surgical residents correct in 94% of patients (p = 0.63). Pediatric EPs and senior surgical residents elicit historical findings from patients with suspected appendicitis with a greater degree of similarity than physical examination findings, which exhibit a wide degree of variability. Pediatric EPs and senior surgical residents do not differ in their ability to clinically predict appendicitis. These findings may be helpful in developing institutional

  14. Components of Standing Postural Control Evaluated in Pediatric Balance Measures: A Scoping Review.

    PubMed

    Sibley, Kathryn M; Beauchamp, Marla K; Van Ooteghem, Karen; Paterson, Marie; Wittmeier, Kristy D

    2017-10-01

    To identify measures of standing balance validated in pediatric populations, and to determine the components of postural control captured in each tool. Electronic searches of MEDLINE, Embase, and CINAHL databases using key word combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests, and child/pediatrics; gray literature; and hand searches. Inclusion criteria were measures with a stated objective to assess balance, with pediatric (≤18y) populations, with at least 1 psychometric evaluation, with at least 1 standing task, with a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. There were 21 measures included. Two reviewers extracted descriptive characteristics, and 2 investigators independently coded components of balance in each measure using a systems perspective for postural control, an established framework for balance in pediatric populations. Components of balance evaluated in measures were underlying motor systems (100% of measures), anticipatory postural control (72%), static stability (62%), sensory integration (52%), dynamic stability (48%), functional stability limits (24%), cognitive influences (24%), verticality (9%), and reactive postural control (0%). Assessing children's balance with valid and comprehensive measures is important for ensuring development of safe mobility and independence with functional tasks. Balance measures validated in pediatric populations to date do not comprehensively assess standing postural control and omit some key components for safe mobility and independence. Existing balance measures, that have been validated in adult populations and address some of the existing gaps in pediatric measures, warrant consideration for validation in children. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. A longitudinal event-related potential study of selective serotonin reuptake inhibitor therapy in treatment-naïve pediatric obsessive compulsive disorder patients.

    PubMed

    Yamamuro, Kazuhiko; Ota, Toyosaku; Iida, Junzo; Kishimoto, Naoko; Nakanishi, Yoko; Matsuura, Hiroki; Uratani, Mitsuhiro; Okazaki, Kosuke; Kishimoto, Toshifumi

    2016-11-30

    Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts and/or compulsive behaviors, involving specific cognition and/or information processing disorders. Event-related potentials (ERPs) are commonly used as physiological measures of cognitive function. In conscious patients, ERPs are easily and non-invasively measured. Previous ERP studies have revealed differences between OCD patients and control subjects. Whether ERPs reflect the pharmacological effects of OCD treatment, particularly in treatment-naïve pediatric patients, remains unknown. We used the Child's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) to evaluate the symptomatic severity of 12 treatment-naïve pediatric OCD patients. Comparisons were made with 12 age-, sex-, and intelligence-matched controls. The P300 and mismatch negativity (MMN) components were measured during an auditory odd-ball task at baseline in both groups and after the 3-year serotonin reuptake inhibitor (SSRI) treatment in OCD patients. Compared with controls, P300 amplitudes were smaller n the OCD group at Fz, Cz, Pz, C3, and C4. After SSRI treatment, P300 amplitudes increased partly at Fz and C4 in association with symptomatic improvements. We found a significant positive correlation between P300 amplitude in C4 and CY-BOCS scores. Our findings confirm the utility of SSRIs in pediatric OCD, and suggest the utility of ERPs for evaluating pharmacological effects in treatment-naïve pediatric OCD patients.

  16. Discriminative Validity of the Danish Version of the Pediatric Evaluation of Disability Inventory (PEDI)

    ERIC Educational Resources Information Center

    Stahlhut, Michelle; Gard, Gunvor; Aadahl, Mette; Christensen, Jette

    2011-01-01

    The Pediatric Evaluation of Disability Inventory (PEDI) assesses functional status in children with disabilities aged 0.5-7.5 years. The purpose of this study was to examine if the Danish version of the PEDI was able to discriminate between nondisabled children and children with cerebral palsy (CP) or juvenile idiopathic arthritis (JIA).…

  17. Autism Training in Pediatric Residency: Evaluation of a Case-Based Curriculum

    ERIC Educational Resources Information Center

    Major, Nili E.; Peacock, Georgina; Ruben, Wendy; Thomas, Jana; Weitzman, Carol C.

    2013-01-01

    Despite recent studies indicating the high prevalence of autism spectrum disorders (ASDs), there has been little focus on improving ASD education during pediatric residency training. The objective of this study was to evaluate a new curriculum developed in partnership with the Centers for Disease Control and Prevention and the Maternal and Child…

  18. Discriminative Validity of the Danish Version of the Pediatric Evaluation of Disability Inventory (PEDI)

    ERIC Educational Resources Information Center

    Stahlhut, Michelle; Gard, Gunvor; Aadahl, Mette; Christensen, Jette

    2011-01-01

    The Pediatric Evaluation of Disability Inventory (PEDI) assesses functional status in children with disabilities aged 0.5-7.5 years. The purpose of this study was to examine if the Danish version of the PEDI was able to discriminate between nondisabled children and children with cerebral palsy (CP) or juvenile idiopathic arthritis (JIA).…

  19. Autism Training in Pediatric Residency: Evaluation of a Case-Based Curriculum

    ERIC Educational Resources Information Center

    Major, Nili E.; Peacock, Georgina; Ruben, Wendy; Thomas, Jana; Weitzman, Carol C.

    2013-01-01

    Despite recent studies indicating the high prevalence of autism spectrum disorders (ASDs), there has been little focus on improving ASD education during pediatric residency training. The objective of this study was to evaluate a new curriculum developed in partnership with the Centers for Disease Control and Prevention and the Maternal and Child…

  20. Item Bank Development for a Revised Pediatric Evaluation of Disability Inventory (PEDI)

    ERIC Educational Resources Information Center

    Dumas, Helene; Fragala-Pinkham, Maria; Haley, Stephen; Coster, Wendy; Kramer, Jessica; Kao, Ying-Chia; Moed, Richard

    2010-01-01

    The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options…

  1. Clinical evaluation of a 2K x 2K workstation for primary diagnosis in pediatric radiology

    NASA Astrophysics Data System (ADS)

    Razavi, Mahmood; Sayre, James W.; Simons, Margaret A.; Hamedaninia, Azar; Boechat, Maria I.; Hall, Theodore R.; Kangarloo, Hooshang; Taira, Ricky K.; Chuang, Keh-Shih; Kashifian, Payam

    1991-07-01

    Preliminary results of a large-scale ROC study evaluating the diagnostic performance of digital hardcopy film and 2K X 2K softcopy display for pediatric chest radiographs are presented. The pediatric disease categories studied were pneumothorax, linear atelectasis, air bronchograms, and interstitial disease. Digital images were obtained directly from a computed radiography system. Results from the readings of 239 chest radiographs by 4 radiologists show no significant difference between viewing images on film and softcopy display for the disease categories pneumothorax and air bronchograms. A slight performance edge for softcopy was seen for the disease categories of interstitial disease and linear atelectasis.

  2. Evaluation of rapid sequence intubation in the pediatric emergency department.

    PubMed

    Sukys, Graziela A; Schvartsman, Cláudio; Reis, Amélia G

    2011-01-01

    To describe the experience of the emergency department of a pediatric hospital with rapid sequence intubation (RSI) and to identify the factors associated with successful intubation. This prospective, observational, cross-sectional study conducted from July 2005 to December 2007 consisted of collection of data regarding tracheal intubations performed at the emergency department of Instituto da Criança of Hospital das Clínicas, School of Medicine, Universidade de São Paulo. Successful tracheal intubations were the ones performed at the first attempt. One-hundred and seventeen tracheal intubations were performed; 80% of them were RSIs; 79% of patients had underlying diseases; acute respiratory failure was the cause of tracheal intubation in 40%; success rate was 39%; second-year pediatric resident physicians were responsible for 74% of tracheal intubations; positive pressure ventilation was performed in 74% of procedures, with less frequent use among patients who were successfully intubated (p = 0.002). Midazolam was the sedative used in 80% of procedures, and rocuronium was the neuromuscular blocker in 100%; complications of RSI were described in 80% of intubations, with decreased oxygen saturation being reported in 47% and lower decrease in those patients successfully intubated (p < 0.001); difficulties related to tracheal intubation were less frequent in the successful procedures (p < 0.001). RSI is the method of choice for tracheal intubations performed in the emergency department (80%). In spite of the low success rate (39%) in the present study, RSI has proven to be a safe method, with a low incidence of severe complications. The success of tracheal intubation using RSI seems to be directly related to the preparation of the procedure and the health professional's experience. Thus, we conclude that further training of resident physicians and health professionals working in the emergency department is required.

  3. QALY weights for neurosensory impairments in pediatric economic evaluations: case studies and a critique.

    PubMed

    Grosse, Scott D; Prosser, Lisa A; Asakawa, Keiko; Feeny, David

    2010-06-01

    The use of utility weights for the calculation of quality-adjusted life years is particularly problematic for pediatric health states. This article reviews variability in utility weights for intellectual disability and permanent hearing loss in economic evaluations of newborn screening and childhood immunizations. Utility weights for severe intellectual disability ranged from 0.06 to 0.74. Most studies either did not vary these utility weights in sensitivity analyses or assumed low variability; consequently, the robustness of cost-effectiveness estimates was not fully assessed. Two recently published catalogs of utility weights for pediatric health states also show wide divergences in estimates. More work is needed to establish measures of health utilities for childhood health states in order to allow for comparable assessments of pediatric interventions.

  4. The Self Study Evaluation of the Guam Pediatric Evaluation and Developmental Services (PEDS) Unit. Final Technical Report.

    ERIC Educational Resources Information Center

    Sablan, Velma A.

    This report presents results of a self-study evaluation of the Pediatric and Developmental Services (PEDS) unit, a center-based collaborative interagency program in Guam which provides screening, assessment, referrals, and initial intervention for children birth to 3 years of age with or at risk for developmental delays/disabilities and their…

  5. Longitudinal evaluation of foetal transverse lie using ultrasonography.

    PubMed

    Oyinloye, Olalekan I; Okoyomo, Alexander A

    2010-03-01

    The purpose of this study was to assess the risk of persistence of transverse lie detected earlier in pregnancy and associated predisposing factors using follow-up ultrasound (US). A longitudinal study was carried out from January 2004 to august 2004 at Federal Medical centre, Lokoja, Nigeria. All singleton pregnancies, with ultrasound diagnosis of transverse lie, between 24-28 weeks were followed to term. At 24-28 weeks, 183 fetuses presented with transverse lie. Thirty seven were lost to follow-up; out of the remaining 146 babies, 22 persisted to term. Overall persistence rate was 15.1%. No identifiable predisposing factors were seen in 91.1%, placenta previa in 5.5%, lower segment fibroids in 2.7%, and ectopic kidney in 0.7%. In conclusion, transverse lie detected early in pregnancy is transient, and majority would convert to a longitudinal lie at term. Potential predisposing factors highlighted above increases the risk of persistent transverse lie at term, with placenta previa and lower segment fibroids being the major predisposing factors.

  6. Trajectories of Symptoms and Impairment for Pediatric Patients with Functional Abdominal Pain: A 5-Year Longitudinal Study

    ERIC Educational Resources Information Center

    Mulvaney, Shelagh; Lambert, E. Warren; Garber, Judy; Walker, Lynn S.

    2006-01-01

    Objective: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method: The Children's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in…

  7. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities

    PubMed Central

    Lee, Alison YM; Enarson, Paul; Clarke, Ann E; La Vieille, Sébastien; Eisman, Harley; Chan, Edmond S; Mill, Christopher; Joseph, Lawrence; Ben-Shoshan, Moshe

    2017-01-01

    Background There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED), triggers, and management of anaphylaxis across different provinces in Canada. Objective To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs). Methods As part of the Cross-Canada Anaphylaxis Registry (C-CARE), children presenting to the British Columbia Children’s Hospital (BCCH) and Montreal Children’s Hospital (MCH) EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval. Results Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at the MCH ED. In both centers, the majority of cases were triggered by food (BCCH 91.3% [88.7, 94.0], MCH 82.4% [79.7, 85.3]), of which peanuts were the most common culprit (24.7% [20.9, 29.9] and 19.0% [15.8, 22.7], respectively). Pre-hospital administration of epinephrine (BCCH 27.7% [23.2, 32.8], MCH 33.1% [29.5, 37.0]) and antihistamines (BCCH 50.6% [45.2, 56.0], MCH 47.1% [43.1, 51.0]) was similar. In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at the BCCH (59.2% [53.9, 64.4], 59.8% [54.4, 65.0], and 60.1% [54.7, 65.3], respectively) compared to the MCH (42.2% [38.3, 46.2], 36.2% [32.5, 40.1], and 11.9% [9.5, 14.8], respectively). Despite differences in management, percentage of cases admitted to the intensive care unit was similar between the two centers. Conclusion Compared to previous European and North American reports, there is a high percentage of anaphylaxis cases in two PEDs across Canada with substantial

  8. SYN-PEDS: SYNtactical Pediatric Evaluation and Diagnostic System

    PubMed Central

    Witten, Matthew; Maloney, David

    1980-01-01

    SYN-PEDS is a multimodular system which is designed to be an inhome interactive access to a neonatal and pediatric diagnostic information database. This system is designed to assist a parent in assessing his child's condition, as well as in determining whether or not the child needs immediate medical attention. This system is not designed to replace the pediatrician but rather, it is designed as a preventative and health maintenance information system which has the unusually nice side benefit if helping to reduce medical system costs by cutting down on the number of unnecessary visits to private and local clinics as well as private physicians. The current version of SYN-PEDS is composed of of four operative modules: CRITICAL, TREAT, CLINFO, and DIAGNOSE/SYMPTM. These four modules allow the parent/user to interact with the SYN-PEDS system in various modes. As an example, CLINFO is the module which provides clinical information on a variety of subjects. This module is for a parent who wishes information on a particular subject of interest.

  9. [Analgesics in pediatrics. Before prescribing: recognize and evaluate pain, reassure].

    PubMed

    Fournier-Charrière, E; Dommergues, J P

    1997-06-07

    CAREFUL ASSESSMENT: In pediatric clinics, it has become habitual to prescribe analgesics in all painful situations. Particular attention must be paid to pain experienced by the child and obtaining objective evidence allowing valid assessment prior to treatment. ACUTE PAIN: Usually clearly expressed by crying screams, agitation, retraction and protection of the painful area, signs of acute pain are nonspecific and not proportional to its intensity. PROLONGED PAIN: Sadness and depression confound the expression of prolonged pain. Diagnosis may be difficult; an association between a potentially painful situation, pain relieving positions, and retraction behavior is specific. ESTABLISH CONFIDENCE: For both the child and his family, an atmosphere of confidence and a clear explanation of the lesions and their treatments are essential to break the viscious cycle of pain and anxiety. EXAMINING A CHILD WITH PAIN: Patience is the essence of examining children, facial mimics, reactions, movements and positions all provide essential information. ASSESSING PAIN INTENSITY: Using the visual analogue scale, VAS, children over 5 years of age can show where the pain is on a drawing of the body. For those under 5, questioning the family and looking for specific signs is an essential source of information. The DEGR scale can be used to score prolonged pain in children from 2 to 6 or 8 years of age.

  10. Knowledge, Attitudes, and Practices of Pediatric Dentists Regarding Speech Evaluation of Patients: Implications for Dental Education.

    PubMed

    Van Eyndhoven, Lisa; Chussid, Steven; Yoon, Richard K

    2015-11-01

    The aim of this cross-sectional study was to determine pediatric dentists' attitudes about speech evaluation in the dental setting and assess their knowledge of speech development and pathology. In October 2013, members of the American Academy of Pediatric Dentistry were invited to participate in an electronic questionnaire. Categories of questions were demographics, attitudes and confidence in speech pathology, and theoretical and practical knowledge of speech development and speech pathology. Theoretical knowledge was assessed using questions about phonetics and speech milestones. Practical knowledge was determined with three 30-second interview-style video clips. A total of 539 responses were received for a response rate of 10.4%. The majority of respondents reported feeling that speech evaluation should be part of the pediatric dental visit (72.8%) and felt confident in their ability to detect speech issues (73.2%). However, they did poorly on the theoretical knowledge questions (41.9%) as well as the practical knowledge questions (8.5%). There was a statistically significant difference in theoretical score between gender and type of occupation (p<0.05). This difference was not observed when examining practical knowledge. This study suggests that although pediatric dentists are in an ideal position to aid in the detection of speech issues, they currently have insufficient training and knowledge to do so.

  11. Expansion and Evaluation of Data Characterizing the Structural Behavior of the Pediatric Abdomen

    PubMed Central

    Lamp, John F.; Salzar, Robert; Kerrigan, Jason; Parent, Daniel; Lopez-Valdez, Francisco; Lau, Sabrina; Lessley, David; Kent, Richard; Luck, Jason; Loyd, Andre; Bass, Cameron

    2010-01-01

    Despite the importance of abdominal injuries in children involved in motor vehicle collisions, only two papers have reported experimental data quantifying the pediatric abdominal response to belt loading. One developed and characterized a porcine model of the pediatric abdomen and the other presented a series of tests performed on a single pediatric (7-year-old female) post-mortem human subject (PMHS) and used the data to evaluate the efficacy of the porcine model. The current paper presents the results from an additional pediatric (6-year-old female) PMHS test series and an expanded evaluation of the porcine model using the combined PMHS data. The two PMHS exhibited remarkably similar abdominal stiffness, both by level (upper and lower) and by rate (quasi-static and ∼2 m/s dynamic). Both PMHS and swine exhibited the same stiffness trend by abdominal level (lower stiffer than upper: 3444 N reaction force at 30.5 mm of displacement compared to 1756 N in the 6-year-old dynamic tests). The magnitude of lower abdomen stiffness was slightly less in the swine than in the PMHS (the average dynamic PMHS response was 1086 N greater than the porcine envelopes at 30.5 mm displacement) while the upper abdomen PMHS responses fit within the porcine response envelope. PMID:21050594

  12. Expansion and evaluation of data characterizing the structural behavior of the pediatric abdomen.

    PubMed

    Lamp, John F; Salzar, Robert; Kerrigan, Jason; Parent, Daniel; Lopez-Valdez, Francisco; Lau, Sabrina; Lessley, David; Kent, Richard; Luck, Jason; Loyd, Andre; Bass, Cameron

    2010-01-01

    Despite the importance of abdominal injuries in children involved in motor vehicle collisions, only two papers have reported experimental data quantifying the pediatric abdominal response to belt loading. One developed and characterized a porcine model of the pediatric abdomen and the other presented a series of tests performed on a single pediatric (7-year-old female) post-mortem human subject (PMHS) and used the data to evaluate the efficacy of the porcine model. The current paper presents the results from an additional pediatric (6-year-old female) PMHS test series and an expanded evaluation of the porcine model using the combined PMHS data. The two PMHS exhibited remarkably similar abdominal stiffness, both by level (upper and lower) and by rate (quasi-static and ∼2 m/s dynamic). Both PMHS and swine exhibited the same stiffness trend by abdominal level (lower stiffer than upper: 3444 N reaction force at 30.5 mm of displacement compared to 1756 N in the 6-year-old dynamic tests). The magnitude of lower abdomen stiffness was slightly less in the swine than in the PMHS (the average dynamic PMHS response was 1086 N greater than the porcine envelopes at 30.5 mm displacement) while the upper abdomen PMHS responses fit within the porcine response envelope.

  13. Evaluation of the pain resource nurse role: a resource for improving pediatric pain management.

    PubMed

    McCleary, Lynn; Ellis, Jacqueline A; Rowley, Betty

    2004-03-01

    Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.

  14. MPCP Longitudinal Educational Growth Study: Fourth Year Report. SCDP Milwaukee Evaluation. Report # 23

    ERIC Educational Resources Information Center

    Witte, John F.; Carlson, Deven; Cowen, Joshua M.; Fleming, David J.; Wolf, Patrick J.

    2011-01-01

    This is the fourth-year report in a five-year evaluation of the Milwaukee Parental Choice Program (MPCP). This report features analyses of student achievement growth three years after the authors carefully assembled longitudinal study panels of MPCP and Milwaukee Public Schools (MPS) students in 2006-07. The general purposes of the evaluation are…

  15. A Longitudinal Evaluation Study of a Science Professional Development Program for K-12 Teachers: NERDS

    ERIC Educational Resources Information Center

    Ewing-Taylor, Jacque M.

    2012-01-01

    A longitudinal evaluation study of a science professional development program for K-12 teachers was conducted using the CIPP evaluation model. Eleven years of program data were described and analyzed. Elementary teachers comprised 62% of the 384 participants, 17% of all participants were middle school teachers, and 13% of all participants were…

  16. Longitudinal Evaluation of the Indian Youth Leadership Conferences for the Years 1983-1987.

    ERIC Educational Resources Information Center

    Charleston, G. Mike

    This report presented results of longitudinal evaluation of Indian Youth Leadership Conference summer camps which provide 8- to 10-day sessions of physical activities and action-oriented problem-solving situations for male and female junior high aged Indian students aimed at developing skills and motivation. The evaluation provided information…

  17. A Mixed-Methods Longitudinal Evaluation of a One-Day Mental Health Wellness Intervention

    ERIC Educational Resources Information Center

    Doyle, Louise; de Vries, Jan; Higgins, Agnes; Keogh, Brian; McBennett, Padraig; O'Shea, Marié T.

    2017-01-01

    Objectives: This study evaluated the impact of a one-day mental health Wellness Workshop on participants' mental health and attitudes towards mental health. Design: Convergent, longitudinal mixed-methods approach. Setting: The study evaluated Wellness Workshops which took place throughout the Republic of Ireland. Method: Questionnaires measuring…

  18. A Mixed-Methods Longitudinal Evaluation of a One-Day Mental Health Wellness Intervention

    ERIC Educational Resources Information Center

    Doyle, Louise; de Vries, Jan; Higgins, Agnes; Keogh, Brian; McBennett, Padraig; O'Shea, Marié T.

    2017-01-01

    Objectives: This study evaluated the impact of a one-day mental health Wellness Workshop on participants' mental health and attitudes towards mental health. Design: Convergent, longitudinal mixed-methods approach. Setting: The study evaluated Wellness Workshops which took place throughout the Republic of Ireland. Method: Questionnaires measuring…

  19. The pediatric hematology/oncology educational laboratory in-training examination (PHOELIX): A formative evaluation of laboratory skills for Canadian pediatric hematology/oncology trainees.

    PubMed

    Leung, Elaine; Dix, David; Ford, Jason; Barnard, Dorothy; McBride, Eileen

    2015-11-01

    Pediatric hematologists/oncologists need to be skilled clinicians, and must also be adept and knowledgeable in relevant areas of laboratory medicine. Canadian training programs in this subspecialty have a minimum requirement for 6 months of training in acquiring "relevant laboratory diagnostic skills." The Canadian pediatric hematology/oncology (PHO) national specialty society, C17, recognized the need for an assessment method in laboratory skills for fellows graduating from PHO training programs. Canadian pediatric hematologists/oncologists were surveyed regarding what were felt to be the essential laboratory-related knowledge and skills deemed necessary for graduating pediatric hematology/oncology trainees. The PHOELIX (Pediatric hematology/oncology educational laboratory in-training examination) was then developed to provide an annual formative evaluation of laboratory skills in Canadian PHO trainees. The majority of PHO respondents (89%) felt that laboratory skills are important in clinical practice. An annual formative examination including review of glass slides was implemented starting in 2010; this provides feedback regarding knowledge of laboratory medicine to both trainees and program directors (PDs). We have successfully created a formative examination that can be used to evaluate and educate trainees, as well as provide PDs with a tool to gauge the effectiveness of their laboratory training curriculum. Feedback has been positive from both trainees and PDs. © 2015 Wiley Periodicals, Inc.

  20. Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Learning Disability.

    PubMed

    C Nair, M K; Prasad, Chhaya; Unni, Jeeson; Bhattacharya, Anjan; Kamath, S S; Dalwai, Samir

    2017-07-15

    Learning Disability (LD) in children is a well-recognized developmental disorder, which has profound academic and psychosocial consequences. Due to the complex nature of LD and multiple disadvantages posed to the child due to LD, a multidisciplinary approach towards intervention is warranted. Given the paucity of evidence-based standardized treatment approaches, consensus guidelines for management of LD are needed. The meeting on formulation of national consensus guidelines on neurodevelopmental disorders was organized by Indian Academy of Pediatrics in Mumbai on 18th and 19th December, 2015. The invited experts included Pediatricians, Developmental Pediatricians, Pediatric Neurologists, Psychiatrists, Remedial Educators and Clinical Psychologists. The participants framed guidelines after extensive discussions. Thereafter, a committee was established to review and finalize the points discussed in the meeting. To provide guidelines on evaluation and management of LD in children in India. A basic intervention approach should focus on: (i) interpretation of evaluation reports; (ii) description of specific skills that may be delayed (e.g., phoneme awareness and phonics; reading comprehension; spelling; number sense and organizational skills) and (iii) identification of co-morbidities. The intervention should be inter-disciplinary and individualized to each child. Required services include: developmental pediatrics evaluation; neurological evaluation; ophthalmology and audiology evaluation; clinical psychology assessment; occupational therapy, remedial education, counseling for family, and career-counselling.

  1. Longitudinal evaluation of leukocyte transcripts in killer whales (Orcinus Orca)

    USGS Publications Warehouse

    Sitt, Tatjana; Bowen, Lizabeth; Lee, Chia-Shan; Blanchard, Myra; McBain, James; Dold, Christopher; Stott, Jeffrey L.

    2016-01-01

    Early identification of illness and/or presence of environmental and/or social stressors in free-ranging and domestic cetaceans is a priority for marine mammal health care professionals. Incorporation of leukocyte gene transcript analysis into the diagnostic tool kit has the potential to augment classical diagnostics based upon ease of sample storage and shipment, inducible nature and well-defined roles of transcription and associated downstream actions. Development of biomarkers that could serve to identify “insults” and potentially differentiate disease etiology would be of great diagnostic value. To this end, a modest number of peripheral blood leukocyte gene transcripts were selected for application to a domestic killer whale population with a focus on broad representation of inducible immunologically relevant genes. Normalized leukocyte transcript values, longitudinally acquired from 232 blood samples derived from 26 clinically healthy whales, were not visibly influenced temporally nor by sex or the specific Park in which they resided. Stability in leukocyte transcript number during periods of health enhances their potential use in diagnostics through identification of outliers. Transcript levels of two cytokine genes, IL-4 and IL-17, were highly variable within the group as compared to the other transcripts. IL-4 transcripts were typically absent. Analysis of transcript levels on the other genes of interest, on an individual animal basis, identified more outliers than were visible when analyzed in the context of the entire population. The majority of outliers (9 samples) were low, though elevated transcripts were identified for IL-17 from 2 animals and one each for Cox-2 and IL-10. The low number of outliers was not unexpected as sample selection was intentionally directed towards animals that were clinically healthy at the time of collection. Outliers may reflect animals experiencing subclinical disease that is transient and self-limiting. The

  2. Longitudinal evaluation of leukocyte transcripts in killer whales (Orcinus Orca).

    PubMed

    Sitt, Tatjana; Bowen, Lizabeth; Lee, Chia-Shan; Blanchard, Myra T; McBain, James; Dold, Christopher; Stott, Jeffrey L

    2016-07-01

    Early identification of illness and/or presence of environmental and/or social stressors in free-ranging and domestic cetaceans is a priority for marine mammal health care professionals. Incorporation of leukocyte gene transcript analysis into the diagnostic tool kit has the potential to augment classical diagnostics based upon ease of sample storage and shipment, inducible nature and well-defined roles of transcription and associated downstream actions. Development of biomarkers that could serve to identify "insults" and potentially differentiate disease etiology would be of great diagnostic value. To this end, a modest number of peripheral blood leukocyte gene transcripts were selected for application to a domestic killer whale population with a focus on broad representation of inducible immunologically relevant genes. Normalized leukocyte transcript values, longitudinally acquired from 232 blood samples derived from 26 clinically healthy whales, were not visibly influenced temporally nor by sex or the specific Park in which they resided. Stability in leukocyte transcript number during periods of health enhances their potential use in diagnostics through identification of outliers. Transcript levels of two cytokine genes, IL-4 and IL-17, were highly variable within the group as compared to the other transcripts. IL-4 transcripts were typically absent. Analysis of transcript levels on the other genes of interest, on an individual animal basis, identified more outliers than were visible when analyzed in the context of the entire population. The majority of outliers (9 samples) were low, though elevated transcripts were identified for IL-17 from 2 animals and one each for Cox-2 and IL-10. The low number of outliers was not unexpected as sample selection was intentionally directed towards animals that were clinically healthy at the time of collection. Outliers may reflect animals experiencing subclinical disease that is transient and self-limiting. The immunologic

  3. Longitudinal evaluation of economic and physical impact of Parkinson's disease.

    PubMed

    Schenkman, M; Wei Zhu, C; Cutson, T M; Whetten-Goldstein, K

    2001-09-01

    The cost of parkinsonism and Parkinson's disease (PD) is largely unknown although clinical experience suggests that the impact of this disease is substantial. Longitudinal data is presented for health status, disease symptoms, functional status, and financial costs for 70 participants with PD or parkinsonism. The sample was dichotomized into those rating their health as excellent, good, or very good ('good health') and those rating their health as fair or poor ('poor health'). The 'poor health' group were significantly more disabled at baseline. Symptoms increased between year 1 and 3 with greatest increases in fatigue, pain, and depression for the 'good health' group. At year 1, total direct cost/capita was about dollars 5000/year for both groups; indirect costs were dollars 5000 for the 'good health' group and dollars 15,000/year for the 'poor health' group. By year 3, total expenditures increased over 25% for the 'good health' group and nearly doubled for the 'poor health' group, while percent costs that were compensated declined for groups. Out of pocket, expenses were as high as dollars 3000/year for the 'poor health' group by year 3. Through analysis of the broad impact of PD, including non-neurological symptoms and economic ramifications, it is possible to better appreciate the impact of this chronic condition on overall quality of life.

  4. Longitudinal evaluation of central corneal thickness in congenital glaucoma.

    PubMed

    Paletta Guedes, R A; Pena, A B; Paletta Guedes, V M; Chaoubah, A

    2016-10-01

    To assess the central corneal thickness in primary congenital glaucoma before and after surgical treatment and compare it with a normal population. We conducted a longitudinal analysis of primary congenital glaucoma patients, in whom we measured central corneal thickness before and after treatment (Group 1). We compared our results with a normal population (Group 2), who underwent ophthalmological examination under anesthesia for other reasons. Mean age (months) in Group 1 (N=23) and Group 2 (N=40) at the time of the first exam was 5.5 and 9.2 (P=0.004), respectively. Mean central corneal thickness (microns) in Group 1 was: 663 before treatment and 557 after treatment (P<0.001). In Group 2, mean central corneal thickness (microns) was 551. Comparisons show statistical difference between mean values before and after treatment (P<0.001), but not between post-treatment CCT mean values in Group 1 and mean CCT values in Group 2 (P=0.627). In primary congenital glaucoma, central corneal thickness values show unique peculiarities. They are higher than normal before treatment (thicker corneas), due to corneal edema caused by elevated intraocular pressure. After surgical treatment, central corneal thickness measurements decrease toward the mean values for the normal population. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Evaluation of a systematic approach to pediatric back pain: the utility of magnetic resonance imaging.

    PubMed

    Ramirez, Norman; Flynn, John M; Hill, Brian W; Serrano, Jose A; Calvo, Carlos E; Bredy, Rafael; Macchiavelli, Raul E

    2015-01-01

    Several studies have suggested that back pain in the majority of pediatric patients does not have an identifiable cause. Many children undergo extensive diagnostic workup that ultimately results in a nonconfirmative diagnosis. The purpose of this study was to (1) describe the prevalence of back pain seen in a pediatric orthopaedic clinic; (2) evaluate the efficacy of a systematic approach dependent on magnetic resonance imaging (MRI) in the diagnosis of pediatric back pain; and (3) analyze sensitivity, specificity, positive predictive value, and negative predictive value of various clinical signs and symptoms. For a 24-month period, all patients that presented with a chief complaint of back pain were prospectively enrolled in this study and evaluated in a systematic approach which utilized MRI for patients with constant pain, night pain, radicular pain, or abnormal neurological examination after an initial history, physical examination, and negative radiographic examination. The prevalence of chief complaint of back pain was 8.6% (261/3042 patients). Of the 261 patients, 34% had an identifiable pathology following the systematic approach. In 8.8% of patients, the diagnosis was established with the history, physical examination, and plain radiographs. MRI yielded a definitive diagnosis in another 25% of patients. It is noteworthy that of the 89 patients with a confirmed pathology, 26% were identified with plain radiographs and 74% with MRI. A systematic approach to diagnose pediatric back pain demonstrated that 34% of pediatric patients that present to an outpatient orthopaedic clinic complaining of back pain will have identifiable pathology. The diagnostic yield increased from 8.8% with the history, physical examination, and plain radiographs to 22% with the TCN Bone Scan to 36% with the use of the MRI. The clinician should be aware that the presences of lumbar pain or constant pain are red flags for the presence of underlying pathology. Level III.

  6. Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists.

    PubMed

    Lomotan, Edwin A; Hoeksema, Laura J; Edmonds, Diana E; Ramírez-Garnica, Gabriela; Shiffman, Richard N; Horwitz, Leora I

    2012-03-01

    To investigate use of a new guideline-based, computerized clinical decision support (CCDS) system for asthma in a pediatric pulmonology clinic of a large academic medical center. We conducted a qualitative evaluation including review of electronic data, direct observation, and interviews with all nine pediatric pulmonologists in the clinic. Outcome measures included patterns of computer use in relation to patient care, and themes surrounding the relationship between asthma care and computer use. The pediatric pulmonologists entered enough data to trigger the decision support system in 397/445 (89.2%) of all asthma visits from January 2009 to May 2009. However, interviews and direct observations revealed use of the decision support system was limited to documentation activities after clinic sessions ended. Reasons for delayed use reflected barriers common to general medical care and barriers specific to subspecialty care. Subspecialist-specific barriers included the perceived high complexity of patients, the impact of subject matter expertise on the types of decision support needed, and unique workflow concerns such as the need to create letters to referring physicians. Pediatric pulmonologists demonstrated low use of a computerized decision support system for asthma care because of a combination of general and subspecialist-specific factors. Subspecialist-specific factors should not be underestimated when designing guideline-based, computerized decision support systems for the subspecialty setting. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Pediatric dentistry clinical education venues evaluation by pre and post-doctoral students.

    PubMed

    Bimstein, E; Mayes, A; Mittal, Hc

    2014-01-01

    To evaluate dental students' perspectives about pre- and post-doctoral pediatric dentistry education venues. Surveys with visual analog scales (from 0 to 100) measuring the educational contribution of pediatric dentistry venues were conducted. The pre-doctoral venues included a 3rd year university twilight clinic (UTC), a 3rd year urban community based clinic (CBC) and 4th year mobile clinics (MCs). The post-doctoral venues included treatment of children under general anesthesia, oral sedations, a regular clinic (no sedations), seminars, journal club, case conferences and studding for the American Board of Pediatric Dentistry. Analyses of variance between the scores indicated that the 3rd year CBC score (68.2 ± 4.5) was statistically significant higher (p= .007) than the one for the 3rd year UTC score (44.9 ± 6.1). The 4th year students' MCs score (61.4 ± 4.0) was statistically significant higher than their retrospective scores for the 3rd year CBC (56.4 ± 4.4) or UTC (42.2 ± 4.9) scores (p= .03 and .004 respectively). Among the didactic or clinical post-doctoral venues, the regular clinic and the seminars received the highest scores (84.3 ± 1.7 and 71.6 ± 2.8 respectively). pre-doctoral community-based clinical education and post-doctoral regular university based clinic are considered by students to provide the main contribution to pediatric dental education.

  8. Social competence in pediatric brain tumor survivors: evaluating the psychometric properties of assessment tools.

    PubMed

    Schulte, Fiona; Barrera, Maru

    2014-02-01

    This study was conducted to identify and describe the instruments that have been used to measure social competence in pediatric brain tumor patients and to summarize the psychometric properties of the most common instruments used to measure social competence in pediatric brain tumor patients. The following psychometric properties were assessed: (a) construct validity; (b) internal consistency reliability; (c) test retest and inter-rater reliability; and (d) responsiveness. Measures were evaluated based on published criteria for psychometric suitability. Ten studies met inclusion criteria for the current review. Based on review of these studies, the Social Skills Rating System (SSRS) yielded the most comprehensive data on psychometric properties. Psychometric properties for the SSRS were considered to be adequate in a pediatric brain tumor population. Specifically, the SSRS meets criteria for construct validity, internal consistency and responsiveness. Other commonly used measures included the CBCL/YSR, the PedsQL4.0 and the Revised Class Play each with sufficient psychometric properties. The SSRS is an appropriate tool to measure social competence in pediatric brain tumor patients. Data for inter-rater reliability and responsiveness in this population is still lacking.

  9. Prospective longitudinal evaluation of a symptom cluster in breast cancer.

    PubMed

    Sanford, Stacy D; Beaumont, Jennifer L; Butt, Zeeshan; Sweet, Jerry J; Cella, David; Wagner, Lynne I

    2014-04-01

    Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation. We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy. Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment. Participants (N = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29-71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time. With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  10. [Longitudinal echocardiographic evaluation in children with thalassemia major].

    PubMed

    Balducci, G; Barbanente, C; Di Lecce, A; Schettini, F

    1984-01-01

    We report the results of a longitudinal echocardiographic survey on 15 children with thalassemia major, who had received multiple transfusions. The average interval between the two examinations was 2.9 +/- 0.7 years. At the second examination the mean hemoglobin (Hb) level for the group was higher because of the increased number of transfusions. During the same period of time the chelating treatment with desferrioxamine was administered subcutaneously instead of intramuscularly. The following echocardiographic parameters have been measured: left ventricular dimension, diastolic (LVDd); left ventricular dimension, systolic (LVDs); septal thickness, diastolic (STd); free wall, diastolic (FWd); left atrial dimension (LAD); aortic root (AoR); fractional shortening (FA); velocity of circumferential shortening (VCF). At the first examination 6 patients had abnormal values of LVDd, STd and AoR; 10 subjects had increased LAD; the mean Hb levels of the patients with abnormal STd and LAD was significantly lower than in normals (p less than 0.05 and less than 0.01 respectively). At the second examination 8 patients had abnormal LVDd values and 7 had increased LAD. Only the patients with increased LVDd had lower Hb values. Patients with increased LAD had received more transfusions. The following functional parameters were found to be decreased at the second study: FA (29 +/- 3.3 vs 32.6 +/- 7; p less than 0.05); VCF (1.16 +/- 0.25 vs 0.99 +/- 0.14; p less than 0.05). From the results it appears that the change of treatment improved some parameters (STd, AoR, LAD), but was unable to arrest the deterioration of the LV contractile efficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Opening the Black Box: Evaluating the Pediatric Athlete With Elbow Pain.

    PubMed

    Soma, David B

    2016-03-01

    Evaluation and treatment of pediatric elbow injuries in sport can be difficult because of the complex anatomy, evolving bony and cartilaginous composition, and multiple varied forces applied during athletic competition. In addition, youth sports are now putting even greater demands on the elbow of young athletes. It is important to understand the risk factors for injury, age-appropriate conditions affecting the elbow, proper treatment of these conditions, and prevention strategies for elbow injuries in this young athletic population.

  12. Preclinical Evaluation of the PARP Inhibitor, Olaparib, in Combination with Cytotoxic Chemotherapy in Pediatric Solid Tumors

    PubMed Central

    Norris, Robin E.; Adamson, Peter C.; Nguyen, Vu T.; Fox, Elizabeth

    2013-01-01

    Background Poly(ADP-ribose) polymerase (PARP) signals DNA damage and facilitates DNA repair. PARP inhibitors are being evaluated in cancers with defective DNA repair mechanisms or in combination with cytotoxic therapy or radiation. We evaluated the PARP inhibitor, olaparib, in combination with chemotherapy using in vitro and in vivo pediatric solid tumor models. Procedure The IC50 of olaparib alone and in combination with cytotoxic agents was determined in 10 pediatric solid tumor cell lines. Synergy was assessed using the combination index of Chou-Talalay. Olaparib alone and in combination with topotecan/cyclophosphamide was evaluated in xenograft models of Ewing sarcoma (ES) and neuroblastoma (NGP). PAR activity was evaluated in cell lines and tumor lysates. Results Olaparib induced growth inhibition, median (range) IC50=3.6 (1–33.8) µM, and inhibited PAR activity in pediatric solid tumor cell lines. The addition of olaparib to DNA damaging agents resulted in additive to synergistic interactions. In ES and NGP xenografts, olaparib inhibited PAR activity by 88% to 100% as a single agent and 100% when administered with cyclophosphamide/topotecan. Although the addition of olaparib did not antagonize the activity of cyclophosphamide/topotecan, clear evidence of synergy could not be demonstrated. Conclusions In pediatric solid tumor cell lines, clinically achievable concentrations of single agent olaparib caused growth inhibition. Although the in vitro data demonstrated synergistic efficacy of olaparib when added to the camptothecins and alkylating agents, synergy was not discernible in vivo. Clinical trials of PARP inhibitors in combination DNA damaging agents are necessary to establish the role of PARP inhibitors in childhood cancer. PMID:24038812

  13. Preclinical evaluation of the PARP inhibitor, olaparib, in combination with cytotoxic chemotherapy in pediatric solid tumors.

    PubMed

    Norris, Robin E; Adamson, Peter C; Nguyen, Vu T; Fox, Elizabeth

    2014-01-01

    Poly(ADP-ribose) polymerase (PARP) signals DNA damage and facilitates DNA repair. PARP inhibitors are being evaluated in cancers with defective DNA repair mechanisms or in combination with cytotoxic therapy or radiation. We evaluated the PARP inhibitor, olaparib, in combination with chemotherapy using in vitro and in vivo pediatric solid tumor models. The IC50 of olaparib alone and in combination with cytotoxic agents was determined in 10 pediatric solid tumor cell lines. Synergy was assessed using the combination index of Chou-Talalay. Olaparib alone and in combination with topotecan/cyclophosphamide was evaluated in xenograft models of Ewing sarcoma (RD-ES) and neuroblastoma (NGP). PAR activity was evaluated in cell lines and tumor lysates. Olaparib induced growth inhibition, median (range) IC50 = 3.6 (1-33.8) µM, and inhibited PAR activity in pediatric solid tumor cell lines. The addition of olaparib to DNA damaging agents resulted in additive to synergistic interactions. In RD-ES and NGP xenografts, olaparib inhibited PAR activity by 88-100% as a single agent and 100% when administered with cyclophosphamide/topotecan. Although the addition of olaparib did not antagonize the activity of cyclophosphamide/topotecan, clear evidence of synergy could not be demonstrated. In pediatric solid tumor cell lines, clinically achievable concentrations of single agent olaparib caused growth inhibition. Although the in vitro data demonstrated synergistic efficacy of olaparib when added to the camptothecins and alkylating agents, synergy was not discernible in vivo. Clinical trials of PARP inhibitors in combination DNA damaging agents are necessary to establish the role of PARP inhibitors in childhood cancer. © 2013 Wiley Periodicals, Inc.

  14. Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory

    PubMed Central

    Teles, Fernanda Moreira; Resegue, Rosa; Puccini, Rosana Fiorini

    2016-01-01

    Abstract Objective: To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. Methods: Cross-sectional study with 181 children aged 7-10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board-District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas-self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. Results: The lower means, with statistically significant differences, were observed for the items related to social function (55.8-72.0), followed by self-care functions (56.0-96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). Conclusions: Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention. PMID:27080218

  15. Longitudinal Relationships between Core Self-Evaluations and Job Satisfaction

    ERIC Educational Resources Information Center

    Wu, Chia-Huei; Griffin, Mark A.

    2012-01-01

    Core self-evaluations (CSE) have been proposed as a static personality trait that influences individuals' work experiences. However, CSE can also be influenced by work experiences. Based on the corresponsive principle of personality development, this study incorporated both dispositional and contextual perspectives to examine longitudinal…

  16. A longitudinal evaluation of blood pressure in children.

    PubMed Central

    Levine, R S; Hennekens, C H; Klein, B; Ferrer, P L; Gourley, J; Cassady, J; Gelband, H; Jesse, M J

    1979-01-01

    Blood pressure levels obtained on two occasions, one year apart, were evaluated among 212 children. An overall correlation of .65 was obtained for systolic pressure and .43 for diastolic pressure. The results suggest that adult levels of correlation are not reached in childhood and that screening programs must consider the relative lability of children's measurements in establishing referral criteria. PMID:507251

  17. Longitudinal Relationships between Core Self-Evaluations and Job Satisfaction

    ERIC Educational Resources Information Center

    Wu, Chia-Huei; Griffin, Mark A.

    2012-01-01

    Core self-evaluations (CSE) have been proposed as a static personality trait that influences individuals' work experiences. However, CSE can also be influenced by work experiences. Based on the corresponsive principle of personality development, this study incorporated both dispositional and contextual perspectives to examine longitudinal…

  18. Longitudinal Design Considerations for the Evaluation of Bilingual Programs.

    ERIC Educational Resources Information Center

    Rodriguez-Brown, Flora V.; And Others

    Five elements necessary for the rigorous evaluation of bilingual programs are discussed: (1) careful collection of meaningful baseline data from selected subjects; (2) the identification and development of instruments to measure key variables, such as context and student characteristics; (3) the identification of treatment characteristics, such as…

  19. Longitudinal Evaluation of a Home Economics Education Professional Program.

    ERIC Educational Resources Information Center

    Pestle, Ruth E.

    Improvements in teaching competencies, attitudes toward children, professional commitment, and philosophy of education of 31 vocational home economics teacher education students were measured through four self-evaluations during the last year in college and the first year of teaching. Comparison of mean scores was done by t-tests. Significant…

  20. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    ERIC Educational Resources Information Center

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  1. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    ERIC Educational Resources Information Center

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  2. MPCP Longitudinal Educational Growth Study: Fifth Year Report. SCDP Milwaukee Evaluation Report #29

    ERIC Educational Resources Information Center

    Witte, John F.; Carlson, Deven; Cowen, Joshua M.; Fleming, David J.; Wolf, Patrick J.

    2012-01-01

    This is the final report in a five-year evaluation of the Milwaukee Parental Choice Program (MPCP). This report features analyses of student achievement growth four years after the authors carefully assembled longitudinal study panels of MPCP and Milwaukee Public Schools (MPS) students in 2006-07. The MPCP, which began in 1990, provides…

  3. MPCP Longitudinal Educational Growth Study: Baseline Report. SCDP Milwaukee Evaluation Report #5

    ERIC Educational Resources Information Center

    Witte, John F.; Wolf, Patrick J.; Cowen, Joshua M.; Fleming, David J.; Lucas-McLean, Juanita

    2008-01-01

    This report focuses on the initial design, implementation and baseline results of the five-year Longitudinal Educational Growth Study (LEGS) of the Milwaukee Parental Choice Program (MPCP) being conducted by the School Choice Demonstration Project (SCDP). The LEGS will be the first evaluation of the participant effects of the MPCP using…

  4. A Report on Longitudinal Evaluations of Preschool Programs. Volume II: Is Early Intervention Effective?

    ERIC Educational Resources Information Center

    Bronfenbrenner, Urie

    This document is the second part in a report on longitudinal evaluations of preschool programs. Part I reviewed long-term, controlled studies in order to generally assess the impact of preschool intervention. Part II reviews follow-up data in order to resolve the following five questions: (1) Do children in experimental programs continue to gain…

  5. Improving Mathematics Teacher Education in Germany: Empirical Results from a Longitudinal Evaluation of Innovative Programs

    ERIC Educational Resources Information Center

    Buchholtz, Nils; Kaiser, Gabriele

    2013-01-01

    Innovative programs for restructuring the entry phase of mathematics teacher education programs have been implemented at various German universities within the last few years. This article reports about the design and the results of a longitudinal evaluation study of the effectiveness of two of these programs aiming to improve mathematics teacher…

  6. Improving Mathematics Teacher Education in Germany: Empirical Results from a Longitudinal Evaluation of Innovative Programs

    ERIC Educational Resources Information Center

    Buchholtz, Nils; Kaiser, Gabriele

    2013-01-01

    Innovative programs for restructuring the entry phase of mathematics teacher education programs have been implemented at various German universities within the last few years. This article reports about the design and the results of a longitudinal evaluation study of the effectiveness of two of these programs aiming to improve mathematics teacher…

  7. Models Matter--The Final Report of the National Longitudinal Evaluation of Comprehensive School Reform

    ERIC Educational Resources Information Center

    Aladjem, Daniel K.; LeFloch, Kerstin Carlson; Zhang, Yu; Kurki, Anja; Boyle, Andrea; Taylor, James E.; Herrmann, Suzannah; Uekawa, Kazuaki; Thomsen, Kerri; Fashola, Olatokunbo

    2006-01-01

    The National Longitudinal Evaluation of Comprehensive School Reform (NLECSR) is a quantitative and qualitative study of behavior, decisions, processes, and outcomes. It employs a quasi-experimental design with matched treatment and comparison schools. NLECSR seeks to determine the effects of CSR models on student achievement in about 650…

  8. Evaluation of "The First Tee" in Promoting Positive Youth Development: Group Comparisons and Longitudinal Trends

    ERIC Educational Resources Information Center

    Weiss, Maureen R.; Bolter, Nicole D.; Kipp, Lindsay E.

    2016-01-01

    Purpose: This manuscript represents the 3rd in a series of articles documenting our longitudinal evaluation of "The First Tee," a physical activity-based youth development program that uses golf as a vehicle for teaching life skills and enhancing developmental outcomes. Previous phases of our project: (a) established initial data-based…

  9. Evaluation of "The First Tee" in Promoting Positive Youth Development: Group Comparisons and Longitudinal Trends

    ERIC Educational Resources Information Center

    Weiss, Maureen R.; Bolter, Nicole D.; Kipp, Lindsay E.

    2016-01-01

    Purpose: This manuscript represents the 3rd in a series of articles documenting our longitudinal evaluation of "The First Tee," a physical activity-based youth development program that uses golf as a vehicle for teaching life skills and enhancing developmental outcomes. Previous phases of our project: (a) established initial data-based…

  10. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Alcohol and Other Drug Use among Adolescents: Evaluation of a Pediatric Residency Curriculum

    ERIC Educational Resources Information Center

    Ryan, Sheryl A.; Martel, Shara; Pantalon, Michael; Martino, Steve; Tetrault, Jeanette; Thung, Stephen F.; Bernstein, Steven L.; Auinger, Peggy; Green, Michael L.; Fiellin, David A.; O'Connor, Patrick G.; D'Onofrio, Gail

    2012-01-01

    The objective of this study was to evaluate the integration of a screening, brief intervention, and referral to treatment (SBIRT) curriculum for alcohol and other drug use into a pediatric residency program. Pediatric and medicine/pediatric residents in an adolescent medicine rotation located in an urban teaching hospital participated in the…

  11. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Alcohol and Other Drug Use among Adolescents: Evaluation of a Pediatric Residency Curriculum

    ERIC Educational Resources Information Center

    Ryan, Sheryl A.; Martel, Shara; Pantalon, Michael; Martino, Steve; Tetrault, Jeanette; Thung, Stephen F.; Bernstein, Steven L.; Auinger, Peggy; Green, Michael L.; Fiellin, David A.; O'Connor, Patrick G.; D'Onofrio, Gail

    2012-01-01

    The objective of this study was to evaluate the integration of a screening, brief intervention, and referral to treatment (SBIRT) curriculum for alcohol and other drug use into a pediatric residency program. Pediatric and medicine/pediatric residents in an adolescent medicine rotation located in an urban teaching hospital participated in the…

  12. Longitudinal evaluation of the seal of IRM root end fillings.

    PubMed

    Crooks, W G; Anderson, R W; Powell, B J; Kimbrough, W F

    1994-05-01

    IRM has been recommended for root end filling during endodontic surgery. This study evaluated the seal of IRM root end fillings prepared with various powder to liquid ratios (P:L) at extended time intervals using a fluid filtration method. The P:L of IRM evaluated included 2, 3, 4, 5, and 6 g/ml and the P:L which resulted from the manufacturer's recommended scoop and dropper. Ten teeth were evaluated for microleakage for each group at 1, 2, 3, 4, 8, and 12 wk after insertion. There were no significant differences in the microleakage of any of the various P:L groups at weeks 3, 8, and 12. These results suggest that higher P:L of IRM than those previously recommended for temporary restorations and for endodontic access preparations may be acceptable for root end fillings. IRM of higher P:L has other advantages such as ease of placement and decreased setting time, toxicity, and solubility.

  13. Sudden arrhythmic death syndrome: diagnostic yield of comprehensive clinical evaluation of pediatric first-degree relatives.

    PubMed

    Giudici, Valentina; Spanaki, Adriani; Hendry, Jennifer; Mead-Regan, Sarah; Field, Ella; Zuccotti, Gian Vincenzo; Abrams, Dominic; Lowe, Martin; Kaski, Juan Pablo

    2014-12-01

    Sudden arrhythmic death syndrome (SADS) is most often caused by heritable cardiac diseases. Studies in adults have identified evidence of inherited cardiovascular diseases in up to 53% of families, but data on the prevalence of familial disease in children are scarce. The aim of this study was to evaluate the yield of clinical screening in pediatric first-degree relatives of victims of SADS using a systematic and comprehensive protocol. Patients referred for family screening after sudden cardiac death (SCD) of a family member were, retrospectively, enrolled into the study. Systematic evaluation of the children included clinical examination, family history, electrocardiogram (ECG), echocardiogram, 24-hour tape, and signal-averaged ECG. Older patients also underwent exercise testing, cardiac magnetic resonance imaging, and ajmaline provocation testing. A total of 90 children from 52 consecutive families were included in the study. An inherited cardiac disease was identified in seven first-degree children from seven (13.5%) families (five children were diagnosed with Brugada syndrome, one with long QT syndrome, and one with catecholaminergic polymorphic ventricular tachycardia). Two further children had late potentials on signal-averaged ECGs with no other abnormalities. These data show a high prevalence of inherited heart disease in pediatric first-degree relatives of SADS victims. The results highlight the importance of a systematic, comprehensive approach and ongoing screening of pediatric family members. ©2014 Wiley Periodicals, Inc.

  14. Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order?

    PubMed

    Sadeq, Hussain; Karim, Jumanah; Marwan, Yousef; AlSaleem, Talal

    2016-01-01

    To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure. We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data. Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease. In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures. © 2015 S. Karger AG, Basel.

  15. Ultrasonography and magnetic resonance imaging evaluation of pediatric spinal anomalies

    PubMed Central

    Dhingani, Dhaval Durlabhbhai; Boruah, Deb Kumar; Dutta, Hemonta Kumar; Gogoi, Rudra Kanta

    2016-01-01

    Context: Spinal dysraphisms are congenital abnormalities of the spine due to imperfect fusion of midline mesenchymal, bony and neural structures. Imaging plays a vital role in their evaluation as significant portion of patients may present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries. Aims: The aims of the study were to evaluate Spinal dysraphisms using USG and MRI and to correlate imaging findings with operative findings in patients undergoing surgery. Settings and Design: Hospital based observational study conducted over a period of year. Materials and Methods: 38 cases of both sexes and below 12 years of age with spinal dysraphism were studied. USG was performed in 29 cases where acoustic window was available for proper evaluation. MRI was performed in all cases. USG findings were compared with MRI findings and operative follow up was taken in 23 cases who underwent operative management. Statistical Analysis Used: Results were analysed using percentage and arithmetic mean. Results: 39.47 % cases were male and 60.53 % cases were female. Neonatal period was the most common presenting age group. Closed spinal dysraphism (63.16%) was more common than open (36.84%). 79.31% cases showed full agreement between spinal USG and MRI examinations and 6 out of 20.69% showed partial agreement. On operative correlation, USG findings were confirmatory in 91.30% cases and MRI findings were confirmatory in 100% cases. Conclusions: USG can be used as the initial modality for evaluation of spinal dysraphism as well as for screening of suspected cases. MRI is indicated to confirm abnormal USG findings, which shows all concurrent abnormalities and also provides additional anatomical details relevant to surgical planning. PMID:27857788

  16. Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

    PubMed Central

    Distelberg, Brian; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne; Pandit, Mayuri

    2015-01-01

    Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness. PMID:24635346

  17. Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND).

    PubMed

    Distelberg, Brian; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne; Pandit, Mayuri

    2014-06-01

    Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness. © 2014 FPI, Inc.

  18. Evaluation of the conjoint efficacy in Chinese medicine with the longitudinal latent variable linear mixed model.

    PubMed

    Yi, Dan-Hui; Li, Yang; Shao, Shu-Xin; Xie, Yan-Ming; Yuwen, Ya

    2013-08-01

    Chinese medicine (CM) clinical efficacy evaluation research involves the longitudinal multivariate measurement which means that patients are measured repeatedly and each patient is measured by several indicators on each fixed cross-section. Although each indicator can be evaluated separately with a longitudinal linear mixed model, it is important to consider all the endpoints together especially when researchers pay special attention to the change of the conjoint efficacy for several indicators in one patient. In this article, we introduce a latent variable linear mixed model to the CM conjoint efficacy evaluation and discuss why and how to analyze the longitudinal multivariate endpoint data in the clinical CM efficacy evaluation research. It may lead to the new insight of using such methodology in the field of conjoint efficacy evaluating of CM study. And with the definition of syndrome and symptom in the CM theory, the applied discussion brings the insight of CM syndrome evaluating in future. We illustrate this methodology using an example of CM efficacy evaluation from an ischemic stroke research.

  19. Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

    PubMed

    Faudeux, Camille; Tran, Antoine; Dupont, Audrey; Desmontils, Jonathan; Montaudié, Isabelle; Bréaud, Jean; Braun, Marc; Fournier, Jean-Paul; Bérard, Etienne; Berlengi, Noémie; Schweitzer, Cyril; Haas, Hervé; Caci, Hervé; Gatin, Amélie; Giovannini-Chami, Lisa

    2017-09-01

    To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Clinical diagnoses and antimicrobials predictive of pediatric antimicrobial stewardship recommendations: a program evaluation.

    PubMed

    Goldman, Jennifer L; Lee, Brian R; Hersh, Adam L; Yu, Diana; Stach, Leslie M; Myers, Angela L; Jackson, Mary Anne; Day, James C; McCulloh, Russell J; Newland, Jason G

    2015-06-01

    The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies. To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP. Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital. ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician. The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections. Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.

  1. Pediatric and Adolescent Gynecology Education through Simulation (PAGES): Development and Evaluation of a Simulation Curriculum.

    PubMed

    Damle, Lauren F; Tefera, Eshetu; McAfee, Julie; Loyd, Mary K; Jackson, Allison M; Auguste, Tamika C; Gomez-Lobo, Veronica

    2015-06-01

    Develop a Pediatric and Adolescent Gynecology (PAG) curriculum, appropriate pelvic model for teaching examination skills, and an objective structured clinical examination (OSCE) for evaluation. Compare OSCE performance between residents with clinical training in PAG vs those that completed the curriculum vs those without either experience. Prospective cohort study. Obstetrics and Gynecology (Ob/Gyn) residency program in an urban academic center. Senior Ob/Gyn residents. A simulation-based teaching curriculum was created to teach PAG skills. A pediatric mannequin with anatomic pre-pubertal genitalia was developed for teaching and assessment of skills. Performance on a PAG-based OSCE as assessed by 2 observers using a 40 point checklist. 17 residents participated in the OSCE; 5 completed the curriculum, 6 completed a clinical rotation, and 6 were controls. The teaching curriculum group had the highest median composite OSCE score (75.0%) compared to the clinical group (73.1%) and control group (55.3%). There was no statistical difference between the scores of the teaching and clinical groups, but the teaching group scored statistically higher than controls (P = .0331). Scores for each OSCE component were compared. The teaching and clinical groups outperformed controls on assessment and procedures. There was no difference in scores on history taking or physical examination. An interactive teaching curriculum incorporating simulation and a realistic pediatric pelvic model can be used to teach PAG clinical skills. Using an OSCE to evaluate skills shows that residents completing the curriculum perform as well as those with clinical experience and better than controls. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  2. Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

    PubMed Central

    Goldman, Jennifer L.; Lee, Brian R.; Hersh, Adam L.; Yu, Diana; Stach, Leslie M.; Myers, Angela L.; Jackson, Mary Anne; Day, James C.; McCulloh, Russell J.; Newland, Jason G.

    2015-01-01

    BACKGROUND The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies. OBJECTIVE To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP. DESIGN AND SETTING Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital. METHODS ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician. RESULTS The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections. CONCLUSIONS Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy. PMID:25773192

  3. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department.

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

    The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities.

  4. Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study

    PubMed Central

    Jaremko, Jacob Lester; Siminoski, Kerry; Firth, Gregory; Matzinger, Mary Ann; Shenouda, Nazih; Konji, Victor N.; Roth, Johannes; Sbrocchi, Anne Marie; Reed, Martin; O’Brien, Kathleen; Nadel, Helen; McKillop, Scott; Kloiber, Reinhard; Dubois, Josée; Coblentz, Craig; Charron, Martin; Ward, Leanne M.

    2015-01-01

    Children with glucocorticoid-treated illnesses are at risk for osteoporotic vertebral fractures and growing awareness has led to increased monitoring for these fractures. However scant literature describes developmental changes in vertebral morphology that can mimic fractures. The goal of this paper is to aid in distinguishing between normal variants and fractures. We illustrate differences using lateral spine radiographs obtained annually from children recruited to the Canada-wide STeroid-Associated Osteoporosis in the Pediatric Population (STOPP) observational study, in which 400 children with glucocorticoid-treated leukemia, rheumatic disorders, and nephrotic syndrome were enrolled near glucocorticoid initiation and followed prospectively for 6 years. Normal variants mimicking fractures exist in all regions of the spine and fall into two groups. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiologic beaking, and spondylolisthesis associated with shortened posterior vertebral height. The second group includes variants mimicking other radiologic signs of fractures: anterior vertebral artery groove resembling an anterior buckle fracture, Cupid’s bow balloon disk morphology, Schmorl nodes mimicking concave endplate fractures, and parallax artifact resembling endplate interruption or biconcavity. If an unexpected vertebral body contour is detected, careful attention to its location, detailed morphology, and (if available) serial changes over time may clarify whether it is a fracture requiring change in management or simply a normal variant. Awareness of the variants described in this paper can improve accuracy in the diagnosis of pediatric vertebral fractures. PMID:25828359

  5. Longitudinal study of parent caregiving self-efficacy and parent stress reactions with pediatric cancer treatment procedures.

    PubMed

    Harper, Felicity W K; Peterson, Amy M; Uphold, Heatherlun; Albrecht, Terrance L; Taub, Jeffrey W; Orom, Heather; Phipps, Sean; Penner, Louis A

    2013-07-01

    Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. We examined relationships between parents' caregiving self-efficacy, parents' affect in response to their children's cancer-related treatment procedures, and parents' symptoms of post-traumatic stress at follow-up. Participants were 75 pediatric cancer patients and parents. On the day of each of three procedures (i.e., port-start, lumbar puncture, or bone marrow aspiration), parents rated their self-efficacy for six caregiving goals. Parents also self-reported their negative affect (i.e., state anxiety, negative mood, and distress) in response to each procedure. Three months after the last procedure, parents reported their level of post-traumatic stress symptoms (PTSS). Higher parent self-efficacy about keeping children calm before treatment and/or keeping children calm during the procedure was associated with lower state anxiety. Self-efficacy for keeping the child calm during procedures was significantly correlated with distress in parents at the time of procedures, and self-efficacy for keeping the child calm before procedures was significantly correlated with PTSS. All three negative affect measures significantly mediated the effects of parents' caregiving self-efficacy for both goals on parents' PTSS 3 months later. Parents' caregiving self-efficacy influences their immediate and longer-term distress reactions to their children's treatment procedures. These findings provide a more nuanced understanding of how parents' cognitions contribute to their ability to cope with their children's treatment and suggest the benefit of an intervention that targets parents' procedure-specific caregiver self-efficacy. Copyright © 2012 John Wiley & Sons, Ltd.

  6. High prevalence of elevated molybdenum levels in pediatric CKD patients. A cross-sectional and longitudinal study
.

    PubMed

    Filler, Guido; Belostotsky, Vladimir; Kobrzynski, Marta; Huang, Shih-Han S; Yang, Liju

    2017-08-01

    Many of the secondary effects of high levels of molybdenum (Mo) overlap with symptoms commonly seen in pediatric patients with chronic kidney disease (CKD). We measured plasma Mo levels and examined the relationship between Mo levels and kidney function. The study was carried out at the London Health Sciences Centre in London, Ontario, Canada with 36 children and adolescents 4 - 18 years of age with CKD. There were 1 - 6 trace element measurements (Mo and copper (Cu)) per patient. We studied the proportion of patients with abnormal trace element levels and the relationship between trace element levels and estimated glomerular filtration rate (eGFR), calculated using the Filler formula. Plasma Mo and Cu levels were measured using High Resolution Sector Field Inductively Coupled Mass Spectrometry. Anthropomorphic data and blood parameters were collected from our electronic chart program. Median eGFR was 51 mL/min/1.73m2 (35, 75). Median Mo level was 2.00 µg/L (1.40, 2.88). 20 patients had at least one set of Mo levels above the published reference interval in either unit, and the results of 46% of the tests were above the interval. There was a strong negative correlation between the Mo levels and the eGFR (Spearman's r = -0.627, p < 0.0001). Our study suggests that pediatric patients with CKD have elevated plasma levels of Mo, which may cause secondary effects commonly associated with CKD. The elevated Mo levels in our center's catchment area may cause an accumulation of this trace element in patients with impaired renal function.
.

  7. Longitudinal study of parent caregiving self-efficacy and parent stress reactions with pediatric cancer treatment procedures

    PubMed Central

    Harper, Felicity W. K.; Peterson, Amy M.; Uphold, Heatherlun; Albrecht, Terrance L.; Taub, Jeffrey W.; Orom, Heather; Phipps, Sean; Penner, Louis A.

    2013-01-01

    Background Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. We examined relationships between parents’ caregiving self-efficacy, parents’ affect in response to their children’s cancer-related treatment procedures, and parents’ symptoms of post-traumatic stress at follow-up. Methods Participants were 75 pediatric cancer patients and parents. On the day of each of three procedures (i.e., port-start, lumbar puncture, or bone marrow aspiration), parents rated their self-efficacy for six caregiving goals. Parents also self-reported their negative affect (i.e., state anxiety, negative mood, and distress) in response to each procedure. Three months after the last procedure, parents reported their level of post-traumatic stress symptoms (PTSS). Results Higher parent self-efficacy about keeping children calm before treatment and/or keeping children calm during the procedure was associated with lower state anxiety. Self-efficacy for keeping the child calm during procedures was significantly correlated with distress in parents at the time of procedures, and self-efficacy for keeping the child calm before procedures was significantly correlated with PTSS. All three negative affect measures significantly mediated the effects of parents’ caregiving self-efficacy for both goals on parents’ PTSS 3 months later. Conclusions Parents’ caregiving self-efficacy influences their immediate and longer-term distress reactions to their children’s treatment procedures. These findings provide a more nuanced understanding of how parents’ cognitions contribute to their ability to cope with their children’s treatment and suggest the benefit of an intervention that targets parents’ procedure-specific caregiver self-efficacy. PMID:23034930

  8. Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study.

    PubMed

    Jaremko, Jacob L; Siminoski, Kerry; Firth, Gregory B; Matzinger, Mary Ann; Shenouda, Nazih; Konji, Victor N; Roth, Johannes; Sbrocchi, Anne Marie; Reed, Martin H; O'Brien, Mary Kathleen; Nadel, Helen; McKillop, Scott; Kloiber, Reinhard; Dubois, Josée; Coblentz, Craig; Charron, Martin; Ward, Leanne M

    2015-04-01

    Children with glucocorticoid-treated illnesses are at risk for osteoporotic vertebral fractures, and growing awareness of this has led to increased monitoring for these fractures. However scant literature describes developmental changes in vertebral morphology that can mimic fractures. The goal of this paper is to aid in distinguishing between normal variants and fractures. We illustrate differences using lateral spine radiographs obtained annually from children recruited to the Canada-wide STeroid-Associated Osteoporosis in the Pediatric Population (STOPP) observational study, in which 400 children with glucocorticoid-treated leukemia, rheumatic disorders, and nephrotic syndrome were enrolled near glucocorticoid initiation and followed prospectively for 6 years. Normal variants mimicking fractures exist in all regions of the spine and fall into two groups. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly, which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiological beaking, or spondylolisthesis associated with shortened posterior vertebral height. The second group includes variants mimicking other radiologic signs of fractures: anterior vertebral artery groove resembling an anterior buckle fracture, Cupid's bow balloon disk morphology, Schmorl nodes mimicking concave endplate fractures, and parallax artifact resembling endplate interruption or biconcavity. If an unexpected vertebral body contour is detected, careful attention to its location, detailed morphology, and (if available) serial changes over time may clarify whether it is a fracture requiring change in management or simply a normal variant. Awareness of the variants described in this paper can improve accuracy in the diagnosis of pediatric vertebral fractures.

  9. Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference

    PubMed Central

    Frankovich, Jennifer; Cooperstock, Michael; Cunningham, Madeleine W.; Latimer, M. Elizabeth; Murphy, Tanya K.; Pasternack, Mark; Thienemann, Margo; Williams, Kyle; Walter, Jolan; Swedo, Susan E.

    2015-01-01

    Abstract On May 23 and 24, 2013, the First PANS Consensus Conference was convened at Stanford University, calling together a geographically diverse group of clinicians and researchers from complementary fields of pediatrics: General and developmental pediatrics, infectious diseases, immunology, rheumatology, neurology, and child psychiatry. Participants were academicians with clinical and research interests in pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) in youth, and the larger category of pediatric acute-onset neuropsychiatric syndrome (PANS). The goals were to clarify the diagnostic boundaries of PANS, to develop systematic strategies for evaluation of suspected PANS cases, and to set forth the most urgently needed studies in this field. Presented here is a consensus statement proposing recommendations for the diagnostic evaluation of youth presenting with PANS. PMID:25325534

  10. Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?

    PubMed

    Erdag, Taner K; Ecevit, M Cenk; Guneri, E Alpin; Dogan, Ersoy; Ikiz, Ahmet O; Sutay, Semih

    2005-10-01

    To evaluate the necessity of histopathologic examination for routine tonsillectomy and/or adenoidectomy in terms of unexpected malignancy by evaluating a large group of pediatric patients retrospectively with review of the literature. A retrospective chart review of all patients under the age of 19 who underwent tonsillectomy and/or adenoidectomy between January 1990 and January 2005 was carried out. The records were analyzed concerning each patient's age, sex, indication for surgery, type of surgical procedure and the result of histopathologic examination of the specimen. The patients operated for chronic or recurrent infections and obstructive hypertrophy were included in the study. Moreover, the English literature was searched in Medline for articles published between 1949 and March 2005 and the studies dealing with pathologic analysis of tonsillectomy and/or adenoidectomy specimens were reviewed. The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from 1 to 18 years (mean: 7.53) were reviewed. There were 1534 males (56%) and 1209 females (44%). Tonsillectomy and adenoidectomy were performed together on 1930 patients (70%) while tonsillectomy and adenoidectomy alone were performed on 287 (10%) and 526 (20%) patients, respectively. Evaluation of the pathology reports revealed no malignancies. Review of the literature identified 14 articles and 5 of them included only pediatric patients. The rate of unexpected malignancies observed in these pediatric series varied between 0 and 0.18%. After being evaluated by an experienced otolaryngologist, pathologic evaluation of all specimens may not be necessary if a child undergoing routine tonsillectomy and/or adenoidectomy is not found to have certain preoperative risk factors.

  11. CT Angiography in Pediatric Extremity Trauma: Preoperative Evaluation Prior to Reconstructive Surgery

    PubMed Central

    Hsu, Charles S.; Hellinger, Jeffrey C.; Rubin, Geoffrey D.

    2007-01-01

    Computed tomographic angiography (CTA) is a noninvasive modality for evaluating the vascular system and planning treatment strategies. The goal of this study was to validate the clinical utility of CTA in assessment of suspected pediatric extremity traumatic vascular injury, prior to emergent and delayed reconstructive surgery. A retrospective review was performed of all operative patients under 18 years of age who underwent multidetector-row CTA for evaluation of suspected extremity vascular injury. Parameters investigated included age, type of injury, referral source, temporal relationship between the injury and the CTA, CTA findings, operations performed, intraoperative findings, and clinical outcome. Between January 2002 and September 2005, 10 pediatric patients (6 males/4 females; mean age 8 years old, range 3–17) sustained either blunt (N = 8) or penetrating (N = 2) trauma and underwent CTA of the upper (N = 5) or lower extremities (N = 5). A total of 30% (3/10) of patients were referred from the emergency department acutely, 50% (5/10) were referred from the inpatient wards subacutely, and 20% (2/10) were referred from the outpatient clinics electively. Half (N = 5) underwent CTA to evaluate need for vascular repair, whereas half (N = 5) underwent CTA to evaluate local vasculature for flap reconstruction. Overall, 40% (4/10) of CTA findings were normal, whereas 60% (6/10) revealed traumatic vascular injuries. Pertinent nonvascular findings included soft tissue defects (60%, 6/10), fractures (40%, 4/10), and contracture deformities (20%, 2/10). In all cases, procedures were completed without complications, and intraoperative findings confirmed those from CTA. At a mean follow-up of 28 months, all injuries have healed without complications. CTA is a reliable noninvasive modality to evaluate pediatric patients with suspected traumatic extremity vascular injury and to plan treatment strategies for both vascular repair and extremity

  12. REDUCE-PCP study: radiographs in the emergency department utilization criteria evaluation-pediatric chest pain.

    PubMed

    Neff, Justin; Anderson, Melanie; Stephenson, Trent; Young, Joe; Hennes, Halim; Suter, Robert

    2012-05-01

    Many emergency physicians order chest x-rays (CXRs) for pediatric patients who present with a chief complaint of chest pain despite a paucity of research to support this testing, which exposes patients to radiation, cost, and delays. This study aimed to begin development of a decision making tool that will allow emergency physicians to selectively obtain CXR films in pediatric patients presenting with chest pain. We performed a retrospective cohort study of 400 consecutive pediatric patients with a chief complaint of chest pain and reviewed charts to determine how many received a CXR and which clinical characteristics were present in all patients. Chest radiograph findings were graded for significance as follows: (1) no or minor clinical significance: normal result in the CXR film without effect on the immediate evaluation of a patient; (2) moderate clinical significance: only impact on plan for follow-up; and (3) major clinical significance: result in the CXR film directly affects immediate management. We then evaluated each chart for historical or examination findings that might identify criteria associated with positive radiographic findings to propose a set of criteria that could lead to the development of a decision rule that allows a reduced utilization while having a high sensitivity for clinically significant positive findings on CXR film. Of the 400 pediatric patients reviewed, 63.5% (n = 254) received a CXR in the emergency department (ED). Of those receiving a CXR, only 8.26% (n = 21) had a finding that affected either ED management or follow-up planning. The criteria that would have identified all patients with positive results in the CXR films were abnormal vital signs, shortness of breath, palpitations, presence of comorbidities, abnormal or unilateral breath sounds, history of trauma, murmur, or cough. This pilot study demonstrates the potential for a decision rule to eliminate both cost and radiation exposure by using defined criteria to determine

  13. Self-exclusion program: a longitudinal evaluation study.

    PubMed

    Ladouceur, Robert; Sylvain, Caroline; Gosselin, Patrick

    2007-03-01

    Few self-exclusion programs have been evaluated and their long-term impact remains unknown. This study has two main goals: (1) to assess changes in gambling behaviour and gambling problems for self-excluded patrons, and (2) to follow self-excluded gamblers for a two-year period (during and after the self-exclusion period). Individuals who excluded themselves (N = 161 at the initial stage) participated in telephone interviews after signing the self-exclusion agreement and were followed at 6, 12, 18 and 24-months. Results show that according to the DSM-IV, 73.1% of the participants were pathological gamblers. The self-exclusion program has many positive effects. During the follow-ups, the urge to gamble was significantly reduced while the perception of control increased significantly for all participants. The intensity of negative consequences for gambling was significantly reduced for daily activities, social life, work, and mood. The DSM score was significantly reduced over time. This reduction also took place between the baseline and the 6-month follow-up. The clinical implications of the results are discussed in relation to the effectiveness of the program. Suggestions are provided in order to increase compliance of self-excluded patrons.

  14. Longitudinal Study Evaluating Postural Balance of Young Athletes.

    PubMed

    Steinberg, Nili; Nemet, Dan; Pantanowitz, Michal; Zeev, Aviva; Hallumi, Monder; Sindiani, Mahmood; Meckel, Yoav; Eliakim, Alon

    2016-02-01

    Repeated anaerobic conditions during athletic performance may cause general and local fatigue that result in postural balance deficit. Evidence suggests that improved postural balance during athletic training may decrease the risk for fallings and traumatic injuries among athletes. Twenty athletes (12 girls, 8 boys) and 20 controls (12 girls, 8 boys) ages 10-15 years participated in the current study. All athletes were active in an 8-month physical activity program, 3 times per week for 90 min., specific to basketball, soccer, or athletic training. The control children participated in physical education at school only, with no involvement in organized extracurricular sports. All participants were evaluated for postural balance in three assessments over one year (at 4-mo intervals); the Interactive Balance System machine (Tetrax device) was used to assess balance at three test times (pre-, post-, and 10 min) after a session of a repeated sprint anaerobic test, consisting of 12 × 20 m run starting every 20 sec. The athletes had better postural balance than controls. There were different group patterns of change over the sessions; a significant interaction of session and group indicated that postural balance of the groups differed. The contribution of low sway frequencies (F1) and high sway frequencies (F6) differed between the controls and the athletes group. Results suggested that although athletes had better postural balance, improvement should be encouraged during training over the sessions and seasons, with special awareness of the balance deficit that occurs immediately after anaerobic stress and at the end of the season, to decrease the risk of injuries. © The Author(s) 2016.

  15. Evaluation and comparison of a 1-month versus a 2-week community pediatrics and advocacy rotation for pediatric residents.

    PubMed

    Delago, Cynthia; Gracely, Edward

    2007-11-01

    This prospective study was conducted to assess the effects of a 4-week community pediatrics and advocacy rotation with a unique project (Curriculum A), a 2-week community pediatrics rotation with advocacy training and unique project throughout residency (Curriculum B), or no curriculum exposure on residents' attitudes, perceived competence, knowledge, and behaviors. A 27-item questionnaire was used to assess attitudes, competence, and knowledge. Examination of residents' patients' use of Early Intervention services during the 5-year period after curricula introduction assessed behaviors. Seventy percent of questionnaires distributed over several years were completed by 105 of 111 eligible residents. Residents exposed to Curriculum A or B demonstrated improved competence and knowledge but no significant increase in positive attitudes toward community pediatrics and advocacy. Residents' patients' use of Early Intervention services increased 65% during the 5-year period after curriculum introduction. No significant differences in outcome measures were observed between Curriculum A and Curriculum B.

  16. Evaluation of isoamyl 2-cyanoacrylate tissue adhesive in management of pediatric lacerations: An alternative to suturing

    PubMed Central

    Devrukhkar, Vishakha N.; Hegde, Rahul J.; Khare, Sumedh S.; Saraf, Tanvi A.

    2015-01-01

    Aims: A study was conducted to evaluate the benefits of cyanoacrylate tissue adhesive as an alternative to suturing in management of pediatric lacerations. Materials and Methods: A total of 7 patients were evaluated and followed for 3-month. The wound was evaluated on 1st, 3rd, and 7th postoperative day for swelling, infection, gaping and pain and at 1st and 3rd postoperative month for scar evaluation. The evaluation was based on different superficial facial wound repairs (i.e., low tension) with an average length <3 cm; and if the surgeon subjectively felt that subcuticular sutures were justified to reduce wound tension, then these were used. Isoamyl 2-cyanoacrylate glue was applied over lacerated wound margins after cleaning the wound and holding together for 15 s by means of tissue holding forceps. Statistical Analysis: Statistical analysis was done using Chi-square test after collection of data. Mean and standard error were estimated from the sample. Results: The mean total time taken for skin closure was 1–2.5 min. There was no wound infection in any of the cases; only one case showed wound dehiscence on 3rd postoperative day. The cosmetic was better as there were no suture marks. Conclusion: Isoamyl 2-cyanoacrylate can be considered as excellent “no needle” alternative for closure of selected pediatric lacerations, those that are short, clean and under low tension. PMID:26389034

  17. Approaching zero: Implications of a computed tomography reduction program for pediatric appendicitis evaluation.

    PubMed

    Anderson, K Tinsley; Bartz-Kurycki, Marisa; Austin, Mary T; Kawaguchi, Akemi; John, Susan D; Kao, Lillian S; Tsao, KuoJen

    2017-09-05

    Because of awareness of iatrogenic radiation exposure, there is a national trend of diminishing computed tomography (CT) use for pediatric suspected appendicitis. The purpose of this study was to evaluate the effects of a CT reduction program for evaluation of appendicitis. A multidisciplinary group (emergency medicine, radiology, and surgery) at a children's hospital developed a reduction program which included: ultrasound (U/S) first (2012), magnetic resonance imaging (MRI) second (2014), and standardized U/S reports (2016). Imaging modality, negative appendectomy rate, time from first image to incision, and imaging costs were evaluated over time. Of the 571 patients evaluated from 2012 to 2016, there was a significant decrease in CT use and increase U/S and MRI use over the study period (all p<0.01). CT use approached zero in 2016. Time from first image to incision (median 10.7h, IQR 5.6-15.5) and negative appendectomy rate (mean 3.7±0.2%) did not change. Median imaging costs ($88, IQR $52-$169) and radiology percent of total costs (range 0.8%-3.9%) increased over time (both p<0.01). Approaching zero CT use for evaluation of pediatric appendicitis is possible through a multidisciplinary protocol without impacting clinical outcomes. However, increased MRI use led to higher costs. Cost-effectiveness of replacing CT with MRI warrants further study. Retrospective comparative study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies.

    PubMed

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period.

  19. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    PubMed Central

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period. PMID:27147865

  20. Evaluation of pediatric abdominal masses by fine-needle aspiration cytology: a clinicoradiologic approach.

    PubMed

    Viswanathan, Seethalakshmi; George, Sophia; Ramadwar, Mukta; Medhi, Seema; Arora, Brijesh; Kurkure, Purna

    2010-01-01

    The pathologist forms a very important part of the clinical team in the management of pediatric intra-abdominal masses in giving a rapid, accurate diagnosis for these potentially curable tumors. Fine-needle aspiration cytology (FNAC) is an invaluable tool in this regard when interpreted with clinicoradiologic parameters. With this in mind, we decided to evaluate the role of FNAC in pediatric abdominal masses in our institution. A total of 83 of 105 FNAC accessioned in the pathology department over 5 years (2003-2007) were studied. These included only cases where a diagnosis could be offered on cytology. Detailed clinicoradiological features were obtained from hospital records. Cytomorphological features examined included cellularity, architectural pattern, background, key cellular details. Immunocytochemistry were done where necessary. Lesions diagnosed on FNAC included Wilms' tumor (19), lymphoma (10), neuroblastoma (6), hepatoblastoma (5), PNET (5), rhabdomyosarcoma (2), DSRCT (2), germ cell tumor (6), and miscellaneous tumors (7). Definite diagnosis could be offered on cytomorphology in 74.7% (62) cases, while in 25.3% (21) cases only a diagnosis of round cell tumor could be offered. Concordance with final histopathology and biochemical parameters was subsequently obtained in 79/83 (95.5%) of cases. A clinically relevant classification is possible on FNAC in pediatric abdominal tumors when interpreted with clinicoradiologic parameters. This obviates the need for a more time-consuming biopsy procedure in critical situations and in stage II nephroblastoma where it is contraindicated. (c) 2009 Wiley-Liss, Inc.

  1. Development of Anxiety Disorders in a Traumatized Pediatric Population: A Preliminary Longitudinal Evaluation

    ERIC Educational Resources Information Center

    Cortes, Adriana M.; Saltzman, Kassey M.; Weems, Carl F.; Regnault, Heather P.; Reiss, Allan L.; Carrion, Victor G.

    2005-01-01

    Objective: The current study was conducted to determine if post-traumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma. Methods: Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder…

  2. Development of Anxiety Disorders in a Traumatized Pediatric Population: A Preliminary Longitudinal Evaluation

    ERIC Educational Resources Information Center

    Cortes, Adriana M.; Saltzman, Kassey M.; Weems, Carl F.; Regnault, Heather P.; Reiss, Allan L.; Carrion, Victor G.

    2005-01-01

    Objective: The current study was conducted to determine if post-traumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma. Methods: Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder…

  3. The Ling 6(HL) test: typical pediatric performance data and clinical use evaluation.

    PubMed

    Glista, Danielle; Scollie, Susan; Moodie, Sheila; Easwar, Vijayalakshmi

    2014-01-01

    The Ling 6(HL) test offers a calibrated version of naturally produced speech sounds in dB HL for evaluation of detection thresholds. Aided performance has been previously characterized in adults. The purpose of this work was to evaluate and refine the Ling 6(HL) test for use in pediatric hearing aid outcome measurement. This work is presented across two studies incorporating an integrated knowledge translation approach in the characterization of normative and typical performance, and in the evaluation of clinical feasibility, utility, acceptability, and implementation. A total of 57 children, 28 normally hearing and 29 with binaural sensorineural hearing loss, were included in Study 1. Children wore their own hearing aids fitted using Desired Sensation Level v5.0. Nine clinicians from The Network of Pediatric Audiologists participated in Study 2. A CD-based test format was used in the collection of unaided and aided detection thresholds in laboratory and clinical settings; thresholds were measured clinically as part of routine clinical care. Confidence intervals were derived to characterize normal performance and typical aided performance according to hearing loss severity. Unaided-aided performance was analyzed using a repeated-measures analysis of variance. The audiologists completed an online questionnaire evaluating the quality, feasibility/executability, utility/comparative value/relative advantage, acceptability/applicability, and interpretability, in addition to recommendation and general comments sections. Ling 6(HL) thresholds were reliably measured with children 3-18 yr old. Normative and typical performance ranges were translated into a scoring tool for use in pediatric outcome measurement. In general, questionnaire respondents generally agreed that the Ling 6(HL) test was a high-quality outcome evaluation tool that can be implemented successfully in clinical settings. By actively collaborating with pediatric audiologists and using an integrated

  4. Reliability and validity of pediatric triage tools evaluated in Low resource settings: a systematic review.

    PubMed

    Hansoti, Bhakti; Jenson, Alexander; Keefe, Devin; De Ramirez, Sarah Stewart; Anest, Trisha; Twomey, Michelle; Lobner, Katie; Kelen, Gabor; Wallis, Lee

    2017-01-26

    Despite the high burden of pediatric mortality from preventable conditions in low and middle income countries and the existence of multiple tools to prioritize critically ill children in low-resource settings, no analysis exists of the reliability and validity of these tools in identifying critically ill children in these scenarios. The authors performed a systematic search of the peer-reviewed literature published, for studies pertaining to for triage and IMCI in low and middle-income countries in English language, from January 01, 2000 to October 22, 2013. An updated literature search was performed on on July 1, 2015. The databases searched included the Cochrane Library, EMBASE, Medline, PubMed and Web of Science. Only studies that presented data on the reliability and validity evaluations of triage tool were included in this review. Two independent reviewers utilized a data abstraction tool to collect data on demographics, triage tool components and the reliability and validity data and summary findings for each triage tool assessed. Of the 4,717 studies searched, seven studies evaluating triage tools and 10 studies evaluating IMCI were included. There were wide varieties in method for assessing reliability and validity, with different settings, outcome metrics and statistical methods. Studies evaluating triage tools for pediatric patients in low and middle income countries are scarce. Furthermore the methodology utilized in the conduct of these studies varies greatly and does not allow for the comparison of tools across study sites.

  5. Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory.

    PubMed

    Teles, Fernanda Moreira; Resegue, Rosa; Puccini, Rosana Fiorini

    2016-12-01

    To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. Cross-sectional study with 181 children aged 7 to 10 years with physical or mental disabilities, undergoing the inclusion process in Elementary school in 2007. 31 schools of the Regional Education Board - District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas - self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. The lower means, with statistically significant differences, were observed for the items related to social function (55.8 to 72.0), followed by self-care functions (56.0 to 96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Using mixed methods to evaluate the Pediatric Lead Assessment Network Education Training Program (PLANET).

    PubMed

    Polivka, Barbara J; Chaudry, Rosemary V; Sharrock, Timberlee

    2009-03-01

    The Pediatric Lead Assessment Network Education Training Program (PLANET) is a peer-to-peer in-person 1-hr lead poisoning prevention educational program for health professionals. This evaluation was designed to determine the impact of the PLANET program. Evaluation methods included analyzing data from PLANET sign-in sheets, evaluation forms, pre/postknowledge tests, claims data, and focus groups (FGs) and interviews (IVs) with PLANET attendees and nonattendees. Claims data were used to compare blood lead testing rates for physicians attending and those not attending a PLANET program. Over 2,000 health professionals attended the 192 PLANET presentations delivered between June 2001 and December 2006; most were registered nurses or physicians. Written evaluations were overwhelmingly positive. Posttests indicated increased provider knowledge about childhood lead poisoning prevention, and assessment of blood lead testing rates showed higher testing rates for PLANET attendees. FG and IV participants suggesting improvements including using alternative delivery modes.

  7. Contemporary models of pediatric obsessive-compulsive disorder: An evaluation with a large clinical sample.

    PubMed

    De Nadai, Alessandro; Nagpal, Prianka S; Piacentini, John; Peris, Tara S; Geffken, Gary R; Geller, Daniel A; Murphy, Tanya K; Storch, Eric A; Lewin, Adam B

    2015-09-30

    We evaluated the construct validity of the Child Yale-Brofwn Obsessive-Compulsive Scale (CYBOCS) in a large clinical sample (N=730) using confirmatory factor analysis. Results found inadequate fit for a priori models, though a model accounting for overlapping item content displayed good fit. Parallel obsessions/compulsions items may provide largely redundant information on the CYBOCS. Findings suggest modifying the CYBOCS to reduce burden on researchers, patients, and clinicians, and to more accurately measure pediatric obsessive-compulsive disorder (OCD). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Exact evaluation of the quadratic longitudinal response function for an unmagnetized Maxwellian plasma

    SciTech Connect

    Layden, B.; Cairns, Iver H.; Robinson, P. A.; Percival, D. J.

    2012-07-15

    The quadratic longitudinal response function describes the second-order nonlinear response of a plasma to electrostatic wave fields. An explicit expression for this function in the weak-turbulence regime requires the evaluation of velocity-space integrals involving the velocity distribution function and various resonant denominators. Previous calculations of the quadratic longitudinal response function were performed by approximating the resonant denominators to facilitate the integration. Here, we evaluate these integrals exactly for a non-relativistic collisionless unmagnetized isotropic Maxwellian plasma in terms of generalized plasma dispersion functions, and correct certain aspects of expressions previously derived for these functions. We show that in the appropriate limits the exact expression reduces to the approximate form used for interactions between two fast waves and one slow wave, such as the electrostatic decay of Langmuir waves into Langmuir waves and ion sound waves, and the scattering of Langmuir waves off thermal ions.

  9. Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery

    PubMed Central

    Ducis, Katrina; Guan, Jian; Karsy, Michael

    2016-01-01

    Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE). PMID:27709099

  10. Evaluating the cancer related fatigue by children, mothers, and nurses in Turkish pediatric oncology patients.

    PubMed

    Yılmaz, Hatice Bal; Gerçeker, Gülçin Özalp; Muslu, Gonca Karayağız

    2016-08-01

    The aims of this study were to evaluate cancer related fatigue by children', mothers', and nurses' perspectives in recently diagnosed pediatric oncology patients, to evaluate levels of agreement between the fatigue scales, and to evaluate the relationships between fatigue and sample characteristics. The sample of this cohort, descriptive, correlational study consisted of 26 recently cancer diagnosed children between the ages of 7 and 12, receiving inpatient treatment in pediatric oncology/hematology units, their mothers and their nurses. The data about children's fatigue were collected using the Child Fatigue Scale-24 h, Parent Fatigue Scale-24 h and Staff Fatigue Scale-24 h, for two consecutive days in the second and third weeks of the patient's first chemotherapy treatment cycle. The mean scores of the Child Fatigue Scale-24 h showed the children's fatigue to be at a moderate level, a statistically significant difference was found between the CFS-24 h and PFS-24 h mean scores in the first and second measurement (p < 0.05). The Intraclass correlation showed a good agreement between scales and repeated measurements for these scales. Fatigue in recently diagnosed cancer patients is an important symptom which is of particular concern to the children, their parents and nurses. The study showed that these three scales can be used alone an also used simultaneously, and also proved that these scales are reliable for repeated measurements. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery.

    PubMed

    Ducis, Katrina; Guan, Jian; Karsy, Michael; Bollo, Robert J

    2016-07-01

    Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE).

  12. Evaluation of the Novel Respiratory Virus Surveillance Program: Pediatric Early Warning Sentinel Surveillance (PEWSS)

    PubMed Central

    Nguyen, Linh M.; Lutman, Michelle L.; Middaugh, John P.

    2013-01-01

    Objectives Infections caused by respiratory viruses are associated with recurrent epidemics and widespread morbidity and mortality. Routine surveillance of these pathogens is necessary to determine virus activity, monitor for changes in circulating strains, and plan for public health preparedness. The Southern Nevada Health District in Las Vegas, Nevada, recruited five pediatric medical practices to serve as sentinel sites for the Pediatric Early Warning Sentinel Surveillance (PEWSS) program. Methods Sentinel staff collected specimens throughout the year from ill children who met the influenza-like illness case definition and submitted specimens to the Southern Nevada Public Health Laboratory for molecular testing for influenza and six non-influenza viruses. Results Laboratory results were analyzed and reported to the medical and general communities in weekly bulletins year-round. PEWSS data were also used to establish viral respiratory seasonal baselines and in influenza vaccination campaigns. The surveillance program was evaluated using the Centers for Disease Control and Prevention's (CDC's) Updated Guidelines for Evaluating Public Health Surveillance Systems. PEWSS met three of six program usefulness criteria and seven of nine surveillance system attributes, which exceeded the CDC Guidelines evaluation criteria for a useful and complete public health surveillance program. Conclusion We found that PEWSS is a useful and complete public health surveillance system that is simple, flexible, accessible, and stable. PMID:23997308

  13. Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.

    PubMed

    Poley, Marten J; van der Starre, Cynthia; van den Bos, Ada; van Dijk, Monique; Tibboel, Dick

    2011-11-01

    Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies. Prospective longitudinal survey study at two points in time. Pediatric surgical intensive care unit at a Dutch university hospital. All unit personnel. To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers. The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p < .01), whereas scores on stress recognition were low (p < .001). The scores on the other scales were somewhat above (job satisfaction), close to (teamwork climate, safety climate

  14. Defining the ultrasound longitudinal natural history of newly diagnosed pediatric small bowel Crohn disease treated with infliximab and infliximab-azathioprine combination therapy.

    PubMed

    Dillman, Jonathan R; Dehkordy, Soudabeh Fazeli; Smith, Ethan A; DiPietro, Michael A; Sanchez, Ramon; DeMatos-Maillard, Vera; Adler, Jeremy; Zhang, Bin; Trout, Andrew T

    2017-07-01

    Little is known about changes in the imaging appearances of the bowel and mesentery over time in either pediatric or adult patients with newly diagnosed small bowel Crohn disease treated with anti-tumor necrosis factor-alpha (anti-TNF-α) therapy. To define how bowel ultrasound findings change over time and correlate with laboratory inflammatory markers in children who have been newly diagnosed with pediatric small bowel Crohn disease and treated with infliximab. We included 28 pediatric patients treated with infliximab for newly diagnosed ileal Crohn disease who underwent bowel sonography prior to medical therapy and at approximately 2 weeks, 1 month, 3 months and 6 months after treatment initiation; these patients also had laboratory testing at baseline, 1 month and 6 months. We used linear mixed models to compare mean results between visits and evaluate whether ultrasound measurements changed over time. We used Spearman rank correlation to assess bivariate relationships. Mean subject age was 15.3±2.2 years; 11 subjects were girls (39%). We observed decreases in mean length of disease involvement (12.0±5.4 vs. 9.1±5.3 cm, P=0.02), maximum bowel wall thickness (5.6±1.8 vs. 4.7±1.7 mm, P=0.02), bowel wall color Doppler signal (1.7±0.9 vs. 1.2±0.8, P=0.002) and mesenteric color Doppler signal (1.1±0.9 vs. 0.6±0.6, P=0.005) at approximately 2 weeks following the initiation of infliximab compared to baseline. All laboratory inflammatory markers decreased at 1 month (P-values<0.0001). There was strong correlation between bowel wall color Doppler signal and fecal calprotectin (ρ=0.710; P<0.0001). Linear mixed models confirmed that maximum bowel wall thickness (P=0.04), length of disease involvement (P=0.0002) and bowel wall color Doppler signal (P<0.0001) change over time in response to infliximab, when adjusted for age, sex, azathioprine therapy, scanning radiologist and baseline short pediatric Crohn's disease activity index score. The ultrasound

  15. Fat embolism in pediatric patients: an autopsy evaluation of incidence and etiology.

    PubMed

    Eriksson, Evert A; Rickey, Joshua; Leon, Stuart M; Minshall, Christian T; Fakhry, Samir M; Schandl, Cynthia A

    2015-02-01

    Little is known about the incidence and etiology of fat embolism in pediatric patients. We sought to determine the incidence, time course, and associated factors of pulmonary fat embolism (PFE), cerebral fat embolism (CFE), and kidney fat embolism (KFE) in trauma and nontrauma pediatric patients at the time of autopsy. Retrospectively, a convenience sample of consecutive pediatric patients (age, ≤10 years) who had undergone autopsy between 2008 and 2012 were evaluated for fat embolism. Patients who had no documented cause of death or who were hospital births and died during the same hospitalization were excluded. Formalin-fixed paraffin sections were reviewed by a forensic pathologist for evidence of fat embolism and nuclear elements. Autopsy reports were used to determine cause of death, injuries, resuscitative efforts taken, sex, height, weight, and age. Sixty-seven decedents were evaluated. The median age was 2.0 years (interquartile range, 0.75-4), median body mass index (BMI) was 18.0 kg/m(2) (interquartile range, 15.7-19.0 kg/m(2)), and 55% of the patients were male. Pulmonary fat embolism, CFE, and KFE were present in 30%, 15%, and 3% of all patients, respectively. The incidence of PFE was not significantly different by cause of death (trauma 33%, drowning 36%, burn 14%, medical 28%). Patients with PFE but not CFE had significantly higher age, height, weight, and BMI. Half of the PFE and 57% of the CFE occurred in patients who lived less than 1 hour after beginning of resuscitation. Seventy-one percent of patients with CFE did not have a patent foramen ovale. Multivariate regression revealed an increased odds ratio of PFE based on BMI (1.244 [95% confidence interval, 1.043-1.484], P = .015). None of the samples evaluated demonstrated nuclear elements. Pulmonary fat embolism, CFE, and KFE are common in pediatric trauma and medical deaths. Body mass index is independently associated with the development of PFE. Absence of nuclear elements suggests that fat

  16. Educating pediatric residents about breastfeeding: evaluation of 3 time-efficient teaching strategies.

    PubMed

    Tender, Jennifer A F; Cuzzi, Sandra; Kind, Terry; Simmens, Samuel J; Blatt, Benjamin; Greenberg, Larrie

    2014-11-01

    Previously reported breastfeeding curricula for residents have combined different teaching methods, have focused on knowledge and attitudes, and have been time-intensive. This study aimed to evaluate 3 time-efficient breastfeeding curricula for effectiveness in regard to pediatric residents' knowledge, confidence, and skills in managing a simulated breastfeeding scenario. First-year pediatric residents during their 4-week community hospital newborn nursery rotation were consecutively assigned to 1 of 3 groups. Group 1 shadowed an International Board Certified Lactation Consultant (IBCLC) for 1 hour; group 2 watched a 25-minute case-based breastfeeding DVD; and group 3 observed a 3-hour prenatal parent breastfeeding class (CLS). Residents were assessed by (1) a pretest and posttest evaluating their breastfeeding knowledge and confidence, and (2) a clinical skills scenario managing a breastfeeding standardized patient (SP). Thirty-nine pediatric residents participated in the study (11 in IBCLC, 16 DVD, 12 CLS) over a 1-year period. All groups significantly improved their knowledge scores and confidence in managing breastfeeding problems, with the IBCLC group showing more improvement in knowledge than the other groups (P = .02) and a higher rating of their teaching method (P = .01). All groups performed well on the SP clinical skills scenario, with no significant difference between groups. All 3 teaching methods were time-efficient and produced important gains in knowledge and confidence, with residents in the IBCLC group demonstrating greatest improvement in knowledge and a higher rating of their teaching method. Our study provides support for 3 methods of teaching residents breastfeeding management and demonstrates that IBCLCs are well-received as interprofessional educators. © The Author(s) 2014.

  17. Developing Validity Evidence for the Written Pediatric History and Physical Exam Evaluation Rubric.

    PubMed

    King, Marta A; Phillipi, Carrie A; Buchanan, Paula M; Lewin, Linda O

    The written history and physical examination (H&P) is an underutilized source of medical trainee assessment. The authors describe development and validity evidence for the Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric: a novel tool for evaluating written H&Ps. Using an iterative process, the authors drafted, revised, and implemented the 10-item rubric at 3 academic institutions in 2014. Eighteen attending physicians and 5 senior residents each scored 10 third-year medical student H&Ps. Inter-rater reliability (IRR) was determined using intraclass correlation coefficients. Cronbach α was used to report consistency and Spearman rank-order correlations to determine relationships between rubric items. Raters provided a global assessment, recorded time to review and score each H&P, and completed a rubric utility survey. Overall intraclass correlation was 0.85, indicating adequate IRR. Global assessment IRR was 0.89. IRR for low- and high-quality H&Ps was significantly greater than for medium-quality ones but did not differ on the basis of rater category (attending physician vs. senior resident), note format (electronic health record vs nonelectronic), or student diagnostic accuracy. Cronbach α was 0.93. The highest correlation between an individual item and total score was for assessments was 0.84; the highest interitem correlation was between assessment and differential diagnosis (0.78). Mean time to review and score an H&P was 16.3 minutes; residents took significantly longer than attending physicians. All raters described rubric utility as "good" or "very good" and endorsed continued use. The P-HAPEE rubric offers a novel, practical, reliable, and valid method for supervising physicians to assess pediatric written H&Ps. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  18. Evaluation of the Tolerability of Intermittent Intravenous Sildenafil in Pediatric Patients With Pulmonary Hypertension

    PubMed Central

    Hasselman, Ty E.; Wang, Yanzhi; Harthan, Aaron A.

    2016-01-01

    OBJECTIVES: The primary purpose of this study was to determine the tolerability of intermittent intravenous (IV) sildenafil for the treatment of pulmonary hypertension in pediatric patients. Secondary objectives were to evaluate parameters related to efficacy. METHODS: This was a retrospective chart review from January 2013 to August 2014 of pediatric patients under age 18 years treated with intermittent doses of IV sildenafil for pulmonary hypertension. Patients were excluded if they were over age 18 years or received sildenafil for other indications. Measures collected to assess tolerability include blood pressure and heart rate before and after the administration of IV sildenafil, as well as adverse events. RESULTS: Thirty-seven patients (21 females and 16 males) were identified meeting inclusion criteria, and 21 (56.8%) were on oral sildenafil prior to the initial IV dose. The mean decrease in blood pressure after the first dose of IV sildenafil was 7.16/2.74 mmHg. The decrease in systolic blood pressure was statistically significant. During the study period, 5 patients experienced medication related adverse events, primarily hypotension. Despite this, none of the patients had the medication discontinued due to these events. For secondary objectives, a statistically significant difference was not found between other clinical measures before and after intermittent IV sildenafil dosing. CONCLUSIONS: Sildenafil, when administered as intermittent IV doses, was tolerated by the majority of patients evaluated in this study. For pediatric patients with pulmonary hypertension in whom enteral or continuous IV sildenafil cannot be administered, intermittent IV sildenafil may be considered as an alternative administration option. PMID:27877095

  19. Long-term experience of steroid-free pediatric renal transplantation: effects on graft function, body mass index, and longitudinal growth.

    PubMed

    Wittenhagen, Per; Thiesson, Helle C; Baudier, François; Pedersen, Erik B; Neland, Mette

    2014-02-01

    Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate the effects of complete steroid avoidance on allograft function, BMI, and linear growth. The majority of transplanted children were induced with antithymocyte globulin and immunosuppressed with a calcineurin inhibitor and mycophenolate mofetil. Steroids were given only when rejection occurred or due to comorbidities. Anthropometric data were collected from 65 transplantations in 60 children. Patient survival was 93%; graft survival was 81% after five yr (N = 42) and 63% after 10 yr (N = 16). Acute rejection within the first year of transplantation was 9%. The distribution of the children's BMI before transplantation was normal; the mean BMI-SDS was 0.21 before transplantation, and this value remained stable during the next five yr. Post-transplantation the children demonstrated significant improved growth as the mean height-SDS increased significantly from -1.7 to -1.1. Catch-up growth was most pronounced in the youngest (< six yr). Steroid-free immunosuppression in pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature.

  20. Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study.

    PubMed

    Yeates, Keith Owen; Beauchamp, Miriam; Craig, William; Doan, Quynh; Zemek, Roger; Bjornson, Bruce; Gravel, Jocelyn; Mikrogianakis, Angelo; Goodyear, Bradley; Abdeen, Nishard; Beaulieu, Christian; Dehaes, Mathieu; Deschenes, Sylvain; Harris, Ashley; Lebel, Catherine; Lamont, Ryan; Williamson, Tyler; Barlow, Karen Maria; Bernier, Francois; Brooks, Brian L; Emery, Carolyn; Freedman, Stephen B; Kowalski, Kristina; Mrklas, Kelly; Tomfohr-Madsen, Lianne; Schneider, Kathryn J

    2017-07-13

    Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals. © Article author(s) (or their employer

  1. Nuances in pediatric trauma.

    PubMed

    Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

    2013-08-01

    Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury.

  2. A randomized, controlled trial to evaluate topical anesthetic for 15 minutes before venipuncture in pediatrics.

    PubMed

    Brenner, Scott M; Rupp, Valerie; Boucher, Jenny; Weaver, Kevin; Dusza, Stephen W; Bokovoy, Joanna

    2013-01-01

    The aim of the study was to assess the differences in reported pain from venipuncture comparing liposomal 4% lidocaine with placebo cream in a pediatric population. Other factors assessed were patient anxiety, difficulty of venipuncture, and history of venipuncture. A prospective, randomized, double-blind, placebo control study design was used in which subjects were assigned to receive either liposomal 4% lidocaine or placebo cream. The study population consisted of pediatric patients aged 5 to 18 years old who presented to 1 site of a multisite, academic, community emergency department. Once subjects had consented and randomized, the liposomal 4% lidocaine or placebo cream was applied for 15 minutes under occlusion. A 6-point validated FACES pain scale was used to evaluate each patient's level of pain during venipuncture. Patient anxiety was evaluated using a 100-mm visual analogue scale before, during, and after the venipuncture. Heart rate was captured as an indirect measurement of pain. There were no significant differences between the study and placebo groups (P > .05) in mean levels of patient ratings of anxiety, patient heart rate, or the patient's mean rating of pain before, during, or after the venipuncture procedure. There was an association between increased anxiety with an increase in venipuncture pain and an inverse association between age and pain. Topical liposomal 4% lidocaine cream in this case did not prove to be effective with a 15-minute dwell time under occlusion because there were no differences in pain between study groups. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic.

    PubMed

    Brodsky, Jacob R; Cusick, Brandon A; Zhou, Guangwei

    2016-01-01

    Epidemiologic studies have shown Vestibular migraine (VM) to be the most common cause of vertigo in children, but little is known about the typical presentation and response to treatment of this disorder in the pediatric population. The aim of this study was to evaluate the diagnostic features and response to therapy of VM in children managed at a pediatric vestibular clinic. Twenty-eight patients ≤18 years old with a diagnosis of VM were identified from 208 patients seen at the Balance and Vestibular Program at Boston Children's Hospital from July 2012-July 2014, after excluding 12 patients with a history of major otologic or neurologic surgery, recent concussion, or additional vestibular disorders. Patients' electronic medical records and testing results were retrospectively reviewed. Patients ranged in age from 9 to 18 years old (mean 14.48). All included patients met criteria for definite (n = 25) or probable (n = 3) VM as defined by the International Classification of Headache Disorders. Rotary chair (n = 17), caloric (n = 8), cervical vestibular evoked myogenic potential (n = 16), and video head impulse (n = 3) tests were normal. Medications effectively reduced reported vestibular symptoms in 88% of those treated with tricyclics (n = 8), 86% of those treated with cyprohepatadine (n = 7), 80% of those treated with topiramate (n = 5), 80% of those treated with triptans (n = 10), and 25% of those treated with gabapentin (n = 4). Vestibular migraine is a common cause of vertigo in the pediatric population that is frequently responsive to medical therapy. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  4. End-user evaluations of a personal computer-based pediatric advanced life support simulator.

    PubMed

    Ventre, Kathleen M; Collingridge, Dave S; DeCarlo, Deborah

    2011-06-01

    : To inform further development of a personal computer-based Pediatric Advanced Life Support (PALS) simulator, we wished to understand users' perceptions of this new technology. Specifically, we sought to determine whether the simulator was perceived as an effective training tool, whether it filled a gap in the users' current training regimen, and whether these perceptions were impacted by professional affiliation and PALS training history. : We surveyed multidisciplinary health care workers in a tertiary care pediatric hospital who used our simulator. : A total of 789 users completed an evaluation of the simulator. Ninety-five percent of respondents agreed that the PALS simulator is an effective educational tool. Eighty-nine percent agreed that the simulator filled a gap in their training, although physicians agreed with this statement more strongly than nurses (P = 0.001). Prior resuscitation training history did not impact whether users perceived that the simulator filled a curricular gap. Users most commonly cited the simulator's realism, its capacity to facilitate practice, and its help feature as the top three qualities they most appreciated. Users' top three suggestions for improving the simulator included provision of a structured tutorial, specific user interface improvements, and encouragement of more widespread access to the simulator. : Hospital-based pediatric providers are open to using personal computer-based simulation to provide on-demand refresher training in the cognitive aspects of PALS. Through its capacity to reach a large number of health care workers without the need for instructor presence, this technology could be used to help develop a more targeted role for mannequin simulation.

  5. Clinical report--guidelines for the ethical conduct of studies to evaluate drugs in pediatric populations.

    PubMed

    Shaddy, Robert E; Denne, Scott C

    2010-04-01

    The proper ethical conduct of studies to evaluate drugs in children is of paramount importance to all those involved in these types of studies. This report is an updated revision to the previously published guidelines from the American Academy of Pediatrics in 1995. Since the previous publication, there have been great strides made in the science and ethics of studying drugs in children. There have also been numerous legislative and regulatory advancements that have promoted the study of drugs in children while simultaneously allowing for the protection of this particularly vulnerable group. This report summarizes these changes and advances and provides a framework from which to guide and monitor the ethical conduct of studies to evaluate drugs in children.

  6. Evaluation of developmental metrics for utilization in a pediatric advanced automatic crash notification algorithm.

    PubMed

    Doud, Andrea N; Weaver, Ashley A; Talton, Jennifer W; Barnard, Ryan T; Petty, John; Stitzel, Joel D

    2016-01-01

    Appropriate treatment at designated trauma centers (TCs) improves outcomes among injured children after motor vehicle crashes (MVCs). Advanced Automatic Crash Notification (AACN) has shown promise in improving triage to appropriate TCs. Pediatric-specific AACN algorithms have not yet been created. To create such an algorithm, it will be necessary to include some metric of development (age, height, or weight) as a covariate in the injury risk algorithm. This study sought to determine which marker of development should serve as a covariate in such an algorithm and to quantify injury risk at different levels of this metric. A retrospective review of occupants age < 19 years within the MVC data set NASS-CDS 2000-2011 was performed. R(2) values of logistic regression models using age, height, or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review, and chi-square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, suboptimal, or unrestrained), and crash mode (rollover, rear, frontal, near-side, or far-side). NASS-CDS analysis produced 11,541 occupants age < 19 years with nonmissing data. Age, height, and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0-4 years, 5-9 years, 10-14 years, and 15-18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age- and gender-specific body mass index (BMI) classifications. Adjusted odds of key injury types with respect to these age categorizations revealed

  7. Evaluation of the Psychometric Properties of the Pediatric Parenting Stress Inventory (PPSI)

    PubMed Central

    Devine, Katie A.; Heckler, Charles E; Katz, Ernest R.; Fairclough, Diane L.; Phipps, Sean; Sherman-Bien, Sandra; Dolgin, Michael J.; Noll, Robert B.; Askins, Martha A.; Butler, Robert W.; Sahler, Olle Jane Z.

    2014-01-01

    Objective The goal of this work was to evaluate the psychometric properties of the Pediatric Parenting Stress Inventory (PPSI), a new measure of problems and distress experienced by parents of children with chronic illnesses. Method One sample of English-, Spanish-, and Hebrew-speaking mothers of children recently diagnosed with cancer (n = 449) and one sample of English- and Spanish-speaking mothers of children recently diagnosed with cancer (n = 399) participated in two problem-solving skills training interventions (Askins et al., 2009; Sahler et al., 2005). The PPSI was administered at baseline with other measures of maternal distress. All analyses used baseline data. Factor structure was evaluated using exploratory factor analysis (EFA) on the first sample and confirmatory factor analysis (CFA) on both samples. Internal consistency was evaluated using Cronbach’s alpha. Construct validity was assessed via Spearman correlations with measures of maternal distress. Results EFA resulted in a stable four-factor solution with 35 items. CFA indicated that the four-factor solution demonstrated reasonable fit in both samples. Internal consistency of the subscales and full scale was adequate to excellent. Construct validity was supported by moderate to strong correlations with measures of maternal distress, depression, and posttraumatic stress symptoms. Conclusions The PPSI demonstrated good psychometric properties in assessing current problems and distress experienced by mothers of children newly diagnosed with cancer. This tool may be used to identify individualized targets for intervention in families of children with cancer. Future studies could evaluate the utility and psychometrics of the PPSI with other pediatric populations. PMID:23544994

  8. An evaluation framework and a pilot study of a mobile platform for diabetes self-management: insights from pediatric users.

    PubMed

    Padman, Rema; Jaladi, Sravani; Kim, Sean; Kumar, Saumitra; Orbeta, Philip; Rudolph, Kate; Tran, Tony

    2013-01-01

    According to WHO, pediatric diabetes is a rising global public health problem, with increasing impact on developing nations. This study summarizes a multidimensional, scalable pilot evaluation of a diabetes self-management platform combining mobile technology with social networking to capture four key metrics of Type 1 diabetes self-management, associated social interactions, and gaming features providing targeted feedback to 8 pediatric users. Based on their 2-month interaction with the application, we analyze click-stream data from social interactions, key health metrics, text comments, and usability and satisfaction surveys to evaluate engagement with the platform and effectiveness in controlling blood glucose using a product-process-program framework. Our preliminary results indicate that this framework was successful in demonstrating the potential of the mobile health platform to effectively leverage the growing use of mobile applications and social media to present a unique benefit that engaged pediatric users and provided useful insights for self-health management.

  9. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals.

    PubMed

    Joeris, Alexander; Lutz, Nicolas; Wicki, Bárbara; Slongo, Theddy; Audigé, Laurent

    2014-12-20

    Children and adolescents are at high risk of sustaining fractures during growth. Therefore, epidemiological assessment is crucial for fracture prevention. The AO Comprehensive Injury Automatic Classifier (AO COIAC) was used to evaluate epidemiological data of pediatric long bone fractures in a large cohort. Data from children and adolescents with long bone fractures sustained between 2009 and 2011, treated at either of two tertiary pediatric surgery hospitals in Switzerland, were retrospectively collected. Fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). For a total of 2716 patients (60% boys), 2807 accidents with 2840 long bone fractures (59% radius/ulna; 21% humerus; 15% tibia/fibula; 5% femur) were documented. Children's mean age (SD) was 8.2 (4.0) years (6% infants; 26% preschool children; 40% school children; 28% adolescents). Adolescent boys sustained more fractures than girls (p < 0.001). The leading cause of fractures was falls (27%), followed by accidents occurring during leisure activities (25%), at home (14%), on playgrounds (11%), and traffic (11%) and school accidents (8%). There was boy predominance for all accident types except for playground and at home accidents. The distribution of accident types differed according to age classes (p < 0.001). Twenty-six percent of patients were classed as overweight or obese - higher than data published by the WHO for the corresponding ages - with a higher proportion of overweight and obese boys than in the Swiss population (p < 0.0001). Overall, differences in the fracture distribution were sex and age related. Overweight and obese patients seemed to be at increased risk of sustaining fractures. Our data give valuable input into future development of prevention strategies. The AO PCCF proved to be useful in epidemiological reporting and analysis of pediatric long bone fractures.

  10. SWOT analysis of a pediatric rehabilitation programme: a participatory evaluation fostering quality improvement.

    PubMed

    Camden, Chantal; Swaine, Bonnie; Tétreault, Sylvie; Bergeron, Sophie

    2009-01-01

    To present the results of a strengths, weaknesses, opportunities and threats (SWOT) analysis used as part of a process aimed at reorganising services provided within a pediatric rehabilitation programme (PRP) in Quebec, Canada and to report the perceptions of the planning committee members regarding the usefulness of the SWOT in this process. Thirty-six service providers working in the PRP completed a SWOT questionnaire and reported what they felt worked and what did not work in the existing model of care. Their responses were used by a planning committee over a 12-month period to assist in the development of a new service delivery model. Committee members shared their thoughts about the usefulness of the SWOT. Current programme strengths included favourable organisational climate and interdisciplinary work whereas weaknesses included lack of psychosocial support to families and long waiting times for children. Opportunities included working with community partners, whereas fear of losing professional autonomy with the new service model was a threat. The SWOT results helped the planning committee redefine the programme goals and make decisions to improve service coordination. SWOT analysis was deemed as a very useful tool to help guide service reorganisation. SWOT analysis appears to be an interesting evaluation tool to promote awareness among service providers regarding the current functioning of a rehabilitation programme. It fosters their active participation in the reorganisation of a new service delivery model for pediatric rehabilitation.

  11. Evaluation of permanent alopecia in pediatric medulloblastoma patients treated with proton radiation.

    PubMed

    Min, Chul Hee; Paganetti, Harald; Winey, Brian A; Adams, Judith; MacDonald, Shannon M; Tarbell, Nancy J; Yock, Torunn I

    2014-11-18

    To precisely calculate skin dose and thus to evaluate the relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with proton beams. The dosimetry and alopecia outcomes of 12 children with medulloblastoma (ages 4-15 years) comprise the study cohort. Permanent alopecia was assessed and graded after completion of the entire therapy. Skin threshold doses of permanent alopecia were calculated based on the skin dose from the craniospinal irradiation (CSI) plan using the concept of generalized equivalent uniform dose (gEUD) and accounting for chemotherapy intensity. Monte Carlo simulations were employed to accurately assess uncertainties due to beam range prediction and secondary particles. Increasing the dose of the CSI field or the dose given by the boost field to the posterior fossa increased total skin dose delivered in that region. It was found that permanent alopecia could be correlated with CSI dose with a threshold of about 21 Gy (relative biological effectiveness, RBE) with high dose chemotherapy and 30 Gy (RBE) with conventional chemotherapy. Our results based on 12 patients provide a relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with protons. The alopecia risk as assessed with gEUD could be predicted based on the treatment plan information.

  12. Evaluation of SLOG/TCI-III pediatric system on target control infusion of propofol

    PubMed Central

    2011-01-01

    Background The target-controlled infusion-III (SLOG/TCI-III) system was derived from a model set up by the local pediatric population for target control infusion of propofol. Methods The current study aimed at evaluating the difference between target concentrations of propofol and performance, which was measured using the SLOG/TCI-III system in children. Thirty children fulfilling the I-II criteria according to American Society of Anesthesiology were enrolled in the study. The target plasma concentration of propofol was fed into the SLOG/TCI-III system and compared with the measured concentrations of propofol. Blood samples were collected and analyzed by high performance liquid chromatography with fluorescence detector. The performance error (PE) was determined for each measured blood propofol concentration. The performances of the TCI-III system were determined by the median performance error (MDPE), the median absolute performance error (MDAPE), and Wobble (the median absolute deviation of each PE from the MDPE), respectively. Results Concentration against target concentration showed good linear correlation: concentration = 1.3428 target concentration - 0.2633 (r = 0.8667). The MDPE and MDAPE of the pediatric system were 10 and 22%, respectively, and the median value for Wobble was 24%. MDPE and MDAPE were less than 15 and 30%, respectively. Conclusions The performance of TCI-III system seems to be in the accepted limits for clinical practice in children. PMID:22044738

  13. Evaluation of SLOG/TCI-III pediatric system on target control infusion of propofol.

    PubMed

    Yang, Wan-hua; Gu, Hong-bin; Chen, Bing; Li, Juan; Fan, Qiu-wei; Yuan, Yong-fang; Wang, Xiangdong

    2011-11-01

    The target-controlled infusion-III (SLOG/TCI-III) system was derived from a model set up by the local pediatric population for target control infusion of propofol. The current study aimed at evaluating the difference between target concentrations of propofol and performance, which was measured using the SLOG/TCI-III system in children. Thirty children fulfilling the I-II criteria according to American Society of Anesthesiology were enrolled in the study. The target plasma concentration of propofol was fed into the SLOG/TCI-III system and compared with the measured concentrations of propofol. Blood samples were collected and analyzed by high performance liquid chromatography with fluorescence detector. The performance error (PE) was determined for each measured blood propofol concentration. The performances of the TCI-III system were determined by the median performance error (MDPE), the median absolute performance error (MDAPE), and Wobble (the median absolute deviation of each PE from the MDPE), respectively. Concentration against target concentration showed good linear correlation: concentration = 1.3428 target concentration - 0.2633 (r = 0.8667). The MDPE and MDAPE of the pediatric system were 10 and 22%, respectively, and the median value for Wobble was 24%. MDPE and MDAPE were less than 15 and 30%, respectively. The performance of TCI-III system seems to be in the accepted limits for clinical practice in children.

  14. Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility

    PubMed Central

    Mattiello, Rita; Vidal, Paula Cristina; Sarria, Edgar Enrique; Pitrez, Paulo Márcio; Stein, Renato Tetelbom; Mocelin, Helena Teresinha; Fischer, Gilberto Bueno; Jones, Marcus Herbert; Pinto, Leonardo Araújo

    2016-01-01

    ABSTRACT Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25-75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications. PMID:27383929

  15. Retrospective Evaluation of Pediatric Oral Biopsies from A Dental and Maxillofacial Surgery Centre in Salem, Tamil Nadu, India

    PubMed Central

    Krishnan, Ramesh; Ramesh, Maya; Paul, George

    2014-01-01

    Aim: The aim of the study was to evaluate the pediatric oral biopsies received between 2002-2011 from a dental and maxillofacial centre in Salem, Tamilnadu, India retrospectively based on age, sex, site and type of the pathologies. Materials and Methods: The records of dental and maxillofacial surgery centre were taken and a retrospective evaluation of the pediatric lesions biopsied over a period of ten years (2002-2011) was done. Patients aged 15 years and below were considered as pediatric patients and pathologies were grouped into 8 categories, according to age, gender, anatomic location and pathologic diagnosis. Results: A total of nine hundred twenty five biopsies were studied, of which 97 cases were from pediatric patients. The pathologies were predominant in mandible to maxilla (47:29).The distribution of the pathologies were 44 odontogenic pathologies, 18 connective tissue tumours, 3 salivary gland tumours, 5 fibro osseous lesions and 25 tumour like lesions. Out of this 44 odontogenic pathologies, 39 were odontogenic cysts, and 5 were odontogenic tumours. Conclusion: Unlike other studies, the lesions were more common in the mandible with a female predilection. The majority of oral and maxillofacial lesions detected in pediatric population were benign similar to the previous reports. PMID:24596780

  16. Design and Evaluation of a Simulation for Pediatric Dentistry in Virtual Worlds

    PubMed Central

    Louloudiadis, Konstantinos; Tsiatsos, Thrasyvoulos-Konstantinos

    2013-01-01

    Background Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world’s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. Objective The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. Methods A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents’ interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared. Results A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool. Conclusions This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques. PMID:24168820

  17. Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation.

    PubMed

    Ko, Sheung-Fat; Tiao, Mao-Meng; Hsieh, Chie-Song; Huang, Fu-Chen; Huang, Chung-Cheng; Ng, Shu-Hang; Lee, Shin-Yee; Chen, Min-Chi

    2010-04-01

    This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric small bowel intussusception with deteriorating ischemic or obstructive symptoms, so-called small bowel intussusception disease (SBID). Between 1988 and 1999, among 18 patients surgically proven SBID (conventional group), 12 mimicked ileocolic intussusception and were conventionally managed with abdominal radiography, ultrasonography, reduction enema, and eventually operation. Between 2000 and 2008, we applied a modified approach with inclusion of early CT evaluation if ultrasonography showed a target lesion suspicious for SBID (diameter Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of bowel complications. Copyright 2010 Mosby, Inc. All rights reserved.

  18. Objective Evaluation of Otoscopy Skills Among Family and Community Medicine, Pediatric, and Otolaryngology Residents.

    PubMed

    Oyewumi, Modupe; Brandt, Michael G; Carrillo, Brian; Atkinson, Adelle; Iglar, Karl; Forte, Vito; Campisi, Paolo

    2016-01-01

    The objective of this study is to evaluate and compare the perceived need for otolaryngology training and otoscopy diagnostic skills in primary care (Family and Community Medicine, Pediatric Medicine), and Otolaryngology Head and Neck Surgery (OTO-HNS) postgraduate trainees. Participant otoscopy skills were evaluated using the OtoSim simulator. Family and Community Medicine, Pediatric, and OTO-HNS residents were recruited. Each resident participated in 3 separate otoscopy training and assessment sessions. The ability to correctly identify middle ear pathology was objectively evaluated using OtoSim™. Pretest, posttest, and 3-month retention test results were compared among residents in a paired comparison paradigm. Survey data assessing exposure to OTO-HNS during undergraduate and postgraduate training were also collected. A total of 57 residents participated in the study. All residents reported limited exposure to OTO-HNS during undergraduate medical training. Primary care trainees performed poorly on pretest assessments (30% ± 7.8%; 95% CI). Significant improvement in diagnostic accuracy was demonstrated following a single 1-hour teaching session (30%-62%; p < 0.001). Primary care residents demonstrated a significant decrease in diagnostic accuracy at a 3-month follow-up assessment (62%-52%, p < 0.001). Self-perceived comfort with otology was poorly correlated to pretest performance among primary care trainees (r = 0.26) and showed a stronger positive correlation among OTO-HNS trainees (r = 0.56). A single teaching session with an otoscopy simulator significantly improved diagnostic accuracy in primary care and OTO-HNS trainees. Improved performance is susceptible to deterioration at 3 months if acquired skills are not frequently used. Self-perceived comfort with otology may not be an accurate predictor of otoscopic diagnostic skill. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. Use of Joint Commission International standards to evaluate and improve pediatric oncology nursing care in Guatemala.

    PubMed

    Day, Sara W; McKeon, Leslie M; Garcia, Jose; Wilimas, Judith A; Carty, Rita M; de Alarcon, Pedro; Antillon, Federico; Howard, Scott C

    2013-05-01

    Inadequate nursing care is a major impediment to development of effective programs for treatment of childhood cancer in low-income countries. When the International Outreach Program at St. Jude Children's Research Hospital established partner sites in low-income countries, few nurses had pediatric oncology skills or experience. A comprehensive nursing program was developed to promote the provision of quality nursing care, and in this manuscript we describe the program's impact on 20 selected Joint Commission International (JCI) quality standards at the National Pediatric Oncology Unit in Guatemala. We utilized JCI standards to focus the nursing evaluation and implementation of improvements. These standards were developed to assess public hospitals in low-income countries and are recognized as the gold standard of international quality evaluation. We compared the number of JCI standards met before and after the nursing program was implemented using direct observation of nursing care; review of medical records, policies, procedures, and job descriptions; and interviews with staff. In 2006, only 1 of the 20 standards was met fully, 2 partially, and 17 not met. In 2009, 16 were met fully, 1 partially, and 3 not met. Several factors contributed to the improvement. The pre-program quality evaluation provided objective and credible findings and an organizational framework for implementing change. The medical, administrative, and nursing staff worked together to improve nursing standards. A systematic approach and involvement of all hospital disciplines led to significant improvement in nursing care that was reflected by fully meeting 16 of 20 standards. Copyright © 2012 Wiley Periodicals, Inc.

  20. Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center.

    PubMed

    Samaan, M Constantine; Valencia, Marlie; Cheung, Connie; Wilk, Boguslaw; Lau, Keith; Thabane, Lehana

    2014-01-01

    Global rates of type 2 diabetes in children and adolescents have increased significantly over the past three decades. Type 2 diabetes is a relatively new disease in this age group, and there is a dearth of information about how to structure treatment programs to manage its comorbidities and complications. In this paper, we describe the design and implementation of a personalized multidisciplinary, family-centered, pediatric and adolescent type 2 diabetes program at a tertiary pediatric center in Hamilton, Ontario, Canada. We report the process of designing and implementing such a program, and show that this multidisciplinary program led to improvement in glycated hemoglobin (n=17, 8% at baseline versus 6.4% at 1 year, 95% confidence interval (0.1-0.28), P-value <0.0001) and stabilized body mass index, with lowered C-peptide and no change in fitness or metabolic biomarkers of lipid metabolism and liver function. As type 2 diabetes becomes more prevalent in youth, the need for programs that successfully address the complex nature of this disease is central to its management and to mitigate its long-term adverse outcomes.

  1. Evaluation of a Family-Centered Preventive Intervention for Military Families: Parent and Child Longitudinal Outcomes.

    PubMed

    Lester, Patricia; Liang, Li-Jung; Milburn, Norweeta; Mogil, Catherine; Woodward, Kirsten; Nash, William; Aralis, Hilary; Sinclair, Maegan; Semaan, Alan; Klosinski, Lee; Beardslee, William; Saltzman, William

    2016-01-01

    This study evaluates the longitudinal outcomes of Families OverComing Under Stress (FOCUS), a family-centered preventive intervention implemented to enhance resilience and to reduce psychological health risk in military families and children who have high levels of stress related to parental wartime military service. We performed a secondary analysis of evaluation data from a large-scale service implementation of the FOCUS intervention collected between July 2008 and December 2013 at 15 military installations in the United States and Japan. We present data for 2,615 unique families (3,499 parents and 3,810 children) with completed intake and at least 1 postintervention assessment. Longitudinal regression models with family-level random effects were used to assess the patterns of change in child and parent (civilian and military) psychological health outcomes over time. Improvement in psychological health outcomes occurred in both service member and civilian parents. Relative to intake, parental anxiety and depression symptoms were significantly reduced postintervention, and these reductions were maintained at 2 subsequent follow-up assessments. In addition, we identified an improvement over time in emotional and behavioral symptoms and in prosocial behaviors for both boys and girls. We observed reductions in the prevalence of unhealthy family functioning and child anxiety symptoms, as well as parental depression, anxiety, and posttraumatic stress symptoms from intake to follow-up. Longitudinal program evaluation data show sustained trajectories of reduced psychological health risk symptoms and improved indices of resilience in children, civilian, and active duty military parents participating in a strength-based, family-centered preventive intervention. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of a technique for predicting longitudinal pilot-induced-oscillations

    NASA Technical Reports Server (NTRS)

    Hess, R. A.; Kalteis, R. M.

    1989-01-01

    A technique for predicting the susceptibility of an aircraft to longitudinal pilot-induced-oscillations (PIO's) is evaluated using 62 configurations from a pair of flight tests involving the NT-33 variable stability aircraft. The technique is based upon the characteristics of the open-loop pilot/vehicle system for attitude control as predicted by the Optimal Control Model (OCM) of the human pilot. The OCM is simplified so that only the index of performance weighting coefficients need to be considered as problem variables and a simple technique for generating these coefficients is reviewed.

  3. Longitudinal evaluation of a teacher education course presented to dental faculty.

    PubMed

    Jedrychowski, J R; Galligani, D J

    1978-10-01

    A three-day course on teaching methods was held for dental educators who were at various stages of their careers. The course was presented by the staff of the Academic Instructor and Allied Officer School of the Department of the Air Force. The purpose of the course was to aid in acquiring new knowledge of teaching methods and to produce behavioral changes in the participants' teaching techniques. A longitudinal evaluation demonstrated that participants changed teaching behaviors related to the courses' goals, and acquired and retained a significant amount of factual information presented in the course.

  4. Condition Self-Management in Pediatric Spina Bifida: A Longitudinal Investigation of Medical Adherence, Responsibility-Sharing, and Independence Skills

    PubMed Central

    Psihogios, Alexandra M.; Kolbuck, Victoria

    2015-01-01

    Objective This study aimed to evaluate rates of medical adherence, responsibility, and independence skills across late childhood and adolescence in youth with spina bifida (SB) and to explore associations among these disease self-management variables. Method 111 youth with SB, their parents, and a health professional participated at two time points. Informants completed questionnaires regarding medical adherence, responsibility-sharing, and child independence skills. Results Youth gained more responsibility and independence skills across time, although adherence rates did not follow a similar trajectory. Increased child medical responsibility was related to poorer adherence, and father-reported independence skills were associated with increased child responsibility. Conclusions This study highlights medical domains that are the most difficult for families to manage (e.g., skin checks). Although youth appear to gain more autonomy across time, ongoing parental involvement in medical care may be necessary to achieve optimal adherence across adolescence. PMID:26002195

  5. A comparison of performance evaluations of students on longitudinal integrated clerkships and rotation-based clerkships.

    PubMed

    McLaughlin, Kevin; Bates, Joanna; Konkin, Jill; Woloschuk, Wayne; Suddards, Carol A; Regehr, Glenn

    2011-10-01

    Longitudinal integrated clerkship (LIC) students typically perform as well as, if not better than, rotation-based clerkship (RBC) students on objective evaluations, yet few studies have compared performance in the clinical setting. This study compared in-training evaluation report (ITER) ratings of LIC and RBC students, including their correlation with more objective evaluations. On the basis of prior academic performance, LIC students (n = 27) at Universities of Alberta, British Columbia, and Calgary were matched with four RBC students from their center. The authors compared reliability of ITER ratings, ITER ratings of clinical skills and professional attributes, and the correlation between ITER ratings and objective evaluations of clinical skills and professional attributes on the Medical Council of Canada Qualifying Examination (MCCQE) Part I. ITER ratings of LIC students were more reliable and significantly higher than those of RBC students for both clinical skills and professional attributes. However, LIC students had lower objective structured clinical examination scores and weaker correlations between subjective and objective evaluations of clinical skills. By comparison, LIC students scored higher on a particular component of the MCCQE and had stronger correlations between subjective and objective evaluations of professionalism. The discrepancy between ratings of LIC students' clinical skills on ITER and other evaluation formats may be due to differences between the content of training and objective evaluations, or systematic rater biases. Further studies are needed to confirm and explain these findings. Promisingly, our data suggest that the LIC model may allow for a more predictive evaluation of professional competencies.

  6. Pediatric headache.

    PubMed

    Winner, Paul

    2008-06-01

    Headaches occur frequently in the pediatric population and have a significant impact on both the patient and their family. Migraine, the most common headache disorder for which patients see a physician, still remains underdiagnosed and undertreated. Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric population. Limitations of the present diagnostic criteria for migraine are presented, and the proposed modifications to these criteria may assist you with early recognition and ultimate treatment. New acute and preventive migraine treatment data demonstrating statistically significant benefit for the primary endpoints will be reviewed in detail. The clinically relevant impact of migraine on the pediatric patient documented by the use of the Pediatric Migraine Disability Assessment and the Pediatric Quality of Life Inventory will be discussed. A comprehensive management approach blending the most current acute, preventive, and biobehavioral treatments will be reviewed. Further research, with novel study designs, in pediatric headaches is needed to help reveal additional pathophysiological mechanisms, improve diagnostic criteria, and advance optimal treatment. Prospective studies are needed to fully evaluate the efficacy of preventive management in this population and to establish whether early intervention might slow this disease progression.

  7. Accuracy and Precision of the Pediatric Evaluation of Disability Inventory Computer-Adaptive Tests (PEDI-CAT)

    ERIC Educational Resources Information Center

    Haley, Stephen M.; Coster, Wendy J.; Dumas, Helene M.; Fragala-Pinkham, Maria A.; Kramer, Jessica; Ni, Pengsheng; Tian, Feng; Kao, Ying-Chia; Moed, Rich; Ludlow, Larry H.

    2011-01-01

    Aim: The aims of the study were to: (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: daily activities, mobility, social/cognitive, and responsibility; and (2) use post-hoc simulations based on the combined normative and disability calibration samples to assess the…

  8. Accuracy and Precision of the Pediatric Evaluation of Disability Inventory Computer-Adaptive Tests (PEDI-CAT)

    ERIC Educational Resources Information Center

    Haley, Stephen M.; Coster, Wendy J.; Dumas, Helene M.; Fragala-Pinkham, Maria A.; Kramer, Jessica; Ni, Pengsheng; Tian, Feng; Kao, Ying-Chia; Moed, Rich; Ludlow, Larry H.

    2011-01-01

    Aim: The aims of the study were to: (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: daily activities, mobility, social/cognitive, and responsibility; and (2) use post-hoc simulations based on the combined normative and disability calibration samples to assess the…

  9. Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

    PubMed

    Sterken, David J; Mooney, JoAnn; Ropele, Diana; Kett, Alysha; Vander Laan, Karen J

    2015-01-01

    Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET). Copyright © 2015 Elsevier Inc. All rights reserved.

  10. If You Do Not Ask, They Will Not Tell: Evaluating Pregnancy Risk in Young Women in Pediatric Hospitals.

    PubMed

    Coles, Mandy S; Lau, May; Akers, Aletha Y

    2016-03-01

    Adolescents experience some of the highest rates of unintended pregnancy among women of all reproductive age groups. And despite the fact that adolescents often receive care in pediatric hospital settings, evaluation of pregnancy risk is inconsistent. Pregnancy risk assessments can identify opportunities to deliver reproductive health services, allow earlier pregnancy diagnoses, and reduce morbidity and mortality for medically complex adolescent patients and their pregnancies. In this commentary we discuss some of the challenges and potential solutions to performing pregnancy risk assessments in pediatric hospital settings.

  11. EVALUATION OF CASES WITH THE USAGE OF COMMERCIALLY AVAILABLE TABLETS IN THE PEDIATRIC FORMULA.

    PubMed

    Kuriata, Elżbieta; Sawicki, Wiesław

    2015-01-01

    Lack of availability, of either the medicinal product intended to be used for children, or such in a dose which is fitting for the individual child's needs, results in physicians administering medicines meant for the adult. The target of the thesis was to evaluate the cases with the usage of commercially avaible conventional tablet-formulated medicinal products intended for the adult in the pediatric formula. The subjects of the evaluation were the form of the pediatric drug, prepared from commercially available tablets and capsules, as well as the legitimacy of their usage in the treatment of the pediatric population. One hundred and fifty-four prescriptions filled in community pharmacies of Warminsko-Mazurskie Voivodeship in 2011 were chosen. A total of 5805 divided powders in starch capsules were prepared. The prescribing practice included 6 groups of manufactured medicinal products in the form of conventional tablets, containing as follows: anti-hypertensive medicines (ACE inhibitors--enalapril, captopril, ramipril, loop diuretics--furosemide, potassium sparing diuretics--spironolactone, β-adrenolytics--propranolol, α- and β-adrenolytics--carvedilol), medicines for heart failure (foxglove glycosides--digoxin, methyldigoxin), anti-clotting medicines (acetylsalicylic acid), peristalsis stimulating agents (metoclopramide), antibacterial medicines (furagin), and dopaminergic (carbidopa-levodopa). The only compounded forms ordered by the physicians were divided powders for an internal use. Starch capsules for powder preparation provided the only 'package' for the dose of the compounded powder, which after pouring, solving or suspending in water was administered to children. Such a shift of the form, between an oral tablet and divided powder for an internal use, did not cause a change in the method of administration. The information on indications and the way of dosage for children, inserted in the Summary of Product Characteristics, enables the administration

  12. Critical evaluation of emergency stockpile ventilators in an in vitro model of pediatric lung injury.

    PubMed

    Custer, Jason W; Watson, Christopher M; Dwyer, Joe; Kaczka, David W; Simon, Brett A; Easley, R Blaine

    2011-11-01

    Modern health care systems may be inadequately prepared for mass casualty respiratory failure requiring mechanical ventilation. Current health policy has focused on the "stockpiling" of emergency ventilators, though little is known about the performance of these ventilators under conditions of respiratory failure in adults and children. In this study, we seek to compare emergency ventilator performance characteristics using a test lung simulating pediatric lung injury. Evaluation of ventilator performance using a test lung. Laboratory. None. Six transport/emergency ventilators capable of adult/child application were chosen on the basis of manufacturer specifications, Autovent 3000, Eagle Univent 754, EPV 100, LP-10, LTV 1200, and Parapac 200D. Manufacturer specifications for each ventilator were reviewed and compared with known standards for alarms and functionality for surge capacity ventilators. The delivered tidal volume, gas flow characteristics, and airway pressure waveforms were evaluated in vitro using a mechanical test lung to model pediatric lung injury and integrated software. Test lung and flow meter recordings were analyzed over a range of ventilator settings. Of the six ventilators assessed, only two had the minimum recommended alarm capability. Four of the six ventilators tested were capable of being set to deliver a tidal volume of less than 200 mL. The delivered tidal volume for all ventilators was within 8% of the nominal setting at a positive end expiratory pressure of zero but was reduced significantly with the addition of positive end expiratory pressure (range, ±10% to 30%; p < .01). All ventilators tested performed comparably at higher set tidal volumes; however, only three of the ventilators tested delivered a tidal volume across the range of ventilator settings that was comparable to that of a standard intensive care unit ventilator. Multiple ventilators are available for the provision of ventilation to children with respiratory failure in

  13. Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost.

    PubMed

    Luther, Gaurav; Miller, Patricia; Waters, Peter M; Bae, Donald S

    2016-01-01

    As ≥30% of displaced pediatric forearm fractures demonstrate loss of reduction (LOR) following closed reduction (CR); radiographic follow-up is advocated at 1, 2, 4, and 6 weeks for detection of redisplacement. We hypothesized that there is minimal change in fracture alignment 2 weeks after CR, and consequently, that radiographs at 4 weeks add cost but little value to clinical care. A total of 184 patients enrolled in a prospective study of pediatric forearm fractures including both distal and diaphyseal injuries were evaluated. All were treated with CR, casting, and radiographic evaluation at 1, 2, 4, and 6 weeks postinjury. Primary endpoint was radiographic LOR. Secondary endpoint was need for any intervention. A modified number-needed to treat analysis estimated the utility of the week 4 x-ray in predicting intervention. Relative value unit (RVU) costing, time-derived activity-based costing (TDABC), and billing totals were used for cost analysis. Seventy patients (38%) demonstrated radiographic LOR. Independent predictors of LOR were initial radius displacement >75% (OR=5.40; CI, 2.23-12.60), concomitant ulna fracture (OR=1.71; CI, 1.15-2.54), and dominant arm involvement (OR=2.87; CI, 1.40-5.87). Eighty percent of all LORs occurred within the first 2 weeks. There was no statistically significant change in radiographic alignment after week 2. Of 40 total interventions, all were performed within the first 2 weeks of follow-up. The 4-week x-ray did not influence decision to intervene, and at most, 1 in every 40 patients would require an intervention after week 2. Elimination of the 4-week x-ray would result in a savings of 4.8% (RVU method) to 11.9% (TDABC method) in the overall cost of nonoperative fracture care. There is minimal change in fracture alignment 2 weeks following CR of pediatric forearm fractures, and all interventions are based on early radiographic follow-up. The week 4 x-ray adds little value to clinical decision making, and its elimination

  14. Development and evaluation of an interactive multimedia clinical skills teaching program designed for the pediatric clerkship.

    PubMed

    Frisby, Anthony J; Lane, J Lindsey; Carr, Anna Marie; Ross, Ellen; Gottlieb, Ruth P

    2006-01-01

    We evaluated the physical-examination section of a multimedia program developed to teach infant history and physical-examination skills. A total of 71 students participated: one group viewed only the physical-examination section (PX), one the history section (HX), one none of the program (CX). We assessed physical-examination skills by direct observation of medical students performing an abdominal exam and scored using a checklist at baseline, immediately after intervention, and at the end of the pediatric clerkship. We analyzed results using analysis of variance with repeated measures. Baseline scores were PX = 2.5, HX = 2.8. The PX group scored significantly higher immediately postintervention at 6.8 compared to the HX group (3.1). At the end of the clerkship, significant differences between the groups remained. Final group mean scores were PX = 5.5, HX = 4.4, and CX = 2.7. The program improved examination skills with attenuation over 6 weeks.

  15. A model for evaluating the delivery of pediatric primary care services.

    PubMed

    Rosenbluth, L; Morehead, M A; Grossi, M; Oliver, C T; Uccellani, C; Robinson, P

    1991-01-01

    This evaluation model describes the components used to assess the functioning of Pediatric Resource Centers which provide primary care to high risk children in New York City. These centers are administered by the Medical and Health Research Association of New York City and are funded by the State through the New York City Department of Health. Measurements are made of: accessibility, availability, accountability, productivity and patient volumes, continuity, coordination, and comprehensiveness. Data is collected from the PRC data reporting system, site visits, chart reviews, and fiscal reports. The findings vary considerably among the different centers with compliance to the various assessments, differing not only within a given center but between centers. In spite of some methodological limitations, it is felt that these measurements are effective in pointing out problem areas in the centers and are helpful to the funding agency in focusing on program areas in need of greater support.

  16. Evaluation of neurological complications in pediatric liver transplant recipients: MRI versus CT.

    PubMed

    Donmez, Fuldem Yildirim; Guvenc, Zeynep; Emiroglu, Feride Kural; Coskun, Mehmet; Haberal, Mehmet

    2009-06-01

    With the aim of guiding choice of the best imaging modality for specific clinical conditions, we retrospectively evaluated neuroradiological findings in pediatric liver transplant recipients with neurological complications. Computed tomography (CT) was used to examine 31 patients with acute neurological symptoms after liver transplantation, and magnetic resonance imaging (MRI) was used for 35 such patients. A total of 16 patients belonged to both groups. Headache was the most common symptom in patients with computed tomography; seizure was most common among patients with magnetic resonance imaging. Magnetic resonance imaging detected additional abnormalities in 5 patients presenting with seizures whose computed tomography results were normal or insufficient to explain the clinical picture. In conclusion, liver transplant recipients with seizure should undergo magnetic resonance imaging emergently when possible; omitting computed tomography. Choice of imaging modality should be directed by nature of symptoms and time interval between transplantation and symptom onset.

  17. Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma.

    PubMed

    Ryan, Maura E; Jaju, Alok; Ciolino, Jody D; Alden, Tord

    2016-08-01

    Rapid MRI with ultrafast T2 sequences can be performed without sedation and is often used in place of computed tomography (CT) to evaluate pediatric patients for indications such as hydrocephalus. This study investigated the sensitivity of rapid magnetic resonance imaging (MRI) for detection and follow-up of acute intracranial hemorrhage in comparison to CT, which is commonly the first-line imaging. Patients presenting to a pediatric hospital with acute intracranial hemorrhage on CT and follow-up rapid MRI within 48 h were included. Rapid MRI studies consisted of three plane ultrafast T2 sequences either with or without axial gradient echo (GRE) sequences. Identification of hemorrhage on rapid MRI was assessed by readers both blinded and unblinded to prior CT results. One hundred two acute hemorrhages in 61 patients were identified by CT. Rapid MRI detection of subdural and epidural hemorrhages was modest in the absence of prior CT for comparison (sensitivity 61-74 %), but increased with review of the prior CT (sensitivity 80-86 %). Hemorrhage size was a significant predictor of detection (p < 0.0001). Three plane fast T2 images alone without GRE sequences were poor at detecting subarachnoid hemorrhage (sensitivity 10-25 %); rapid MRI with GRE sequences identified the majority of subarachnoid hemorrhage (sensitivity 71-93 %). GRE modestly increased detection of other extra-axial hemorrhages. Rapid MRI with GRE sequences is sensitive for most acute intracranial hemorrhages only when a prior CT is available for review. Rapid MRI is not adequate to replace CT in initial evaluation of intracranial hemorrhages but may be helpful in follow-up of known hemorrhages.

  18. Evaluation of administered dose using portal images in craniospinal irradiation of pediatric patients.

    PubMed

    Coelho, Carina Marques; Calçada, Raquel; Rodrigues, Sofia; Barragán, Juan Antonio; Sá, Ana Cravo; Macedo, Ana Paula; de Fátima Monsanto, Maria

    2017-03-21

    This study aimed to assess the administered dose based on portal imaging in craniospinal pediatric irradiation by evaluating cases in which portal images did or did not account for the total administered dose. We also intended to calculate the mean increase in total administered dose. Data were collected from General University Hospital Gregorio Marañón; we evaluated the total dose administered, total dose planned, number of portal images per treatment and corresponding monitor units of two different groups: one in which the dose from portal images is deducted from the total administered dose (D), and another in which it was not (N). We used descriptive statistics to analyze the collected data, including the mean and respective standard deviation. We used the Shapiro-Wilk and Spearman rank correlation coefficient tests and estimated the linear regression coefficients. Patients in group D received a mean dose of 29.00 ± 10.28 cGy based on the verification portal images, a quantity that was deducted from the planned dose to match the total administered dose. Patients in group N received a mean dose of 41.50 ± 30.53 cGy, which was not deducted from the planned dose, evidencing a mean increase of 41.50 ± 30.55 cGy over the total administered dose. The acquisition of the set-up verification portal images, without their inclusion in the total administered dose, reflects an average increase in total dose for craniospinal irradiation of pediatric patients. Subtraction of the monitor units used to acquire the verification images is recommended.

  19. Strategies to promote evidence-based practice in pediatric physical therapy: a formative evaluation pilot project.

    PubMed

    Schreiber, Joe; Stern, Perri; Marchetti, Gregory; Provident, Ingrid

    2009-09-01

    The physical therapy profession has been perceived as one that bases its practice largely on anecdotal evidence and that uses treatment techniques for which there is little scientific support. Physical therapists have been urged to increase evidence-based practice behaviors as a means to address this perception and to enhance the translation of knowledge from research evidence into clinical practice. However, little attention has been paid to the best ways in which to support clinicians' efforts toward improving evidence-based practice. The purpose of this study was to identify, implement, and evaluate the effectiveness of strategies aimed at enhancing the ability of 5 pediatric physical therapists to integrate scientific research evidence into clinical decision making. This study was a formative evaluation pilot project. The participants in this study collaborated with the first author to identify and implement strategies and outcomes aimed at enhancing their ability to use research evidence during clinical decision making. Outcome data were analyzed with qualitative methods. The participants were able to implement several, but not all, of the strategies and made modest self-reported improvements in evidence-based practice behaviors, such as reading journal articles and completing database searches. They identified several barriers, including a lack of time, other influences on clinical decision making, and a lack of incentives for evidence-based practice activities. The pediatric physical therapists who took part in this project had positive attitudes toward evidence-based practice and made modest improvements in this area. It is critical for the profession to continue to investigate optimal strategies to aid practicing clinicians in applying research evidence to clinical decision making.

  20. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  1. Intravenous and Intracavitary Use of Contrast-Enhanced Ultrasound in the Evaluation and Management of Complicated Pediatric Pneumonia.

    PubMed

    Deganello, Annamaria; Rafailidis, Vasileios; Sellars, Maria E; Ntoulia, Aikaterini; Kalogerakou, Kleanthi; Ruiz, Gary; Cosgrove, David O; Sidhu, Paul S

    2017-09-01

    Pediatric pneumonia can be complicated by necrotizing pneumonia or a parapneumonic effusion either in the form of an empyema or a clear effusion. Ultrasonography (US) and computed tomography represent well-established modalities for evaluation of complicated pediatric pneumonia. Contrast-enhanced ultrasound (CEUS) was recently introduced and is gaining increasing acceptance in pediatric imaging. In this case series, we present our initial experience with both intravenous and intracavitary use of CEUS in children with complicated pneumonia. Intravenous CEUS accurately and confidently showed necrotizing pneumonia and delineated pleural effusions, whereas intracavitary CEUS accurately identified the chest catheter location and patency and showed the presence of loculations, suggesting the use of fibrinolytics. © 2017 by the American Institute of Ultrasound in Medicine.

  2. Development of a nurse-assisted preanesthesia evaluation program for pediatric outpatient anesthesia.

    PubMed

    Wittkugel, Eric; Varughese, Anna

    2015-07-01

    Historically, anesthesiologists have conducted preanesthesia evaluation, but more recently, nurse practitioners (NPs) are increasingly assisting with the preanesthesia evaluation of children. In the current economic environment for healthcare, strategies to provide superior outcomes and exceptional patient experience at the lowest possible cost are constantly being explored. We examined whether well trained nurses, working alongside NPs, could safely and effectively assist in preanesthesia evaluation. The aim of this quality improvement project was to implement a new model for preanesthesia evaluation for healthy outpatient pediatric patients: nurse-assisted preanesthesia evaluation (NAPE). Using quality improvement methods, Key Driver Diagrams and SMART aims gave direction for the training and clinical implementation of this new process. Using small tests of change and Plan-Do-Study-Act cycles, we developed a training process and a stepwise process to integrate them into the clinical work flow. The primary outcome measure was the proportion of the total preanesthesia evaluations in which the Anesthesia Nurses assisted. To ensure quality and safety, data on balancing measures and quality metrics were collected. The weekly percentage of outpatients evaluated by Anesthesia Nurses increased from 0% to 55% within the first 4 months and was then sustained. The remaining patients were evaluated by the Anesthesia NPs. The balancing measures did not show any significant negative effect. Our perioperative quality metrics were also not changed significantly. Using quality improvement methods, we successfully improved the utilization of staff resources by adding an Anesthesia Nurse-assisted preanesthesia evaluation program alongside our NPs to provide outstanding preanesthesia care at the lowest possible cost. © 2015 John Wiley & Sons Ltd.

  3. Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations.

    PubMed

    Neder, Luciana; van Weelden, Marlon; Viola, Gabriela Ribeiro; Lourenço, Daniela Mencaroni; Len, Claudio A; Silva, Clovis A

    2015-01-01

    To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients. A cross-sectional study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations. The median of current age was similar in leprosy patients and controls [12(6-18) vs. 15(5-18)years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75(45-100) vs. 90(45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p = 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25(50-100) vs. 98.44(50-100), p = 0.036] and school activities domain by child-self report [60(50-85) vs. 80(45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05). Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  4. The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice.

    PubMed

    Edalat, Faramarz; Lindquester, Will S; Gill, Anne E; Simoneaux, Stephen F; Gaines, Jennifer; Hawkins, C Matthew

    2017-03-01

    Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.

  5. The evaluation of drug provocation tests in pediatric allergy clinic: a single center experience.

    PubMed

    Vezir, Emine; Erkocoglu, Mustafa; Civelek, Ersoy; Kaya, Aysenur; Azkur, Dilek; Akan, Aysegül; Ozcan, Celal; Toyran, Muge; Ginis, Tayfur; Misirlioglu, Emine Dibek; Kocabas, Can Naci

    2014-01-01

    Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluate the results and safety of diagnostic methods including DPTs during childhood. Between January 2010 and February 2013 DPTs were performed and evaluated, prospectively, in children who attended our pediatric allergy clinic with a suspected drug hypersensitivity reaction. One hundred ninety-eight suspected drug reactions in 175 patients (88 boys and 87 girls) were evaluated. The median age of the subjects at the time of the suspected drug-induced hypersensitivity reaction and at the time of the study was 56 (interquartile range [IQR] = 24-120 months) months and 76 (IQR = 35-149 months) months, respectively. Suspected drugs were beta-lactam antibiotics in 108 cases (54.5%), non-beta-lactam antibiotics in 22 cases (11.1%), and nonsteroid anti-inflammatory drugs in 52 cases (26.3%). The history was compatible with immediate-type reactions in 69 cases (34.8%). Skin-prick tests were not positive in any of the cases. Intradermal tests were positive in three cases (4%). DPTs were positive in 13 (6.8%) of 191 provocation cases, which were performed with culprit drugs. Our results suggest that a positive clinical history is not enough to make a diagnosis of drug allergy, which highlights the significance of undertaking further diagnostic evaluation especially for DPTs.

  6. An evaluation of pediatric dental patient education materials using contemporary health literacy measures.

    PubMed

    Kang, Edith; Fields, Henry W; Cornett, Sandy; Beck, F Michael

    2005-01-01

    The purpose of this study was to determine the appropriateness of nationally available dental information materials according to the suitability assessment of materials (SAM) method. Clinically related, professionally produced patient dental health education materials (N=22) provided by the American Academy of Pediatric Dentistry (AAPD) were evaluated using the SAM method that had previously been judged valid and reliable. A rater was trained by an experienced health literacy evaluator to establish validity. The rater then rated all materials for 5 categories of assessment (content, literacy demand, graphics, layout and typography, and learning stimulation/motivation) and an overall assessment, and repeated 5 materials to establish intrarater reliability. When compared to the experienced rater, the validity was K=0.43. The reliability was established for all ratings as K=0.52. The consistently weakest categories were content, graphics, and learning stimulation, while reading level as part of literacy demand was often not suitable. The overall suitability of the AAPD materials was generally classified as superior. Reliable and valid evaluation of available dental patient information materials can be accomplished. The materials were largely superior. There is great variability within the categories of evaluation. The categories of content, graphics, and learning stimulation require attention and could raise the overall quality of the materials.

  7. From pediatric to adult care: strategic evaluation of a transition program for patients with osteogenesis imperfecta.

    PubMed

    Dogba, Maman Joyce; Rauch, Frank; Wong, Trudy; Ruck, Joanne; Glorieux, Francis H; Bedos, Christophe

    2014-10-31

    Achieving a successful transition from pediatric to adult care for young adults with special needs, especially rare genetic diseases such as osteogenesis imperfecta (OI), is a prominent issue in healthcare research. This transition represents a challenge for patients with OI, their families, clinicians and healthcare managers because of the complex nature of the process and the lack of evaluation of existing transition programs. We evaluated a transition program for adolescents and young adults with OI from a pediatric orthopedic hospital to adult care. Data were collected by interview, observation, and document review from April 2013 to October 2013. Participants included six patients with OI, four parents, and 15 staff, including administrators, coordinators, social workers, nurses, pediatricians, surgeons, occupational therapists and physiotherapists. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis was performed. The strengths of the transition program included a solid theoretical approach based on a partnership with parents, and a comprehensive transition model based on fostering independent living and professional integration. The program's main weaknesses were the successive organizational changes and discontinuation of certain transition activities, and the potential conflict between the transition program and participation in research protocols. Further opportunities include the implementation of a multi-site transition model with cross-site personnel and user evaluations, with the inclusion of second-generation patients. Dissatisfaction reported by some care-team members at the adult care hospital could threaten collaboration among institutions involved in the transition process, whereas dissatisfaction of some former patients may reduce their perceptions of quality of care received during the transition. This study confirmed that a "one-size-fits-all" transition model for patients with OI would be inappropriate across, or even within

  8. Undergraduate medical education programme renewal: a longitudinal context, input, process and product evaluation study.

    PubMed

    Mirzazadeh, Azim; Gandomkar, Roghayeh; Hejri, Sara Mortaz; Hassanzadeh, Gholamreza; Koochak, Hamid Emadi; Golestani, Abolfazl; Jafarian, Ali; Jalili, Mohammad; Nayeri, Fatemeh; Saleh, Narges; Shahi, Farhad; Razavi, Seyed Hasan Emami

    2016-02-01

    The purpose of this study was to utilize the Context, Input, Process and Product (CIPP) evaluation model as a comprehensive framework to guide initiating, planning, implementing and evaluating a revised undergraduate medical education programme. The eight-year longitudinal evaluation study consisted of four phases compatible with the four components of the CIPP model. In the first phase, we explored the strengths and weaknesses of the traditional programme as well as contextual needs, assets, and resources. For the second phase, we proposed a model for the programme considering contextual features. During the process phase, we provided formative information for revisions and adjustments. Finally, in the fourth phase, we evaluated the outcomes of the new undergraduate medical education programme in the basic sciences phase. Information was collected from different sources such as medical students, faculty members, administrators, and graduates, using various qualitative and quantitative methods including focus groups, questionnaires, and performance measures. The CIPP model has the potential to guide policy makers to systematically collect evaluation data and to manage stakeholders' reactions at each stage of the reform in order to make informed decisions. However, the model may result in evaluation burden and fail to address some unplanned evaluation questions.

  9. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.

    PubMed

    Shanafelt, Tait D; Mungo, Michelle; Schmitgen, Jaime; Storz, Kristin A; Reeves, David; Hayes, Sharonne N; Sloan, Jeff A; Swensen, Stephen J; Buskirk, Steven J

    2016-04-01

    To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort. Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction. Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months. Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier

  10. Resource Utilization Reduction for Evaluation of Chest Pain in Pediatrics Using a Novel Standardized Clinical Assessment and Management Plan (SCAMP)

    PubMed Central

    Verghese, George R.; Friedman, Kevin G.; Rathod, Rahul H.; Meiri, Amir; Saleeb, Susan F.; Graham, Dionne A.; Geggel, Robert L.; Fulton, David R.

    2012-01-01

    Background Chest pain is a common reason for referral to pediatric cardiologists. Although pediatric chest pain is rarely attributable to serious cardiac pathology, extensive and costly evaluation is often performed. We have implemented a standardized approach to pediatric chest pain in our pediatric cardiology clinics as part of a broader quality improvement initiative termed Standardized Clinical Assessment and Management Plans (SCAMPs). In this study, we evaluate the impact of a SCAMP for chest pain on practice variation and resource utilization. Methods and Results We compared demographic variables, clinical characteristics, and cardiac testing in a historical cohort (n=406) of patients presenting to our outpatient division for initial evaluation of chest pain in the most recent pre-SCAMP calendar year (2009) to patients enrolled in the chest pain SCAMP (n=364). Demographic variables including age at presentation, sex, and clinical characteristics were similar between groups. Adherence to the SCAMP algorithm for echocardiography was 84%. Practice variation decreased significantly after implementation of the SCAMP (P<0.001). The number of exercise stress tests obtained was significantly lower in the SCAMP-enrolled patients compared with the historic cohort (∼3% of patients versus 29%, respectively; P<0.001). Similarly, there was a 66% decrease in utilization of Holter monitors and 75% decrease in the use of long-term event monitors after implementation of the chest pain SCAMP (P=0.003 and P<0.001, respectively). The number of echocardiograms obtained was similar between groups. Conclusions Implementation of a SCAMP for evaluation of pediatric chest pain has lead to a decrease in practice variation and resource utilization. (J Am Heart Assoc. 2012;1:jah3-e000349 doi: 10.1161/JAHA.111.000349.) PMID:23130120

  11. An evaluation of the safety and efficacy of bimatoprost for eyelash growth in pediatric subjects

    PubMed Central

    Borchert, Mark; Bruce, Suzanne; Wirta, David; Yoelin, Steven G; Lee, Sungwook; Mao, Cheri; VanDenburgh, Amanda

    2016-01-01

    Purpose Evaluate the safety and effectiveness of bimatoprost 0.03% for treatment of eyelash hypotrichosis in a pediatric population. Patients and methods This multicenter, randomized, double-masked, parallel-group study was conducted at seven sites in the US and Brazil. Subjects with eyelash hypotrichosis caused by chemotherapy or alopecia areata (aged 5–17 years) or healthy adolescents aged 15–17 years were enrolled (N=71). Subjects applied bimatoprost 0.03% or vehicle to upper eyelid margins once nightly for 4 months and were followed for 1 month post-treatment. Eyelash prominence was assessed using the validated 4-grade Global Eyelash Assessment scale with photonumeric guide. Changes in eyelash length, thickness, and darkness were measured by digital image analysis. Safety was assessed by adverse events and ophthalmic observations. Results Eyelash prominence improved in a significantly greater proportion of subjects treated with bimatoprost compared with vehicle at month 4 (70.8% versus 26.1%; P<0.001). This benefit was sustained at month 5 post-treatment assessment. Digital image analysis measures were significantly improved with bimatoprost. Significant treatment benefits with bimatoprost versus vehicle were evident among the healthy adolescents but not in the postchemotherapy or alopecia areata subgroups. The safety profile of bimatoprost was consistent with previous studies in adults. Conclusion Bimatoprost was safe and well tolerated in pediatric subjects with eyelash hypotrichosis. In this study with limited sample size, subgroup analyses showed that treatment was effective in healthy adolescents with no concurrent contributing medical condition, but not in those with eyelash hypotrichosis due to chemotherapy or alopecia areata. PMID:27022239

  12. Evaluation of active and passive recruitment methods used in randomized controlled trials targeting pediatric obesity.

    PubMed

    Raynor, Hollie A; Osterholt, Kathrin M; Hart, Chantelle N; Jelalian, Elissa; Vivier, Patrick; Wing, Rena R

    2009-01-01

    Evaluate enrollment numbers, randomization rates, costs, and cost-effectiveness of active versus passive recruitment methods for parent-child dyads into two pediatric obesity intervention trials. Recruitment methods were categorized into active (pediatrician referral and targeted mailings, with participants identified by researcher/health care provider) versus passive methods (newspaper, bus, internet, television, and earning statements; fairs/community centers/schools; and word of mouth; with participants self-identified). Numbers of enrolled and randomized families and costs/recruitment method were monitored throughout the 22-month recruitment period. Costs (in USD) per recruitment method included staff time, mileage, and targeted costs of each method. A total of 940 families were referred or made contact, with 164 families randomized (child: 7.2+/-1.6 years, 2.27+/-0.61 standardized body mass index [zBMI], 86.6% obese, 61.7% female, 83.5% Caucasian; parent: 38.0+/-5.8 years, 32.9+/-8.4 BMI, 55.2% obese, 92.7% female, 89.6% caucasian). Pediatrician referral, followed by targeted mailings, produced the largest number of enrolled and randomized families (both methods combined producing 87.2% of randomized families). Passive recruitment methods yielded better retention from enrollment to randomization (p<0.05), but produced few families (21 in total). Approximately $91,000 was spent on recruitment, with cost per randomized family at $554.77. Pediatrician referral was the most cost-effective method, $145.95/randomized family, but yielded only 91 randomized families over 22-months of continuous recruitment. Pediatrician referral and targeted mailings, which are active recruitment methods, were the most successful strategies. However, recruitment demanded significant resources. Successful recruitment for pediatric trials should use several strategies. NCT00259324, NCT00200265.

  13. Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland.

    PubMed

    Pelc, Raphaëlle; Redant, Sébastien; Julliand, Sébastien; Llor, Juan; Lorrot, Mathie; Oostenbrink, Rianne; Gajdos, Vincent; Angoulvant, François

    2014-05-16

    Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland. An electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal -Wallis Rank test. We analyzed 68 responses, distributed as follows: Belgium N = 10, France N = 37, The Netherlands N = 7, and Switzerland N = 14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics. We found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.

  14. Glucose sensor evaluation of glycemic instability in pediatric type 1 diabetes mellitus.

    PubMed

    Alemzadeh, Ramin; Loppnow, Cindy; Parton, Elaine; Kirby, Midge

    2003-01-01

    Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.

  15. Evaluation of the Two-Bag System for Fluid Management in Pediatric Patients with Diabetic Ketoacidosis

    PubMed Central

    So, Tsz-Yin; Grunewalder, Elizabeth

    2009-01-01

    OBJECTIVES A one-bag and a two-bag system have both been used to manage intravenous fluid administration in pediatric patients with diabetic ketoacidosis (DKA). The one-bag system, however, has been noted to have limitations, such as slow response time. This study evaluates whether the two-bag system provides any clinical benefit in pediatric DKA patients as compared to the one-bag system. METHODS This was a retrospective, non-blinded chart review. Inclusion criteria were patients ≤ 18 years old and whose admission had the code of DKA as the diagnosis. Baseline clinical and demographic data were collected. Descriptive statistics were used in the data analysis. RESULTS A total of 31 patients were included, 9 (29%) in the one-bag group and 22 (71%) in the two-bag group. Baseline characteristics were similar between the two groups. Mean (SD) rate of complete blood glucose (CBG) correction was 31.04 mg/dL/hr (20.61) in the two-bag group and 21.04 mg/dL/hr (16.26) in the one-bag group (p = 0.297). The rate of bicarbonate correction, however, was faster with the two-bag system than the one-bag system (0.949 ± 0.553 mEq/L/hr and 0.606 ± 0.297 mEq/L/hr, respectively) (p = 0.047). The two-bag system also had a faster time to ketone (p = 0.04), but not pH (p = 0.172), correction. CONCLUSIONS The two-bag system provided a faster rate of bicarbonate and ketone correction compared to the one-bag system. The two-bag system also provided a trend towards a faster rate of blood glucose and pH correction. PMID:23055897

  16. An evaluation of the safety and efficacy of bimatoprost for eyelash growth in pediatric subjects.

    PubMed

    Borchert, Mark; Bruce, Suzanne; Wirta, David; Yoelin, Steven G; Lee, Sungwook; Mao, Cheri; VanDenburgh, Amanda

    2016-01-01

    Evaluate the safety and effectiveness of bimatoprost 0.03% for treatment of eyelash hypotrichosis in a pediatric population. This multicenter, randomized, double-masked, parallel-group study was conducted at seven sites in the US and Brazil. Subjects with eyelash hypotrichosis caused by chemotherapy or alopecia areata (aged 5-17 years) or healthy adolescents aged 15-17 years were enrolled (N=71). Subjects applied bimatoprost 0.03% or vehicle to upper eyelid margins once nightly for 4 months and were followed for 1 month post-treatment. Eyelash prominence was assessed using the validated 4-grade Global Eyelash Assessment scale with photonumeric guide. Changes in eyelash length, thickness, and darkness were measured by digital image analysis. Safety was assessed by adverse events and ophthalmic observations. Eyelash prominence improved in a significantly greater proportion of subjects treated with bimatoprost compared with vehicle at month 4 (70.8% versus 26.1%; P<0.001). This benefit was sustained at month 5 post-treatment assessment. Digital image analysis measures were significantly improved with bimatoprost. Significant treatment benefits with bimatoprost versus vehicle were evident among the healthy adolescents but not in the postchemotherapy or alopecia areata subgroups. The safety profile of bimatoprost was consistent with previous studies in adults. Bimatoprost was safe and well tolerated in pediatric subjects with eyelash hypotrichosis. In this study with limited sample size, subgroup analyses showed that treatment was effective in healthy adolescents with no concurrent contributing medical condition, but not in those with eyelash hypotrichosis due to chemotherapy or alopecia areata.

  17. A qualitative description of the development and evaluation of our voice, a health promotion magazine created by pediatric patients for hospitalized pediatric patients.

    PubMed

    Luca, Paola D; Chan, Melissa; Basak, Sanjukta; Segal, Audrey O; Porepa, Michelle; Pinard, Marie; Au, Hosanna; Birken, Catherine S

    2013-01-01

    To facilitate a peer-developed health promotion magazine that provides health education and engages hospitalized pediatric patients during a hospital admission. To evaluate patient satisfaction with the content and layout of the magazine and its impact on patients' attitudes toward healthy living. A pediatric resident-led multidisciplinary team collaborated with the Children's Council at The Hospital for Sick Children to create a health promotion magazine for inpatients. Articles included a scavenger hunt, healthy recipes, physical activities, hospital staff interviews, and patient stories. Patients 7 to 18 years of age admitted to Pediatric Medicine or Respirology were invited to read the magazine and complete a questionnaire 24 hours later on their satisfaction with the magazine and their attitudes regarding healthy living. Thirty-seven patients received a copy of the magazine, and 24 patients completed the questionnaire (mean 13.4 years, 54% female, 25% overweight/obese). Eleven of 24 (46%) read the entire magazine, and 19 of 23 (83%) reported learning. The exercises, recipes, and patient stories were most liked. Ten of 24 (42%) participants performed the exercises; the most common reason for not trying an exercise was pain. After reading the magazine, 15 of 24 (65%) patients reported that they will try to be more active, and 11 of 23 (48%) reported that they will try to eat more fruits and vegetables. Eighty-three percent were interested in a future edition. A health promotion magazine created by patients for patients changed patient-reported attitudes about healthy living. Peer-led interventions in the inpatient setting may be an important opportunity to promote healthy lifestyles and require further study.

  18. Longitudinal evaluation of dental arch asymmetry in Class II subdivision malocclusion with 3-dimensional digital models.

    PubMed

    Veli, Ilknur; Yuksel, Burcin; Uysal, Tancan

    2014-06-01

    Class II subdivision malocclusions with their asymmetric occlusal relationships often pose treatment difficulties. The aim of this study was to evaluate the longitudinal changes of dental arch asymmetry in untreated subjects with Class II subdivision malocclusion. From 706 files from the University of Michigan Growth Study, longitudinal records of 17 untreated subjects with Class II subdivision malocclusion were included this study. Dental arch changes at 3 consecutive longitudinal intervals, defined by the cervical vertebral maturation method, were analyzed on digital dental models. The average ages of the subjects were 12.4, 15.1, and 19.1 years at the 3 time periods, respectively. Maxillary and mandibular reference lines were constructed and used for the intra-arch asymmetry measurements. The Friedman test and analysis of variance with repeated measures were used to determine dental arch asymmetries at the P <0.05 level. All subjects were found to have a type 1 Class II subdivision malocclusion characterized by distal positioning of the mandibular first molar on the Class II side. No statistically significant intra-arch asymmetry changes were found for the maxillary and mandibular dental arches in any time period. Between the baseline and the final follow-up, the data indicated decreases in maxillary and mandibular intercanine arch widths and arch lengths symmetrically. The results of this study indicate that the dental arch asymmetry in patients with Class II subdivision malocclusions did not improve or worsen with growth. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  19. Automatic detection of new tumors and tumor burden evaluation in longitudinal liver CT scan studies.

    PubMed

    Vivanti, R; Szeskin, A; Lev-Cohain, N; Sosna, J; Joskowicz, L

    2017-08-30

    Radiological longitudinal follow-up of liver tumors in CT scans is the standard of care for disease progression assessment and for liver tumor therapy. Finding new tumors in the follow-up scan is essential to determine malignancy, to evaluate the total tumor burden, and to determine treatment efficacy. Since new tumors are typically small, they may be missed by examining radiologists. We describe a new method for the automatic detection and segmentation of new tumors in longitudinal liver CT studies and for liver tumors burden quantification. Its inputs are the baseline and follow-up CT scans, the baseline tumors delineation, and a tumor appearance prior model. Its outputs are the new tumors segmentations in the follow-up scan, the tumor burden quantification in both scans, and the tumor burden change. Our method is the first comprehensive method that is explicitly designed to find new liver tumors. It integrates information from the scans, the baseline known tumors delineations, and a tumor appearance prior model in the form of a global convolutional neural network classifier. Unlike other deep learning-based methods, it does not require large tagged training sets. Our experimental results on 246 tumors, of which 97 were new tumors, from 37 longitudinal liver CT studies with radiologist approved ground-truth segmentations, yields a true positive new tumors detection rate of 86 versus 72% with stand-alone detection, and a tumor burden volume overlap error of 16%. New tumors detection and tumor burden volumetry are important for diagnosis and treatment. Our new method enables a simplified radiologist-friendly workflow that is potentially more accurate and reliable than the existing one by automatically and accurately following known tumors and detecting new tumors in the follow-up scan.

  20. Pediatric hematology providers on referral for transplant evaluation for sickle cell disease: a regional perspective.

    PubMed

    Mikles, Bethany; Bhatia, Monica; Oyeku, Suzette O; Jin, Zhezhen; Green, Nancy S

    2014-10-01

    Hematology referral for evaluation is a key step for hematopoietic stem cell transplantation for sickle cell disease (SCD). Pediatric SCD providers in the US Northeast (New York-Mid-Atlantic and New England regions) were surveyed anonymously for perspectives and practices regarding transplant referral and compared by whether they practiced at SCD transplant centers. Data were analyzed using the Fisher exact test, χ test, and logistic regression. Half of the respondents practiced primarily at transplant sites. Most (79%) were enthusiastic about transplant for SCD and 78% had recently referred ≥1 child for evaluation. Overall, 77% limited referral to certain sickle hemoglobinopathies and 44% preferred referral for β-thalassemia to SCD. Indications selected for referral resembled current transplant criteria, plus family request or poor response to therapy. Referral for children on chronic transfusions predicted enthusiasm and prior referral. Many (66%) referred children with multiple SCD complications, even without matched sibling donors, 37% with sibling donors despite limited disease. Practitioners at transplant centers more commonly accepted event-free survival rates of ≤90% (P=0.002). Northeastern providers expressed varying enthusiasm for referral for evaluation based on eligibility, donor availability, and acceptable risk, with modestly more interest from practitioners at transplant centers. Differing provider perspectives may affect patient referral for transplant consideration.

  1. Pediatric Hematology Providers on Referral for Transplant Evaluation for Sickle Cell Disease: A Regional Perspective

    PubMed Central

    Mikles, Bethany; Bhatia, Monica; Oyeku, Suzette O.; Jin, Zhezhen; Green, Nancy S.

    2014-01-01

    Summary Hematology referral for evaluation is a key step for hematopoietic stem cell transplantation for sickle cell disease (SCD). Pediatric SCD providers in the US Northeast (New York-Mid-Atlantic and New England regions) were surveyed anony-mously for perspectives and practices regarding transplant referral and compared by whether they practiced at SCD transplant centers. Data were analyzed using the Fisher exact test, χ2 test, and logistic regression. Half of the respondents practiced primarily at transplant sites. Most (79%) were enthusiastic about transplant for SCD and 78% had recently referred ≥1 child for evaluation. Overall, 77% limited referral to certain sickle hemoglobinopathies and 44% preferred referral for β-thalassemia to SCD. Indications selected for referral resembled current transplant criteria, plus family request or poor response to therapy. Referral for children on chronic transfusions predicted enthusiasm and prior referral. Many (66%) referred children with multiple SCD complications, even without matched sibling donors, 37% with sibling donors despite limited disease. Practitioners at transplant centers more commonly accepted event-free survival rates of ≤90% (P = 0.002). North-eastern providers expressed varying enthusiasm for referral for evaluation based on eligibility, donor availability, and acceptable risk, with modestly more interest from practitioners at transplant centers. Differing provider perspectives may affect patient referral for transplant consideration. PMID:24633300

  2. Longitudinal construct validity: establishment of clinical meaning in patient evaluative instruments.

    PubMed

    Liang, M H

    2000-09-01

    Although widely used and reported in research for the evaluation of groups, measures of health status and health-related quality of life have had little application in clinical practice for the assessment of individual patients. One of the principal barriers is the demonstration that these measures add clinically significant information to measures of function or symptoms alone. Here, we review the methods for evaluation of construct validity in longitudinal studies and make recommendations for nomenclature, reporting of study results, and future research agenda. Analytical review. The terms "sensitivity" and "responsiveness" have been used interchangeably, and there are few studies that evaluate the extent to which health status or health-related quality-of life measures capture clinically important changes ("responsiveness"). Current methods of evaluating responsiveness are not standardized or evaluated. Approaches for the assessment of a clinically significant or meaningful change are described; rather than normative information, however, standardized transition questions are proposed. They would be reported routinely and as separate axes of description to capture individual perceptions. Research in methods to assess the subject's evaluation of the importance and magnitude of a measured change are critical if health status and health-related quality-of-life measures are to have an impact on patient care.

  3. Reference Intervals of Thromboelastometric Evaluation of Coagulation in Pediatric Patients with Congenital Heart Diseases: A Retrospective Investigation

    PubMed Central

    Kim, Ji Young; Shin, Yu Rim; Kil, Hae Keum; Park, Mi Ran; Lee, Jong Wha

    2016-01-01

    Background Rotational thromboelastometry (ROTEM®) is a point-of-care test for coagulation, enabling physicians to make a swift decision. The aim of this investigation was to establish reference intervals of thromboelastometric evaluation for coagulation in pediatric patients with congenital heart diseases (CHD). Material/Methods As baseline data, 3 assays of ROTEM® (INTEM, EXTEM, and FIBTEM) were measured after anesthesia induction. ROTEM® parameters were clotting time (CT), amplitude at 10 min (A10), clot formation time (CFT), α angle, maximal clot firmness (MCF), clot lysis index at 60 min (LI60), and maximal clot elasticity (MCE). As age is a well-known factor for maturation, age groups were determined as follows; 1) <1 month, 2) 1–3 months, 3) 4–12 months, 4) 1–3 years, 5) 4–6 years, 6) 7–12 years, and 7) 13–16 years. Reference limits representing 95% of distribution of ROTEM® parameters and 90% confidence intervals of upper and lower reference limits were calculated. Results The data of 413 patients were analyzed. Although INTEM CT was prolonged, significantly shorter CT and CFT, steeper α, and greater A10, MCF, and MCE were shown in patients age <3 months compared to older children. Conclusions Reference intervals of thromboelastometric evaluation for coagulation from pediatric patients with CHD were shown to have similar pattern to those obtained from healthy pediatric patients. Pediatric patients with CHD, even with cyanosis, were demonstrated to have functionally intact coagulation profile before surgery. PMID:27711024

  4. Reference Intervals of Thromboelastometric Evaluation of Coagulation in Pediatric Patients with Congenital Heart Diseases: A Retrospective Investigation.

    PubMed

    Kim, Ji Young; Shin, Yu Rim; Kil, Hae Keum; Park, Mi Ran; Lee, Jong Wha

    2016-10-06

    BACKGROUND Rotational thromboelastometry (ROTEM®) is a point-of-care test for coagulation, enabling physicians to make a swift decision. The aim of this investigation was to establish reference intervals of thromboelastometric evaluation for coagulation in pediatric patients with congenital heart diseases (CHD). MATERIAL AND METHODS As baseline data, 3 assays of ROTEM® (INTEM, EXTEM, and FIBTEM) were measured after anesthesia induction. ROTEM® parameters were clotting time (CT), amplitude at 10 min (A10), clot formation time (CFT), a angle, maximal clot firmness (MCF), clot lysis index at 60 min (LI60), and maximal clot elasticity (MCE). As age is a well-known factor for maturation, age groups were determined as follows; 1) <1 month, 2) 1-3 months, 3) 4-12 months, 4) 1-3 years, 5) 4-6 years, 6) 7-12 years, and 7) 13-16 years. Reference limits representing 95% of distribution of ROTEM® parameters and 90% confidence intervals of upper and lower reference limits were calculated. RESULTS The data of 413 patients were analyzed. Although INTEM CT was prolonged, significantly shorter CT and CFT, steeper α, and greater A10, MCF, and MCE were shown in patients age <3 months compared to older children. CONCLUSIONS Reference intervals of thromboelastometric evaluation for coagulation from pediatric patients with CHD were shown to have similar pattern to those obtained from healthy pediatric patients. Pediatric patients with CHD, even with cyanosis, were demonstrated to have functionally intact coagulation profile before surgery.

  5. The Role of Limited Head Computed Tomography in the Evaluation of Pediatric Ventriculoperitoneal Shunt Malfunction.

    PubMed

    Park, Daniel B; Hill, Jeanne G; Thacker, Paul G; Rumboldt, Zoran; Huda, Walter; Ashley, Bryan; Hulsey, Thomas; Russell, W Scott

    2016-09-01

    The evaluation of children with suspected ventriculoperitoneal shunt (VPS) malfunction has evolved into a diagnostic dilemma. This patient population is vulnerable not only to the medical risks of hydrocephalus and surgical complications but also to silent but harmful effects of ionizing radiation secondary to imaging used to evaluate shunt efficacy and patency. The combination of increased medical awareness regarding ionizing radiation and public concern has generated desire to reduce the reliance on head computed tomography (CT) for the evaluation of VPS malfunction. Many centers have started to investigate the utility of low-dose CT scans and alternatives, such as fast magnetic resonance imaging for the investigation of VP shunt malfunction in order to keep radiation exposure as low as reasonably achievable. This pilot study hopes to add to the armamentarium available to the clinician charged with evaluating this challenging patient population by testing the feasibility of a limited CT protocol as an alternative to a full head CT examination. To evaluate the efficacy of a limited head CT protocol compared with a complete head CT for the evaluation of children presenting to the pediatric emergency department with suspected shunt malfunction. We retrospectively reviewed all pediatric patients who received a head CT for suspected VPS malfunction evaluation at a tertiary care children's hospital from January 2001 through January 2013. Children were included in the pilot study if they had at least 2 CT scans in this study period interpreted by a specific senior attending neuroradiologist. For each patient enrolled, a limited series was generated from the most recent CT scan by selecting four representative axial slices based on the sagittal scout image. These 4 slices where selected at the level of the fourth ventricle, third ventricle, basal ganglia level, and lateral ventricles, respectively. A blinded, senior attending neuroradiologist first reviewed the limited 4

  6. Evaluation of the New York City Dropout Prevention Initiative 1985-86 through 1987-88. Final Longitudinal Report.

    ERIC Educational Resources Information Center

    Grannis, Joseph; And Others

    This document, a two-volume report, provides in volume 1 the final longitudinal evaluation of the New York City Dropout Prevention Initiative (DPI), 1985-86 through 1987-88. (The second volume comprises appendices containing summaries of each previous evaluation for this time period.) The DPI was implemented in 13 high schools and 29 feeder middle…

  7. Antimicrobial susceptibility among Gram-positive organisms collected from pediatric patients globally between 2004 and 2011: results from the Tigecycline Evaluation and Surveillance Trial.

    PubMed

    Brandon, Michael; Dowzicky, Michael J

    2013-07-01

    The Tigecycline Evaluation and Surveillance Trial (TEST) was designed to monitor global longitudinal changes in bacterial susceptibility to a panel of antimicrobial agents, including tigecycline. In this study, we examine susceptibility among Gram-positive isolates collected from pediatric patients globally between 2004 and 2011. A total of 9,422 Gram-positive isolates were contributed by 1,255 centers, predominantly from Europe and North America. One-third of Staphylococcus aureus isolates were methicillin resistant, peaking in prevalence in 2007. All S. aureus isolates (n = 3,614) were susceptible to linezolid, tigecycline, and vancomycin; minocycline, imipenem, and meropenem were also highly active (>92% susceptibility). Ampicillin and penicillin susceptibility increased significantly during the study period (P < 0.0001 for both). Streptococcus pneumoniae isolates (n = 3,373) were highly susceptible to vancomycin (100%), linezolid (>99%), and levofloxacin and tigecycline (both >96%); imipenem susceptibility was low (32%) in Africa while minocycline susceptibility was low in Asia-Pacific Rim (38%). Penicillin resistance occurred in one-fifth of all S. pneumoniae isolates, with penicillin susceptibility ranging from 14% in Africa to 65% in Europe. Streptococcus agalactiae isolates (n = 1,056) were highly susceptible to most antimicrobials, although only 16% were susceptible to minocycline. Enterococcus faecalis isolates (n = 1,112) were highly susceptible (>97%) to ampicillin, linezolid, penicillin, tigecycline, and vancomycin globally, but only 34% were minocycline susceptible; minocycline susceptibility decreased significantly from 2004 to 2011 (P < 0.001). Tigecycline and linezolid were highly active against Enterococcus faecium (n = 267) globally (100% and 98% susceptible, respectively). Tigecycline and linezolid were highly active against Gram-positive pathogens from pediatric patients in TEST 2004 to 2011, with vancomycin and the carbapenems performing well

  8. Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

    PubMed Central

    Shepherd, Edward G.; Gee, Samantha W.

    2017-01-01

    Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant. PMID:28275613

  9. Health-promoting vending machines: evaluation of a pediatric hospital intervention.

    PubMed

    Van Hulst, Andraea; Barnett, Tracie A; Déry, Véronique; Côté, Geneviève; Colin, Christine

    2013-01-01

    Taking advantage of a natural experiment made possible by the placement of health-promoting vending machines (HPVMs), we evaluated the impact of the intervention on consumers' attitudes toward and practices with vending machines in a pediatric hospital. Vending machines offering healthy snacks, meals, and beverages were developed to replace four vending machines offering the usual high-energy, low-nutrition fare. A pre- and post-intervention evaluation design was used; data were collected through exit surveys and six-week follow-up telephone surveys among potential vending machine users before (n=293) and after (n=226) placement of HPVMs. Chi-2 statistics were used to compare pre- and post-intervention participants' responses. More than 90% of pre- and post-intervention participants were satisfied with their purchase. Post-intervention participants were more likely to state that nutritional content and appropriateness of portion size were elements that influenced their purchase. Overall, post-intervention participants were more likely than pre-intervention participants to perceive as healthy the options offered by the hospital vending machines. Thirty-three percent of post-intervention participants recalled two or more sources of information integrated in the HPVM concept. No differences were found between pre- and post-intervention participants' readiness to adopt healthy diets. While the HPVM project had challenges as well as strengths, vending machines offering healthy snacks are feasible in hospital settings.

  10. Pharmacotherapy for Pediatric Generalized Anxiety Disorder: A Systematic Evaluation of Efficacy, Safety and Tolerability

    PubMed Central

    Dobson, Eric T.; Strawn, Jeffrey R.

    2016-01-01

    Background Randomized controlled trials consistently support the efficacy of antidepressants in treating youth with generalized anxiety disorder (GAD), although integrated examinations of efficacy, safety, and tolerability of psychotropic medications in GAD specifically are rare. With this in mind, we sought to describe the efficacy, safety and tolerability of psychopharmacologic interventions in youth with GAD. Methods Randomized, double-blind, placebo-controlled, prospective trials of psychopharmacologic interventions in youth with GAD were identified through a PubMed/Medline (1966–2015) search. Both authors manually reviewed trials and, to evaluate comparative efficacy and tolerability across medications, numbers needed to treat (NNT) (based on Pediatric Anxiety Rating Scale (PARS) remission criteria (PARS ≤8 [1]), and number needed to harm (NNH) for selected treatment-emergent adverse events (TEAEs) were calculated. Finally, treatment-emergent suicidality and taper-emergent/post-study adverse events are reported descriptively. Results Five trials that involved 1,186 patients and evaluated four medications were reviewed and efficacy data were extracted with regard to dimensional measures of anxiety. SSRI/SNRIs demonstrated efficacy in the reduction of anxiety symptoms with NNTs ranging from 2.8 to 9.3. TEAEs varied considerably between studies but tended to be mild and generally did not lead to discontinuation. Conclusions Data from five trials of SSRI/SNRI in youth with GAD, many of whom had co-occurring separation and social anxiety disorders, suggest superiority to placebo and favorable tolerability profiles. PMID:26660158

  11. Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation.

    PubMed

    Frazier, W Joshua; Shepherd, Edward G; Gee, Samantha W

    2017-02-01

    Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant.

  12. Pediatric photosensitivity.

    PubMed

    Grossberg, Anna L

    2012-08-01

    Photosensitivity is a rarely encountered problem in the pediatric population. It may be caused by a diverse group of primary, idiopathic photosensitivity conditions, or may reflect photoexacerbation of an existing dermatosis. In addition, there are several genodermatoses, metabolic disorders, and connective tissue disorders that can present with photosensitivity, usually in addition to other extracutaneous clinical and laboratory findings. It is important that both dermatologic and pediatric practitioners be able to recognize the various causes of photosensitivity, as well as be familiar with the associated stigmata and necessary workup, if needed, of each particular disorder. This review offers an approach to the pediatric patient who presents with photosensitivity, with emphasis on arriving at the proper diagnosis, necessary evaluations, and management strategies. © 2012 John Wiley & Sons A/S.

  13. Update of Diagnostic Evaluation of Craniosynostosis with a Focus on Pediatric Systematic Evaluation and Genetic Studies.

    PubMed

    Hwang, Su-Kyeong; Park, Ki-Su; Park, Seong-Hyun; Hwang, Sung Kyoo

    2016-05-01

    Most craniosynostoses are sporadic, but may have an underlying genetic basis. Secondary and syndromic craniosynostosis accompanies various systemic diseases or associated anomalies. Early detection of an associated disease may facilitate the interdisciplinary management of patients and improve outcomes. For that reason, systematic evaluation of craniosynostosis is mandatory. The authors reviewed systematic evaluation of craniosynostosis with an emphasis on genetic analysis.

  14. Update of Diagnostic Evaluation of Craniosynostosis with a Focus on Pediatric Systematic Evaluation and Genetic Studies

    PubMed Central

    Hwang, Su-Kyeong; Park, Ki-Su; Park, Seong-Hyun

    2016-01-01

    Most craniosynostoses are sporadic, but may have an underlying genetic basis. Secondary and syndromic craniosynostosis accompanies various systemic diseases or associated anomalies. Early detection of an associated disease may facilitate the interdisciplinary management of patients and improve outcomes. For that reason, systematic evaluation of craniosynostosis is mandatory. The authors reviewed systematic evaluation of craniosynostosis with an emphasis on genetic analysis. PMID:27226851

  15. Parental Evaluation of a Nurse Practitioner-Developed Pediatric Neurosurgery Website.

    PubMed

    Vogel, Tina Kovacs; Kleib, Manal; Davidson, Sandra J; Scott, Shannon D

    2016-04-12

    Parents often turn to the Internet to seek health information about their child's diagnosis and condition. Information, support, and resources regarding pediatric neurosurgery are scarce, hard to find, and difficult to comprehend. To address this gap, a pediatric nurse practitioner designed a website called the Neurosurgery Kids Fund (NKF). Analyzing the legitimacy of the NKF website for parents seeking health information and fulfilling their social and resource needs is critical to the website's future development and success. To explore parental usage of the NKF website, track visitor behavior, evaluate usability and design, establish ways to improve user experience, and identify ways to redesign the website. The aim of this study was to assess and evaluate whether a custom-designed health website could meet parents' health information, support, and resource needs. A multimethod approach was used. Google Analytic usage reports were collected and analyzed for the period of April 23, 2013, to November 30, 2013. Fifty-two online questionnaires that targeted the website's usability were collected between June 18, 2014, and July 30, 2014. Finally, a focus group was conducted on August 20, 2014, to explore parents' perceptions and user experiences. Findings were analyzed using an inductive content analysis approach. There were a total of 2998 sessions and 8818 page views, with 2.94 pages viewed per session, a 56.20% bounce rate, an average session duration of 2 minutes 24 seconds, and a 56.24% new sessions rate. Results from 52 eligible surveys included that the majority of NKF users were Caucasian (90%), females (92%), aged 36-45 years (48%), with a university or college degree or diploma (69%). Half plan to use the health information. Over half reported turning to the Internet for health information and spending 2 to 4 hours a day online. The most common reasons for using the NKF website were to (1) gather information about the 2 summer camps, (2) explore the Media

  16. Parental Evaluation of a Nurse Practitioner-Developed Pediatric Neurosurgery Website

    PubMed Central

    Vogel, Tina Kovacs; Kleib, Manal; Davidson, Sandra J

    2016-01-01

    Background Parents often turn to the Internet to seek health information about their child’s diagnosis and condition. Information, support, and resources regarding pediatric neurosurgery are scarce, hard to find, and difficult to comprehend. To address this gap, a pediatric nurse practitioner designed a website called the Neurosurgery Kids Fund (NKF). Analyzing the legitimacy of the NKF website for parents seeking health information and fulfilling their social and resource needs is critical to the website’s future development and success. Objective To explore parental usage of the NKF website, track visitor behavior, evaluate usability and design, establish ways to improve user experience, and identify ways to redesign the website. The aim of this study was to assess and evaluate whether a custom-designed health website could meet parents’ health information, support, and resource needs. Methods A multimethod approach was used. Google Analytic usage reports were collected and analyzed for the period of April 23, 2013, to November 30, 2013. Fifty-two online questionnaires that targeted the website’s usability were collected between June 18, 2014, and July 30, 2014. Finally, a focus group was conducted on August 20, 2014, to explore parents’ perceptions and user experiences. Findings were analyzed using an inductive content analysis approach. Results There were a total of 2998 sessions and 8818 page views, with 2.94 pages viewed per session, a 56.20% bounce rate, an average session duration of 2 minutes 24 seconds, and a 56.24% new sessions rate. Results from 52 eligible surveys included that the majority of NKF users were Caucasian (90%), females (92%), aged 36-45 years (48%), with a university or college degree or diploma (69%). Half plan to use the health information. Over half reported turning to the Internet for health information and spending 2 to 4 hours a day online. The most common reasons for using the NKF website were to (1) gather information

  17. Evaluating pain induced by venipuncture in pediatric patients with developmental delay.

    PubMed

    Benini, Franca; Trapanotto, Manuela; Gobber, Daniela; Agosto, Caterina; Carli, Giovanna; Drigo, Paola; Eland, Jo; Zacchello, Franco

    2004-01-01

    Little attention has been paid to the assessment of pain in children with developmental delay. The aim of this study was to explore several methods for assessing pain during venipuncture in this population of children, using classic and modified scales to evaluate the children's response to simplified tools. Sixteen children with mild or moderate developmental delay were evaluated using three standard self-rating scales (Visual Analog Scale [VAS], Eland Scale, and Faces Scale) and three modified methods (Cube Test, Modified Eland Scale, and Modified Faces Scale), recording subjective self-ratings and behavioral expressions of pain during a venipuncture procedure, apart from the initial fear. The children's pain and reaction time were assessed by an outside observer, while their pain and fear were also evaluated by the parents. The VAS was used without difficulty by all the children and revealed a good consistency with the Cube Test. The parents' and neutral observer's indirect pain assessment was also consistent with the child's evaluations. The Eland Scale proved difficult to use, especially for Down's syndrome children, while its modified version was easier. Results emerging from the original and modified Faces Scales were inconsistent. Frightened children attributed higher pain scores, demonstrating that negative emotions exacerbate the experience of pain in developmentally delayed children. The patients showed a limited capacity for verbal and behavioral expression in reaction to the painful stimulus (especially the Down's cases). These findings support the conviction that even developmentally delayed children can use self-rating methods effectively. This sector demands further, more extensive study, including the development of simplified tools, to ensure an adequate pain assessment and optimal antalgic approach to this particular pediatric population.

  18. Evaluation of the immune function assay in pediatric living donor liver transplantation.

    PubMed

    Fukuda, Akinari; Imadome, Ken-Ichi; Sakamoto, Seisuke; Shigeta, Takanobu; Uchida, Hajime; Matsunami, Masatoshi; Sasaki, Kengo; Kanazawa, Hiroyuki; Kawano, Fuyuko; Nakazawa, Atsuko; Fujiwara, Shigeyoshi; Kasahara, Mureo

    2015-03-01

    The immune function (ImmuKnow) assay is a measure of cell-mediated immunity based on the peripheral CD4+ T cell ATP activity. The efficacy of ImmuKnow in pediatric LDLT is not well documented. The aim of this study was to assess the correlations between the ImmuKnow and the clinical status in pediatric LDLT recipients. A total of 716 blood samples were obtained from 60 pediatric LDLT recipients (one month to 16 yr of age). The recipient's status was classified as follows: stable, infection, or rejection. The ImmuKnow values in the pediatric LDLT recipients with a clinically stable status had a lower immune response (IQR 85-297 ATP ng/mL) than that previously reported in adults. Meanwhile, the ImmuKnow values of the stable patients were not correlated with age. Furthermore, a significant difference was found in the ImmuKnow values between the bacterial or fungal infection and stable groups, but not between the CMV or EBV infection and stable groups. The ImmuKnow levels in the pediatric LDLT were lower than those observed in the adult LDLT. The proposed reference value is between 85 and 297 ATP ng/mL in pediatric LDLT recipients. We conclude that the ImmuKnow assay could be helpful for monitoring pediatric LDLT recipients with bacterial or fungal infections. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. A fast building and effective hydraulic pediatric mock circulatory system for the evaluation of a left ventricular assist device.

    PubMed

    Huang, Feng; Ruan, Xiaodong; Zou, Jun; Qian, Wenwei; Fu, Xin

    2013-01-01

    A mock circulatory system (MCS) has been proven a useful tool in the development of a ventricular assist device. Nowadays a MCS aimed at the evaluation of pediatric blood pumps, which require many different considerations compared with that of adults, has become an urgent need. This article presents the details on how the dynamic process of the left ventricle, which is described in terms of the pressure-volume loop (P-V loop), and the properties of the circulation such as compliance and resistance are simulated by hydraulic elements. A simple control method is introduced to reproduce the physiological afterload and preload sensitivities of the mock ventricle for the first time. Hemodynamic performance of the system is obtained by medical sensors to validate the similarity of the device to the native cardiovascular system. The actual sensitivities of the mock ventricle are obtained intuitively from the changes of the P-V loops. The aortic input impedance of the MCS is also obtained and compared with the data from previous medical reports. At last a pediatric left ventricular assist device (LVAD) prototype is introduced for testing to further verify the effectiveness of the MCS. The experimental results indicate that this pediatric MCS is capable of reproducing basic hemodynamic characteristics of a child in both normal and pathological conditions and it is sufficient for testing a pediatric LVAD. Besides, most components constituting the main hydraulic part of this MCS are inexpensive off-the-shelf products, making the MCS easy and fast to build.

  20. Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population.

    PubMed

    Bourne, Theresa; Waltz, Michael; Casper, T C; Kavak, K; Aaen, G; Belman, A; Benson, L; Candee, M; Chitnis, T; Graves, J; Greenberg, B; Gorman, M; Harris, Y; Krupp, L; Lotze, T; Mar, S; Ness, J; Olsen, C; Roalstad, S; Rodriguez, M; Rose, J; Rubin, J; Schreiner, T; Tillema, J M; Kahn, I; Waldman, A; Barcellos, L; Waubant, E; Weinstock-Guttman, B

    2017-04-15

    Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results. To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort. The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT). We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01). While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Evaluation of Computerized Adaptive Tests (CATs) for longitudinal monitoring of depression, anxiety, and stress reactions.

    PubMed

    Devine, Janine; Fliege, Herbert; Kocalevent, Rüya; Mierke, Annett; Klapp, Burghard F; Rose, Matthias

    2016-01-15

    Computerized adaptive testing (CAT) based on Item Response Theory, (IRT) offers an efficient way for accurate measurement of patient reported outcomes. The efficiency lies within a minimal response burden and a high measurement precision over a broad measurement range. The objective of the study was to evaluate and compare the responsiveness of CATs measuring anxiety, depression, and stress reaction to standard static self-assessment tools. Longitudinal data of n=595 psychosomatic inpatients were analyzed for evaluating retest-reliability and sensitivity to change of the CATs compared to static measures (GAD-7, PHQ-9, and PSQ) using correlational and ANOVA statistics. The study hypothesized that CATs are at least as retest-reliable and as sensitive to change as static tools. The three CATs show a low burden for patients, administering on average 5-7 (±2-6SD) items with similar retest-reliability compared to the static tools applied (A-CAT: r=.78 vs. GAD-7: r=.75, D-CAT: r=.71 vs. PHQ-9: r=.75, S-CAT: r=.80 vs. PSQworries scale: r=.80). The CATs were overall as sensitive to change as the static tools (Cohen׳s d ranged between .19 and .69). This is a monocenter, observational, longitudinal study without external clinical criteria; thus generalization to other settings may be limited. The tested CATs belong to the first generation of CATs being used in daily routine for more than a decade. They are as retest reliable and sensitive to change as static tools. Newer CATs may provide further practical advantages. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery.

    PubMed

    Hadley, Caroline; Lam, Sandi K; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

    2015-08-28

    OBJECT Currently there is no standardized tool for assessment of neurosurgical resident performance in the operating room. In light of enhanced requirements issued by the Accreditation Council for Graduate Medical Education's Milestone Project and the Matrix Curriculum Project from the Society of Neurological Surgeons, the implementation of such a tool seems essential for objective evaluation of resident competence. Beyond compliance with governing body guidelines, objective assessment tools may be useful to direct early intervention for trainees performing below the level of their peers so that they may be given more hands-on teaching, while strong residents can be encouraged by faculty members to progress to conducting operations more independently with passive supervision. The aims of this study were to implement a validated assessment tool for evaluation of operative skills in pediatric neurosurgery and determine its feasibility and reliability. METHODS All neurosurgery residents completing their pediatric rotation over a 6-month period from January 1, 2014, to June 30, 2014, at the authors' institution were enrolled in this study. For each procedure, residents were evaluated by means of a form, with one copy being completed by the resident and a separate copy being completed by the attending surgeon. The evaluation form was based on the validated Objective Structured Assessment of Technical Skills for Surgery (OSATS) and used a 5-point Likert-type scale with 7 categories: respect for tissue; time and motion; instrument handling; knowledge of instruments; flow of operation; use of assistants; and knowledge of specific procedure. Data were then stratified by faculty versus resident (self-) assessment; postgraduate year level; and difficulty of procedure. Descriptive statistics (means and SDs) were calculated, and the results were compared using the Wilcoxon signed-rank test and Student t-test. A p value < 0.05 was considered statistically significant. RESULTS

  3. Decision making in pediatric oncology: evaluation and incorporation of patient and parent preferences.

    PubMed

    Sung, Lillian; Regier, Dean A

    2013-04-01

    Decision making in pediatric cancer is particularly difficult. There may be uncertainty about prognosis, and long-term survival estimates from trials may not be applicable to current patients. There are many motivations to conduct research into patient and provider decision making. This review discusses three approaches to understanding decision making, namely decision analysis, the threshold technique and discrete choice experiment. These techniques are applied to situations in pediatric oncology to illustrate how the results may be useful for patient care. Future work in pediatric oncology decision making should focus on methods to facilitate decision making and elicit preferences from children themselves. Copyright © 2012 Wiley Periodicals, Inc.

  4. Evaluation of pediatric foot problems: Part I. The forefoot and the midfoot.

    PubMed

    Manusov, E G; Lillegard, W A; Raspa, R F; Epperly, T D

    1996-08-01

    Foot problems in children can be the result of infection, trauma or overuse. Ingrown toenails, bunions, sesamoid disease, congenital overriding of the fifth toe, and fractures may occur in both adults and children. Some disorders, such as Freiberg's infarction and Kohler's disease, however, are unique to the pediatric population. The potential for adverse sequelae is greater in children than in adults. A thorough understanding of the anatomy of the pediatric foot and a systematic examination will facilitate the diagnosis of pediatric foot problems. A conservative approach to management will improve both compliance and outcome.

  5. Synthetic hematocrit derived from the longitudinal relaxation of blood can lead to clinically significant errors in measurement of extracellular volume fraction in pediatric and young adult patients.

    PubMed

    Raucci, Frank J; Parra, David A; Christensen, Jason T; Hernandez, Lazaro E; Markham, Larry W; Xu, Meng; Slaughter, James C; Soslow, Jonathan H

    2017-08-02

    Extracellular volume fraction (ECV) is altered in pathological cardiac remodeling and predicts death and arrhythmia. ECV can be quantified using cardiovascular magnetic resonance (CMR) T1 mapping but calculation requires a measured hematocrit (Hct). The longitudinal relaxation of blood has been used in adults to generate a synthetic Hct (estimate of true Hct) but has not been validated in pediatric populations. One hundred fourteen children and young adults underwent a total of 163 CMRs with T1 mapping. The majority of subjects had a measured Hct the same day (N = 146). Native and post-contrast T1 were determined in blood pool, septum, and free wall of mid-LV, avoiding areas of late gadolinium enhancement. Synthetic Hct and ECV were calculated and intraclass correlation coefficient (ICC) and linear regression were used to compare measured and synthetic values. The mean age was 16.4 ± 6.4 years and mean left ventricular ejection fraction was 59% ± 9%. The mean measured Hct was 41.8 ± 3.0% compared to the mean synthetic Hct of 43.2% ± 2.9% (p < 0.001, ICC 0.46 [0.27, 0.52]) with the previously published model and 41.8% ± 1.4% (p < 0.001, ICC 0.28 [0.13, 0. 42]) with the locally-derived model. Mean measured mid-free wall ECV was 30.5% ± 4.8% and mean synthetic mid-free wall ECV of local model was 29.7% ± 4.6% (p < 0.001, ICC 0.93 [0.91, 0.95]). Correlations were not affected by heart rate and did not significantly differ in subpopulation analysis. While the ICC was strong, differences between measured and synthetic ECV ranged from -8.4% to 4.3% in the septum and -12.6% to 15.8% in the free wall. Using our laboratory's normal cut-off of 28.5%, 59 patients (37%) were miscategorized (53 false negatives, 6 false positives) with published model ECV. The local model had 37 miscategorizations (20 false negatives, 17 false positives), significantly fewer but still a substantial number (23%). Our data suggest that use of synthetic Hct for the

  6. Agreement between therapists, parents, patients, and independent evaluators on clinical improvement in pediatric obsessive compulsive disorder

    PubMed Central

    Lewin, Adam B.; Peris, Tara S.; De Nadai, Alessandro S.; McCracken, James T.; Piacentini, John

    2012-01-01

    Objective Independent evaluators (IE) are employed widely in clinical trials to make unbiased determinations of treatment response. By virtue of being kept blind to treatment condition, however, IEs are also kept unaware of many pertinent clinical details that are relevant for decisions about clinical improvement. In this study, agreement among raters (children, parents, therapists, and IEs) about treatment response over the course of a 14-week clinical trial for pediatric obsessive compulsive disorder (OCD) was examined in order to determine the utility of non-blind clinician and patient ratings of treatment response. Method Participants were 71 youth (mean age= 12.2 years; 63.4% female) with a primary diagnosis of OCD and their parents participating in a psychotherapy trial. Independent evaluators provided response ratings (Clinician's Global Impressions-Improvement Scale; CGI-I) at weeks 4, week 8 and 14 and therapists, children and parents completed independent CGI-I ratings at weeks 2, 4, 8 and 14. Results Nonlinear mixed models revealed differences in rating parties, with therapists and IEs slower to rate treatment improvement compared to children and parents and growth curve models suggested that therapists and IEs produced generally consistent ratings. In addition, no evidence was found for an evaluator-by-treatment interaction, indicating that raters displayed these differences consistently across both active and placebo conditions. Conclusions Youth and parents may be able to provide accurate ratings of global improvement; non-blinded treating clinicians (with training in research-oriented assessment) can offer global improvement ratings commensurate with blinded IEs. Findings suggest that alternatives (or additions) to the blinded-IE model may be appropriate for assessing global improvement, especially with the growing emphasis on dissemination and effectiveness trials. PMID:22963592

  7. MO-E-17A-10: Evaluation of Body and Head Dimensions of Pediatric Patients as a Function of Age

    SciTech Connect

    Seibert, JA; Boone, JM

    2014-06-15

    Purpose: Phantom development in medical physics plays an important role in radiation dose assessment and image quality evaluation, and this is especially true in the pediatric patient population. The purpose of this investigation was to establish the relationship between patient age and patient size, focusing on the abdomen-pelvis and head effective diameters, for patients ranging in age from newborn to 18 years. Methods: A dose reporting tool for computed tomography systems was installed at our institution to achieve compliance with state law commencing on July 1, 2012. The software records a number of patient-specific data, and also reports CT dose metrics (CTDIvol and DLP) into the patients interpretive report. The database generated by the software was mined to determine patient effective diameter as a function of age for pediatric patients aged 0–18 years. CT protocols including abdomen-pelvis and routine head were evaluated, and specific to this study the patients age, gender and equivalent diameter were recorded. Results: Six age ranges were evaluated: A(0–3), B(4–6), C(7–9), D(10–12),E(13–15),F(16–18). For the torso in these groups based upon 694 patients, median effective diameters were 147, 167, 184, 214, 231, 246 mm, respectively. For the head (N=1833), median diameters were 143, 157, 162, 168, 174, and 174, respectively. Conclusion: A solid understanding of the approximate dimensions of pediatric patients as a function of age is useful in the development of age-based imaging protocols and dose assessments. CT dose-reporting tools generate a great deal of data with respect to body dimensions automatically. In this study, median equivalent diameters for the abdomen-pelvis and head of pediatric patients were evaluated. These data may prove useful in the development of both mathematical and physical phantoms for dosimetry and image quality assessment.

  8. Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

    PubMed

    Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

    2015-08-01

    The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=<0.001-0.01). No significant difference was observed between case experience and frequency of post-operative complications (P=0.125), although the CUSUM chart demonstrated a directional change in slope for the last 12 cases in which there were high proportions of re-do cases and patients <6 months of age. The CUSUM method has a valuable role for learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition

  9. Pediatric stridor.

    PubMed

    Ida, Jonathan B; Thompson, Dana Mara

    2014-10-01

    Pediatric stridor is an important symptom of upper airway obstruction, and must be recognized early by evaluating physicians. Proper evaluation and management, both acutely and chronically, can provide improved outcomes and better quality of life for patients. This article discusses the physiology of stridor and its intimate relation to airway anatomy, the work-up of the stridorous child, and recent advances in treatment, and provides illustrative examples of common lesions.

  10. [Nutritional evaluation of children with respiratory failure (RF): anthropometric evaluation upon admission to the pediatric intensive care units].

    PubMed

    Almeida Santos, L; Ruza, F; Guerra, A J; Alves, A; Dorao, P; García, S; Santos, N T

    1998-07-01

    Protein-energy malnutrition (PEM) constitutes an important complication in children submitted to intensive care treatment for respiratory failure (RF). This complication is not usually evaluated in assessment protocols. Nutrition assessment in a Pediatric Intensive Care Unit (PICU) was performed in children with respiratory failure. A prospective study involving 65 children (1-158 months of age) with RF at admission to the PICU was carried out. The patients studied were divided into four groups according to their etiology: Group I (n = 29) included those with acute bronchial pathology; Group II (n = 17) those with pneumonia: Group III (n = 11) those in the post-operative period following cardiac surgery; and Group IV (n = 8) those patients with multiple-organ dysfunction. All patients in Groups I, II, and III had chronic diseases. Anthropometrical and nutritional evaluation included weight, height and body mass index (w/h2). The weight for age was low (59%). Height deficit was observed in a significantly lower percentage of the patients (13.1%). The body mass index showed values in relationship to the 50th percentile that varied between 83.4 +/- 23.1% and 97.1 +/- 4.7%. In 68.9% of the patients the criteria of global malnutrition were met according to the classification of McLaren and Read. The data confirm that PEM is frequent in patients with RF in the PICU and emphasize the usefulness of anthropometrical evaluation as an important, simple and non-invasive method of nutritional evaluation. Early and intensive nutritional intervention can reduce or prevent the vicious circle of malnutrition in RF patients hospitalized in the PICU.

  11. Evaluation of predictors of adverse outcome in febrile neutropenic episodes in pediatric oncology patients.

    PubMed

    Bothra, Meenakshi; Seth, Rachna; Kapil, Arti; Dwivedi, S N; Bhatnagar, Shinjini; Xess, Immaculata

    2013-04-01

    To identify predictors associated with adverse outcome in febrile neutropenic episodes among pediatric oncology patients between 1 and 18 y age, to ascertain the prevalence of invasive bacterial or fungal infection/mortality, to determine the common organisms causing invasive bacterial infection in children with febrile neutropenia and to evaluate their current antimicrobial sensitivity pattern. It was an observational descriptive study conducted between February 2009 through July 2010. Febrile neutropenic episodes satisfying the inclusion criteria were enrolled. Relevant history was taken followed by a detailed clinical examination and laboratory examination. Logistic Regression analysis was used to identify significant predictors of adverse outcome in febrile neutropenic episodes. Out of the 155 febrile neutropenic episodes studied, adverse outcome occurred in 53(34 %) of the episodes. History of three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radiograph abnormality at presentation were found to be significantly associated with adverse outcome on multivariate logistic regression analysis. Documented invasive bacterial and fungal infection was seen in 27.8 % and 14.2 % episodes. Mortality occurred in 8 (5 %) of episodes. Gram negative bacterial infections were more common. Most common bacteria isolated was Escherichia coli and the commonest gram positive organism isolated was Staphylococcus aureus (MSSA). On multivariate analysis, the variables found to be significantly associated with adverse outcome in febrile neutropenic episodes were three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radioraph abnormality at presentation.

  12. Radiologic Response Assessment in Pediatric Soft Tissue Sarcoma: Computed-Assisted Volume Evaluation.

    PubMed

    Orsatti, Giovanna; Beltrame, Valeria; Crimì, Filippo; Frigo, Anna Chiara; Bisogno, Gianni; Stramare, Roberto

    2017-03-01

    To compare 3 methods of dimensional assessment, with particular attention to a new software assisted method of volume calculation, in soft tissue sarcoma, and to investigate the interobserver agreement and the intermethod agreement in chemotherapy response classification and resultant clinical repercussions. We studied 34 pediatric patients with nonmetastatic soft tissue sarcoma who had undergone only diagnostic biopsy. Tumor size was measured both at diagnosis and after induction chemotherapy by 3 observers and using 3 measurement methods: maximum axis (1 diameter), estimated volume (3 diameters), and computed volume (software-assisted volume calculation). We used overall concordance correlation coefficient and Bland-Altman statistical methods to assess interobserver agreement and overall concordance correlation coefficient and the κ Cohen coefficient to assess intermethod agreement. According to overall concordance correlation coefficient, the interobserver agreement was very high for each method, with a slight superiority of the software assisted method; this agreement was not confirmed in Bland-Altman plots for maximum axis and estimated volume methods. According to kappa coefficients, the intermethod agreement in chemotherapy response evaluation was poor. Computed volume was the most accurate method in soft tissue sarcoma tumor size assessment. One- and 3-dimensional methods are not concordant in chemotherapy response classification. In particular, the maximum axis method underestimates chemotherapy response and can lead to switching the chemotherapy regimen erroneously. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Evaluation of hospital-learning environment for pediatric residency in eastern region of Saudi Arabia

    PubMed Central

    2015-01-01

    Purpose: No study had been conducted to assess the hospitals’ environment for learning purposes in multicenter sites in Saudi Arabia. It aims to evaluate the environment of hospitals for learning purposes of pediatric residents. Methods: We applied Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the learning environment at six teaching hospitals in the Eastern Region of Saudi Arabia from September to December 2013. Results: The number of respondents was 104 (86.7%) out of 120 residents and 37 females and 67 male residents have responded. The residents’ response scored 100 out of 160 maximum score in rating of PHEEM that showed overall learning environment is favorable for training. There were some items in the social support domain suggesting improvements. There was no significant difference between male and female residents. There was a difference among the participant teaching hospitals (p<0.05). Conclusion: The result pointed an overall positive rating. Individual item scores suggested that their social life during residency could be uninspiring. They have the low satisfactory level and they feel racism, and sexual discrimination. Therefore, there is still a room for improvement. PMID:25959654

  14. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies.

    PubMed

    Uslu, Lebriz; Donig, Jessica; Link, Michael; Rosenberg, Jarrett; Quon, Andrew; Daldrup-Link, Heike E

    2015-02-01

    Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.

  15. An Evaluation of the Identification and Management of Overweight and Obesity in a Pediatric Clinic.

    PubMed

    Reyes, Imelda

    2015-01-01

    With the rise in overweight and obesity in children, it is imperative for health care providers to routinely address appropriate body mass index for children during primary care visits. The purposes of this project were to determine if overweight and obese children are accurately being identified and to evaluate provider adherence to American Academy of Pediatrics guidelines for the management of obesity. A retrospective chart review was completed for all children ages 2, 6, and 10 years who presented for a well-child visit from January 1, 2011, through June 30, 2011. Based on a review of 255 charts, 21.6% of patients were overweight and 18.4% were obese according to standards of the Centers for Disease Control and Prevention. Of these children, 34% were properly documented as being either overweight or obese, and documentation was lacking for the remaining 66%. Of the children correctly identified as being overweight or obese, only 11% and 26%, respectively, were counseled on therapeutic lifestyle changes, including diet and exercise. This review provides evidence that providers have opportunities to intervene early with well-child examinations and that providers have great room for improvement on counseling overweight and obese children.

  16. Development and Evaluation of a Manganese and Iron Food Frequency Questionnaire for Pediatrics.

    PubMed

    Zipkin, Frida B; Falciglia, Grace A; Kuhnell, Pierce; Haynes, Erin N

    2017-09-14

    Manganese (Mn) is an essential nutrient, but overexposure can lead to neurotoxicity. Given the essentiality of Mn in the diet, particularly during children's growth and development, it is imperative to quantify dietary Mn intake in populations that may be exposed to industrial sources of Mn. Dietary absorption of Mn is inversely associated with iron (Fe) stores, yet there is currently no food frequency questionnaire (FFQ) to assess dietary Mn and Fe intake. The study objective was to develop and evaluate the validity of a FFQ to measure dietary Mn and Fe intake in pediatrics by comparing the estimated intakes of Mn and Fe with biomarkers: Mn in blood and hair and Fe in serum. This study utilized a subset of the Communities Actively Researching Exposure Study (CARES) population residing in Guernsey County, Ohio. Dietary Mn was not correlated with either blood or hair Mn; however, dietary Mn and serum ferritin were significantly correlated, with a correlation coefficient of 0.51, p < 0.01. Moreover, dietary Fe and serum ferritin were also significantly correlated, with a correlation coefficient of 0.51, p < 0.01. This FFQ is a valid measurement tool for Fe intake as measured by serum ferritin; however, Mn intake did not correlate with either blood or hair Mn.

  17. Accuracy and Precision of the Pediatric Evaluation of Disability Inventory Computer Adapted Tests (PEDI-CAT)

    PubMed Central

    Haley, Stephen M.; Coster, Wendy J.; Dumas, Helene M.; Fragala-Pinkham, Maria A.; Kramer, Jessica; Ni, Pengsheng; Tian, Feng; Kao, Ying-Chia; Moed, Rich; Ludlow, Larry H.

    2013-01-01

    Aim The aims of the study were to (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: Daily Activities, Mobility, Social/Cognitive, and Responsibility and 2) use post-hoc simulations based on the combined normative and disability calibration samples to assess the accuracy and precision of the PEDI computerized adaptive tests (PEDI-CAT) in comparison to the administration of all items. Methods Parents of typically developing children (n=2,205) and parents of children with disabilities (n=703) between ages 0 to 21 years, stratified by age and gender participated by responding to PEDI-CAT surveys through an existing Internet Opt-in Survey Panel in the USA and by computer tablets in clinical sites. Results Confirmatory factor analyses supported four unidimensional content domains. Scores using the real data post-hoc demonstrated excellent accuracy (ICCs ≥0.95) with the full item banks. Simulations using item parameter estimates demonstrated relatively small bias in the 10- and 15-item CAT versions; error was generally higher at the scale extremes. Interpretation These results suggest the PEDI-CAT can be an accurate and precise assessment of children’s daily functioning at all functional levels. PMID:22077695

  18. Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study.

    PubMed

    Eche, Ijeoma Julie; Aronowitz, Teri

    2017-06-01

    This cross-sectional descriptive study evaluated registered nurses' self-ratings of cultural competence on the hematology/oncology unit at a large Northeastern urban children's hospital. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals was used to measure 5 constructs of cultural competence. The study findings show that there were significant correlations between the knowledge and skill subscales (ρ = .57, P < .001) and the knowledge and desire subscales (ρ = .42, P < .05). The highest mean among the 5 subscales was cultural desire (mean = 15.5), indicating that nurses were motivated to engage in the process of becoming culturally competent. The lowest mean among the 5 subscales was cultural knowledge (mean = 11.2), followed by cultural skill (mean = 11.8), indicating that nurses did not perceive themselves to be well informed in these areas. The findings from this pilot study suggest that nurses on this pediatric oncology unit are most likely to possess cultural desire and cultural awareness, but there is certainly opportunity to engage and educate the staff. Targeted interventions to improve cultural competence on this inpatient unit are being explored and a larger scale study is being planned to assess the cultural competence of nurses across the hospital.

  19. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

    PubMed Central

    Santos, Kelli Maria Souza; de Cerqueira Neto, Manoel Luiz; Carvalho, Vitor Oliveira; de Santana Filho, Valter Joviniano; da Silva Junior, Walderi Monteiro; Araújo Filho, Amaro Afrânio; Cerqueira, Telma Cristina Fontes; Cacau, Lucas de Assis Pereira

    2014-01-01

    Introduction Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline. PMID:25372909

  20. Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument

    PubMed Central

    2014-01-01

    Background The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs. Methods A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument. Results Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was “strongly recommended” while the French and Danish CGs were mainly “not recommended”. The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the “editorial independence” domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services

  1. Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument.

    PubMed

    Parisi, Pasquale; Vanacore, Nicola; Belcastro, Vincenzo; Carotenuto, Marco; Del Giudice, Ennio; Mariani, Rosanna; Papetti, Laura; Pavone, Piero; Savasta, Salvatore; Striano, Pasquale; Toldo, Irene; Tozzi, Elisabetta; Verrotti, Alberto; Raucci, Umberto

    2014-09-01

    The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs. A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument. Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was "strongly recommended" while the French and Danish CGs were mainly "not recommended". The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs. 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the "editorial independence" domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services dedicated pediatric headache assigned a

  2. Is There a Good App for That? Evaluating m-Health Apps for Strategies That Promote Pediatric Medication Adherence.

    PubMed

    Nguyen, Eve; Bugno, Lindsey; Kandah, Cassandra; Plevinsky, Jill; Poulopoulos, Natasha; Wojtowicz, Andrea; Schneider, Kristin L; Greenley, Rachel Neff

    2016-11-01

    Mobile health medication reminder apps may be a useful supplement to traditional adherence-promotion interventions for pediatric chronic illness populations because they can give real-time reminders and provide education and promote behavior modification (components known to enhance adherence in traditional interventions) in an engaging and developmentally acceptable way. Moreover, apps have the potential to be used by youth and parents, an important consideration given that shared involvement in condition management is associated with better adherence. This study evaluated the content and usability of existing medication reminder apps operating on the Apple platform. Two researchers coded 101 apps on 15 desirable reminder, educational, and behavioral modification features. Usability testing was conducted with the subset of apps (n = 8) that had the greatest number of content features using a validated measure. Apps contained an average of 4.21 of 15 content features, with medication reminder features being more common than either educational or behavioral modification features. Apps most commonly included a medication name storage feature (95%), a time-based reminder feature (87%), and a medication dosage storage feature (68%). Of the eight apps that had the highest number of content features, Mango Health, myRX Planner, and MediSafe evidenced the highest usability ratings. No apps identified were specifically designed for pediatric use. Most apps lacked content known to be useful in traditional pediatric adherence-promotion interventions. Greater attention to educational and behavioral modification features may enhance the usefulness of medication reminder apps for pediatric groups. Collaborations between behavioral medicine providers and app developers may improve the quality of medication reminder apps for use in pediatric populations.

  3. [Evaluation of safety and efficacy of tebipenem pivoxil granules for pediatric in pneumonia, otitis media and sinusitis].

    PubMed

    Kataoka, Hiroshi; Kasahara, Hiroshi; Sasagawa, Yuji; Matsumoto, Masato; Shimada, Seiya

    2016-02-01

    We conducted a postmarketing surveillance of tebipenem pivoxil granules (Orapenem® fine granules 10% for pediatric), an oral carbapenem antibacterial agent, between April 2010 and March 2013 to evaluate the safety and efficacy in patients with pneumonia or otitis media, or sinusitis Of 3,547 patients enrolled, 3,540 from whom survey forms were collected were analyzed. Of these 3,540 patients, there were a total of 3,331 patients included in the safety analysis, 2,844 in the efficacy analysis, 2,769 in the clinical efficacy analysis, and 461 in the bacteriological efficacy analysis. The incidence of adverse drug reactions (ADRs) was 9.97% (332/3,331 patients), and the major ADRs were gastrointestinal disorders including diarrhoea in 317 patients (9.52%). Diarrhoea was reported in 313 patients (316 events), which were not clinically significant and 94.9% (297/313 patients) were recovery and/or remission. The overall clinical efficacy rate was 94.0% (2,604/2,769 patients). The clinical efficacy rate by the type of infection was 95.6% (415/434 patients) for pneumonia, 93.7% (1,389/1,482 patients) for otitis media and 93.6% (659/704 patients) for sinusitis. The eradication rate of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella (Branhamella) catarrhalis which are major causative organisms in pediatric infection of pneumonia, otitis media and sinusitis were 94.4% (134/142 strains), 92.2% (130/141 strains) and 97.8% (45/46 strains), respectively. The compliance was good in 83.1% of the patients (2,767/3,331 patients). Overall, Orapenem® fine granules 10% for pediatric showed good safety, efficacy, and compliance. These results indicate that Orapenem® fine granules 10% for pediatric is a useful agent in pediatrics with pneumonia or otitis media, or sinusitis.

  4. A six-month longitudinal evaluation significantly improves accuracy of predicting incipient Alzheimer's disease in mild cognitive impairment.

    PubMed

    Mubeen, Asim M; Asaei, Ali; Bachman, Alvin H; Sidtis, John J; Ardekani, Babak A

    2017-07-01

    Early prediction of incipient Alzheimer's disease (AD) dementia in individuals with mild cognitive impairment (MCI) is important for timely therapeutic intervention and identifying participants for clinical trials at greater risk of developing AD. Methods to predict incipient AD in MCI have mostly utilized cross-sectional data. Longitudinal data enables estimation of the rate of change of variables, which along with the variable levels have been shown to improve prediction power. While some efforts have already been made in this direction, all previous longitudinal studies have been based on observation periods longer than one year, hence limiting their practical utility. It remains to be seen if follow-up evaluations within shorter intervals can significantly improve the accuracy of prediction in this problem. Our aim was to determine the added value of incorporating 6-month longitudinal data for predicting progression from MCI to AD. Using 6-months longitudinal data from 247 participants with MCI, we trained two Random Forest classifiers to distinguish between progressive MCI (n=162) and stable MCI (n=85) cases. These models utilized structural MRI, neurocognitive assessments, and demographic information. The first model (cross-sectional) only used baseline data. The second model (longitudinal) used data from both baseline and a 6-month follow-up evaluation allowing the model to additionally incorporate biomarkers' rate of change. The longitudinal model (AUC=0.87; accuracy=80.2%) performed significantly better (P<0.05) than the cross-sectional model (AUC=0.82; accuracy=71.7%). Short-term longitudinal assessments significantly enhance the performance of AD prediction models. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Health care-associated rotavirus illness in pediatric inpatients in Germany, Austria, and Switzerland.

    PubMed

    Foppa, Ivo M; Karmaus, Wilfried; Ehlken, Birgit; Fruhwirth, Martin; Heininger, Ulrich; Plenge-Bonig, Anita; Forster, Johannes

    2006-06-01

    A longitudinal study of health care-associated transmission of rotaviruses (RVs) in pediatric inpatients 0-48 months old in Austria, Germany, and Switzerland showed that almost one third of all cases occurred in patients 2 months old or younger. The effectiveness of vaccination against RV from 2 months of age onward remains to be evaluated.

  6. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: methods and findings to date.

    PubMed

    Wagner, H; Barr, J T; Zadnik, K

    2007-09-01

    To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. The CLEK Study is an 8-year, multi-center, natural history study of 1209 patients with keratoconus who were examined annually for 8 years. Its goals are to prospectively characterize changes in vision, corneal curvature, corneal status, and vision-specific quality of life. CLEK Study subjects had a mean age at baseline of 39.3+/-10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a 7-year decrease in high- (2.03 letters) and low- (4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average 8-year increase in corneal curvature of 1.60D in the flat corneal meridian, with 24% demonstrating increases of 3.00D or more. The 8-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity. Although we report measures of disease severity and visual function across the CLEK sample, clinicians can begin to envisage the course of keratoconus in individual patients by determining whether factors predictive of disease progression are present in those patients.

  7. Longitudinal structure in temperate stream fish communities: evaluating conceptual models with temporal data

    USGS Publications Warehouse

    Roberts, James H.; Hitt, Nathaniel P.

    2010-01-01

    Five conceptual models of longitudinal fish community organization in streams were examined: (1) niche diversity model (NDM), (2) stream continuum model (SCM), (3) immigrant accessibility model (IAM), (4) environmental stability model (ESM), and (5) adventitious stream model (ASM). We used differences among models in their predictions about temporal species turnover, along with five spatiotemporal fish community data sets, to evaluate model applicability. Models were similar in predicting a positive species richness–stream size relationship and longitudinal species nestedness, but differed in predicting either similar temporal species turnover throughout the stream continuum (NDM, SCM), higher turnover upstream (IAM, ESM), or higher turnover downstream (ASM). We calculated measures of spatial and temporal variation from spatiotemporal fish data in five wadeable streams in central and eastern North America spanning 34–68 years (French Creek [New York], Piasa Creek [Illinois], Spruce Run [Virginia], Little Stony Creek [Virginia], and Sinking Creek [Virginia]). All streams exhibited substantial species turnover (i.e., at least 27% turnover in stream-scale species pools), in contrast to the predictions of the SCM. Furthermore, community change was greater in downstream than upstream reaches in four of five streams. This result is most consistent with the ASM and suggests that downstream communities are strongly influenced by migrants to and from species pools outside the focal stream. In Sinking Creek, which is isolated from external species pools, temporal species turnover (via increased richness) was higher upstream than downstream, which is a pattern most consistent with the IAM or ESM. These results corroborate the hypothesis that temperate stream habitats and fish communities are temporally dynamic and that fish migration and environmental disturbances play fundamental roles in stream fish community organization.

  8. Evaluation of longitudinal steroid profiles from male football players in UEFA competitions between 2008 and 2013.

    PubMed

    Baume, Norbert; Geyer, Hans; Vouillamoz, Marc; Grisdale, Richard; Earl, Mike; Aguilera, Rodrigo; Cowan, David A; Ericsson, Magnus; Gmeiner, Günter; Kwiatkowska, Dorota; Kioukia-Fougia, Nassia; Molina, Adeline; Ruivo, João; Segura, Jordi; Van Eenoo, Peter; Jan, Nicolas; Robinson, Neil; Saugy, Martial

    2016-07-01

    Testosterone and related compounds are the most recurrent doping substances. The steroid profile, consisting of the quantification of testosterone and its metabolites, has been described as the most significant biomarker to detect doping with pseudo-endogenous anabolic steroids. The steroidal module of the Athlete Biological Passport (ABP) was launched by the World Anti-Doping Agency (WADA) in 2014. To assess the value of introducing the module to its anti-doping programme, the Union of European Football Associations (UEFA) decided to analyze retrospectively the steroid profile data of 4195 urine samples, collected from 879 male football players and analyzed in 12 WADA-accredited laboratories between 2008 and mid-2013. This study focused on the evaluation of T/E ratios. The coefficient of variation (CV) and the adaptive model were the two statistical models used to study the longitudinal follow-up. A CV of 46% was determined to be the maximal natural intra-individual variation of the T/E when the sequence consisted of single data points analyzed in different laboratories. The adaptive model showed some profiles with an atypical T/E sequence and also enabled an estimate of the prevalence of external factors impacting the T/E sequences. Despite the limitations of this retrospective study, it clearly showed that the longitudinal and individual follow-up of the T/E biomarker of the players is a good tool for target testing in football. UEFA has therefore decided to implement the steroidal module of the ABP from the start of the next European football season in September 2015. Copyright © 2015 John Wiley & Sons, Ltd.

  9. Scanning electron-microscopic evaluation of cuff shoulders in pediatric tracheal tubes.

    PubMed

    Moehrlen, Ueli; Ziegler, Urs; Weiss, Markus

    2008-03-01

    Technical and conceptual shortcomings of cuffed pediatric tracheal tubes have been pointed out in the past, all representing a potential risk for mucosal damage of the pediatric airway. In this study, cuffed pediatric tracheal tubes from different manufacturers were investigated with regard to the cuff shoulder design using scanning electron microscopy (SEM). Cuffed pediatric tracheal tubes with the smallest internal diameter available were ordered from five manufacturers. SEM scans were performed from the tube shaft - cuff shoulder - tube cuff assembly and from the cuff shoulder alone. Each investigation was repeated in four samples of each tube brand. In addition, thickness of cuff membrane was measured. Major differences were found among the cuff shoulders investigated ranging from smooth transitions, softened borders to very sharp steps. There was also considerable difference in the thickness among the cuff membranes between the different tube brands ranging from 18 microm in polyurethane cuffs up to 90 microm in polyvinylchloride cuffs. Because the gap between the outer tracheal tube and the internal mucosal layer of the pediatric airway is often very narrow, some of the observed irregularities have the potential to injure the airway mucosa in pediatric patients, particularly during long-term use and firm fit of the tracheal tube in the airway. As cuffed tubes are increasingly used in small children, the observed irregularities in some tracheal tube brands may need to be improved and their safety should be proved by the manufacturers.

  10. A scoping review of pediatric economic evaluation 1980-2014: do trends over time reflect changing priorities in evaluation methods and childhood disease?

    PubMed

    Sullivan, Shannon M; Tsiplova, Kate; Ungar, Wendy J

    2016-10-01

    Economic evaluations conducted in children have unique features compared to adults. Important developments in pediatric economic evaluation in recent years include new options for valuing health states for cost-utility analysis (CUA) and shifting child health priorities. The Pediatric Economic Database Evaluation (PEDE) project includes a comprehensive database of pediatric health economic evaluations published since 1980. The objective of this scoping review was to identify trends over time in the use of CUA and other analytic techniques, and the therapeutic areas chosen for study. Areas covered: Medical and grey literature were searched, key characteristics were extracted, frequencies were tabulated and cross-tabulations were performed. Differences between early (1980 and 1999) and late (2000 and 2014) periods were assessed using a chi-squared statistic. Of the 2,776 pediatric economic evaluations published between 1980 and 2014, substantially more were cost-effectiveness analyses (CEAs) and CUAs than cost benefit analyses and cost minimization analyses (63.9 and 24.9% versus 7.6 and 3.6%, respectively). This pattern was consistent regardless of the type of intervention, disease or age group studied. A trend toward higher proportions of CUAs and CEAs was evident in the later period (X(2) p < 0.0001). Other significant trends included a higher proportion of studies of preventive interventions (X(2) p < 0.0001), and more studies in children aged 1 to 12 years and fewer in perinates in the later period (X(2) p < 0.0001). Overall the most common disease class studied was infectious diseases (29.2%). Expert commentary: Pediatric economic evaluation continues to grow in volume and methodologic complexity. While CUAs have increased, whether their quality has improved remains unknown. Although most studies are in infectious disease, the volume of publications may not align with emerging child health priorities such as adolescent health, injury, developmental

  11. Generating a learning curve for pediatric caudal epidural blocks: an empirical evaluation of technical skills in novice and experienced anesthetists.

    PubMed

    Schuepfer, G; Konrad, C; Schmeck, J; Poortmans, G; Staffelbach, B; Jöhr, M

    2000-01-01

    Learning curves for anesthesia procedures in adult patients have been determined, but no data are available on procedures in pediatric anesthesia. The aim of this study was to assess the number of caudal blocks needed to guarantee a high success rate in performing caudal epidural analgesia in children. At a teaching hospital, the technical skills of 7 residents in anesthesiology who performed caudal blocks were evaluated during 4 months using a standardized self-evaluation questionnaire. At the start of the study period, the residents had no prior experience in pediatric anesthesia or in performing caudal epidural blocks. All residents entered the pediatric rotation after a minimum of 1 year of training in adult general and regional anesthesia. The blocks were rated using a binary score. For comparison, the success rates of 8 experienced staff anesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves using the pooled data. The learning curves were calculated with the aid of a least-square fit model and 95% confidence intervals were estimated by a Monte Carlo procedure with a bootstrap technique. The success rate of residents was 80% after 32 procedures (95% confidence interval of 0.59 to 1.00). The pooled success rate of the staff anesthesiologists was 0.73 (mean) with a standard deviation of 0.45, which was not statistically different from the success rate of the residents. High success rates in performing caudal anesthesia in pediatric patients can be acquired after a limited number of cases. Success rates of residents learning this procedure are comparable to the results of staff anesthesiologists.

  12. Evaluation of intestinal biopsies for pediatric enteropathy: a proposed immunohistochemical panel approach.

    PubMed

    Martin, Brock A; Kerner, John A; Hazard, Florette K; Longacre, Teri A

    2014-10-01

    Congenital enteropathies are rare disorders with significant clinical consequences; however, definitive diagnosis based on morphologic assessment of duodenal biopsies with routine stains alone is often impossible. To determine the role of immunohistochemistry (IHC) in the evaluation for microvillous inclusion disease, congenital tufting enteropathy (intestinal epithelial dysplasia), and enteroendocrine cell dysgenesis, a series of duodenal biopsies from 26 pediatric patients with chronic/intractable diarrhea was retrospectively reviewed. IHC stains for CD10, EpCAM, chromogranin, and villin were performed on all biopsies, and the results were correlated with hematoxylin and eosin and ultrastructural findings using electron microscopy, when available. Biopsies from 2 patients diagnosed with microvillous inclusion disease at the time of original biopsy demonstrated diffuse CD10-positive cytoplasmic inclusions within enterocytes and normal expression of EpCAM and chromogranin. Biopsies from 3 patients, including 2 siblings with confirmed EPCAM mutations, demonstrated complete loss of EpCAM expression and normal expression of CD10 and chromogranin; electron microscopic evaluation revealed characteristic ultrastructural findings of tufting enteropathy. Biopsies from 1 patient with a confirmed NEUROG3 mutation demonstrated an absence of intestinal enteroendocrine cells by chromogranin staining, consistent with enteroendocrine cell dysgenesis. Four patients' biopsies displayed nonspecific staining patterns for CD10 and/or EpCAM with normal expression of chromogranin, and 16 patients' biopsies exhibited normal expression for all 3 markers. Villin stains demonstrated heterogenous brush border labeling with nonspecific cytoplasmic reactivity, a pattern variably present throughout the biopsy series. In conclusion, the routine use of an IHC panel of CD10, EpCAM, and chromogranin is warranted in patients meeting specific age and/or clinical criteria, as the morphologic findings

  13. Perceptual evaluation of severe pediatric voice disorders: rater reliability using the consensus auditory perceptual evaluation of voice.

    PubMed

    Kelchner, Lisa N; Brehm, Susan B; Weinrich, Barbara; Middendorf, Janet; deAlarcon, Alessandro; Levin, Linda; Elluru, Ravi

    2010-07-01

    The purpose of this nonrandomized prospective study was to quantify the inter- and intrarater reliability of experienced speech-language pathologist's perceptual ratings of voice in pediatric patients post-laryngotracheal reconstruction (LTR). Moderate to severe dysphonia is common in this population. Using the sentence portion of the Consensus Auditory Perceptual Evaluation-Voice (CAPE-V) rating scale, three experienced speech-language pathologists independently rated randomized voice samples of 50 participants ages 4-20 years, who had acquired or congenital airway conditions requiring at least one LTR on the six salient perceptual vocal attributes. Data collection and listening conditions were carefully controlled. Seventeen (34%) of the samples were randomly selected for rerating at a later time. Estimates of interrater reliability were strongest for perceptual ratings of breathiness (intraclass correlation coefficient [ICC]=71%), roughness (ICC=68%), pitch (ICC=68%), and overall severity (ICC=67%). Reliability was lower for ratings of loudness (ICC=57%) and strain (ICC=35%). For each rater, the intrarater reliability on all but one parameter (strain) was moderate to strong (ICC=63-93%). There was a strong interrater eliability for four of six vocal parameters rated using the CAPE-V in a population of children and adolescents with marked dysphonia. The parameter of strain, when rated by auditory sample alone and apart from the clinical context, was difficult to rate. Copyright (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  14. Strategies To Maximize Retention of a Sample of Young Adolescents in a Longitudinal Evaluation of "Healthy & Alive!"

    ERIC Educational Resources Information Center

    Simkin, Linda S.; Hirsch, Lesley; Radosh, Alice; Middlestadt, Susan E.; Kaiser, Javaid; Santelli, John S.

    2000-01-01

    Investigated the effectiveness of strategies to maximize cohort retention in a longitudinal evaluation of a middle school human immunodeficiency virus/sexually transmitted disease prevention intervention. Retention rates of 80 percent at 6 months and 73 percent at 18 months were achieved. This required joint, proactive problem solving at the…

  15. Review of "The Comprehensive Longitudinal Evaluation of the Milwaukee Parental Choice Program: Summary of Fourth Year Reports"

    ERIC Educational Resources Information Center

    Belfield, Clive

    2011-01-01

    This review is of "The Comprehensive Longitudinal Evaluation of the Milwaukee Parental Choice Program: Summary of Fourth Year Reports," published by the School Choice Demonstration Project, University of Arkansas. The report makes eight claims about the effectiveness of the program, most of them positive. On the key issue of achievement…

  16. Strategies To Maximize Retention of a Sample of Young Adolescents in a Longitudinal Evaluation of "Healthy & Alive!"

    ERIC Educational Resources Information Center

    Simkin, Linda S.; Hirsch, Lesley; Radosh, Alice; Middlestadt, Susan E.; Kaiser, Javaid; Santelli, John S.

    2000-01-01

    Investigated the effectiveness of strategies to maximize cohort retention in a longitudinal evaluation of a middle school human immunodeficiency virus/sexually transmitted disease prevention intervention. Retention rates of 80 percent at 6 months and 73 percent at 18 months were achieved. This required joint, proactive problem solving at the…

  17. Longitudinal evaluation of upper extremity reachable workspace in ALS by Kinect sensor.

    PubMed

    de Bie, Evan; Oskarsson, Bjorn; Joyce, Nanette C; Nicorici, Alina; Kurillo, Gregorij; Han, Jay J

    2017-02-01

    Our objective was to evaluate longitudinal changes in Microsoft Kinect measured upper extremity reachable workspace relative surface area (RSA) versus the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), ALSFRS-R upper extremity sub-scale and Forced Vital Capacity (FVC) in a cohort of patients diagnosed with amyotrophic lateral sclerosis (ALS). Ten patients diagnosed with ALS (ages 52-76 years, ALSFRS-R: 8-41 at entry) were tested using single 3D depth sensor, Microsoft Kinect, to measure reachable workspace RSA across five visits spanning one year. Changes in RSA, ALSFRS-R, ALSFRS-R upper extremity sub-scale, and FVC were assessed using a linear mixed model. Results showed that upper lateral quadrant RSA declined significantly in one year by approximately 19% (p <0.01) while all other quadrants and total RSA did not change significantly in this time-period. Simultaneously, ALSFRS-R upper extremity sub-scale worsened significantly by 25% (p <0.01). In conclusion, upper extremity reachable workspace RSA as a novel ALS outcome measure is capable of objectively quantifying declines in upper extremity ability over time in patients with ALS with more granularity than other common outcome measures. RSA may serve as a clinical endpoint for the evaluation of upper extremity targeted therapeutics.

  18. An Evaluation Methodology for Longitudinal Studies of Short-Term Cancer Research Training Programs.

    PubMed

    Padilla, Luz A; Venkatesh, Raam; Daniel, Casey L; Desmond, Renee A; Brooks, C Michael; Waterbor, John W

    2016-03-01

    The need to familiarize medical students and graduate health professional students with research training opportunities that cultivate the appeal of research careers is vital to the future of research. Comprehensive evaluation of a cancer research training program can be achieved through longitudinal tracking of program alumni to assess the program's impact on each participant's career path and professional achievements. With advances in technology and smarter means of communication, effective ways to track alumni have changed. In order to collect data on the career outcomes and achievements of nearly 500 short-term cancer research training program alumni from 1999-2013, we sought to contact each alumnus to request completion of a survey instrument online, or by means of a telephone interview. The effectiveness of each contact method that we used was quantified according to ease of use and time required. The most reliable source of contact information for tracking alumni from the early years of the program was previous tracking results, and for alumni from the later years, the most important source of contact information was university alumni records that provided email addresses and telephone numbers. Personal contacts with former preceptors were sometimes helpful, as were generic search engines and people search engines. Social networking was of little value for most searches. Using information from two or more sources in combination was most effective in tracking alumni. These results provide insights and tools for other research training programs that wish to track their alumni for long-term program evaluation.

  19. In vivo macrophage imaging using MR targeted contrast agent for longitudinal evaluation of septic arthritis.

    PubMed

    Bierry, Guillaume; Lefevre, Sophie; Dietemann, Jean-Louis; Jehl, François

    2013-10-20

    Macrophages are key-cells in the initiation, the development and the regulation of the inflammatory response to bacterial infection. Macrophages are intensively and increasingly recruited in septic joints from the early phases of infection and the infiltration is supposed to regress once efficient removal of the pathogens is obtained. The ability to identify in vivo macrophage activity in an infected joint can therefore provide two main applications: early detection of acute synovitis and monitoring of therapy. In vivo noninvasive detection of macrophages can be performed with magnetic resonance imaging using iron nanoparticles such as ultrasmall superparamagnetic iron oxide (USPIO). After intravascular or intraarticular administration, USPIO are specifically phagocytized by activated macrophages, and, due to their magnetic properties, induce signal changes in tissues presenting macrophage infiltration. A quantitative evaluation of the infiltrate is feasible, as the area with signal loss (number of dark pixels) observed on gradient echo MR images after particles injection is correlated with the amount of iron within the tissue and therefore reflects the number of USPIO-loaded cells. We present here a protocol to perform macrophage imaging using USPIO-enhanced MR imaging in an animal model of septic arthritis, allowing an initial and longitudinal in vivo noninvasive evaluation of macrophages infiltration and an assessment of therapy action.

  20. New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties.

    PubMed

    Mancini, Marisa C; Coster, Wendy J; Amaral, Maíra F; Avelar, Bruna S; Freitas, Raphael; Sampaio, Rosana F

    2016-01-01

    The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.

  1. New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties

    PubMed Central

    Mancini, Marisa C.; Coster, Wendy J.; Amaral, Maíra F.; Avelar, Bruna S.; Freitas, Raphael; Sampaio, Rosana F.

    2016-01-01

    ABSTRACT Background The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. Objectives Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. Method This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). Results The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. Conclusion The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research. PMID:27333475

  2. A Longitudinal Evaluation Study of a Science Professional Development Program for K-12 Teachers: NERDS

    NASA Astrophysics Data System (ADS)

    Ewing-Taylor, Jacque M.

    A longitudinal evaluation study of a science professional development program for K-12 teachers was conducted using the CIPP evaluation model. Eleven years of program data were described and analyzed. Elementary teachers comprised 62% of the 384 participants, 17% of all participants were middle school teachers, and 13% of all participants were high school teachers. The program was focused on education reform initiatives as prescribed in the RFPs of each of three different funding agencies. Activities were congruent with the principles of adult, life-long and active learning. Program design was carefully planned and supported, and focused on content that was coherent with the state's science standards. The program duration was significant; it spread across two semesters and one summer, and incorporating over 180 hours of coursework. Participants worked in small groups, often coming from the same schools, throughout the program. The professional development program that was the subject of this evaluation study was informed by research findings on best practices and adhered to the research-based elements of effective professional development programs. Results indicated that the professional development model that was studied resulted in increased self-efficacy for the science teachers who participated in the program. Increases in self efficacy have been shown to positively affect student achievement. It is therefore reasonable to conclude that the program had a positive effect on student achievement through the teachers who participated in the professional development program. Additionally, this evaluation has demonstrated that the program and associated activities were designed to address national priorities in existence when each proposal was written.

  3. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system.

    PubMed

    Kanatli, Ulunay; Yetkin, Haluk; Yalcin, Nadir

    2003-06-01

    This study included 92 patients with an accessory navicular (AN) noted on an anteroposterior roentgenography. This group was selected from 860 patients admitted to the authors' gait analysis laboratory. The medial longitudinal arch was evaluated by using an "arch index" calculated from the pressure picture obtained from a pressure distribution measurement system. The average arch index was 0.15 and there was no significant correlation between AN types and arch index. The study concluded that the presence and type of AN are not correlated with the height of the medial longitudinal arch of the foot and that AN is not associated with pes planus.

  4. Effectiveness and safety of independent pediatric nurse practitioners in evaluating plagiocephaly.

    PubMed

    Kuang, Anna A; Bergquist, Curtis; Crupi, Lisa; Oliverio, Maureen; Selden, Nathan R

    2013-08-01

    The American Academy of Pediatrics Back to Sleep program in 1992 dramatically increased the incidence of posterior plagiocephaly in infants. In 2000, the craniofacial disorders program at Oregon Health & Science University established a plagiocephaly screening clinic staffed by pediatric nurse practitioners. Electronic medical records of patients seen in a single accredited craniofacial disorders clinic from 2005 to 2011 were reviewed retrospectively to identify patients screened independently by pediatric nurse practitioners for positional plagiocephaly versus synostosis. Over a 7-year period, 1228 patients were independently screened. Over half [638 patients (52 percent)] were followed through subsequent visits for craniofacial disorders without any direct surgeon input. Of these, 169 (26 percent) were treated with orthotic consultation for a molding helmet, 385 (60 percent) received a combination of counseling and/or physical therapy for torticollis, and 84 (13 percent) were lost to follow-up. No patient managed by pediatric nurse practitioners was identified to have cranial synostosis and no patient underwent early or delayed surgery. All returning patients [n=554 (86 percent)] showed improvement in, or resolution of, their presenting deformity. The remaining 590 patients (48 percent) were referred by the pediatric nurse practitioner for surgical consultation. Computed tomographic imaging revealed synostosis in 121 patients. Pediatric nurse practitioners accurately screened over half of patients referred to a high-volume craniofacial disorders program for positional plagiocephaly versus synostosis, without surgeon input. Based on available information, no synostosis diagnosis was overlooked using this approach. With specific training, pediatric nurse practitioners working in a craniofacial disorders program can safely and independently screen for positional versus synostotic plagiocephaly. Diagnostic, III.

  5. Evaluation of the Lipid Interference for Siemens BN ProSpec Cystatin C Assay Using Pediatric Samples.

    PubMed

    Akbas, Neval; Gonzalez, Graciela; Devaraj, Sridevi

    2015-01-01

    Endogenous interferents (lipids, hemoglobin and bilirubin) are a common cause of pre-analytical laboratory errors. We evaluated the effect of lipemia on Siemens cystatin C assay using pediatric samples. Lipemic samples were prepared by adding various concentrations of triglycerides into low and high cystatin C sample pools. Cystatin C concentrations were then measured on Siemens BN ProSpec analyzer and change of the analyte concentrations was determined. Low and high cystatin C sample pools were not affected by additions of lower lipid concentrations (150, 500 and 750 mg/dL), while the negative bias of <10% was seen with additions of higher lipid concentrations (1000 and 1500 mg/dL). Our results suggest that the BN ProSpec assay is a good alternative for cystatin C measurements in our pediatric population with no major interference from lipemia.

  6. Pediatric vasculitis.

    PubMed

    Barut, Kenan; Sahin, Sezgin; Kasapcopur, Ozgur

    2016-01-01

    The aim of this review is to define childhood vasculitis and to highlight new causative factors and treatment modalities under the guidance of recently published studies. Childhood vasculitis is difficult to diagnose because of the wide variation in the symptoms and signs. New nomenclature and classification criteria were proposed for the diagnosis of pediatric vasculitis. Recently, progress has been made toward understanding the genetic susceptibility to pediatric vasculitis as it was in other diseases. Various radiological techniques provide great opportunities in establishing the diagnosis of pediatric vasculitis. Mild central nervous system disease can accompany Henoch-Schonlein purpura and can go unnoticed. Antineutrophilic cytoplasmic antibody-associated vasculitis is rare in children. Increased severity of the disease, subglottic stenosis, and renal disease are described more frequently among children. Biological therapies are used with success in children as in adults. Future studies, whose aims are to evaluate treatment responses, prognosis and to design guidelines for activity, and damage index of vasculitis for children are required. Henoch-Schonlein purpura and Kawasaki disease are the most frequent vasculitides of children. Experience from adult studies for treatment and prognosis are usually used because of low incidence of other vasculitides in children. Multicenter studies of pediatric vasculitis should be conducted to detail treatment responses and prognosis in children.

  7. Evaluation of longitudinal tracking and data mining for an imaging informatics-based multiple sclerosis e-folder (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Ma, Kevin C.; Forsyth, Sydney; Amezcua, Lilyana; Liu, Brent J.

    2017-03-01

    We have designed and developed a multiple sclerosis eFolder system for patient data storage, image viewing, and automatic lesion quantification results to allow patient tracking. The web-based system aims to be integrated in DICOM-compliant clinical and research environments to aid clinicians in patient treatments and data analysis. The system quantifies lesion volumes, identify and register lesion locations to track shifts in volume and quantity of lesions in a longitudinal study. We aim to evaluate the two most important features of the system, data mining and longitudinal lesion tracking, to demonstrate the MS eFolder's capability in improving clinical workflow efficiency and outcome analysis for research. In order to evaluate data mining capabilities, we have collected radiological and neurological data from 72 patients, 36 Caucasian and 36 Hispanic matched by gender, disease duration, and age. Data analysis on those patients based on ethnicity is performed, and analysis results are displayed by the system's web-based user interface. The data mining module is able to successfully separate Hispanic and Caucasian patients and compare their disease profiles. For longitudinal lesion tracking, we have collected 4 longitudinal cases and simulated different lesion growths over the next year. As a result, the eFolder is able to detect changes in lesion volume and identifying lesions with the most changes. Data mining and lesion tracking evaluation results show high potential of eFolder's usefulness in patientcare and informatics research for multiple sclerosis.

  8. Evaluating the need for alternative didactic learning options in pediatric dental residency training.

    PubMed

    Keck, Douglas B; Rutkauskas, John S; Clothey, Rebecca A

    2009-06-01

    The need for an alternative means of delivery of a didactic curriculum to pediatric dental residents is described. It is our hope with this project to encourage a much-needed didactic curriculum for programs lacking faculty and to endorse other programs in which academicians exist but cannot cover all the material with which a resident needs to become familiar in the two years of postgraduate residency training. A decrease in faculty number due to retirement, debt burden, or marginal recruitment techniques along with an increase in positions in pediatric dentistry residency programs poses a unique educational dilemma. Using a mixed-method research methodology, we sent a twelve-question survey to 105 pediatric dentistry residency program directors and department chairs, followed by eight telephone interviews. Results from a 55 percent return rate show that the debt burden of most pediatric dental residents is well over $100,000 and that this affects a resident's decision to enter academia, as does the relative lack of positive recruitment techniques and poor faculty remuneration. The survey results affirm the need for improvement in the didactic curriculum of pediatric dentistry residents and show that program directors and department chairs also feel that an alternative delivery method using DVD or online/web-based programs would be welcomed. Despite their extremely heavy workloads, educators are willing to contribute by providing lectures or reading lists in their area of expertise.

  9. Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection

    PubMed Central

    Choi, Da Min; Heo, Tae Hoon; Yoo, Kee Hwan

    2015-01-01

    Purpose To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR. PMID:26512260

  10. A pediatric animal model to evaluate the effects of disuse on musculoskeletal growth and development.

    PubMed

    Miranda, Daniel L; Putman, Melissa; Kandah, Ruby; Cubria, Maria; Suarez, Sebastian; Nazarian, Ara; Snyder, Brian

    2016-10-03

    Prolonged immobilization in hospitalized children can lead to fragility fractures and muscle contractures and atrophy. The purpose of this study was to develop a lower-extremity disuse rabbit model with musculoskeletal changes similar to those observed in children subjected to prolonged immobilization. Six-week-old rabbits were randomly assigned to control (CTRL, n=4) or bilateral sciatic and femoral neurectomy (bSFN, n=4) groups. Trans-axial helical CT scans of each rabbit׳s hind limbs were acquired after eight weeks. The rabbits were then euthanized and the tibiae and calcanea were harvested from each rabbit. μCT imaging was performed on the tibiae and calcanea mid-diaphysis. Four-point bending, gas pycnometry, and ashing were then performed on each tibia. All comparisons reflect the differences between the bSFN and CTRL rabbits. Significant decreases in tibiae bone mineral density (≥9.41%, p≤0.006), axial rigidity (≥50.47%, p≤0.02), and soft tissue mass (55.25%, p=0.006) were observed from the trans-axial helical CT scans. The μCT results indicated significant detriments in tibia and calcaneus cortical thickness and bone volume fraction (p≤0.011). Significant changes in stiffness, yield load, ultimate load, and ultimate displacement (≥30.05%, p≤0.025) were observed from mechanical testing. These data indicate that limb disuse at a time of rapid musculoskeletal growth severely impairs muscle and bone development, reflecting the musculoskeletal complications observed in children with chronic medical conditions causing immobilization. Interventions to reduce these musculoskeletal complications in children are urgently needed. This disuse rabbit model will be useful in pre-clinical studies evaluating novel interventions for improving pediatric musculoskeletal health. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. A Clinical and Laboratory Approach to the Evaluation of Innate Immunity in Pediatric CVID Patients.

    PubMed

    Kutukculer, Necil; Azarsiz, Elif; Karaca, Neslihan Edeer; Ulusoy, Ezgi; Koturoglu, Guldane; Aksu, Guzide

    2015-01-01

    Defective adaptive immune responses are well studied in common variable immunodeficiency (CVID) patients; however, more focus is needed on innate immune system defects to explain CVID's clinical and laboratory heterogeneity. This is the first study comparing migratory function of granulocytes, oxidative burst activity of phagocytic cells, surface integrin expressions on neutrophils and lymphocytes, natural killer (NK) cell numbers and cytotoxic activity, natural killer T cells, lymphocyte subsets such as CD8(+)CD28(+), CD4(+)CTLA-4(+) cells in CVID patients (n: 20) and healthy controls (n: 26). The relationship between laboratory findings and some clinical was also investigated. CD3(+)CD8(+) T cytotoxic cells were found to be elevated in CVID patients, but CD3(+)CD8(+)CD28(+) or CD3(+)CD8(+)CD28(-) cells did not show any significant difference. CD4(+)CTLA-4(+) cell percentages were significantly lower in CVID patients compared to healthy controls. Severe CVID patients had decreased percentages of NK cells with increased NK cell cytotoxicity suggesting possibly increased activation. Furthermore, CD3(-)CD16(+)CD56(+)CD28(+) cells of CVID patients were elevated while percentage of CD28(-) NK cells was decreased. Neutrophil migration percentages were lower but and oxidative burst activity was not affected. CD11a expressions on these cells were depressed in contrast to increased expression of CD18. Innate immunity defects may affect the extent of recurrence and severity of infections in CVID. Our observations highlight some of these associations and indicate the need for further similar studies for improving better innate system evaluation batteries for these patients. Further phenotypic correlations of these analyses will help clinicians reach a more definitive target for the molecular genetic diagnostic of pediatric CVID patients.

  12. Evaluation of the pediatric post anesthesia discharge scoring system in an ambulatory surgery unit.

    PubMed

    Moncel, Jean Benoit; Nardi, Nicolas; Wodey, Eric; Pouvreau, Aline; Ecoffey, Claude

    2015-06-01

    To optimize the care pathway for children scheduled for ambulatory surgery, a pediatric postanesthetic discharge scoring system (Ped-PADSS) was developed from a score used in adults. The objective of this study was to evaluate this score prospectively on a cohort of children who had a day case surgical procedure. This was a single center prospective observational study. Inclusion criteria were predefined as follows: children aged 6 months-16 years at the time of the study, with a scheduled day surgery. Discharge was validated by Ped-PADSS scores ≥9, obtained at one hour intervals, after the return from the operating room and with the agreement of the surgeon. The duration of postoperative hospitalization was compared with data collected before the implementation of the score using the Student's t-test. From February to July 2012, 1060 children were included. One hour after the return from the operating room, 97.2% of children were dischargeable using Ped-PADSS. Two hours after the return from the operating room, 99.8% of children were dischargeable. The median postoperative hospital stay (n = 1041) was reduced by 69 min compared to the median stay before using the output score (n = 150) (P < 0.01). The Ped-PADSS score allows for the majority of children to be discharged 1 h after their return from the postanesthesia care unit. Children who were discharged using the Ped-PADSS score returned home in safe and optimal conditions. © 2015 John Wiley & Sons Ltd.

  13. Abdominal pediatric cancer surveillance using serial computed tomography: evaluation of organ absorbed dose and effective dose.

    PubMed

    Lam, Diana; Wootton-Gorges, Sandra L; McGahan, John P; Stern, Robin; Boone, John M

    2011-02-01

    Computed tomography (CT) is used extensively in cancer diagnosis, staging, evaluation of response to treatment, and in active surveillance for cancer reoccurrence. A review of CT technology is provided, at a level of detail appropriate for a busy clinician to review. The basis of x-ray CT dosimetry is also discussed, and concepts of absorbed dose and effective dose (ED) are distinguished. Absorbed dose is a physical quantity (measured in milligray [mGy]) equal to the x-ray energy deposited in a mass of tissue, whereas ED uses an organ-specific weighting method that converts organ doses to ED measured in millisieverts (mSv). The organ weighting values carry with them a measure of radiation risk, and so ED (in mSv) is not a physical dose metric but rather is one that conveys radiation risk. The use of CT in a cancer surveillance protocol was used as an example of a pediatric patient who had kidney cancer, with surgery and radiation therapy. The active use of CT for cancer surveillance along with diagnostic CT scans led to a total of 50 CT scans performed on this child in a 7-year period. It was estimated that the patient received an average organ dose of 431 mGy from these CT scans. By comparison, the radiation therapy was performed and delivered 50.4 Gy to the patient's abdomen. Thus, the total dose from CT represented only 0.8% of the patient's radiation dose. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Multicenter evaluation of different target volume delineation concepts in pediatric Hodgkin's lymphoma. A case study.

    PubMed

    Lütgendorf-Caucig, C; Fotina, I; Gallop-Evans, E; Claude, L; Lindh, J; Pelz, T; Knäusl, B; Georg, D; Pötter, R; Dieckmann, K

    2012-11-01

    In pediatric Hodgkin's lymphoma (PHL) improvements in imaging and multiagent chemotherapy have allowed for a reduction in target volume. The involved-node (IN) concept is being tested in several treatment regimens for adult Hodgkin's lymphoma. So far there is no consensus on the definition of the IN. To improve the reproducibility of the IN, we tested a new involved-node-level (INL) concept, using defined anatomical boundaries as basis for target delineation. The aim was to evaluate the feasibility of IN and INL concepts for PHL in terms of interobserver variability. The INL concept was defined for the neck and mediastinum by the PHL Radiotherapy Group based on accepted concepts for solid tumors. Seven radiation oncologists from six European centers contoured neck and mediastinal clinical target volumes (CTVs) of 2 patients according to the IN and the new INL concepts. The median CTVs, coefficient of variation (COV), and general conformity index (CI) were assessed. The intraclass correlation coefficient (ICC) for reliability of delineations was calculated. All observers agreed that INL is a feasible and practicable delineation concept resulting in stronger interobserver concordance than the IN (mediastinum CI(INL) = 0.39 vs. CI(IN) = 0.28, neck left CI(INL) = 0.33; CI(IN) = 0.18; neck right CI(INL) = 0.24, CI(IN) = 0.14). The COV showed less dispersion and the ICC indicated higher reliability of contouring for INL (ICC(INL) = 0.62, p < 0.05) as for IN (ICC(IN) = 0.40, p < 0.05). INL is a practical and feasible alternative to IN resulting in more homogeneous target delineation, and it should be therefore considered as a future target volume concept in PHL.

  15. A Clinical and Laboratory Approach to the Evaluation of Innate Immunity in Pediatric CVID Patients

    PubMed Central

    Kutukculer, Necil; Azarsiz, Elif; Karaca, Neslihan Edeer; Ulusoy, Ezgi; Koturoglu, Guldane; Aksu, Guzide

    2015-01-01

    Defective adaptive immune responses are well studied in common variable immunodeficiency (CVID) patients; however, more focus is needed on innate immune system defects to explain CVID’s clinical and laboratory heterogeneity. This is the first study comparing migratory function of granulocytes, oxidative burst activity of phagocytic cells, surface integrin expressions on neutrophils and lymphocytes, natural killer (NK) cell numbers and cytotoxic activity, natural killer T cells, lymphocyte subsets such as CD8+CD28+, CD4+CTLA-4+ cells in CVID patients (n: 20) and healthy controls (n: 26). The relationship between laboratory findings and some clinical was also investigated. CD3+CD8+ T cytotoxic cells were found to be elevated in CVID patients, but CD3+CD8+CD28+ or CD3+CD8+CD28− cells did not show any significant difference. CD4+CTLA-4+ cell percentages were significantly lower in CVID patients compared to healthy controls. Severe CVID patients had decreased percentages of NK cells with increased NK cell cytotoxicity suggesting possibly increased activation. Furthermore, CD3−CD16+CD56+CD28+ cells of CVID patients were elevated while percentage of CD28− NK cells was decreased. Neutrophil migration percentages were lower but and oxidative burst activity was not affected. CD11a expressions on these cells were depressed in contrast to increased expression of CD18. Innate immunity defects may affect the extent of recurrence and severity of infections in CVID. Our observations highlight some of these associations and indicate the need for further similar studies for improving better innate system evaluation batteries for these patients. Further phenotypic correlations of these analyses will help clinicians reach a more definitive target for the molecular genetic diagnostic of pediatric CVID patients. PMID:25964782

  16. Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation

    PubMed Central

    Speizer, Ilene S; Corroon, Meghan; Calhoun, Lisa; Lance, Peter; Montana, Livia; Nanda, Priya; Guilkey, David

    2014-01-01

    ABSTRACT Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all. PMID:25611476

  17. Evidence for validity within workplace assessment: the Longitudinal Evaluation of Performance (LEP).

    PubMed

    Prescott-Clements, Linda; van der Vleuten, Cees P M; Schuwirth, Lambert W T; Hurst, Yvonne; Rennie, James S

    2008-05-01

    The drive towards valid and reliable assessment methods for health professions' training is becoming increasingly focused towards authentic models of workplace performance assessment. This study investigates the validity of such a method, longitudinal evaluation of performance (LEP), which has been implemented in the assessment of postgraduate dental trainees in Scotland. Although it is similar in format to the mini-CEX (mini clinical evaluation exercise) and other tools that use global ratings for assessing performance in the workplace, a number of differences exist in the way in which the LEP has been implemented. These include the use of a reference point for evaluators' judgement that represents the standard expected upon completion of the training, flexibility, a greater range of cases assessed and the use of frequency scores within feedback to identify trainees' progress over time. A range of qualitative and quantitative data were collected and analysed from 2 consecutive cohorts of trainees in Scotland (2002-03 and 2003-04). There is rich evidence supporting the validity, educational impact and feasibility of the LEP. In particular, a great deal of support was given by trainers for the use of a fixed reference point for judgements, despite initial concerns that this might be demotivating to trainees. Trainers were highly positive about this approach and considered it useful in identifying trainees' progress and helping to drive learning. The LEP has been successful in combining a strong formative approach to continuous assessment with the collection of evidence on performance within the workplace that (alongside other tools within an assessment system) can contribute towards a summative decision regarding competence.

  18. Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing?

    PubMed

    Johnson, Erik R; Etheridge, Susan P; Minich, L Luann; Bardsley, Tyler; Heywood, Mason; Menon, Shaji C

    2014-06-01

    Syncope is a common problem in children and adolescents. Usually vasovagal in etiology, this benign problem often results in considerable testing and expense. We sought to define the current practice, practice variation, and resource utilization as well as evaluate a screening strategy for syncope at an academic tertiary care center. We reviewed the medical records of all patients age 8 to 19 years who presented with syncope between January 1994 and January 2012 and collected data regarding demographics, history, physical examination, and diagnostic tests. Practice variation was evaluated based on provider experience and subspecialty. The sensitivity and specificity of history, physical examination, and electrocardiogram (ECG) to identify a cardiac cause for syncope were calculated. Of the 617 patients studied, a cardiac cause for syncope was found in 15 (2 %). A screening strategy consisting of history, physical examination, and ECG was 100 % sensitive and 55 % specific for diagnosing a cardiac cause for syncope. Despite having a negative screen, 314 (54 %) patients had a total of 334 additional tests at an average charge of $983/patient. Although practice variation existed, it was not explained by provider experience or electrophysiology training. Factors associated with increased testing included greater number of clinic visits and increased frequency of events, whereas those associated with decreased testing included increased number of syncopal episodes and history of psychiatric medication use. A more standardized approach to syncope is needed to decrease resource use and cost while maintaining quality of care.

  19. Evaluation of autoimmune phenomena in patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

    PubMed

    Stagi, Stefano; Rigante, Donato; Lepri, Gemma; Bertini, Federico; Matucci-Cerinic, Marco; Falcini, Fernanda

    2014-12-01

    The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are basically characterized by obsessive-compulsive symptoms and/or tics triggered by group-A beta-hemolytic Streptococcus infections. Poor data are available about the clear definition of PANDAS's autoimmune origin. The aim of our study was to evaluate the prevalence of autoimmune phenomena, including thyroid function abnormalities, specific celiac disease antibodies, and positivity of organ- or nonorgan-specific autoantibodies in a large cohort of Caucasian children and adolescents with PANDAS. Seventy-seven consecutive patients (59 males, 18 females; mean age 6.3±2.5 years, range 2.0-14.5 years) strictly fulfilling the clinical criteria for PANDAS diagnosis were recruited. In all subjects we evaluated serum concentrations of free-T3, free-T4, thyrotropin, and the following auto-antibodies: anti-thyroperoxidase, anti-thyroglobulin, anti-thyrotropin receptor, anti-gliadin, anti-endomysium, anti-tissue transglutaminase, anti-nuclear, anti-smooth muscle, anti-extractable nuclear antigens, anti-phospholipid, plus lupus-like anticoagulant. The results were compared with those obtained from 197 age- and sex-matched healthy controls (130 males, 67 females; mean age 6.8±2.9 years, range 2.3-14.8 years). The frequencies of subclinical (3.8% vs 3.6%) and overt hypothyroidism (1.2% vs 0%), autoimmune thyroiditis (2.46% vs 1.14%), celiac disease (1.2% vs 0.05%), and positivity of organ- and nonorgan-specific autoantibodies (5.1% vs 4.8%) were not statistically significant between patients with PANDAS and controls. Evaluating the overall disease duration, we did not observe any significant difference between patients with (3.4±2.15 years) and without (3.4±2.89 years) autoimmune abnormalities. However, PANDAS patients with autoimmune diseases or positivity for any organ- and nonorgan-specific antibodies showed significantly higher anti-streptolysin O and anti-DNAse B

  20. Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

    PubMed

    Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

    2015-03-01

    Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education

  1. Educating Parents About Pediatric Research: Children and Clinical Studies Website Qualitative Evaluation.

    PubMed

    Marceau, Lisa D; Welch, Lisa C; Pemberton, Victoria L; Pearson, Gail D

    2016-07-01

    A gap in information about pediatric clinical trials exists, and parents remain uncertain about what is involved in research studies involving children. We aimed to understand parent perspectives about pediatric clinical research after viewing the online Children and Clinical Studies (CaCS) program. Using a qualitative descriptive study design, we conducted focus groups with parents and phone interviews with physicians. Three themes emerged providing approaches to improve parent's understanding of clinical research by including strategies where parents (a) hear from parents like themselves to learn about pediatric research, (b) receive general clinical research information to complement study-specific details, and (c) are provided more information about the role of healthy child volunteers. Parents found the website a valuable tool that would help them make a decision about what it means to participate in research. This tool can assist parents, providers, and researchers by connecting general information with study-specific information.

  2. Long-Term Changes of Subcutaneous Fat Mass in HIV-Infected Children on Antiretroviral Therapy: A Retrospective Analysis of Longitudinal Data from Two Pediatric HIV-Cohorts

    PubMed Central

    Cohen, Sophie; Innes, Steve; Geelen, Sibyl P. M.; Wells, Jonathan C. K.; Smit, Colette; Wolfs, Tom F. W.; van Eck-Smit, Berthe L. F.; Kuijpers, Taco W.; Reiss, Peter; Scherpbier, Henriette J.

    2015-01-01

    Objective Longitudinal studies objectively evaluating changes in regional fat distribution of HIV-infected children assessed by whole body dual energy X-ray absorptiometry (DEXA) are scarce, whilst this long-term effect of HIV and antiretroviral therapy (cART) is an important issue in infected children in need for lifelong treatment. Methods We assessed regional fat distribution over time, measured with sequential DEXA-scans in HIV-infected children on cART in cohorts from South Africa (SA) and the Netherlands (NL), and in healthy controls (SA). Limb and trunk fat Z-scores were calculated with the lambda-mu-sigma (LMS) method. Multivariable linear regression models with mixed effects were used to investigate the effect of cART compounds on body fat distribution over time. Results In total, 218 children underwent 445 DEXA assessments with a median follow-up of 3.5 years. Fat mass in all limbs was decreased in HIV-infected children compared to controls (arm fat Z-score: coefficient -0.4813; P = 0.006, leg fat Z-score: coefficient -0.4345; P = 0.013). In the HIV-infected group, stavudine treatment was associated with lower subcutaneous fat mass (arm fat Z-score: coefficient -0.5838; P = 0.001), with an additional cumulative exposure effect (arm fat Z-score: coefficient -0.0867; P = 0.003). Conclusions Our study shows that subcutaneous fat loss is still prevalent in HIV-infected children on cART, and is strongly associated with cumulative stavudine exposure. These results underline the need for early detection of subcutaneous fat loss and alternative treatment options for HIV-infected children globally. PMID:26148119

  3. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge.

    PubMed

    Flaigle, Melanie Cooper; Ascenzi, Judy; Kudchadkar, Sapna R

    2016-01-01

    Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.

  4. Evaluation of cumulative lead dose and longitudinal changes in structural MRI in former organolead workers

    PubMed Central

    Schwartz, Brian S.; Caffo, Brian; Stewart, Walter F.; Hedlin, Haley; James, Bryan D.; Yousem, David; Davatzikos, Christos

    2010-01-01

    Objective We evaluated whether tibia lead was associated with longitudinal change in brain volumes and white matter lesions in male former lead workers and population-based controls in whom we have previously reported on the cognitive and structural consequences of cumulative lead dose. Methods We used linear regression to identify predictors of change in brain volumes and white matter lesion grade scores, using two MRIs an average of five years apart. Results On average, total brain volume declined almost 30 cm3, predominantly in gray matter. Increasing age at the first MRI was strongly associated with larger declines in volumes and greater increases in white matter lesion scores. Tibia lead was not associated with change in brain volumes or white matter lesion scores. Conclusions In former lead workers in whom cumulative lead dose was associated with progressive declines in cognitive function decades after occupational exposure had ended, cumulative lead dose was associated with earlier persistent effects on brain structure, but not with additional worsening over five years. PMID:20357679

  5. Evaluation of Pain Preoperatively and Postoperatively in Patients with Chronic Pancreatitis Undergoing Longitudinal Pancreaticojejunostomy.

    PubMed

    Bhat, K R Seetharam; Khajanchi, Monty; Prajapati, Ram; Satoskar, R R

    2015-12-01

    Chronic pancreatitis is a fairly common condition with pain being the major symptom, and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess relief of pain post-LPJ for chronic pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational non-interventional study enrolling 28 patients. This study involved a questionnaire studying various risk factors and pain related to chronic pancreatitis, pancreaticojejunostomy, and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ; the degree of relief was less in the alcoholics vs non-alcoholics (p = 0.09) and smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. Fifty-seven percent of patients had a complete remission of their pain after LPJ for CP. In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ, although the degree of relief is less in the alcoholics and smokers.

  6. Quantitative skeletal evaluation based on cervical vertebral maturation: a longitudinal study of adolescents with normal occlusion.

    PubMed

    Chen, L; Liu, J; Xu, T; Long, X; Lin, J

    2010-07-01

    The study aims were to investigate the correlation between vertebral shape and hand-wrist maturation and to select characteristic parameters of C2-C5 (the second to fifth cervical vertebrae) for cervical vertebral maturation determination by mixed longitudinal data. 87 adolescents (32 males, 55 females) aged 8-18 years with normal occlusion were studied. Sequential lateral cephalograms and hand-wrist radiographs were taken annually for 6 consecutive years. Lateral cephalograms were divided into 11 maturation groups according to Fishman Skeletal Maturity Indicators (SMI). 62 morphological measurements of C2-C5 at 11 different developmental stages (SMI1-11) were measured and analysed. Locally weighted scatterplot smoothing, correlation coefficient analysis and variable cluster analysis were used for statistical analysis. Of the 62 cervical vertebral parameters, 44 were positively correlated with SMI, 6 were negatively correlated and 12 were not correlated. The correlation coefficients between cervical vertebral parameters and SMI were relatively high. Characteristic parameters for quantitative analysis of cervical vertebral maturation were selected. In summary, cervical vertebral maturation could be used reliably to evaluate the skeletal stage instead of the hand-wrist radiographic method. Selected characteristic parameters offered a simple and objective reference for the assessment of skeletal maturity and timing of orthognathic surgery.

  7. Longitudinal evaluation of the skin microbiome and association with microenvironment and treatment in canine atopic dermatitis

    PubMed Central

    Bradley, Charles W.; Morris, Daniel O.; Rankin, Shelley C.; Cain, Christine L.; Misic, Ana M.; Houser, Timothy; Mauldin, Elizabeth A.; Grice, Elizabeth A.

    2016-01-01

    Host-microbe interactions may play a fundamental role in the pathogenesis of atopic dermatitis (AD), a chronic relapsing inflammatory skin disorder characterized by universal colonization with Staphylococcus. To examine the relationship between epidermal barrier function and the cutaneous microbiota in AD, this study employed a spontaneous model of canine AD (cAD). In a cohort of 14 dogs with cAD, the skin microbiota was longitudinally evaluated with parallel assessment of skin barrier function at disease flare, during antimicrobial therapy and posttherapy. Sequencing of the bacterial 16S ribosomal RNA gene revealed decreased bacterial diversity and increased proportions of Staphylococcus (S. pseudintermedius in particular) and Corynebacterium in comparison to a cohort of healthy control dogs (n=16). Treatment restored bacterial diversity with decreased Staphylococcus proportions, concurrent with decreased cAD severity. Skin barrier function, as measured by corneometry, pH, and transepidermal water loss (TEWL) also normalized with treatment. Bacterial diversity correlated with TEWL and pH, but not corneometry. These findings provide insights into the relationship between the cutaneous microbiome and skin barrier function in AD, the impact of antimicrobial therapy on the skin microbiome, and highlight the utility of cAD as a spontaneous non-rodent model of AD. PMID:26854488

  8. Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

    PubMed Central

    Bonini, G.; Pezzotta, G.; Morzenti, C.; Agazzi, R.; Nani, R.

    2007-01-01

    Purpose To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n = 6) and hepatic vein (n = 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients. PMID:23396596

  9. SOFIA(®)RSV: prospective laboratory evaluation and implementation of a rapid diagnostic test in a pediatric emergency ward.

    PubMed

    Tran, Léa C; Tournus, Céline; Dina, Julia; Morello, Rémy; Brouard, Jacques; Vabret, Astrid

    2017-06-26

    Respiratory syncytial virus (RSV) is responsible for severe respiratory infections and higher costs in medical care. The two aims of this work were to assess the performances of SOFIA(®)RSV tests in "real-life-laboratory" conditions (study 1) and implemented at point-of-care testing in a pediatric emergency department (ED, study 2), during two consecutive winter seasons. In study 1, fresh nasopharyngeal swabs from patients of all ages were sampled in 1.5 ml of Universal virological Transport Medium (UTM) and prospectively tested using SOFIA(®)RSV tests. In study 2, conducted in a pediatric ED, nasopharyngeal swabs were placed in 3 ml of UTM. All SOFIA(®)RSV tests were confirmed by molecular testing, considered as reference method. The epidemiological and clinical features of tested patients, as well as the care of these patients after obtaining quick results were evaluated. The sensitivities of SOFIA(®)RSV in infants (aged under 24 months) performed in the laboratory and in the pediatric ED were respectively 95% (95% CI: 86.8-98.1) and 74.8% (95% CI: 68.0-80.9) compared to PCR. In study 1, the sensitivity among children (from 2 to 15 years old) and adults (above 15 years old) dropped to 45% (95% CI: 23.1-68.5) and 59% (95% CI: 32.9-81.6), respectively. In study 2, there were some differences in bed-management of SOFIA(®)RSV positive compared to SOFIA(®)RSV negative infants. SOFIA(®)RSV tests performed in the laboratory and in the pediatric ED show high and satisfactory sensitivities among young children under 24 months, which supports its robustness and reliability. However, the impact of these tests on patient care at point-of-care cannot be clearly assessed when considering the limits of the study 2 design.

  10. An Evaluation Methodology for Longitudinal Studies of Short Term Cancer Research Training Programs

    PubMed Central

    Padilla, Luz A.; Venkatesh, Raam; Daniel, Casey L.; Desmond, Renee A.; Brooks, C. Michael; Waterbor, John W.

    2014-01-01

    The need to familiarize medical students and graduate health professional students with research training opportunities that cultivate the appeal of research careers is vital to the future of research. Comprehensive evaluation of a cancer research training program can be achieved through longitudinal tracking of program alumni to assess the program’s impact on each participant’s career path and professional achievements. With advances in technology and smarter means of communication, effective ways to track alumni have changed. In order to collect data on the career outcomes and achievements of nearly 500 short-term cancer research training program alumni from 1999–2013, we sought to contact each alumnus to request completion of a survey instrument online, or by means of a telephone interview. The effectiveness of each contact method that we used was quantified according to ease of use and time required. The most reliable source of contact information for tracking alumni from the early years of the program was previous tracking results; and for alumni from the later years, the most important source of contact information was university alumni records that provided email addresses and telephone numbers. Personal contacts with former preceptors were sometimes helpful, as were generic search engines and people search engines. Social networking was of little value for most searches. Using information from two or more sources in combination was most effective in tracking alumni. These results provide insights and tools for other research training programs that wish to track their alumni for long-term program evaluation. PMID:25412722

  11. Evaluation of a cooking skills programme in parents of young children--a longitudinal study.

    PubMed

    Garcia, Ada L; Vargas, Elisa; Lam, Po S; Shennan, David B; Smith, Fiona; Parrett, Alison

    2014-05-01

    To evaluate longitudinally the effectiveness of a cooking programme on self-reported confidence about cooking skills and food consumption patterns in parents of young children. An evaluation of cooking programmes delivered by National Health Service (NHS) community food workers using a single group pre-test/post-test repeated measures design. A shortened version of a validated questionnaire at baseline, post intervention and 1-year follow-up determined confidence in cooking using basic ingredients, following a simple recipe, tasting new foods, preparing and cooking new foods on consumption of ready meals, vegetables and fruit. Deprived communities in Ayrshire and Arran, Scotland. Parents of nursery age children, 97 % were female and <45 years old. One hundred and two participants had completed baseline and post-intervention questionnaires. Forty-four participants contacted by telephone completed a follow-up questionnaire. In participants who completed all questionnaires (n 44), median confidence in four aspects of cooking increased significantly from baseline to post intervention (P < 0·001) but was retained at 1-year follow-up only for following a simple recipe and preparing and cooking new foods. Improved food consumption patterns were reported from baseline to post intervention (ready-meal consumption reduced from 2-4 times/week to 1 time/week, P < 0·001; vegetable consumption increased from 5-6 times/week to 1 time/d, P < 0·001; fruit consumption increased from 5-6 times/week to 1 time/d, P < 0·001) and remained at 1-year follow-up. The cooking programmes appeared to improve cooking confidence and food consumption patterns in the target group and some of these changes were retained after 1 year.

  12. The Indiana Chronic Disease Management Program's impact on medicaid claims: a longitudinal, statewide evaluation.

    PubMed

    Katz, Barry P; Holmes, Ann M; Stump, Timothy E; Downs, Steven M; Zillich, Alan J; Ackermann, Ronald T; Inui, Thomas S

    2009-02-01

    : Disease management programs have grown in popularity over the past decade as a strategy to curb escalating healthcare costs for persons with chronic diseases. : To evaluate the effect of the Indiana Chronic Disease Management Program (ICDMP) on the longitudinal changes in Medicaid claims statewide. : Phased implementation of a chronic disease management program in 3 regions of the state. Fourteen repeated cohorts of Medicaid members were drawn over a period of 3.5 years and the trends in claims were evaluated using a repeated measures model. : A total of 44,218 Medicaid members with diabetes and/or congestive heart failure in 3 geographic regions in Indiana. : Across all 3 regions and both disease classes, we found a flattening of cost trends between the pre- and post-ICDMP-initiation periods. This change in the slopes was significant for all of the models except for congestive heart failure in southern Indiana. Thus, the average per member claims paid was increasing at a faster rate before ICDMP but slowed once the program was initiated. To distinguish shorter and longer-term effects related to ICDMP, we estimated annual slopes within the pre- and post-ICDMP- time periods. A similar pattern was found in all regions: claims were increasing before ICDMP, flattened in the years around program initiation, and remained flat in the final year of follow-up. : This analysis shows that the trend in average total claims changed significantly after the implementation of ICDMP, with a decline in the rate of increase in claims paid observed for targeted Medicaid program populations across the state of Indiana.

  13. An ultrasound evaluation of laryngeal mask airway position in pediatric patients: an observational study.

    PubMed

    Kim, Jeongmin; Kim, Ji Young; Kim, Won Oak; Kil, Hae Keum

    2015-02-01

    In children, the laryngeal mask airway (LMA) is frequently displaced within the hypopharynx, resulting in repositioning of the device. When the tip of the LMA is placed in the esophageal inlet, the arytenoids are moved ventrally. When the LMA is rotated or deviated, the ventral movement of the arytenoids may result in asymmetric elevation of an arytenoid cartilage, which can be detected with ultrasound (US). In this study, we sought to estimate the incidence of LMA malposition detected with US in pediatric patients. The primary end point was to compare the incidence of LMA malposition between US and fiber optic bronchoscopy (FOB). The secondary end points were to find the interrelationship between US-detected and FOB-detected malposition of the LMA and to locate the diagnostic performance of US in detecting LMA malposition. In this observational study, 100 consecutive children were included. After anesthetic induction, US evaluation was performed before and after LMA insertion to obtain the glottic image on the anterior neck. FOB was performed to assess LMA position (FOB LMA grade and LMA rotation grade). With a post-LMA US image, the symmetry of the arytenoid cartilages was evaluated. Asymmetrical elevation of an arytenoid cartilage in reference to the glottic midline and the opposite arytenoid cartilage was graded as 0 to 3 (US arytenoid grade). The interrelationships between US arytenoid grade and FOB LMA grade or LMA rotation grade were assessed. The incidence of asymmetrical elevation of an arytenoid was 50% (95% confidence interval [CI], 40%-60%). On FOB, the incidence of LMA malposition was 78% (95% CI, 69%-86%), and that of LMA rotation was 43% (95% CI, 33%-53%). The incidence of LMA malposition was higher with FOB (P < 0.0001), but the incidence of rotation was similar (P = 0.395). US arytenoid grade did not correlate with FOB LMA grade (P = 0.611) but showed a significant correlation with LMA rotation grade (P < 0.0001; 95% CI, 60%-83%). To detect a

  14. Retinal image enhancement and registration for the evaluation of longitudinal changes

    NASA Astrophysics Data System (ADS)

    Xiao, Di; Frost, Shaun; Vignarajan, Janardhan; Lock, Jane; Tay-Kearney, Mei-Ling; Kanagasingam, Yogesan

    2012-03-01

    Retinal images are long-accepted clinical diagnostic method for ocular diseases. Of late, automated assessment of retinal images has proven to be a useful adjunct in clinical decision support systems. In this paper, we propose a retinal image registration method, which combine retinal image enhancement and non-rigid image registration methods, for longitudinal retinal image alignment. A further illumination correction and gray value matching methods are applied for the longitudinal image comparison and subtraction. The solution can enhance the assessment of longitudinal changes of retinal images and image subtraction in a clinical application system. The performance of the proposed solution has been tested on longitudinal retinal images. Preliminary results have demonstrated the accuracy and robustness of the solutions and their potential application in a clinical environment.

  15. The Development and Evaluation of a Measure Assessing School Nurses' Perceived Barriers to Addressing Pediatric Obesity

    ERIC Educational Resources Information Center

    Wu, Yelena P.; Steele, Ric G.

    2011-01-01

    School nurses represent an important resource for addressing pediatric obesity and weight-related health. However, school nurses perceive numerous barriers that prevent them from addressing the weight-related health of students. The current study developed and tested a new, comprehensive measure of nurses' perceptions of 10 types of barriers to…

  16. The Development and Evaluation of a Measure Assessing School Nurses' Perceived Barriers to Addressing Pediatric Obesity

    ERIC Educational Resources Information Center

    Wu, Yelena P.; Steele, Ric G.

    2011-01-01

    School nurses represent an important resource for addressing pediatric obesity and weight-related health. However, school nurses perceive numerous barriers that prevent them from addressing the weight-related health of students. The current study developed and tested a new, comprehensive measure of nurses' perceptions of 10 types of barriers to…

  17. Evaluation of pediatric residents’ attitudes toward ethical conflict: a cross-sectional study in Tehran, Iran

    PubMed Central

    Kadivar, Maliheh; Mardani-Hamooleh, Marjan; Shayestefar, Shiva

    2017-01-01

    Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014. The data collection tool was a 32-item research-based questionnaire. Its validity and reliability were confirmed by the researchers and the medical faculty members. To analyze data, descriptive and inferential statistics were used. However, based on the results, lack of an advanced directive and written procedure for withdrawing life-sustaining treatment of an incompetent or critically-ill child (4.38 ± 0.80), lack of provision of sufficient information on obtaining informed consent (4.12 ± 1.10), and the absence of a legal written process for doing not resuscitate (DNR) orders (3.98 ± 0.95) were the most salient causes of ethical conflicts in pediatrics. Furthermore, in accordance with the linear regression analysis of demographic characteristics, there was a significant relationship (P = 0.04, r = 0.046) between residents’ year of education and attitude toward ethical conflict; however, this relationship was not observed in other demographic characteristics. Taking the priorities of ethical conflicts in pediatrics into account may help improve the designing of medical ethics education programs in hospitals for residents, thereby reducing the conflicts related to the issues of medical ethics. PMID:28523117

  18. Comparative Evaluation of Pediatric Patients with Mental Retardation undergoing Dental Treatment under General Anesthesia: A Retrospective Analysis.

    PubMed

    Ahuja, Ravish; Jyoti, Bhuvan; Shewale, Vinod; Shetty, Shridhar; Subudhi, Santosh Kumar; Kaur, Manpreet

    2016-08-01

    Behavioral management of patients forms one of the foremost components of pediatric dental treatment. Some children readily cooperate with dental treatment, while others require general anesthesia as a part of treatment protocol for carrying out various dental procedures. Hence, we evaluated the pediatric patients with and without mental retardation, who underwent dental treatment under general anesthesia. The present study analyzed the record of 480 pediatric patients reporting in the department of pedodontics from 2008 to 2014. Analysis of the records of the patients who underwent dental treatment under general anesthesia was done and all the patients were divided into two study groups depending upon their mental level. For the purpose of evaluation, the patients were also grouped according to their age; 4 to 7 years, 8 to 12 years, and 13 to 18 years. Measurement of decayed, missing, and filled teeth and scores for both deciduous and permanent dentition was done before and after the commencement of the dental treatment. Chi-square test and independent t-test were used for evaluating the level of significance. While comparing the patients in the two groups, maximum number of patients is present in the age group of 13 to 18 years. While comparing the indices' score between the two study groups in various age intervals, no statistically significant results were obtained. Restorative treatment and dental extractions were the most common dental treatments that were seen at a higher frequency in the intellectual disability study group. In patients with mental retardation, a higher frequency of restorative treatment and extractions occurs as compared to healthy subjects of similar age group. Therefore, they require special attention regarding maintenance of their oral health. Special attention should be given for maintaining the oral health of patients with special health care needs as compared to their physically and mentally normal counterparts.

  19. Prospective evaluation of clinical lung ultrasonography in the diagnosis of community-acquired pneumonia in a pediatric emergency department.

    PubMed

    Samson, Frédéric; Gorostiza, Inigo; González, Andrés; Landa, María; Ruiz, Lucía; Grau, Miguel

    2016-08-17

    To evaluate the applicability and utility of point-of-care lung ultrasonography (POCLUS) for the diagnosis of community-acquired pneumonia (CAP) in a pediatric emergency department. A prospective observational study on children with suspected CAP was carried out in a pediatric emergency department from August to December 2014. The evaluation of the chest radiography (CR) by two independent radiologists was considered as a reference standard. POCLUS was performed by pediatricians who were blinded to CR results. Following the WHO criteria, typical CAP was defined as an alveolar consolidation or infiltrate in CR and a visualization of lung consolidation with sonographic air bronchograms in POCLUS. The diagnostic accuracy of POCLUS (sensitivity, specificity, positive, and negative predictive values) was established using CR as a gold standard. We enrolled 200 children with a median age of 29.5 months (interquartile range, 18.5-52.5); 58.1% were males and 42.0% had focal decreased breath sounds and/or crackles. The prevalence of typical CAP according to the radiologist's evaluation was 42.5% (end-point consolidation and/or pleural effusion 56.5%, alveolar infiltrate 43.5%). The sensitivity and specificity of POCLUS were 87.1% [95% confidence interval (CI) 78.0-93.4] and 94.8% (95% CI 89.0-98.1), respectively. The positive and negative predictive values were 92.5% (95% CI 84.4-97.2) and 90.8% (95% CI 84.2-95.3), respectively. POCLUS performed by an emergency pediatrician with a limited experience in ultrasonography enables the diagnosis of pneumonia with high accuracy. POCLUS could become a feasible and promising alternative to CR in the diagnosis of suspected CAP, leading to a relevant decrease in children's exposure to ionizing radiations. Further studies specifically carried out in the pediatric outpatient setting are needed.

  20. Pediatric parasomnias.

    PubMed

    Mason, Thornton B A; Pack, Allan I

    2007-02-01

    Parasomnias in childhood are common, and often more frequent than in adults. The large number of parasomnias underscore that sleep is not simply a quiescent state, but can involve complex episodes of movement, ranging from subtle to dramatic and complex. Clinicians should be aware that many pediatric parasomnias are benign, self-limited, and may not persist into late childhood or adolescence. Importantly, parasomnias in childhood often differ in type from adults. Nevertheless, parasomnias across ages can be classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM sleep; and 3) other parasomnias. We detail here issues in the clinical diagosis, evaluation, and management of multiple pediatric parasomnias. The further study of parasomnias in children may help elucidate the multi-factorial etiologies of these fascinating conditions, shedding light on the potential genetic bases as well as environmental contributions.

  1. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score.

    PubMed

    El-Nawawy, Ahmed

    2003-04-01

    The aim of this prospective study was to evaluate the use of pediatric risk of mortality (PRISM) score to predict the patient outcome in Alexandria Pediatric Intensive Care Unit (PICU). The study included all admissions to a tertiary care teaching hospital for 13 months. All patients were subjected to thorough history taking and clinical examination. The PRISM score was obtained within 8 h from admission (including 14 parameters with 34 variables). The primary affected system, referral site, number of organ failure on admission, length of hospital stay (LOS) and outcome of patients were recorded. The bed occupancy rate, turnover rate, average LOS, total and adjusted death rates were also recorded. Results showed that the total and adjusted mortality rates were 50 and 38 per cent respectively (n = 205/406 and 125/326, respectively). The mean PRISM score on admission was 26. Non-survivors showed a significantly higher mean score compared with survivors (36 vs. 17). Non-survivors compared with survivors, were significantly younger (12 vs. 23 months), had shorter LOS (3.8 vs. 5.3 days), three or four organ system failure on admission (77 vs. 25 per cent, and 9 vs. 0 per cent of patients) and had significantly higher percentage of sepsis syndrome and neurological diseases, as the primary affected system (20 vs. 10 per cent and 26 vs. 16 per cent). The PRISM score showed a significant positive correlation only with the number of organ failure on admission (r = 0.8104; p < 0.001). The cut-off point of survival was a PRISM score 26 with expected/observed ratio of 1.05 for non-survivors with 91.6 per cent accuracy. Multiple logistic regression analysis revealed that PRISM score, LOS, and the primary affected system were relevant predictors of patient outcome in PICU. In conclusion, the PRISM score is proved to be a good predictor of outcome for children admitted to a PICU with a cut-off point of 26. The mortality in the PICU is affected by LOS, primary system affected, and

  2. Evaluation of ventricular dysfunction using semi-automatic longitudinal strain analysis of four-chamber cine MR imaging.

    PubMed

    Kawakubo, Masateru; Nagao, Michinobu; Kumazawa, Seiji; Yamasaki, Yuzo; Chishaki, Akiko S; Nakamura, Yasuhiko; Honda, Hiroshi; Morishita, Junji

    2016-02-01

    The aim of this study was to evaluate ventricular dysfunction using the longitudinal strain analysis in 4-chamber (4CH) cine MR imaging, and to investigate the agreement between the semi-automatic and manual measurements in the analysis. Fifty-two consecutive patients with ischemic, or non-ischemic cardiomyopathy and repaired tetralogy of Fallot who underwent cardiac MR examination incorporating cine MR imaging were retrospectively enrolled. The LV and RV longitudinal strain values were obtained by semi-automatically and manually. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff of the minimum longitudinal strain value for the detection of patients with cardiac dysfunction. The correlations between manual and semi-automatic measurements for LV and RV walls were analyzed by Pearson coefficient analysis. ROC analysis demonstrated the optimal cut-off of the minimum longitudinal strain values (εL_min) for diagnoses the LV and RV dysfunction at a high accuracy (LV εL_min = -7.8 %: area under the curve, 0.89; sensitivity, 83 %; specificity, 91 %, RV εL_min = -15.7 %: area under the curve, 0.82; sensitivity, 92 %; specificity, 68 %). Excellent correlations between manual and semi-automatic measurements for LV and RV free wall were observed (LV, r = 0.97, p < 0.01; RV, r = 0.79, p < 0.01). Our semi-automatic longitudinal strain analysis in 4CH cine MR imaging can evaluate LV and RV dysfunction with simply and easy measurements. The strain analysis could have extensive application in cardiac imaging for various clinical cases.

  3. Evaluating the effectiveness of restoring longitudinal connectivity for stream fish communities: towards a more holistic approach.

    PubMed

    Tummers, Jeroen S; Hudson, Steve; Lucas, Martyn C

    2016-11-01

    A more holistic approach towards testing longitudinal connectivity restoration is needed in order to establish that intended ecological functions of such restoration are achieved. We illustrate the use of a multi-method scheme to evaluate the effectiveness of 'nature-like' connectivity restoration for stream fish communities in the River Deerness, NE England. Electric-fishing, capture-mark-recapture, PIT telemetry and radio-telemetry were used to measure fish community composition, dispersal, fishway efficiency and upstream migration respectively. For measuring passage and dispersal, our rationale was to evaluate a wide size range of strong swimmers (exemplified by brown trout Salmo trutta) and weak swimmers (exemplified by bullhead Cottus perifretum) in situ in the stream ecosystem. Radio-tracking of adult trout during the spawning migration showed that passage efficiency at each of five connectivity-restored sites was 81.3-100%. Unaltered (experimental control) structures on the migration route had a bottle-neck effect on upstream migration, especially during low flows. However, even during low flows, displaced PIT tagged juvenile trout (total n=153) exhibited a passage efficiency of 70.1-93.1% at two nature-like passes. In mark-recapture experiments juvenile brown trout and bullhead tagged (total n=5303) succeeded in dispersing upstream more often at most structures following obstacle modification, but not at the two control sites, based on a Laplace kernel modelling approach of observed dispersal distance and barrier traverses. Medium-term post-restoration data (2-3years) showed that the fish assemblage remained similar at five of six connectivity-restored sites and two control sites, but at one connectivity-restored headwater site previously inhabited by trout only, three native non-salmonid species colonized. We conclude that stream habitat reconnection should support free movement of a wide range of species and life stages, wherever retention of such

  4. Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation.

    PubMed

    Speizer, Ilene S; Corroon, Meghan; Calhoun, Lisa; Lance, Peter; Montana, Livia; Nanda, Priya; Guilkey, David

    2014-11-06

    Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all. © Speizer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits

  5. Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery.

    PubMed

    Biswas, Indranil; Mathew, Preethy J; Singh, Rana S; Puri, Goverdhan D

    2013-12-01

    The objective of this study was to compare the feasibility of closed-loop anesthesia delivery with manual control of propofol in pediatric patients during cardiac surgery. Forty ASA II-III children, undergoing elective cardiac surgery under cardiopulmonary bypass (CPB) in a tertiary care hospital, were randomized to receive propofol either through a closed-loop anesthesia delivery system (CL group) or through traditional manual control (manual group) to achieve a target BIS of 50. Patients were induced and subsequently maintained with a propofol infusion. The propofol usage and the efficacy of closed-loop system in controlling BIS within ±10 of the target were compared with that of manual control. The maintenance of BIS within ±10 of target and intraoperative hemodynamic stability were similar between the two groups. However, induction dose of propofol was less in the CL group (2.06 ± 0.79 mg·kg(-1) ) than the manual group (2.95 ± 1.03 mg·kg(-1) ) (P = 0.006) with less overshoot of BIS during induction in the closed-loop group (P = 0.007). Total propofol used in the off-CPB period was less in the CL group (6.29 ± 2.48 mg·kg(-1) h(-1) vs 7.82 ± 2.1 mg·kg(-1) h(-1) ) (P = 0.037). Phenylephrine use in the pre-CPB period was more in the manual group (16.92 ± 10.92 μg·kg(-1) vs 5.79 ± 5.98 μg·kg(-1) ) (P = 0.014). Manual group required a median of 18 (range 8-29) dose adjustments per hour, while the CL group required none. This study demonstrated the feasibility of closed-loop controlled propofol anesthesia in children, even in challenging procedures such as cardiac surgery. Closed-loop system needs further and larger evaluation to establish its safety and efficacy. © 2013 John Wiley & Sons Ltd.

  6. Evaluation of the National Tips From Former Smokers Campaign: the 2014 Longitudinal Cohort

    PubMed Central

    Patel, Deesha; Davis, Kevin; Ridgeway, William; Shafer, Paul; Cox, Shanna

    2016-01-01

    Introduction Since 2012, the Centers for Disease Control and Prevention has aired a national tobacco education campaign to encourage quitting, Tips From Former Smokers (Tips), which consists of graphic antismoking advertisements that feature former cigarette smokers. We evaluated phase 2 of the 2014 campaign by using a nationally representative longitudinal cohort. Methods Cigarette smokers who participated in a baseline survey were re-contacted for follow-up (n = 4,248) approximately 4 months later, immediately after the campaign’s conclusion. The primary outcomes were incidence of a quit attempt in the previous 3 months, intention to quit within 30 days, and intention to quit within 6 months during the postcampaign period. We used multivariate logistic regression models to estimate the odds of each outcome. We also stratified models by race/ethnicity, education, and mental health status. Postcampaign rates of quit attempts, intentions to quit, and sustained quits were also estimated. Results Exposure to the campaign was associated with increased odds of a quit attempt in the previous 3 months (OR, 1.17; P = .03) among baseline smokers and intentions to quit within the next 6 months (OR, 1.28; P = .01) among current smokers at follow-up. The Tips campaign was associated with an estimated 1.83 million additional quit attempts, 1.73 million additional smokers intending to quit within 6 months, and 104,000 sustained quits of at least 6 months. Conclusion The Tips campaign continued to have a significant impact on cessation-related behaviors, providing further justification for the continued use of tobacco education campaigns to accelerate progress toward the goal of reducing adult smoking in the United States. PMID:27010845

  7. Experiences of outreach workers in promoting smoking cessation to Bangladeshi and Pakistani men: longitudinal qualitative evaluation

    PubMed Central

    2011-01-01

    Background Despite having high smoking rates, there have been few tailored cessation programmes for male Bangladeshi and Pakistani smokers in the UK. We report on a qualitative evaluation of a community-based, outreach worker delivered, intervention that aimed to increase uptake of NHS smoking cessation services and tailor services to meet the needs of Bangladeshi and Pakistani men. Methods This was a longitudinal, qualitative study, nested within a phase II cluster randomised controlled trial of a complex intervention. We explored the perspectives and experiences of five outreach workers, two stop smoking service managers and a specialist stop smoking advisor. Data were collected through focus group discussions, weekly diaries, observations of management meetings, shadowing of outreach workers, and one-to-one interviews with outreach workers and their managers. Analysis was undertaken using a modified Framework approach. Results Outreach workers promoted cessation services by word of mouth on the streets, in health service premises, in local businesses and at a wide range of community events. They emphasised the reasons for cessation, especially health effects, financial implications, and the impact of smoking on the family. Many smokers agreed to be referred to cessation services, but few attended, this in part being explained by concerns about the relative inflexibility of existing service provision. Although outreach workers successfully expanded service reach, they faced the challenges of perceived lack of awareness of the health risks associated with smoking in older smokers and apathy in younger smokers. These were compounded by perceptions of "lip service" being given to their role by community organisations and tensions both amongst the outreach workers and with the wider management team. Conclusions Outreach workers expanded reach of the service through taking it to diverse locations of relevance to Pakistani and Bangladeshi communities. The optimum

  8. Experiences of outreach workers in promoting smoking cessation to Bangladeshi and Pakistani men: longitudinal qualitative evaluation.

    PubMed

    Begh, Rachna A; Aveyard, Paul; Upton, Penney; Bhopal, Raj S; White, Martin; Amos, Amanda; Prescott, Robin J; Bedi, Raman; Barton, Pelham M; Fletcher, Monica; Gill, Paramjit; Zaidi, Qaim; Sheikh, Aziz

    2011-06-09

    Despite having high smoking rates, there have been few tailored cessation programmes for male Bangladeshi and Pakistani smokers in the UK. We report on a qualitative evaluation of a community-based, outreach worker delivered, intervention that aimed to increase uptake of NHS smoking cessation services and tailor services to meet the needs of Bangladeshi and Pakistani men. This was a longitudinal, qualitative study, nested within a phase II cluster randomised controlled trial of a complex intervention. We explored the perspectives and experiences of five outreach workers, two stop smoking service managers and a specialist stop smoking advisor. Data were collected through focus group discussions, weekly diaries, observations of management meetings, shadowing of outreach workers, and one-to-one interviews with outreach workers and their managers. Analysis was undertaken using a modified Framework approach. Outreach workers promoted cessation services by word of mouth on the streets, in health service premises, in local businesses and at a wide range of community events. They emphasised the reasons for cessation, especially health effects, financial implications, and the impact of smoking on the family. Many smokers agreed to be referred to cessation services, but few attended, this in part being explained by concerns about the relative inflexibility of existing service provision. Although outreach workers successfully expanded service reach, they faced the challenges of perceived lack of awareness of the health risks associated with smoking in older smokers and apathy in younger smokers. These were compounded by perceptions of "lip service" being given to their role by community organisations and tensions both amongst the outreach workers and with the wider management team. Outreach workers expanded reach of the service through taking it to diverse locations of relevance to Pakistani and Bangladeshi communities. The optimum method of outreach to retain and treat

  9. Evaluation of the National Tips From Former Smokers Campaign: the 2014 Longitudinal Cohort.

    PubMed

    Neff, Linda J; Patel, Deesha; Davis, Kevin; Ridgeway, William; Shafer, Paul; Cox, Shanna

    2016-03-24

    Since 2012, the Centers for Disease Control and Prevention has aired a national tobacco education campaign to encourage quitting, Tips From Former Smokers (Tips), which consists of graphic antismoking advertisements that feature former cigarette smokers. We evaluated phase 2 of the 2014 campaign by using a nationally representative longitudinal cohort. Cigarette smokers who participated in a baseline survey were re-contacted for follow-up (n = 4,248) approximately 4 months later, immediately after the campaign's conclusion. The primary outcomes were incidence of a quit attempt in the previous 3 months, intention to quit within 30 days, and intention to quit within 6 months during the postcampaign period. We used multivariate logistic regression models to estimate the odds of each outcome. We also stratified models by race/ethnicity, education, and mental health status. Postcampaign rates of quit attempts, intentions to quit, and sustained quits were also estimated. Exposure to the campaign was associated with increased odds of a quit attempt in the previous 3 months (OR, 1.17; P = .03) among baseline smokers and intentions to quit within the next 6 months (OR, 1.28; P = .01) among current smokers at follow-up. The Tips campaign was associated with an estimated 1.83 million additional quit attempts, 1.73 million additional smokers intending to quit within 6 months, and 104,000 sustained quits of at least 6 months. The Tips campaign continued to have a significant impact on cessation-related behaviors, providing further justification for the continued use of tobacco education campaigns to accelerate progress toward the goal of reducing adult smoking in the United States.

  10. Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma.

    PubMed

    Borgialli, Dominic A; Mahajan, Prashant; Hoyle, John D; Powell, Elizabeth C; Nadel, Frances M; Tunik, Michael G; Foerster, Adele; Dong, Lydia; Miskin, Michelle; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2016-08-01

    The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma. This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes. We enrolled 42,041 patients, of whom 10,499 (25.0%) were <2 years old. Among patients <2 years, 313/3,329 (9.4%, 95% confidence interval [CI] = 8.4% to 10.4%) of those imaged had TBIs on CT and 146/10,499 (1.4%, 95% CI = 1.2% to 1.6%) had ciTBIs. In patients ≥2 years, 773/11,977 (6.5%, 95% CI = 6.0% to 6.9%) of those imaged had TBIs on CT and 572/31,542 (1.8%, 95% CI = 1.7% to 2.0%) had ciTBIs. For the pediatric GCS in children <2 years old, the area under the ROC curve was 0.61 (95% CI = 0.59 to 0.64) for TBI on CT and 0.77 (95% CI = 0.73 to 0.81) for ciTBI. For the standard GCS in older children, the area under the ROC curve was 0.71 (95% CI = 0.70 to 0.73) for TBI on CT scan and 0.81 (95% CI = 0.79 to 0.83) for ciTBI. The pediatric GCS for preverbal children was somewhat less accurate than the standard GCS for older children in identifying those with TBI on CT

  11. Evaluating the impact of a minimally invasive pediatric surgeon on hospital practice: comparison of two children's hospitals.

    PubMed

    Jackson, Hope T; Shah, Sohail R; Hathaway, Emily; Nadler, Evan P; Amdur, Richard L; McGue, Shannon; Kane, Timothy D

    2016-06-01

    Widespread adoption of minimally invasive surgery (MIS) techniques in pediatric surgery has progressed slowly, and the shift in practice patterns has been variable among surgeons. We hypothesized that a pediatric surgeon committed to MIS could effectively change surgical practice by creating an emphasis on MIS. Annual case volumes from 2000 to 2009 at two tertiary care pediatric hospitals, one with a dedicated minimally invasive pediatric surgeon, were evaluated for trends in MIS for ten different operations. Univariate analyses of the differences between hospitals in the use of the open versus laparoscopic approach were performed. The Breslow-Day test was used to examine differences in use of laparoscopic procedures across hospitals in early versus middle and middle versus late time periods. Between the two hospitals, for 9 of the 10 types of surgery, the number of laparoscopic and open procedures differed significantly (p values ranged from <0.0001 to 0.003). Over the 10-year period, the hospital with a dedicated MIS surgeon had a larger proportion of procedures done laparoscopically for all years. This difference reached statistical significance for appendectomy (p < 0.0001), congenital diaphragmatic hernia (p < 0.0002), chest wall reconstruction (p < 0.0001), cholecystectomy (p = <0.0001), gastrostomy (p < 0.0001), nissen fundoplication (p < 0.0001) oophorectomy (p < 0.0001), pyloromyotomy (p < 0.0001) and splenectomy (p = 0.0006). After grouping the years into early (2000-2003), middle (2004-2006) and late (2007-2009) categories, the hospital with a dedicated MIS surgeon had a significantly higher rate of increase in use of laparoscopic surgery between the early and middle years for four procedures: diaphragmatic hernia repair (p = 0.003), chest wall reconstruction (p = 0.0086), cholecystectomy (0.0083) and endorectal pull-through (p = 0.025). The presence of a dedicated minimally invasive pediatric surgeon led to a significant change

  12. Evaluation of Congenital Heart Defects Treatment Options–Establishment of Pediatric Cardiology/Cardiosurgery in Bosnia and Herzegovina

    PubMed Central

    Begic, Zijo; Pandur, Sanko; Omerbasic, Edo; Kadic, Almira; Halimic, Mirza

    2017-01-01

    Introduction: Modern pediatric cardiology mainly deals with congenital heart defects (CHD), as the most common congenital anomalies. In most cases CHD requires surgical or interventional treatment. Goal: The goal of the research was to evaluate CHD treatment at Pediatric Clinic, University Clinical Center (UCC) Sarajevo, Bosnia and Herzegovina (B&H). UCC Sarajevo is the only institution in B&H where cardiac treatment of CHD in pediatric population is performed. Pediatric cardiosurgery has started to develop in Bosnia and Herzegovina in April 1997. Patients and methods: Study included 745 patients (period from April 1997 to January 2017). Results: Cardiac treatment was performed on 745 patients with CHD, 541 (72.6%) of them were acyanotic patients and 204 (27.4%) were cyanotic patients. Reoperation was performed in 49 (6.5%) of patients. Out of total number of patients, 59 (7.9%) died. In 660 children (88.5%) a complete correction and in 85 (11.5%) a palliative operation/correction was performed. Defects with left to right shunt were present in 397 (53.2%) patients, complex heart defects with Tetralogy of Fallot in 173 (23.2%), obstructive heart defects in 106 (14.2%), obstructive heart defects with shunt in 53 (7.1%), and others in 16 (2.1%) of patients. During surgery, extracorporeal circulation was regulated in 554 (74.3%) patients. Peri and early postoperative complications occurred in 180 (24.1%) of patients. During this period 24 pacemakers were implanted and 24 radiofrequency ablations were performed. Conclusion: Results of CHD cardiac treatment in childhood, which took place simultaneously, followed by the contractual joint programs and individual work of the Bosnian and Herzegovinian team has reached the highest level in the last two years, not only by the number, type and complexity of corrected CHD, but also by the age and body weight of the patients who underwent surgery, and development of invasive procedures, arrhytmology, pacemaker placement

  13. Evaluating the Impact of the Healthy Beginnings System of Care Model on Pediatric Emergency Department Utilization.

    PubMed

    Tan, Cheryl H; Gazmararian, Julie

    2017-03-01

    The aim of this study was to evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) model is associated with a decrease in emergency department (ED) visits among children aged 6 months to 5.5 years. A retrospective, longitudinal study of ED utilization was conducted among children enrolled in the Healthy Beginnings SOC model between February 2011 and May 2013. Using medical records obtained from a children's hospital in Atlanta, the rate of ED visits per quarter was examined as the main outcome. A multilevel, multivariate Poisson model, with family- and child-level random effects, compared ED utilization rates before and after enrollment. Adjusted rate ratios and 95% confidence intervals were calculated after controlling for sociodemographic confounders. The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. The rate of ED visits after enrollment was not significantly different than the rate of ED visits before enrollment for children whose primary parent had an annual income of less than $5000 (P = 0.298), $20,000 to $29,999 (P = 0.199), or $30,000 or more (P = 0.117). However, for the children whose primary parent's annual income was $5000 to $19,999, the rate of ED visits after enrollment was significantly higher than the rate of ED visits before enrollment (adjusted rate ratio, 1.48; 95% confidence interval, 1.17-1.87). Enrollment in the SOC model does not appear to decrease the rate of ED visits among enrolled children. Additional strategies, such as education sessions on ED utilization, are needed to reduce the rate of ED utilization among SOC-enrolled children.

  14. Audience-response systems for evaluation of pediatric lectures--comparison with a classic end-of-term online-based evaluation.

    PubMed

    Bode, Sebastian Felix Nepomuk; Straub, Christine; Giesler, Marianne; Biller, Silke; Forster, Johannes; Krüger, Marcus

    2015-01-01

    Course evaluations are often conducted and analyzed well after the course has taken place. By using a digital audience response system (ARS), it is possible to collect, view and discuss feedback during or directly following a course or lecture session. This paper analyzes a student evaluation of a lecture course with ARS to determine if significant differences exist between the results of the ARS lecture evaluation and those of the online evaluation at the end of the semester. In terms of the overall evaluation, consideration is given to the level of students' prior knowledge, the presentation of the lecture material by the lecturers and the relevance of the lecture topic for students. During the 2011-12 winter semester, the lecture on Pediatrics at the Freiburg Center for Pediatric and Adolescent Medicine (Zentrum für Kinder- und Jugendmedizin (ZKJ) Freiburg) was evaluated using ARS. Thirty-four lectures were evaluated by an average of 22 (range 8-44) students, who responded to four questions each time an evaluation took place. On a 6-point Likert scale (1=very good to 6=deficient), the students rated their level of preparedness with a mean of 3.18, the presentation of the lecture with 2.44, and the relevance of the lecture topic with 2.19. The overall evaluation of the lecture course by means of ARS resulted in 2.31. The online evaluation conducted at the end of the semester yielded a score of 2.45. Highly significant correlations were seen between the results of the ARS for the overall evaluation, assessment of prior knowledge, lecture presentation, and the estimated relevance of the lecture topic. The use of ARS is suitable for immediate evaluation of lectures, in particular regarding timely feedback for the individual lecturer/lecturers. In comparison with an end-of-term evaluation, ARS yielded a better assessment.

  15. Audience-response systems for evaluation of pediatric lectures – comparison with a classic end-of-term online-based evaluation

    PubMed Central

    Bode, Sebastian Felix Nepomuk; Straub, Christine; Giesler, Marianne; Biller, Silke; Forster, Johannes; Krüger, Marcus

    2015-01-01

    Aim: Course evaluations are often conducted and analyzed well after the course has taken place. By using a digital audience response system (ARS), it is possible to collect, view and discuss feedback during or directly following a course or lecture session. This paper analyzes a student evaluation of a lecture course with ARS to determine if significant differences exist between the results of the ARS lecture evaluation and those of the online evaluation at the end of the semester. In terms of the overall evaluation, consideration is given to the level of students’ prior knowledge, the presentation of the lecture material by the lecturers and the relevance of the lecture topic for students. Method: During the 2011-12 winter semester, the lecture on Pediatrics at the Freiburg Center for Pediatric and Adolescent Medicine (Zentrum für Kinder- und Jugendmedizin (ZKJ) Freiburg) was evaluated using ARS. Thirty-four lectures were evaluated by an average of 22 (range 8-44) students, who responded to four questions each time an evaluation took place. Results: On a 6-point Likert scale (1=very good to 6=deficient), the students rated their level of preparedness with a mean of 3.18, the presentation of the lecture with 2.44, and the relevance of the lecture topic with 2.19. The overall evaluation of the lecture course by means of ARS resulted in 2.31. The online evaluation conducted at the end of the semester yielded a score of 2.45. Highly significant correlations were seen between the results of the ARS for the overall evaluation, assessment of prior knowledge, lecture presentation, and the estimated relevance of the lecture topic. Conclusion: The use of ARS is suitable for immediate evaluation of lectures, in particular regarding timely feedback for the individual lecturerlecturers. In comparison with an end-of-term evaluation, ARS yielded a better assessment. PMID:26038683

  16. PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies.

    PubMed

    Zapata, Claudia P; Cuglievan, Branko; Zapata, Catalina M; Olavarrieta, Raquel; Raskin, Scott; Desai, Kavita; De Angulo, Guillermo

    2017-09-13

    Accurate staging is essential in the prognosis and management of pediatric malignancies. Current protocols require screening for marrow infiltration with bone marrow biopsy (BMB) as the gold standard. Positron emission tomography-computed tomography (PET-CT) is commonly used to complete the staging process and can also be used to evaluate marrow infiltration. To compare PET-CT and BMB in the initial evaluation of bone marrow infiltration in pediatric cancers. We retrospectively reviewed new cases of EWS, rhabdomyosarcoma, neuroblastoma, and lymphoma diagnosed between January 2009 and October 2014. Each case had undergone both PET-CT and BMB within 4 weeks without treatment in the interval between screening modalities. We reviewed 69 cases. Bone marrow infiltration was demonstrated in 34 cases by PET-CT and in 18 cases by BMB. The sensitivity and negative predictive value of PET-CT were both 100%. Interestingly, the cases in which infiltration was not detected on BMB had an abnormal marrow signal on PET-CT focal or distant to iliac crest. PET-CT has a high sensitivity when assessing marrow infiltration in pediatric malignancies. Advances in radiologic modalities may obviate the use of invasive, painful, and costly procedures like BMB. Furthermore, biopsy results are limited by insufficient tissue or the degree of marrow infiltration (diffuse vs. focal disease). PET-CT can improve the precision of biopsy when used as a guiding tool. This study proposes the use of PET-CT as first-line screening for bone marrow infiltration to improve the accuracy of staging in new diagnoses. © 2017 Wiley Periodicals, Inc.

  17. Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis.

    PubMed

    Iroh Tam, Pui-Ying; Bernstein, Ethan; Ma, Xiaoye; Ferrieri, Patricia

    2015-06-01

    Current guidelines strongly recommend collection of blood cultures (BCs) in children requiring hospitalization for presumed moderate to severe bacterial community-acquired pneumonia (CAP). Our objective was to systematically review the international pediatric literature to evaluate how often BCs are positive in hospitalized children with CAP, identify the most commonly isolated pathogens, and determine the impact of positive BCs on clinical management. We identified articles in PubMed and Scopus published from January 1970 through December 2013 that addressed BCs in children with CAP. We extracted total number of BCs collected and prevalence of positive BCs and used meta-regression to evaluate whether subgroups had any impact on prevalence. Meta-analysis showed that the overall prevalence of positive BCs was 5.14% (95% confidence interval 3.61-7.28). Studies focusing on severe CAP had a significant effect on prevalence (P=.008), at 9.89% (95% CI 6.79-14.19) compared with 4.17% (95% confidence interval 2.79-6.18) for studies not focusing on severe CAP. The most commonly isolated organisms were Streptococcus pneumoniae (76.7%) followed by Haemophilus influenzae (3.1%) and Staphylococcus aureus (2.1%). Contaminants accounted for 14.7%. Only 3 studies reported on BC-driven change in management, with contrasting findings. BCs in pediatric CAP identified organisms in only a small percentage of patients, predominantly S. pneumoniae. False-positive BC rates can be substantial. The 3 studies that examined BC-driven changes in management had conflicting results. This systematic review was limited by heterogeneous case definitions, which may overestimate the true prevalence of positive BCs in hospitalized children. Copyright © 2015 by the American Academy of Pediatrics.

  18. Standardized descriptive method for the anthropological evaluation of pediatric skull fractures.

    PubMed

    Wiersema, Jason M; Love, Jennifer C; Derrick, Sharon M; Pinto, Deborrah C; Donaruma-Kwoh, Marcella; Greeley, Christopher S

    2014-11-01

    The literature pertaining to pediatric skull fracture is primarily clinically based and thus motivated by the need for effective assessment of both fracture characteristics (type, frequency, location, and mechanics) and context (severity of injury, associated soft tissue damage, and prognosis). From a strictly descriptive standpoint, these schemas employ overlapping levels of detail that confound the nonclinical description of fractures in the forensic context. For this reason, application of these schemas in the forensic anthropological interpretation of skull fractures is inappropriate. We argue that forensic anthropological interpretation of skull fractures requires a standard classification system that reflects fracture morphology alone, and we suggest a three-stepped classification system that conveys increasing detail with each additional step. A retrospective application of the method to a sample of 31 children aged 1 month to 2 years demonstrated its efficacy in the description of pediatric skull fractures.

  19. Pediatric Specialists

    MedlinePlus

    ... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & ... is a Pediatric Rheumatologist? What is a Pediatric Sports Medicine Specialist? What is a Pediatric Surgeon? What is a Pediatric Transport ... Find Us Donate Contact ...

  20. The evaluation of burnout and job satisfaction levels in residents of pediatrics.

    PubMed

    Anıl, Murat; Yurtseven, Ali; Yurtseven, İlkay; Ülgen, Mevlüt; Anıl, Ayşe Berna; Helvacı, Mehmet; Aksu, Nejat

    2017-06-01

    The aim of the study was to examine the level of job-related burnout and the level of job satisfaction among residents of pediatrics. A total of 102 residents of pediatrics who were trained in two Ministry of Health teaching and research hospitals and in two university hospitals in Izmir were included in the study. Demographic data (age, sex), lifestyle (living with parents or not, marital status, number of children) and professional characteristics (total time spent in profession, time spent in residency, number of night shifts per month, institution type: teaching hospital/university) were collected. Maslach Burnout Inventory (subscales: emotional exhaustion, desensitization, personal accomplishment) and Minnesota Satisfaction Questionnaire were used. High levels of emotional exhaustion and desensitization, and low levels of personal accomplishment and job satisfaction were found in residents of pediatrics. Low levels of emotional exhaustion in teaching and research hospitals and low levels of desensitization in university hospitals were determined (p<0.05). We found a positive correlation between age and job satisfaction levels and a negative correlation between age and emotional exhaustion levels (p<0.05). There were negative correlations between the length of time in education and desensitization and between the number of night shifts per month and desensitization (p<0.05). In residents of pediatrics, there is a high-level burnout and low-level of job satisfaction. Emotional exhaustion is more common in teaching and research hospitals and desensitization is more common in universities. Younger age, lower seniority, and the higher number of work-shift increases the burnout.

  1. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections

    PubMed Central

    Becknell, Brian; Schober, Megan; Korbel, Lindsey; Spencer, John David

    2015-01-01

    Urinary tract infection is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute urinary tract infection and recurrent urinary tract infection in children remains controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent urinary tract infection in the pediatric population. PMID:25421102

  2. The evaluation of burnout and job satisfaction levels in residents of pediatrics

    PubMed Central

    Anıl, Murat; Yurtseven, Ali; Yurtseven, İlkay; Ülgen, Mevlüt; Anıl, Ayşe Berna; Helvacı, Mehmet; Aksu, Nejat

    2017-01-01

    Aim The aim of the study was to examine the level of job-related burnout and the level of job satisfaction among residents of pediatrics. Material and Methods A total of 102 residents of pediatrics who were trained in two Ministry of Health teaching and research hospitals and in two university hospitals in Izmir were included in the study. Demographic data (age, sex), lifestyle (living with parents or not, marital status, number of children) and professional characteristics (total time spent in profession, time spent in residency, number of night shifts per month, institution type: teaching hospital/university) were collected. Maslach Burnout Inventory (subscales: emotional exhaustion, desensitization, personal accomplishment) and Minnesota Satisfaction Questionnaire were used. Results High levels of emotional exhaustion and desensitization, and low levels of personal accomplishment and job satisfaction were found in residents of pediatrics. Low levels of emotional exhaustion in teaching and research hospitals and low levels of desensitization in university hospitals were determined (p<0.05). We found a positive correlation between age and job satisfaction levels and a negative correlation between age and emotional exhaustion levels (p<0.05). There were negative correlations between the length of time in education and desensitization and between the number of night shifts per month and desensitization (p<0.05). Conclusions In residents of pediatrics, there is a high-level burnout and low-level of job satisfaction. Emotional exhaustion is more common in teaching and research hospitals and desensitization is more common in universities. Younger age, lower seniority, and the higher number of work-shift increases the burnout. PMID:28747836

  3. Evaluation of the hybrid III and Q-series pediatric ATD upper neck loads as compared to pediatric volunteers in low-speed frontal crashes.

    PubMed

    Seacrist, Thomas; Mathews, Emily A; Balasubramanian, Sriram; Maltese, Matthew R; Arbogast, Kristy B

    2013-11-01

    Debate exists in the automotive community regarding the validity of the pediatric ATD neck response and corresponding neck loads. Previous research has shown that the pediatric ATDs exhibit hyper-flexion and chin-to-chest contact resulting in overestimations of neck loads and neck injury criteria. Our previous work comparing the kinematics of the Hybrid III and Q-series 6 and 10-year-old ATDs to pediatric volunteers in low-speed frontal sled tests revealed decreased ATD cervical and thoracic spine excursions. These kinematic differences may contribute to the overestimation of upper neck loads by the ATD. The current study compared upper neck loads of the Hybrid III and Q-series 6 and 10-year-old ATDs against size-matched male pediatric volunteers in low-speed frontal sled tests. A 3-D near-infrared target tracking system quantified the position of markers on the ATD and pediatric volunteers (head top, nasion, bilateral external auditory meatus). Shear force (F x ), axial force (F z ), bending moment (M y ), and head angular acceleration ([Formula: see text]) were calculated about the upper neck using standard equations of motion. In general, the ATDs underestimated axial force and overestimated bending moment compared to the human volunteers. The Hybrid III 6, Q6, and Q10 exhibited reduced head angular acceleration and modest increases in upper neck shear compared to the pediatric volunteers. The reduction in axial force and bending moment has important implications for neck injury predictions as both are used when calculating N ij . These analyses provide insight into the biofidelity of the pediatric ATD upper neck loads in low-speed crash environments.

  4. [Evaluation of oral midazolam conscious sedation in different age groups in pediatric dentistry].

    PubMed

    Jing, Quan; Wan, Kuo; Ma, Lin; Chen, Xi; Tong, Ya-li

    2010-12-01

    To summarize the effect of oral midazolam sedation in a group of uncooperative patients in pediatric dentistry and analyze the influence of age on treatment results and safety. Oral midazolam conscious sedation (dosages range: 0.50 - 0.75 mg/kg) was applied to 109 uncooperative pediatric patients in outpatient department. The patients were divided into two age groups: group A (under 3 years) and group B (over 3 years). Treatment results and safety were statistically analyzed. The mean success rate was 71% (77/109), which was higher in group B [78% (54/69)] than in group A [58% (23/40)]. The incidence of adverse reactions was 17% (19/109), which was higher in group A [28% (11/40)] than in group B [12% (8/69)]. Oral midazolam conscious sedation at a dosage range of 0.50 - 0.75 mg/kg is more effective and safe in pediatric dental patients over 3 years of age.

  5. In vitro evaluation of the TandemHeart pediatric centrifugal pump.

    PubMed

    Svitek, Robert G; Smith, Douglas E; Magovern, James A

    2007-01-01

    The pediatric TandemHeart pump is being developed for short-term circulatory support of patients varying in size from 2 to 40 kg. The pump withdraws blood from the left atrium via cannula inserted percutaneously, either through the right internal jugular vein or transhepatically, and pumps the blood back into the arterial system via the carotid or femoral artery. High resolution stereolithography (SLA) was used to create an upper housing and impeller design, which were assembled into a functional pump prototype. Pressure-flow characteristics of the pump were determined in a blood analogue solution and compared with the pressure-flow requirements of the intended cannulation. At 5,500 rpm, the pump was able to generate 0.4 L/min of flow with a pressure rise of 325 mm Hg and 2.0 L/min with a pressure rise of 250 mm Hg. The hydraulic performance of the pump will enable at least 50% of cardiac output when the arterial cannula is placed in the carotid artery. The hemolysis of the TandemHeart pediatric pump at 5,500 rpm was compared with the BP-50 pediatric centrifugal pump in vitro using bovine blood flowing at 0.4 L/min against 250 mm Hg. The TandemHeart pump produced a similar increase in plasma free hemoglobin levels during the duration of the 6 hour test.

  6. Evaluation of a pediatric hospitalist service: impact on length of stay and hospital charges.

    PubMed

    Bellet, P S; Whitaker, R C

    2000-03-01

    Inpatient medical services supervised by pediatric hospitalist physicians are a new development in academic medical centers in the United States. In a large pediatric teaching hospital, we compared length of stay, readmission rates, and hospital charges for children admitted to medical services with and without a hospitalist system of care. This retrospective observational study compared a baseline year of a traditional ward service (TS) with a subsequent year of a new hospitalist system of care called the Generalist Inpatient Service (GIS). Data were obtained from the hospital's clinical, demographic, and financial databases and from selected record review. All hospitalizations were at least 24 hours long and did not involve a stay in an intensive care unit. The average length of stay was longer for the 627 TS hospitalizations than for the 813 GIS hospitalizations (2.7 +/- 2.0 vs 2.4 +/- 1.7 days). Total hospital charges were significantly lower on the GIS ($3002 +/- $2160 vs $2720 +/- $1933) because of lower room and respiratory therapy charges. Three readmissions to the TS and 8 to the GIS occurred within 24 hours of hospital discharge and were, therefore, considered potentially preventable by a longer initial hospital stay. In a large pediatric teaching hospital, a system of inpatient care provided by hospitalists can reduce length of stay. This model has the potential to control hospital charges in a period of increasing health care costs.

  7. Evaluation of radiation dose to pediatric patients during certain special procedures

    NASA Astrophysics Data System (ADS)

    Sulieman, A.; Alzimami, K.; Elhag, B.; Babikir, E.; Alsafi, K.

    2014-11-01

    This study was intended to measure pediatric entrance surface air kerma (ESAK) and effective dose during micturating cystourethrography (MCU), intravenous urography (IVU) and barium studies (barium meal, enema, and swallow) and to propose a local diagnostic reference level (DRL). ESAK was measured for patients using calibrated thermoluminescent dosimeters (TLDs, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 236 special pediatric procedures were investigated. 21.7% of the sample comprised barium procedures, 18.6% were MCU procedures while 59.5% of the sample were IVU procedures. The mean ESAK measurements (mGy) were 2.1±0.8, 3.0±23 and 1.2±0.2 for barium meal, enema and swallow in the same order. The mean patient dose for IVU procedures was 12.4±8.7 mGy per procedure and the mean patient dose per MCU procedure was 5.8±7 mGy. Local DRLs were proposed for all procedures. The patient doses in this study are within the reported values, suggesting that pediatric patients are adequately protected.

  8. Surgical and Molecular Evaluation of Pediatric Hydatid Cyst Cases in Eastern Turkey.

    PubMed

    Bakal, Unal; Simsek, Sami; Kazez, Ahmet

    2015-12-01

    Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.

  9. Prospective Evaluation of Postural Control and Gait in Pediatric Patients with Cancer After a 4-Week Inpatient Rehabilitation Program.

    PubMed

    Müller, Carsten; Rosenbaum, Dieter; Krauth, Konstantin A

    2017-09-01

    The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer. Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait. Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of -0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05). The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.

  10. The role of 18F-FDG PET/CT in the evaluation of pediatric transplant patients.

    PubMed

    Yang, Jigang; Zhuang, Hongming

    2015-01-01

    Intensive immunosuppressive regimens effectively reduce acute or chronic rejection in transplant patients, while these regimens can result in long term side-effects such as viral infection, fever, secondary tumor(s) etc. Our aim was to evaluate the role of 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in pediatric transplant patients. Forty one (18)F-FDG PET/CT scans in 18 patients before or after transplantation were analyzed retrospectively. One patient had PET/CT scan prior to transplantation. Seventeen patients had PET/CT scan(s) following transplantation. The PET/CT scan was used to evaluate the therapy response of post transplant lymphoproliferative disorder (PTLD) in 11 patients, establish the cause of fever of unknown origin (FUO) in 5 patients, and restage in 2 patients. PET/CT scan showed development in 3 PTLD patients, improvement in 4 PTLD patients, development and improvement in 1 PTLD patient, new lesions in 1 PTLD patient, and no lesions in 2 PTLD patients. The scan demonstrated the cause of FUO in 2 patients but did not demonstrate the cause of FUO in 2 patients. The PET/CT was false positive in 1 FUO patient and did not show any new lesion(s) in 2 restaging patients. PET/CT may have an important role in follow-up of pediatric transplant patients. Further investigations with more patients are necessary to assess the validity of our findings.

  11. Evaluation of Serum Carnitine Levels for Pediatric Patients Receiving Carnitine-Free and Carnitine-Supplemented Parenteral Nutrition

    PubMed Central

    Jackson, Daniel; Mulroy, Cecilia; MacKay, Mark

    2014-01-01

    Purpose: Carnitine is a carrier molecule transporting long-chain fatty acids (LCFAs) into the mitochondria for fatty acid β-oxidation. The purpose of this study is to evaluate the role of carnitine supplementation in parenteral nutrition (PN) within the pediatric population. Our goal was to determine a weight range for which empiric carnitine supplementation is justified and to determine a weight range at which a carnitine level should first be drawn to confirm a deficiency prior to supplementation. Secondarily, we tried to determine a relationship among carnitine deficiency, hypoglycemia, and hypertriglyceridemia. Methods: This was a retrospective observational study to evaluate 2 groups of pediatric patients (weighing 0.68 kg to 60 kg) who were NPO and receiving PN. The first group of patients (n = 454) received carnitine supplementation (15 mg/kg/day) upon initiation of PN. The second group (n = 299) did not receive carnitine supplementation until they were determined to have a carnitine deficiency. Results: The data indicated that 82% of the patients weighing less than 5 kg were deficient. Patients weighing more than 5 kg had serum carnitine levels within the normal range. Therefore, patients receiving PN and weighing less than 5 kg should be supplemented with carnitine. Comparison of triglyceride, glucose, and carnitine showed no statistically significant difference (P = .1936). Conclusion: Patients weighing more than 5 kg